Running head: NURSE PRACTITIONERS STRUGGLE TO USE STRATEGIES TO

Nurse Practitioners Struggle to Use Strategies to Increase Health Literacy in Primary Care Areas
Angela Long
Coppin State University Helene Fuld School of Nursing
Primary Care of Adults and Older Adult
Nursing 660
Dr. Robin Warren-Dorsey
March 29, 2014
Nurse Practitioners Struggle to Use Strategies to Increase Health Literacy in Primary Care Areas

Nurse practitioners struggle to use their knowledge and experience to teach patients about
health literacy. Health literacy the ability to obtain, process, and understand basic health
information and services needed to make appropriate health decisions and follow instructions for
treatment is an increasing problem in the United States (Raiche, 2014, p. 1). Nurse practitioners
continue to struggle to have the right strategies, time and techniques to education patients in the
primary care setting about health literacy. This problem effects not only the nurse practitioner
and the patient, but it affects the whole health care delivery system overall (Cafiero, 2013, p. 70).

Primary care or Family nurse practitioners and the patient-encounters impact the areas of
communication and patient safety (Cafiero, 2013, p. 70).
Statement concerning the primary care related problem/challenge
Low health literacy is associated with poor health outcomes and increased use of our
scarce health resources and improper use of our health resources (Rowe, 2014, p. 1). Limited
health literacy is an indicator of health status and health behaviors other than race or education
(Rowe, 2014, p. 1). Health literacy affects adults in every way such as the ability to understand
prescriptions, ability to read food labels, read and understand educational pamphlets and
brochures, appointment slips, information concerning health insurance plans and coverage
(Rowe, 2014, p. 1). These are only just a few examples of the many challenges that the Family
nurse practitioner must face on a daily basis.
The nurse practitioner must assess the patient health literacy prior to giving care. This
issue can be addressed by asking questions such as Do you have any limitations to learning?
What was the last grade completed? these questions can help you identify the patients health
literacy status (4). It is estimated that nearly 40 % of healthcare providers over estimate their
patients health literacy which leads to miss management and errors (Dickens, Lambert,
Cromwell, & Piano, 2013, p. 62).
Discussion of the prevalence of the health problem/challenge
As of January 2014, 30 million more Americans have gained health care coverage due to
the Obama health care act, creating an even bigger more critical health care shortage, organizing
our scarce resources in order to meet the needs of all patients is the medical communitys top
priority, while providing patient safety (Cafiero, 2013, p. 70). According to Rowe, 90 million
American adults lack the literacy skills that are essential for understanding and using this new

NURSE PRACTITIONERS STRUGGLE TO USE STRATEGIES TO

healthcare system (Rowe, 2014, p. 1). The United States healthcare system has become so
complex; patients are limited in their ability to understand and navigate the system (Rowe, 2014,
p. 1). Healthcare literacy costs an additional $73 billion annually in healthcare expendures that
are unnecessary (Raiche, 2014, p. 1). Some examples of this are higher rates of hospitalizations,
increased usage of emergency rooms, lower numbers of patients getting influenza vaccines and
all vaccines in general, increased in patients taking medications improperly, increased likelihood
of chronic health conditions ineffectively managed (Raiche, 2014, p. 1).
Health literacy affects every population but is more prevalent and more problematic for specific
populations, such as the elderly, poor, minority groups, people that dont speak English, rural
Americans because of their isolation (Raiche, 2014, p. 1). The 2000 census counted that 10
million people speak no English and 20 million people speak poor English and that less than 60
percent of the population has English as a first language (6). It cannot be assumed that educated
or white Americans have higher health literacy because they too have difficulty understanding
terminology used by healthcare providers (Raiche, 2014, p. 1).
Healthcare costs for patients that had low health literacy are more than four times as high
as patients with high health literacy, which is an estimated $13,000 a year compared to $3000 a
year for those patients that understand health literacy (National Institutes of Health, 2014, p. 1).
Discuss resources/agencies that have taken initiatives/efforts to address the problem
There is national attention that is focusing on health literacy; Healthy People 2010 Report
addresses many of these issues (Weill, 2006, p. 1). Health People 2010 state an individual is
health literate when they possess the skills to understand information and services and use them
to make appropriate decisions about health (National Institutes of Health, 2014, p. 1). Some
areas that are focused on in healthy people 2010 are patient-physician communication, drug

NURSE PRACTITIONERS STRUGGLE TO USE STRATEGIES TO

labeling instructions, medical compliance, health information and other resources, informed
consent, responding to medical and insurance forms, giving patient history (National Institutes of
Health, 2014, p. 1) . Health People 2010 states that these skills and strategies are absent in more
than half of the United States population (National Institutes of Health, 2014, p. 1). Having these
very skills can lead to a longer life or improved quality of life and reduction of health disparities
and chronic disease as well as health savings (National Institutes of Health, 2014, p. 1). Health
literacy has been addressed at National Primary Care Week focusing on breaking down barriers:
health literacy in community health (Weill, 2006, p. 1).
Schools of nursing and health care organizations need to take on the task of educating
family nurse practitioner and all medical providers to assess health literacy (Dickens et al., 2013,
p. 62). One college that is preparing nurse practitioners to address health literacy is University of
Pennsylvania School of Nursing. The National Organization of Nurse Practitioner Faculties
offers a perspective on health literacy in Nurse practitioner education which promotes quality
nurse practitioner education at the national and international levels (Weill, 2006, p. 1). The
NONPF has come up with guidelines that are recommended skills the nurse practitioners should
have in order to address health literacy. First a nurse practitioner must be able to critique patient
education materials or presentations currently used to ensure that they are appropriate for the
specific population that is being cared for (Weill, 2006, p. 1). The nurse practitioner must be able
to assess the reading level of the patient education materials so that it is assigned appropriately to
the patients, all reading material should be at six grades or below reading level (Weill, 2006, p.
1). Nurse practitioners should be able to adapt or create new patient education materials that
meet the needs of their patient population, which includes visual as well as text (Weill, 2006, p.
1). Nurse practitioners need to be able to understand a variety of teaching strategies other than

NURSE PRACTITIONERS STRUGGLE TO USE STRATEGIES TO

giving a pamphlet or brochure to a patient (Weill, 2006, p. 1). A Family nurse practitioner needs
to be able to assess patients self care and whether the written material is effective (Weill, 2006, p.
1). Most important is that the nurse practitioner demonstrates effective communication skills in
all patient encounters with all patient populations that they care for (Weill, 2006, p. 1).
Discuss barriers that exist which impede resolving the health problem/challenge
Some of the top reported barriers to implementing a health literacy programs in primary
health areas were reported as not enough time, lack of resources, low priority and lack of
knowledge (8). According to Barrett & Puryear, 2008, administrators thought the biggest barriers
were the lack of awareness that the medical staff had that health literacy was even a problem and
if the medical staff did recognize it then they felt it was a very low priority (8). Some medical
providers disagreed with administrators but felt that the framework in place at the health care
facility limited their use of health literacy practices (8). Some medical staff and administrators
have stated that monetary resources have been concerns for implemented a program to assess for
health literacy. Primary care sites that are already strapped for cash dont have the funds or
resources to use for necessary staff training, development of forms and new written health
information brochures and pamphlets (8). Barriers that are faced by family nurse practitioners in
the primary care area as related to health literacy are lack of resources in the clinic or area in
which they are practicing. I searched for resources addressing this issue for nurse practitioners
and was able to come up with four good resources for family nurse practitioners. The first being
the American Medical Association Foundation which has a Health Literacy Kit available for
purchase (7). This tool helps inform health care providers about health literacy and how to
address the issue. Another resource is The Medical Library Association Task Force on Health
Information Literacy which plays a role in making sure health professionals empower patients to

NURSE PRACTITIONERS STRUGGLE TO USE STRATEGIES TO

read, understand and act on health information (7). A government wide group of volunteers
working on improving communication from the federal government to the public associated
about healthcare called the Plain Language Action & Information Network works on improving
health literacy (7). This group also works on providing information on health communication for
the consumers (7). Lastly a group called the Science and Literacy for Health Drug Education
Partnership is a collaboration that identifies and creates culturally sensitive material for the use in
literacy programs (7).
Review of the literature about the health problem/challenge
Health literacy can be described using three levels based on The Department of Health
and Human Services (Rowe, 2014, p. 1). First being Functional literacy which requires
sufficient reading and writing skills to function in everyday situations (Rowe, 2014, p. 1).
Second being interactive literacy which is the ability to apply meaning to information from
different forms of communication and apply new knowledge to changing circumstances (Rowe,
2014, p. 1). The third is critical literacy which the patient can think about information critically
and be able to have control over life events and situations (Rowe, 2014, p. 1).
Health literacy should be a team effort that begins at the front desk and includes the nurse
practitioner, medical assistants, clinical pharmists, nursing staff and all other team members (8).
Nurse practitioners should use a standardized communication tool such as Teach Back, Ask Me 3
or Motivational Interviewing which are effective in improving communication (8). Nurse
practitioners should use plain language, face to face communication, pictorials and educational
material (8). Some simple common sense approaches can be effective in improving health care
literacy such as use plain language free of all medical jargon, sit face to face, use simple
diagrams to explain medical conditions or pictograms to illustrate explanations, use educational

NURSE PRACTITIONERS STRUGGLE TO USE STRATEGIES TO

materials such as pamphlets and brochures that are geared to low health literacy patients (8, 6).
Nurse practitioners need to repeat their directions or recommendations to the patient in order to
be sure they are heard and even frankly asking if they understand their treatment plan, purpose of
any medications and the dosing (8, 6). Goal setting with the patient can partner the nurse
practitioner with the patient in order to achieve the collaboratation needs to achieve the goals,
which obtains the patients or parents agreement and consent (8, 7).
Conclusion which summarizes the implications for advanced nursing practice
Like physicians, the family nurse practitioner can diagnose and provide care, but the
nurse practitioner places extra emphasis on health promotion, disease prevention and health
education all of which need to be provided to the patient in a way they can understand. Providing
lots of pamphlets and brochures to a patient that cannot be read or understood is pointless.
Providing English educational materials to a Spanish only patient is useless. Providing
medication prescriptions to a patient is pointless if the patient doesnt understand the proper way
to take the medication or doesnt have the means to get them filled. The nurse practitioner must
take the time to assess the patient health literacy prior to completing any education with the
patient. Assessing health literacy can improve the patients quality of life in so many ways listed
previous in this paper, and can save the health care system billions of wasted health care dollars.
A highly health literate patient has the ability to make smarter, healthier lifestyles choice in
which can prolong the life span. Many of the recommendations suggest that patients will receive
high quality patient centered care if the nurse practitioner is prepare throughout their training
both formal and informally.

NURSE PRACTITIONERS STRUGGLE TO USE STRATEGIES TO

References
Cafiero, M. (2013). Nurse practitioners knowledge, experience, and intention to use health
literacy strategies in clinical practice. Journal of Health Communication, 18(18), 70-81.
http://dx.doi.org/10.1080/10810730.2013.825665
Dickens, C., Lambert, B., Cromwell, T., & Piano, M. (2013). Nurse overestimation of patients
health literacy. Journal of Health Communication, 18(18), 62-69.
http://dx.doi.org/10.1080/10810730.2013.825670
National Institutes of Health. (2014). What is health literacy? Retrieved from
http://www.nih.gov/clearcommunication/healthliteracy.htm
Raiche, L. (2014). Health literacy improvement in everyday practice you can increase your
patients understanding of healthcare concepts in simple ways. Retrieved from
www.advanceweb.com
Rowe, S. (2014). A look at health literacy implementing clear culmination, being open to
alternative teaching methods can improve patient outcomes. Retrieved from
www.advanceweb.com
Weill, V. (2006). Health literacy practitioner education: the nonpf perspective. Retrieved from
www.nonpf.org