Empowering patients through effective communication: The teach-back method as a tool for health literacy

Health literacy is a top priority for Healthy People 2030. Healthy People 2030 defines personal health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” The purpose is to understand the experience of physical therapy students using health literacy tools with older adults to promote the adoption of health literacy tools in healthcare encounters. This project analyzes the reflection responses from students using qualitative methods. The qualitative methods included student reflection papers, word clouds, and focus groups. Twelve students participated in focus groups/ reflections. Thirty-seven students participated in word clouds. Health literacy tools included plain language, teaching teach back and “Ask me 3”®. Students were taught by student leaders and faculty about the meaning of health literacy and oral communication tools. Pairs of students provided health education with health literacy tools to older adults. Students then participated in a small group reflection to create word clouds. Students answered questions and provided five words that best answer each question. Students believed the benefits of health literacy tools for older adults includes better learning, participation and engagement. Reasons to use health literacy in the future were improved older adult independence, education and adherence. Students completed reflections and interviews at the end of the year to detail their experience with the health literacy tools. The pedagogical approach highlighted the value of experiential learning for the students while mentoring older adults.

177 Background: Within our academic oncology institute, patient’s health-related social needs (HRSN) are identified through the new patient intake questionnaire (NPIQ). 28% (n=2787) of patients who completed the NPIQ (n=9836) reported low/marginal health literacy (HL). While reviewing the HRSN data, it was discovered that there was no formal process to support patients who reported having low/marginal HL. While printed and online health materials use standard reading levels, verbal communications are not individualized to patients’ literacy needs. As an integral member of the interdisciplinary team, Oncology Nurse Navigators (ONNs) communicate vital and complex health information with patients throughout the cancer continuum. This quality improvement project explored the impact ONNs could have with patients who self-identify as having low/marginal HL. Methods: To assess ONN HL knowledge and communication strategies for patients with low/marginal HL, a survey was conducted in March 2024. Findings revealed a HL knowledge gap across all disease programs. For project manageability, our team piloted HL interventions to the sarcoma disease group where 33% of patients (n=223) responded to the NPIQ as having low/marginal HL. Two-part intervention included: 1) creation of a HL training and tools for ONNs (e.g., teach-back method; scripting; reference materials) and 2) development of Epic Smartphrase acknowledging training and tools were utilized. Results: To understand ONNs knowledge of where to find patient HL score in Epic, we conducted a survey (n=69; response rate=43%). 94% of ONNs reported not knowing where to access HL information. The first intervention was training-based. ONN trainings (n=2) were held from 3/12/2024 to 5/14/2024. At baseline, 0% of ONNs (n=4) used HL tools, as they were not in existence. At first reassessment, 75% of ONNs reported using the HL tools to communicate with patients. Part two of the intervention (in-progress) is the creation of a Smartphrase to document when ONNs altered patient communication. Data on Smartphrase usage are forthcoming. Conclusions: Providing HL training and tools to ONNs equips them to 1) identify patients who have low/marginal HL, and 2) conduct conversations with patients at an appropriate literacy level.

Black women are diagnosed, disabled, and die from obesity and associated chronic diseases at higher rates than any other sex or race. Advanced practice registered nurses (APRN) can potentially improve culturally relevant health education and counseling by using health literacy communication tools. Explore individualized barriers and APRNs' role in providing obesity prevention education and counseling by assessing the efficacy of the Teach-Back Method (TBM) to understand health habits and attitudes. Black women aged 18-45, previously diagnosed as overweight or obese, and identified with perceived barriers were recruited from a predominantly Black church in Atlanta. They engaged in weekly, 1-hour educational sessions via Zoom, addressing four common barriers identified in the literature. Sessions ended with a 5-10 minute Teach-Back session. Pre- and post-intervention Readiness to Change Questionnaire (RCQ) were completed. Descriptive statistics and quantitative data from surveys and pre- and post-RCQ were analyzed. Twenty women completed the intervention. Paired sample t-test revealed no statistical significance or correlation between pre- and post-RCQ scores after using TBM in educational sessions. However, Pearson's correlation showed positive associations between elevated body mass index levels as one advances their education and annual income, with a p-value of 0.05. Increased rates of obesity are experienced despite higher educational attainment or pay. Stress and high-coping mechanisms contributed to disordered eating, decreased physical activity engagement, and decreased motivation toward habit change. Clinicians should be held accountable for delivering culturally sensitive care using the TBM, addressing social determinants of health, performing routine stress assessments, and checking their implicit biases.

Background Breast cancer (BC) is a major malignancy that seriously threatens women’s health. No unified, evidence-based, standardized assessment tools for BC literacy are available in China yet. Objectives We sought to develop an assessment tool to measure BC health literacy among Chinese women and to test the tool’s reliability, validity, and feasibility. Methods Group discussion, expert consultation, and small-sample pilot investigation were conducted to develop an initial assessment tool. A multi-stage stratified random-sampling process was used to select women aged 18-64 years in Yichang City, Hubei Province, China, for an onsite survey. Project analysis and exploratory factor analysis were used to screen the questions to create a formal assessment tool, which was further evaluated by feasibility analysis and the measurement of reliability and validity. Results The official version of the assessment tool for Chinese female BC health literacy includes 32 items. Nine common factors (policy knowledge, uncorrectable risk factors, modifiable risk factors, identification of early warning signs #1 and #2, screening methods, breast self-awareness and examination behaviors, timely seeking of medical help and standardized treatment, and rehabilitation) were extracted through exploratory factor analysis with factor loadings of 0.511-0.873 and a cumulative explained variance of 65.989%. Confirmatory factor analysis revealed χ2/df = 1.61, CFI = 0.91, TLI = 0.90, RMSEA = 0.04, and SRMR = 0.06. The overall Cronbach’s α coefficient was 0.875, and the split-half reliability was 0.770 (both >0.700). Conclusions An assessment tool for Chinese female BC health literacy was developed with acceptable feasibility, reliability, and validity. The application of this tool can help to promote BC prevention and control in China and may also benefit other countries. Key messages • An assessment tool for Chinese female BC health literacy was developed with acceptable feasibility, reliability, and validity. • The application of this tool can help to promote BC prevention and control in China and may also benefit other countries.

Health literacy is documented to impact older adult outcomes and effective rehabilitation may be minimized by low health literacy. The purpose of this phenomenological study is to understand the meaning in a physical therapist’s experience of using Teach Back and Ask Me 3, health literacy tools. This research study involves several parts. After therapists are trained to implement Teach Back and Ask Me 3, they are randomly assigned a tool to use with consenting patients. At the end of the project, therapists are interviewed about the health literacy tools related to patient collaboration, benefits to patients, and barriers/facilitators for therapists. Transcribed interviews are reviewed by four researchers both individually and as a group for key phrases. Next, themes are identified across all therapist responses to questions and then overarching themes are developed. Ten volunteer therapists from two different outpatient clinics participated. The mean age is 43.5 years, 8 were female, 9 identified as white and one as Asian. Most therapists preferred the familiar teach back method and identified ask me 3 as a tool to empower patients. Themes identified for collaborative relationships included patient inclusion and empowerment. Themes that emerged around patient benefits included improved outcomes and ownership. Barriers/ facilitators included time perceptions, routines with cues and reminders and method for process management in a busy environment. The qualitative findings suggest health literacy tools may improve quality of care through focused patient dialogue, enhanced patient understanding and empowerment. Interviews suggest there are unique aspects/ purposes to each health literacy tool.

Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies

Tools to Measure Health Literacy among US African Americans and Hispanics/Latinos with Type 2 Diabetes: A Scoping Review of the Literature

Health literacy has been defined and studied as an important component of a patient's ability to understand and obtain appropriate healthcare. However, a laboratory component of health literacy, as it pertains to the understanding of laboratory tests and their results, has not been previously defined. An analysis of readily available health literacy tools was conducted to determine laboratory testing-specific content representation. One hundred and four health literacy tools from a publicly available database were analyzed. Many of the health literacy tools were found to be lacking items related to laboratory testing. Of the health literacy tools that did contain a laboratory component, they were categorized pertaining to the laboratory test/testing content. Emerging from this process, eight competencies were identified that encompassed the entire range of laboratory-related aspects of health literacy. We propose that these eight competencies form the basis of a set of competencies needed for one to access, interpret, and act on laboratory results–a capacity we are referring to as “laboratory literacy.”

ObjectivesThis study aims to develop an assessment tool for health literacy and knowledge specific to chronic kidney disease (CKD) for use in examining the associations between health literacy, disease-specific knowledge...

This article analyzes and reflects on Dr. Rima Rudd's organizational health literacy ideas and tools and their influence on the field generally and on four projects over 12 years in Maryland specifically. We present four organizational health literacy projects - two from oral health and two from COVID-19 vaccination - that used or were influenced by Dr. Rudd's the Health Literacy Environment of Hospitals and Health Centers. In the oral health projects, we describe the organizational assessments we conducted, the assessment results, and the actions organizations took in response. In a Frederick, Maryland, COVID-19 project, we worked with multiple organizations in a single city to train them in the organizational assessment process, and we report the activities and results of this training. In the Baltimore, Maryland COVID-19 project, we provided general information about organizational health literacy and trained key health professionals in local organizations. Our results confirm that Dr. Rudd's tools work mainly as intended because they help organizations or third-party evaluators identify health literacy barriers and create health literacy insights. Also, we observed that organizational health literacy tools can support organizations' interest in equity goals and increase their willingness to spend time on health literacy projects. Translating knowledge and skills to actions can require more time than organizations can commit or be more difficult than they can handle. In our projects, the four most positive examples were driven by a collaboration between our team and a change champion who had the power to institute new ideas and actions. While it can take time and money to gain traction, our Maryland work shows that organizational assessments are accessible, practical and tangible. We conclude that Dr. Rudd's influence extends beyond specific tools and is reflected in the field's acceptance of organizational and professional responsibility for health literacy as an equity and justice issue. [HLRP: Health Literacy Research and Practice. 2024;8(3):e151-e158.].

Background. Despite the strong link between health literacy and cardiovascular health outcomes, health literacy measurements remain flawed and fragmented. There exists a gap in the knowledge when formulating a valid measurement to capture the broad concept of health literacy. The existence of various tools for health literacy measurement also hampers the availability of health literacy data. Additionally, little research is available on a valid measurement tool for cardiovascular health literacy. Objective. This study aims to provide an overview of the health literacy measurement tools used in the context of cardiovascular health. Method. A scoping review was conducted. Two electronic databases, Medline and Embase, were searched to identify studies that described a tool for the measurement of health literacy in the context of cardiovascular health. Results. After reviewing the available studies, 53 studies met the inclusion criteria. A total of 26 health literacy measurement tools were identified in the studies. Among the 26 tools, 16 used an objective measurement approach, 9 adopted a subjective approach, and 1 employed a mixed approach. Additionally, 28 studies used tools to measure print literacy, 15 studies measured print literacy and numeracy, and 5 studies measured print literacy, oral literacy, and numeracy. Conclusions. STOFHLA, TOFHLA, and REALM were the mostly commonly used tools in the selected studies. The majority of tools were based heavily on reading skills and word recognition. Researchers should focus on the development of more comprehensive and reliable health literacy measurement tool(s) specific to cardiovascular health to assist health care providers to more efficiently and accurately identify people with cardiovascular problems who have inadequate health literacy.

IntroductionPeople with low health literacy are more likely to delay seeking care and experience adverse outcomes. While health literacy is the product of individuals’ capacities, it is also affected by the complexities of the health care system. System-level changes are needed to align health care demands better with the public’s skills and abilities. We aimed to identify the evidence base for effective strategies for creating health literate organisations.MethodsA systematic review and narrative synthesis of empirical studies was performed. Medline, Embase, PsychInfo and CINHAL databases were searched for empirical studies from OECD countries published from 2008 onwards, focusing on health literacy interventions at the organisational level. Analysis of the findings was informed by the National Academies’ five-dimensional framework for the attributes of a health literate organisation, which include: organisational commitment, accessible education and technology infrastructure, augmented workforce, embedded policies and practices, and effective bidirectional communication.ResultsThe title and abstract of 867 records were screened according to the selection criteria, leading to full text review of 125 articles. Seven studies were identified in the peer review literature. Adapting health literacy guidelines and tools was the most common approach to addressing organisational health literacy.ConclusionWhile the use of health literacy tools proved important for raising awareness of health literacy issues within organisations, these tools were insufficient for generating the organisational changes necessary to improve organisational health literacy.

Background Hospitals can gain valuable insights into their current level of organizational health literacy (OHL) by using self-assessment tools. OHL self-assessment tools can serve as useful instruments for supporting the planning and implementation of OHL interventions aimed at promoting health equity and improving patient outcomes. This explorative study aimed to pilot the International Self-Assessment Tool for Organizational Health Literacy (Responsiveness) of Hospitals (OHL-Hos) among hospitals across six countries. Methods The OHL-Hos, grounded in a comprehensive theoretical framework consisting of eight standards, 21 sub-standards and 141 indicators, was piloted in seven hospitals: one in Austria, Germany, the Czech Republic, Norway and Serbia, and two in Italy. In each hospital, the feasibility of using the OHL-Hos was investigated regarding acceptability, implementation, practicality, and integration, identifying strengths and areas for improvement using descriptive analyses. The self-assessment process included individual rating of an interdisciplinary and inter-hierarchical assessment team regarding OHL-Hos indicators from their personal perspectives, followed by a joint assessment to reach a consensus on different ratings. The process and experiences were documented in semi-structured forms, while the ratings on the indicators were documented numerically. Results All hospitals successfully self-assessed their OHL, identifying strengths and areas for improvement. The self-assessment process varied slightly among countries. While the tool was considered important but lengthy and complex, introductory workshops facilitated successful implementation. The self-assessment process raised awareness and stimulated discussions on improving OHL, highlighting the tool's potential for organizational development. Conclusions The OHL-Hos can serve as a useful tool to identify strengths and areas for improvement in OHL in hospitals. The overall experience with the tool was positive and the joint assessment with the tool was found to foster consensus and enable reflection on OHL, but its comprehensive nature poses challenges to its implementation, leading to recommendations for developing a shortened version of the tool with simple language. Certain indicators require specific knowledge, suggesting different professional groups should address relevant parts.

BackgroundHospitals can gain valuable insights into their current level of organizational health literacy (OHL) by using self-assessment tools. OHL self-assessment tools can serve as useful instruments for supporting the planning and implementation of OHL interventions aimed at promoting health equity and improving patient outcomes. This explorative study aimed to pilot the International Self-Assessment Tool for Organizational Health Literacy (Responsiveness) of Hospitals (OHL-Hos) among hospitals across six countries.MethodsThe OHL-Hos, grounded in a comprehensive theoretical framework consisting of eight standards, 21 sub-standards and 141 indicators, was piloted in seven hospitals: one in Austria, Germany, the Czech Republic, Norway and Serbia, and two in Italy. In each hospital, the feasibility of using the OHL-Hos was investigated regarding acceptability, implementation, practicality, and integration, identifying strengths and areas for improvement using descriptive analyses. The self-assessment process included individual rating of an interdisciplinary and inter-hierarchical assessment team regarding OHL-Hos indicators from their personal perspectives, followed by a joint assessment to reach a consensus on different ratings. The process and experiences were documented in semi-structured forms, while the ratings on the indicators were documented numerically.ResultsAll hospitals successfully self-assessed their OHL, identifying strengths and areas for improvement. The self-assessment process varied slightly among countries. While the tool was considered important but lengthy and complex, introductory workshops facilitated successful implementation. The self-assessment process raised awareness and stimulated discussions on improving OHL, highlighting the tool’s potential for organizational development.ConclusionsThe OHL-Hos can serve as a useful tool to identify strengths and areas for improvement in OHL in hospitals. The overall experience with the tool was positive and the joint assessment with the tool was found to foster consensus and enable reflection on OHL, but its comprehensive nature poses challenges to its implementation, leading to recommendations for developing a shortened version of the tool with simple language. Certain indicators require specific knowledge, suggesting different professional groups should address relevant parts.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13367-4.

Scoping review. To summarize and provide existing health literacy (HL) assessment tools used in spine surgery and identify their advantages, limitations, and gaps in measuring spine-specific health literacy. Health literacy plays a crucial role in patient-reported outcomes (PROs), particularly in spine surgery, where complex decisions and comprehension are required. However, the current tools used to assess HL often lack spine-specific content and fail to address the multidimensional nature of HL, such as numeracy, print, and visual comprehension. A comprehensive search was conducted across PubMed, Embase, and Cochrane Library databases in August 2024. Studies published between 2014 and 2024, involving human participants and directly assessing HL in patients with spinal conditions, were included. Data on study design, HL tools, HL dimensions, and associated sociodemographic factors were extracted and analyzed descriptively. Nine studies, encompassing 2958 spine patients, met the inclusion criteria. Eight HL tools were identified, including 3 objective (LiMP, NVS, and REALM-SF) and 5 subjective methods (BRIEF, verbal and visual comprehension tasks, surveys, and single-item screening questions). The studies covered various HL dimensions, including print literacy (n=3), print and numeracy literacy (n=1), combined print, oral, and numeracy literacy (n=1), oral and visual comprehension (n=2), and a mix of print and oral literacy (n=1). Limited HL was reported in 9%-50% of patients and was associated with older age, lower education levels, non-native English speakers, and socioeconomic disparities. None of the tools specifically addressed spine-related literacy needs. Current HL tools used in spine surgery focus primarily on general literacy skills and lack spine-specific components. Developing a comprehensive, spine-focused HL tool that incorporates multiple dimensions is crucial to improving patient understanding and shared decision-making. Level V.