In this video, Dr Rima Rudd talks about the communication responsibility.
Title: Harvard School of Public Health
Dr Rima Rudd:
Hi, I'm Rima Rudd. I'm in the Department of Society, Human Development and Health. The focus of my work for the past 15 years or so has been health and literacy.
One of the things I call for in the prospective piece in the New England Journal of Medicine is for us to pause for a moment and look in the mirror, and recognise our responsibility in the communication exchange with the public or with the patient.
We often use words that get in the way [shots of signage – Paediatric Research, Ambulatory Services]. Let me give one example of signage in a hospital. It said, loud and clear, 'nephrology unit this way'.
[Note on screen: Nephrology: branch of medicine that deals with the kidneys, especially their functions or diseases.]
Quite frankly, nephrologists know where they work. It's the poor patient with kidney disease who may not be able to interpret or pronounce the sign.
We think too of shopping; good nutrition is extraordinarily important. And we might consider for example how labels are listed. [Shot of the 'Nutrition Facts' on the side of a can, listing the amounts of various nutrients in the food.] If you're given a salt-free diet, you might not know that sodium is the ingredient you really have to be on the look-out for. Salt is very often not listed [the example can only lists sodium, 120 mg]. Sodium certainly is.
It's more important too when you think about medicine labels. We ask people to take their medicine as prescribed, and yet we don't necessarily provide them with the tools that they need in order to do this properly. [Shot of a doctor writing out a script for '100mg Ambdextral, 3x/dy'] I think for example of an old medicine label that said, 'take this on an empty stomach'. We very rarely explain that an empty stomach is not just before you're about to eat. It means 2 hours before eating and at least 2 hours after eating.
So in a similar way, words get in the way, and we inadvertantly erect literacy-related barriers to care, to access, to action.
Title: For more HSPH multimedia: http://www.hsph.harvard.edu/multimedia. Music: incompetech. Harvard School of Public Health.
In this video, Dr Rima Rudd talks about refocusing our attention on the context and system.
Title: Workbase – Conference: Health Literacy – from discussion to action. 1 May 2012. Dr Rima Rudd talks about how we need to refocus health literacy to include all systems within the health context.
Slide heading: Health Literacy and the Focus of Attention.
Recommended action for individuals and communities:
Who carries the burden of change?
Dr Rima Rudd:
And so, we saw the definition of health literacy, we expect and call upon people to participate, to find information, to understand information, to evaluate it, and to use that information, for example, in making informed decisions to determine what's correct for them. And notice that we put the burden on the patient, we put the burden on the individual. We expect the individual to understand. We expect the individual to participate, to find accurate information.
But what if that information is not accessible? I may go to a computer, and go online, and print out information – you mentioned gout – information about gout and have all of my print-outs. I have that information, I found it, I have that information. But is it usable? It depends. Is it well written? Is it clearly defined? Are the words understandable to me? If that information is not accessible, something is amiss.
Slide heading: Refocus.
Diagram with 4 overlapping circles, labelled:
- health care
- public health
- civil society
- commercial sector.
The point where all 4 overlap is labelled with a list reading:
- professional skills:
Dr Rima Rudd:
And indeed, we need to refocus our attention simply on the patient. But we have to look at what it is that we expect of people, what it is we offer to people? And we have to look very closely at our own systems and our own work, and ask ourselves, for example, is that information that I'm providing accessible information? Are the processes that I ask people to undergo realistic? Reasonable? Comfortable? Easy to do? We have to really look not so much at the patient but at the context within which we expect that patient to function.
In this video, Dr Rima Rudd talks about reviewing physical and social environments.
Title: Workbase – Conference: Health Literacy – from discussion to action. 1 May 2012. Dr Rima Rudd talks about health organisations improving health literacy through training, creating shame-free environments, and having quality standards for patient materials.
Slide heading: Develop Accessible Organisations.
- Physical environment: remove barriers to entry, navigation, services
- Social context: change expectations, norms, language, rituals, and encourage dialogue
Dr Rima Rudd:
We have to develop accessible organisations. So we have to look both at the physical environment – and I don't mean just to talk about signage, although that's important, there's an indignity in getting lost, it's very disconcerting – but we have to talk about the social environment as well, the kinds of language that we use, the norms. The idea that questions are really not welcomed. We have to change that, we have to change those social environments, the way we talk to people and the way we talk amongst ourselves and the language that we use.
Slide heading: Orient and Train Health Care Workers
- Normative change
- Staff as ambassadors
- Questions welcomed
- Integration for HL into orientation and training for all
- Scripts & tool boxes for common interations
Dr Rima Rudd:
We have to orient and train health are workers on all levels. For example, we did tours – this was a study several years ago – we did tours in hospitals and institutions about finding your way, from the main entrance perhaps to the place where you're going to get a specific test. And we watched people and we asked people where do you turn for help?
In many instances, people did not stop the busy doctor or nurse, who looked very professional and seemed to be walking very quickly about their business. But they stopped the person pushing the broom, who very often was from their community, and looked like them. And they said, 'how can I find', 'where is', any number of questions that they may have had. And the experience was that the person pushing the broom was exceedingly friendly, was very warm, was very welcoming, but had never been given an orientation to the hospital, and couldn't help out – wanted to help, but couldn't help out.
Why don't we think about people who are at the front desk, people who answer the phone as the ambassadors of our institutions, and offer them the kinds of training and orientation that they need. Everyone needs to be oriented in that way, understand the issues of literacy and health literacy. This should be integrated in the training. The person who answers the phone should be given a script for the most common questions about how they get there or where something is, and be able to turn to that on the phone; should learn that you cannot talk quickly to people; should learn that their voice is the voice of the hospital, and is sometimes the very first impression that is shaped of the institution.
Slide heading: Create Shame Free Environments
- Offer help to all
- Encourage questions & sharing conerns
- Let patients know that others have difficulties
- Define medical and scientific words
- Explain procedures [what is next]
Literacy and Patient Safety: Help Patients Understand. Manual for clinicians. AMA Foundation, 2007.
Dr Rima Rudd:
And so, we have to create shame-free environments, where people feel comfortable asking for help, asking for assistance, asking questions. Be able to say, with a kind of sense of dignity, 'Oh, sorry, but I didn't understand that word, can you tell me what it means?' instead of being embarrassed and staying quiet, and make-believe that they understand it.