To mark World Patient Safety Day on 17 September 2023, which aims to elevate the patient voice and safety through health literacy, Communications Manager with the National Screening Service, Norma Deasy, explains that becoming a more health literate organisation will contribute to increased patient safety in Ireland, and provides some advice about communicating more clearly.
A Manchester-based GP shared her story at a patient safety conference. She referred a patient for an X-ray and the hospital replied that he didn’t attend his appointment. This meant a GP and hospital staff made an appointment that was un-used and a patient didn’t get treatment. A month later back in her clinic, she asked him why he hadn’t attended. He told her he took a bus to the hospital, walked around for an hour and looked at all the signs. He couldn’t find the X-ray department. So, he went home. She explained radiology to him and referred him again. The second time round he had his X-ray, got his results and started his treatment. This could have been avoided had the system been more health literate.
Our capacity to access, understand and use health information and services to make appropriate health decisions is defined as ‘health literacy’. The more literate we are, the more capable we are deemed to make health decisions and manage our health. However, this tide is changing. Healthcare organisations are realising that it is not just the individual who has an onus to be health literate. It is equally, if not more important, for healthcare professionals to communicate clearly with the people we care for. We have an equal responsibility in ensuring health literacy.
Healthcare professionals should be clear, invite questions and ensure patients understand. This will improve equity, reduce errors and make healthcare delivery more efficient.
Being health literacy-friendly is not difficult. It may take time and a change of practices and mindsets to adopt. Appointment times may increase while we listen and explain. However, this can result in patients managing their conditions better and reduce overall treatment time. Their outcomes may also improve due to an increase in understanding. Creating information in plain English might take longer as we simplify terms. On balance, it’s better to publish materials patients can understand and use. It may also be challenging for some. Formal disease names and informal acronyms become the norm during academic training.
Tips to make communications clearer
Consider more common terms when speaking. Instead of retina, say part of the eye. Say children instead of paediatrics. X-ray can be used instead of mammogram, and cancer instead of oncology. One study found that less than half of the women attending a breast clinic knew what an oncologist was. Only one in four could define a radiologist.
Check that your patient understood your advice. If you ask a patient did you understand everything, they will more than likely respond that they did. If you ask a patient is there anything you didn’t understand, they will more than likely respond that they understood everything. Using a method known as ‘teach-back’ can help to confirm that they have understood. For example, you could ask “I appreciate this form is difficult and I want to make sure that I explained it clearly. Will you tell me three things about this agreement?” If they can give you three correct answers, you have explained yourself clearly. Otherwise, take a few minutes and explain it again.
Take a look at your building signage.
- Is the name which clearly explains the purpose of the healthcare facility displayed?
- Is there a map or list of services or departments on display when you enter the building?
- Are the signs to the treatment rooms and facilities clear and easy to follow?
If your responses are negative, people cannot confidently find their way around. Time can be lost with patients late for appointments and staff having to help them to their destination.
When writing, think about your reader and their potential understanding of your topic.
- Research reveals that most people find it easier to read dark colours on a light background. Black text on a white background is the clearest.
- Use clear typefaces (Arial or Helvetica). Use large font sizes if your readers are older and wear glasses.
- Terms should be easy to understand and be jargon free. Explain medical terms.
- Be personal and direct, use “I”, “we” and “you”.
- Explain numbers or statistics clearly (1 in 4 people instead of 25%). Present them in context, for example, is the number high or low for this health condition; is it higher or lower than expected. Provide visual formats (tables or charts) to further explain numerical text.
- Write in the active tense (“I will send you a letter” instead of “a letter will be sent to you”).
- Be concise, avoid wordy phrases. For example, replace “With reference to” with “about”; replace “in the event that” with “if”).
- Illustrations or pictures can help to explain complex terms or instructions.
- Ask someone from the intended audience to read it and give feedback.
Consider the complexities for people accessing digital information. Apps, virtual registrations, appointment bookings and other interactive tools are new. They call for an even more sophisticated understanding from patients. They need to understand and check the quality of the health information. We should be mindful of that. We should provide alternative solutions for those why may need help with technology.
Health literacy at the National Screening Service
Choose Screening, our 5-year strategy, commits to building a health literate system. We will achieve this through communications, engagement and information development. Building health literacy capacity takes leadership, time and financial resources. It takes people-centred services based on user engagement, technology and innovation, data governance, and partnership and inter-sectoral collaboration. We have lots of work going on, including:
- working with our Patient and Public Partnership (PPP) representatives on information development, and improving equality and equity
- improving communications with women not attending for HPV cervical cancer screening. Encouraging them to choose screening
- providing information videos on our four screening programmes in many languages
- consulting with those eligible for bowel screening. Finding out what stops them from coming, improving our messages and materials based on their responses
- providing surveys to BreastCheck and BowelScreen participants. Responding to their requests and needs
- providing plain English training for staff.
Progress is evident. Materials are stripping out jargon and explaining medical terms. Translated materials are increasing. Other formats such as easy-reads, podcasts and videos with subtitles are being made available. More people are coming forward to work on our PPP. We will continue to use scientific evidence and insights to develop our communications. We want to help more people be informed to choose screening.
More information: World Patient Safety Day resources
Note: tips in this blog came from hse.ie/communicatingclearly