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A little ice cream can tell you a lot


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Health literacy is often difficult to gauge, but now hospitals have a new assessment tool to aid them. The Clear Health Communication Initiative has developed a simple six-question test that uses an ice cream label to measure a patient's health literacy. The tool was presented during the National Patient Safety Foundation's Congress in May.

Dubbed "The Newest Vital Sign" by the Pfizer-backed Initiative, the assessment is best done during admission, said Barbara DeBuono, MD, MPH, Pfizer senior medical advisor for U.S. Health and Public Policy, during the conference. "If we improve health literacy in this country, we will improve patient safety."

Innumeracy is a big part of health literacy, said Jason Spangler, MD, MPH, senior fellow for the Partnership for Prevention and member of the Initiative. Spangler also spoke during the conference.

"It's obvious when you think of a prescription," he said. "You have to ask yourself, 'How much of a medication do I take, and how many times a day?' "

Give your patients the test during admission

During the admission process, the nurse should have patients read the ice cream label and then ask them questions about the content. For example, the first question asks patients how many calories they would eat if they ate the entire container of ice cream. The patient must multiply the number of calories in a serving (250) by the number of servings in the container (4) to get the correct answer (1,000).

The kit, developed at the University of Arizona in Tucson, comes with a laminated ice cream label and a pad of questions. The question sheets have the answers on them, so they should not be given to patients to read. Instead, the nurse or admitting staff member should read the questions and record the patients' answers themselves, said Spangler.

If a patient can answer four or more of the questions correctly, you can assume that he or she has adequate health literacy. Patients who only answer two or three questions correctly might have limited literacy, and pa tients who answer none or only one of the questions correctly most likely have limited literacy.

There has been surprisingly little resistance from pa tients, Spangler said. Low literacy is a difficult topic for patients to talk about, but most were willing to take the examination, even after staff members explained that it was to help measure their ability to understand directions.

"One of the criticisms we heard was, 'There's such a stigma, patients don't want to be tested like this,' " said Spangler. "Only 1% of patients approached had any problem with doing this."

Put your staff members in the patient's shoes

DeBuono said gaining staff acceptance of the test can take some time, but one manager tried a team exercise to earn buy-in from her nurses: she had them take the test.

"She took 20 minutes and had the entire staff do it, and it was an 'a-ha!' moment," DeBuono said.

Once you determine that a patient has low health literacy, it should be marked discreetly on his or her chart so every caregiver who deals with the patient can make sure to provide clear directions. A big part of that is cutting down on jargon and Latin-based terminology.

"Saying 'Are you dizzy?' or 'Does it feel like the room is spinning?' instead of 'Vertigo,' is better for everyone," said DeBuono. Clear language will result in better comprehension and better follow-up care, because patients who understand their care plan are more likely to make follow-up appointments and take their prescriptions correctly. DeBuono said most people have difficulty with literacy in some area or another, so staff members should empathize with their patients.

"Everyone has experienced this when they talk with a lawyer, accountant, or a car mechanic," she said.

Health literacy is a widespread problem. According to the 2003 National Adult Literacy Survey (NALS), approximately 40% of Americans are health-illiterate. Most are able to read and write but have significant trouble understanding and processing health information.

"The scope of the problem is really underestimated in healthcare," said DeBuono. "When asked, physicians will say only one in 20 patients has health literacy problems, but NALS says it's 40%."