Strategies to improve health literacy: plain English and teach back - - PowerPoint PPT Presentation
Strategies to improve health literacy: plain English and teach back - - PowerPoint PPT Presentation
Strategies to improve health literacy: plain English and teach back Claire ORiordan, NALA 4 March 2016 What I am going to cover Definitions of teach back and plain English Support for each strategy Tips for using both strategies
What I am going to cover
- Definitions of teach back and plain English
- Support for each strategy
- Tips for using both strategies
Why? Teach back and plain English can improve:
your communication skills, patient safety, and… health literacy.
Do you find it hard to communicate clearly?
- Relaying all the information that you have to
relay
- Finding the time to explain and or discuss a
condition or treatment fully
- Simplifying complex or confusing medical
concepts
- Not to overestimate a patient’s knowledge
and or ability to retain information
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Do you know that patients can sometimes find it hard to understand you?
- Worry / fear
- Pain
- Lack of confidence
- Low retention skills
- Sedating meds
- Literacy difficulties (1 in 6 low literacy;
1 in 4 low numeracy skills)…
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Ways To Make Things Clearer (MSD 2015) Research)Something To Patients
Base: All Respondents: 1,000
Q.7 In what way/s do you think GPs, hospital doctors, pharmacists or nurses could make things clearer for patients when they are explaining something to them?
*Answers 1% not shown
As with the survey in 2007, using less medical terminology helps patients’ understanding. While 17% of respondents don’t know how HCPs could make things clearer for patients. Interestingly, this response is more common among men than women. [Research commissioned by MSD in
association with NALA.]
What is teach back?
What is teach back?
- Asking patients to repeat in their own words
what they need to know or do.
- Use when checking for understanding about a
patient’s understanding of their:
- medical condition,
- treatments, and or
- self-care.
- A chance to check for understanding and, if
necessary, re-teach the information.
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Why?
- Assures you that your message has been
understood
- Helps people who want less medical jargon
(39% called for it – MSD 2015)
- Stop people take wrong dosage of
medicines (17% - MSD 2015)
- Avoid embarrassment – as we saw just now.
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Evidence of benefits
- Becoming more popular based on support of
research and usage in NHS in Scotland, in the US…
- Patients, who have a clear understanding at
discharge, are 30% less likely to be readmitted
- r visit the emergency department than patients
who lack this information, according to a study funded by the Agency for Healthcare Research and Quality (AHRQ) and published in the Annals
- f Internal Medicine.
When to use teach back
- New/change meds
- Care planning
- Informed consent
- Showing patients how to use equipment
such as a glucose measuring device
- Follow up calls…
Think of a situation where you can use teach back
Tips for using teach back
- Prepare! – what are you going to say to your
patient? Example: “Mr Clooney, can you tell me why
you are in the hospital?”
- [Don’t ask ‘Do you understand?’ Keep questions open]
- ‘Chunk and Check’
- Clarify and check again
- Start slowly
- Show-me how to…
- Use handouts with teach-back.
What is plain English?
What is plain English?
- Plain English is a way to write and present
information so a reader can understand and act
- n it after a single reading.
- Plain English means:
− writing accurately and clearly for the intended reader, − avoiding jargon, except for people who will understand it − using clear layout and design so the information is easy
to read.
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Plain English checklist for documents
This checklist offers a quick way for you to review a letter, leaflet, booklet or short report to see whether it uses plain English and is easy to follow. Not all questions will apply to every document, by try to answer ‘yes’ as much as possible to the questions that do apply. Language, punctuation and grammar
Yes No
1 Does the document use ‘you’ and ‘we’, where possible? 2 Does it use the active voice most of the time? 3 Does it keep technical terms and abbreviations to a minimum? 4 Does it define any necessary terms and abbreviations clearly? 5 Does it keep ‘corporate jargon’ to a minimum? 6 Does it avoid Latin and French phrases and Latin abbreviations? 7 Does it use the same term for the same concept throughout? 8 Does it have an average of 15 to 20 words in each sentence? 9 Does it use the simplest verb tense possible? 10 Does it avoid abstract nouns where possible? 11 Does it use correct punctuation? 12 Do nouns and verbs agree (singular noun with singular verb, for example)? Structure 13 Does it organise information according to the reader’s needs and interests? 14 Does it use informative headings or questions to break up text? 15 Does it include a natural flow from one point to the next? 16 Are paragraphs relatively short? 17 Does it use bullet point lists for detailed or complicated information? Page design
18 Does it avoid underlining, groups of italics and unnecessary capital letters? 19 Is text in a readable typeface (font), aligned to the left and 1.5 spaced? 20 Are images, charts or blocks of colour, if any, clear and relevant to the text?
Where is plain English used?
Ireland
- The Director of Corporate
Enforcement
- Health Information and
Quality Authority
- Health and Safety
Authority
- CORU
- PCRS – under 6s Medical
Card Form
- Some hospitals
Abroad
- US Plain Writing Act,
2010
- Canada: government
communications policy, 2012
- UK: Office of Fair Trading
- European Commission:
Clear Writing campaign
Benefits of plain English
- It improves accountability and compliance.
- It is more precise and legally sound than less
comprehensible English.
- It can help people save time and money.
- It improves the general standard of writing.
- It gives everyone a fair chance to access
essential services.
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Evidence of benefits
- The Royal Mail saved £500,000 in nine
months by redesigning just one form.
- When Arizona’s Department of Revenue
rewrote one letter in plain English, it got about 11,000 fewer phone calls than the previous year.
Evidence of benefits
- In a study to test understanding of
medical consent forms in the US, readers
- f the original form could answer correctly
- nly 2.36 questions out of 5. Using the
plainer form they got 4.52 questions right, a 91% improvement; they also took less time to answer.
Plain English Guidelines
Be direct – use the active voice
Guidelines 1-2
Be direct (subject – verb – object)
Before The request will be considered by the Authority. After The Authority will consider the request.
Be direct
Before All details should be included (by you). After You should include all details.
Use positive and assertive language (not in the guidelines but I will add!)
Be positive...
- Sentences should assert
- Say what is – not what isn’t
- Try to express negativity in positive form
Use everyday language Guidelines 3-7 inclusive
Use everyday words
Why use a long word when a short word will do?
For example:
If you must use specialised language or jargon, explain what it means.
Instead of Use catheter tube immunise protect negative (test results) you do not have, you are not
Be concise Guideline 8
This sentence has 59 words
In circumstances where a patient subject to an involuntary admission order is deemed to require ECT in order to ameliorate his/her condition or to safe guard the life of the patient and restore his/her health a second opinion is sought from the consultant psychiatrist (who is demonstratively independent and on the panel drawn up by the HSE).
Now, the information is divided into two sentences (37 words)
If the consultant psychiatrist believes that an involuntary patient requires ECT to improve their condition or to safeguard their life, the opinion of a another independent consultant psychiatrist is
- sought. This consultant must be on the
HSE panel.
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Make your verbs obvious Guidelines 9 and 10
Making verbs obvious
- conduct an analysis
- present a report
- do an assessment
- provide assistance
- come to the conclusion
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Before (25 words)
They will conduct an investigation into the failure of the system and then make a decision about when the publication of findings should
- ccur.
32
Rewrite (15 words)
They will investigate why the system failed and then decide when to publicise the findings.
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Punctuation Guideline 11
Differences
Let’s eat granny. Let’s eat, granny.
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Noun and verb agreement Guideline 12
Noun and verb agreement
37
The dog is barking. The dogs are barking. The consequence of over-eating and lack of exercise after a long period of time are that general health suffers. Longer sentences make it harder to see
- Disagreement. Can you see it?
Structure and design Guidelines 13-17
Use lists
Before: If you send us a letter, fax or email we endeavour to acknowledge receipt of all such correspondence within 5 days of receiving same and ensure that a substantive reply to a query will issue within 20 days where information is readily available.
Use lists
After: If you send us a letter, fax or e-mail, we try to:
- acknowledge it within five days of receiving
it, and
- give you a full answer within 20 days, if we
have enough information.
The Inverted Pyramid – but be careful of tone used
Layout guidelines Guidelines
Other pointers
- Use title case; not all capitals, up to 30%
faster to read
- Bold for emphasis, don’t underline or use
italics
- Use sans serif font such as Arial, point size
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- Line spacing 1.5. Small font is hard to read
- Align text to the left
Plain English checklist for documents
This checklist offers a quick way for you to review a letter, leaflet, booklet or short report to see whether it uses plain English and is easy to follow. Not all questions will apply to every document, by try to answer ‘yes’ as much as possible to the questions that do apply. Language, punctuation and grammar
Yes No
1 Does the document use ‘you’ and ‘we’, where possible? 2 Does it use the active voice most of the time? 3 Does it keep technical terms and abbreviations to a minimum? 4 Does it define any necessary terms and abbreviations clearly? 5 Does it keep ‘corporate jargon’ to a minimum? 6 Does it avoid Latin and French phrases and Latin abbreviations? 7 Does it use the same term for the same concept throughout? 8 Does it have an average of 15 to 20 words in each sentence? 9 Does it use the simplest verb tense possible? 10 Does it avoid abstract nouns where possible? 11 Does it use correct punctuation? 12 Do nouns and verbs agree (singular noun with singular verb, for example)? Structure 13 Does it organise information according to the reader’s needs and interests? 14 Does it use informative headings or questions to break up text? 15 Does it include a natural flow from one point to the next? 16 Are paragraphs relatively short? 17 Does it use bullet point lists for detailed or complicated information? Page design
18 Does it avoid underlining, groups of italics and unnecessary capital letters? 19 Is text in a readable typeface (font), aligned to the left and 1.5 spaced? 20 Are images, charts or blocks of colour, if any, clear and relevant to the text?
Finally…
What we covered today
- Definitions of teach back and plain English
- Support for each strategy and tips for using
both strategies I hope that you see that teach back and plain English improve:
your communication skills, patient safety, and… health literacy.
Further resources
Teach back http://www.teachbacktraining.org/ https://www.youtube.com/watch?v=PKq8hV
- B4zs&feature=youtu.be
Plain English http://www.simplyput.ie/ NALA http://www.nala.ie (health literacy resources, audit tools, and much more)
Further information
NALA
Sandford Lodge Sandford Close Ranelagh Dublin 6
Tel: (01) 412 7900 Website: www.nala.ie Plain English website: www.simplyput.ie
http://twitter.com/nalaireland http://facebook.com/nalaireland