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Center for Health Literacy Promotion Blog

Promoting Health Literacy - Do they get the picture? Does it match yours?

“Give it to them briefly so they will read it, clearly so they will appreciate it, picturesquely so they will remember it and above all accurately so they will be guided by its light.”
~ Joseph Pulitzer

Previously on the blog we explored definitions of health literacy-before you give information, offer it. This keeps the learner in charge of the learning. We also said keep it brief. Focus on the critical minimum your client needs to solve the problem s/he has now.  Make it clear to the learner. Simple is not always clear. Always check-back to confirm understanding. We discussed making materials picturesque
to attract and guide the eye.

Now we consider picturesque words. Familiar words make mental pictures. Technical terms, acronyms and medical jargon make static. So for clarity, you have replaced limbs (they grow on trees, right?) with arms and legs; and you
have advised the patient/client to walk instead of ambulate. Now your instruction is memorable because it creates pictures in the learner’s mind. Right? What if they got the picture, but it was not the one you intended?

A cartoon presents a simple instruction in familiar language: “One capful every four hours”. But this man got a picture of “cap” that is not what the writer was seeing when s/he wrote the instruction. The man saw his hat; the writer saw the lid to the medicine bottle. This man understands the instruction; but he understands it differently. Is he non-compliant? It looks that way, but he is complying to the letter with the instruction, as he understands it.

Does he have low literacy? Low health literacy? Yes to both; he does not grasp the context of the instruction so he does not interpret the meaning; he takes it literally within the limits of his own experience. He is likely to have more trouble with the second half of the instruction. Does every four hours mean you wake up to take it during the night? When do you stop taking it?

It is always worth the time it takes to check understanding, even with an apparently simple instruction. “Do you understand” is not the question to ask. No one wants to admit ignorance, so the answer will almost always be yes. Try something like: “The medicine only works well if you take it a certain way.
Let’s make sure I’ve been clear. The bottle will say “One capful every four hours?” How much of this are you going to take? How will you measure? When will you take it? OK good. Be sure to call if you don’t feel better in three days.”

The sender is responsible for the message. Note that in the example, the provider takes responsibility for the patient/client’s understanding. S/he said, “Let’s make sure I have been clear.” S/he takes the burden off the patient/client. This is more than a good communication strategy. Federal and State civil rights law, accreditation standards and Medicaid/Medicare regulations all hold health services providers responsible for making sure the patient/ client gets the right picture, despite low literacy, language barriers and time constraints.

Have you discovered a patient or client that got a picture different from what you intended? How did you handle it? Share your story on the blog!


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