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Tackling Health Literacy to Improve Patient Care


Navigating the intricacies of one’s healthcare can be a daunting task for anyone. Add limited health literacy to the equation and an individual’s ability to properly take medication or manage a chronic illness like diabetes or kidney disease may be negatively impacted. In fact, only 12 percent of adults have proficient health literacy skills, according to the U.S. Department of Health and Human Services. Nurse explains discharge instructions to family

Children’s Hospital Central California recently began a pilot program to improve health literacy. Entitled “Mind the Gap,” the program turns a doctor’s orders into an audio recording patient families can listen to repeatedly. It is part of a larger, hospital-wide commitment to continuously develop ways to improve patient safety. The program could eventually serve as a model for hospitals across the country to improve health literacy among their pediatric and adult patients.

“The goal of Mind the Gap is to address the concerns of poor health literacy in our patient population,” said Dr. Samuel Lehman, Medical Director of Patient Safety. “Since much of the information about the care of our children is communicated in a written format, by replacing it with an audible format, we hope to improve our patients’
compliance with discharge instructions.”

Health literacy is the degree to which individuals can obtain, process and understand the basic health information and services they need to make appropriate health decisions. A person can be literate and still have difficulty understanding medical information. Research shows limited health literacy skills result in increased medication errors, higher rates of hospitalization and use of emergency services. Individuals with limited health literacy skills are more likely to skip important preventive measures like flu shots and are less able to manage chronic medical conditions effectively.

About 80 percent of patients, for example, forget their physician’s instructions as soon as they leave the doctor’s office. “The types of potential errors could fill a book,” said Lehman. “Some examples include giving their children too much or too little medication, going swimming with an open wound which can result in an infection or not knowing the symptoms that should trigger a call to the doctor.”

The Hospital has a team of interpreters, chaplains and social workers who work closely with patient families to identify and address their needs. Mind the Gap goes a step further by evaluating patient families’ ability to understand written instructions. It is funded in part by a $25,000 Cardinal Health Patient Safety Grant and supported by Children’s Health Literacy Taskforce composed of representatives from Patient Safety, Information Technology Services, Medical Education, Clinical Education and Informatics and Interpreter Services.

Specifically, the pilot program addresses the needs of patient families who speak Spanish, Hmong and Mixteco-Baio. In the Central Valley, nearly 40 percent of the population is Latino, and the Hmong population of about 50,000 represents one-half the U.S. total Hmong population. “The two most utilized types of interpreters at the Hospital are Hmong and Spanish so it only made sense to start with those languages,” said Simran Kaur, Patient Safety Project Manager. “We have a small population of Mixteco-Bajo-speaking patients and since it is a unique language, we decided to include those patients in our study as well.”

The program’s long-term goal is to provide this service to all Children’s Hospital patients, including those who speak English.

Currently when a patient is discharged from the Hospital, the physician writes the discharge order and instructions. The nurse explains the discharge instructions through an interpreter to the child’s parents and provides them a written instruction sheet with the same information. In contrast, the pilot program involves making a password-protected audio recording of the discharge instructions as the interpreter translates them to the parents. Other questions and answers are included on the recording along with instructions to call the doctor if something is unclear. Patient families are shown how to access the recording and given a small refrigerator magnet with the telephone number. The recording is accessible for 15 days.

“When we designed the intervention, we kept in mind the needs of our patients and families,” said Kaur. “The recording can be accessed via a toll-free number and a personal access code which is provided to each patient family.”

When the three-month pilot concludes in July, the taskforce will evaluate the program’s effectiveness, paying particular attention to reduced medication errors and patient harm. It will also measure improvements in communication between patients and caregivers and the family’s involvement in care.