Sometimes I give an instruction to a patient during a lung function test and am amazed when the patient does almost the opposite of what I requested. This has lead me down an interesting path of looking at the teaching-learning process in relation to adult learners.
The aim of the information and education we provide is to reducing levels of psychological distress, aid compliance and ultimately patient satisfaction (Poroch, 1995). The more informed the person is, the more likely they will have favorable health outcomes and experience less psychological stress) Joanna Briggs Institute, 2000).
Teaching is more then just imparting knowledge, as learning is more than simply listening to instructions; we want our patients to understand the information. According to O’Brien (2004), the skills required for effective health education include knowledge of the subject matter, communication skills and empathy. Barriers are time constraints, lack of resources and knowledge, disagreement with the patient regarding their expectations, powerlessness, frustration and cultural differences. These barriers of course can be overcome by a planned approach where realistic goals have been agreed upon.
We need to be able to think critically and make clinical judgments in order to meet our patients’ needs. This can be achieved by asking the patient if words are understood and welcoming questions whilst observing non-verbal cues as well as assessing a patient’s learning needs and preferred learning style whether it be visual, auditory or physical. Patient information needs are highly diverse and shaped by gender, age, socio-economic status as well as beliefs, preferences and styles of coping which are all difficult to identify and define.
According to the 1992 National Adult Literacy Survey, one out of every five adults in the United States cannot understand written materials that require only basic proficiency in reading. The average adult in the United States cannot read above eight grade level. Therefore health care providers must prepare materials at the lowest possible reading level preferably the sixth grade level (age nine). People with good reading skills are not offended by simple reading material and most prefer easy-to-read material (Davis et al 1998). Lowering the reading level does not significantly alter the meaning of the text. Studies have shown that regardless of the reading ability and socio-economic status, patients are able to read a simpler brochure quicker and with better comprehension.
Seventy percent of newspapers sold in the UK have been found to be written at a reading age of 12 (Nicklin, 2002).
It is widely recognized that patients often forget things they are told during their consultation therefore written information can be used as a useful adjunct to verbal communication. Two popular formulas are used to determine the readability of written materials; the greater the number of polysyllabic words, the greater the reading difficulty; and the longer the sentences, the greater the reading difficulty.
The following data has inspired me to evaluate the information we provide to our patients. The following approaches have been found to ease patients’ reading. Using short, familiar words of one or two syllables, avoiding medical terminology whenever possible, using short sentences under ten words, using the second-person pronoun (“you”), using active rather then passive voice and using numerals rather than spelled numbers (Nicklin,2002). Information should be non-alarmist, non-patronizing and include a publication date indicating it is up to date.
Pictures apparently enhance memory, lists are easier to read than paragraphs, and in order to facilitate reading, ensure there is adequate white space on the page, set margins left-justified and ragged-right and use 12-point font (Heath, 1999). Health information is apparently accessed by 60-80% of internet users and studies show that 72% of these folk believe online information is credible. Due to the unregulated nature of the Internet we are in a fortunate position of being able to direct our patients to credible sites.
Every interaction we have with our patients and their families is an ideal opportunity to focus on risk management, health promotion and to provide teaching that can influence and affect their lives.
Vanessa
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