Page 36 - Small Animal Clinical Nutrition 5th Edition

36 Small Animal Clinical Nutrition

of health information (including the national media, the print communications can improve health outcomes, but
VetBooks.ir Internet, product marketing, health education and consumer research also shows that they are less effective at influencing
individuals who are not serious about making a behavioral
protection) intensify the need for improved health literacy.
Improving Health Literacy change (Revere and Dunbar, 2001; IOM, 2002).
Arcane language and jargon that are common to health care
Health literacy is fundamental to quality care (IOM, 2004). workers are usually indecipherable to patients. Adults who have
Without improvements, the effect of many advances to difficulty reading or understanding written materials are often
improve health outcomes will be diminished. Consequently,the embarrassed and devise ways to hide their inability to under-
IOM of the National Academies (U.S.) has identified improv- stand. If health care professionals invested more time to ask
ing health literacy as one of two crosscutting issues in health their patients to explain exactly what they understand about
care requiring attention (IOM, 2003). The IOM reports that their diagnoses, instructions and bottle labels, the caregivers
enabling patients to understand their condition and its treat- would find many gaps in knowledge, difficulties in understand-
ment, to make the best decisions for their care and to take the ing and misinterpretations (IOM, 2004). These problems are
right medications at the right time in the intended dose; that is, exacerbated by language and cultural variation, by technologi-
to act in their own interest remains a neglected, final pathway cal complexity in health care and by intricate administrative
to high-quality health care (IOM, 2004). documents and requirements.
A 1998 report from the U.S. Department of Health and Female primary care physicians tend to engage in longer
Human Services provided evidence from accumulated studies visits and have more “patient-centered” consultations than
that health, morbidity and mortality are related to income and their male counterparts (Roter et al, 2002). Female physicians
educational factors (Pamuk et al, 1998). Life expectancy and engage in significantly more active partnership behaviors,
death rates from cancer and heart disease, incidence of diabetes positive talk, psychosocial counseling, psychosocial question
and hypertension and use of health services were related to asking and emotionally focused talk. Medical visits with
family income. Death rates from chronic diseases, communica- female physicians are, on average, two minutes (10%) longer
ble diseases and injuries were inversely related to education (i.e., than those with male physicians.
those with lower educational achievement were more likely to Distinguishing between noncompliance and inadequate lit-
die of a chronic disease than those with higher educational eracy may be difficult unless health care providers regularly ask
achievement). In essence, the lower one’s income or education- patients questions such as, “Was I clear?” “Is there anything
al achievement, the worse one’s health (IOM, 2004). you’d like for me to go over again?”These types of questions put
Approaches that appear to successfully improve health liter- the burden of responsibility on the speaker rather than on the
acy include: listener. Researchers and the American Medical Association
1. Provision of simplified/more attractive written materials advocate the importance of teachback. For example, asking
2. Technology-based communication techniques “Just so we both agree, why don’t you tell me what you would
3. Personal communication and education do if XYZ happens?” or to demonstrate how the patient would
4. Combined tailored approaches do something, like monitor blood glucose concentration.
5. Partnerships (collaborative measures between patient and In veterinary medicine, this simple approach of having pet
the health care team). owners relate back their understanding (without feeling like
In all of these, using plain language (common words, defin- they’ve been put on the spot) can have dramatically positive
ing unusual words, writing the way people talk); simple, spe- ramifications for pet care. Speaking clearly and being an atten-
cific and direct sentences; active, inflective voice; sequencing tive listener can express that you care. Empathy goes a long way
ideas clearly and logically; being attentive to and respectful of in building trust and establishing a relationship so that commu-
culture enhance the patient’s ability to understand and retain nication is successful. Focus on using basic words and making
information. It is also imperative to be cognizant of overt and the message clear.
covert messages and to improve skills, materials and process- A meta-analysis of 41 research studies showed that giving
es. This includes changing outdated approaches and encour- patients more information is associated with increased patient
aging professionals to improve verbal and written communi- satisfaction, better compliance and better recall and under-
cation skills, including work with the adult education sector, standing of medical conditions (Rankin and Stallings, 1996).
etc. (Rudd, 2002).
Professionals are also encouraged to write legibly or type, and Technology-Based Communication
use simplified language with more white space, improved for- It’s very hard to cover all the complex information needed to
mat and pictograms (See below.) or other graphic devices. make decisions in spoken and written words. Covering some
Pictograms may be especially useful for communicating infor- information with tools such as CD-ROMs before patients
mation to consumers who speak English as a second language meet with their doctors has increased satisfaction in at least one
and to those with lower reading ability levels (IOM, 2004). study in human medicine.
The telephone can be a great means of delivering interven- According to the Memorial Sloan-Kettering Cancer
tions such as health-related counseling and reminders, if the Center, “New technology (i.e., a CD-ROM educational tool)
caller has competent verbal communication skills. Tailored can save nurses’ time by eliminating the need for repetitive