photo by: LMH Health

LMH Health, 325 Maine St., is pictured in May 2021.

During my residency in Denver, my pager buzzed with a message from the emergency department. I frowned with worry when I saw Mrs. K’s name listed again.

Our team discharged her two days earlier, after she finished another round of chemotherapy. I mentally ran through the possible complications that would have landed her in the ED as I headed to evaluate her.

During the course of treatment, we identified multiple gaps in health literacy that prevented Mrs. K from receiving the best level of care and tried our best to bridge them. Improving this would help her ability to manage her symptoms outside the hospital and spend as much time at home as possible.

What is health literacy?

The CDC defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

A person’s health literacy is affected by:

• Reading, writing and number skills

• Ability to communicate with health care professionals

• Knowledge of how the health care system works

• Personal factors, such as language, culture, age, income and education

Health care organizations recognize the importance of improving health literacy, as it allows for health care professionals to communicate information with their patients in a timely and effective manner. One of the ultimate goals, according to the Health Resources and Services Administration, is for people to use health information, rather than just understand it, and to be able to put their knowledge into practice. It’s as simple as things like moving beyond simply knowing you should eat fresh fruits and vegetables to seeking out and preparing fresh produce.

Another goal of health literacy is to help patients “make ‘well-informed’ decisions rather than ‘appropriate’ ones.” I see this daily as I discuss cancer screenings with my patients. Some people may avoid screenings until they need to have one due to age or potential symptoms of cancer. A well-informed decision stems from understanding why it’s important to screen for cancer instead of waiting until you reach a certain age or symptoms are present.

Why is health literacy important?

Taking care of your health is not reserved only for when you need medical care, but should be a part of your daily life. We all need to be able to understand and use health information and health care services. Health literacy can help you to:

• Take control of your physical well-being

• Better manage chronic conditions such as diabetes and high blood pressure

• Increase the use of preventative care

• Improve health outcomes

• Reduce unnecessary emergency department visits

One component of health literacy includes understanding how to communicate, listen and speak. Mrs. K and her elderly husband moved to the United States from Afghanistan to reunite with their extended family a decade before I cared for her. Neither Mrs. K nor her husband spoke English and we quickly learned that the extent of her English consisted of murmuring “thank you” with a gentle nod of her head after our conversations.

When Mrs. K came to the ED with severe abdominal pain and was diagnosed with ovarian cancer, our residency team realized that we needed to help her family increase their health literacy to understand what was happening and what they could expect to come.

Mrs. K needed help interpreting the information into Dari, her preferred language. We initially worked with phone interpreters to communicate with her, a service also available to help us communicate with patients at LMH Health, but she much preferred having her family interpret when they were available. Her son, who served with the U.S. Army in Afghanistan as an interpreter, admitted he struggled relaying the details of her health information. He did not understand how the medical field and health care professionals operated, which limited Mrs. K’s ability to receive and understand the proper information.

Understanding medications

While medications can treat disease and ease pain, they can be harmful when not taken correctly. Our team found that our biggest hurdle in helping Mrs. K after she left the hospital wasn’t the complexity of her cancer. It was helping make sure she knew which pill she could take to control which symptom, and how to take it safely.

When Mrs. K returned to the ED with severe abdominal pain after a month, we learned that she didn’t realize she needed to request a refill from her pharmacy. We also learned that Mrs. K never learned how to read letters or numbers, which made it impossible to understand the instructions to “take 1-2 tablets every six hours as needed” for her nausea medication.

According to the American Association of Retired Persons, 86% of adults ages 65 and older regularly take at least one prescription medication, and 42% take five or more drugs. Mrs. K had a number of medications used to control pain, treat nausea and acid reflux, prevent constipation, and one to help her fall asleep if needed.

Our team had explained the medications, handing each bottle to her and her husband and explaining the medications using a Dari interpreter. But the bottles got jumbled up, and another one got misplaced when they returned home so they returned.

Our team ultimately designed a chart using symbols to help her understand her medication regimen. We had a shared Google document that we could update as she was back and forth for her chemotherapy treatments. The hospital pharmacy team coordinated with us so Mrs. K left the hospital with her properly identified bottles of medications and her guide of when and how to take them.

Over the next few months, we saw Mrs. K less and less. She was able to stay home more and felt better between her treatments by having the appropriate health literacy skills. This is our ultimate goal as a health care system — for people to return home with the supports, knowledge and to live healthily in our community.

— Dr. Ashley Bloom is a primary care physician at LMH Health Primary Care — East Heights.