Question 3
The authors of this study begin the article by stating that dietitians are often unaware of a patient's or client's health literacy level and conclude by recommending dietitians promote nutrition and health literacy improvement efforts. What are specific ways dietitians can do this? What are the benefits of doing so?
posted by Anonymous @ 4:36 PM
30 comments
30 Comments:
I think that this is a great thought. This may be difficult because of the concept of the lower reading level as mentioned in the text. I think the best way to improve literacy is to provide clients with appropriate sources to find information and ways to do so. I think that this will benefit the patient by showing them where not to go and providing them with the knowledge to be proactive in their own care.
A specific way that dietitians can promote nutrition and health literacy improvement efforts is by encouraging the patient to ask question and letting the patient speak freely during the initial visit. Although time is limited, it is better to take an extra two minutes than to cut the patient short and not answer all their questions. The short-term pay off may conclude to long-term pay offs of compliance to diet, focused and shorter future interactions with the patient and less frequent follow-up visits as the patient continues to treat their disease.
An example of this idea is the proposed change of front-of-packaging nutrition rating systems and symbols to help promote healthier choices. The current systems and symbols on the front of food packages are meant to make choices easier but instead bewilder the consumer to head-scratching puzzlement. This increases two-folds when the consumers don’t understand the rating system behind the symbol or system and are pressed for time. In order to help consumers find healthy options quickly they are moving towards developing a simple system without written
Molly, you bring up some interesting thoughts and triggered a thought for me. Hy-vee grocery stores have what they call NuVal system. This system placed numbers on products around the store, concept is simple.. the higher the number- the better the food is for you. Even though this system does not educate the shopper on why certain foods are better than others it is still encourages them to make healthier choices and does not require any reading. Perhaps more systems like this can be implemented as more grocery stores are higher dietitians.
This is a good question and difficult to answer. Encouraging patients to read into the disease or syndrome that they are dealing with might help create more advanced discussion when they talk to an RD. Learning about nutrition is such a complex task itself, starting with learning about what is troubling them may help them build up enough interest and desire to learn more as you meet with them. A basic example is being able to explain why a recommended diet is important to help keep their blood sugar levels stable. Providing them the resources is very important to keep them from being overwhelmed with misleading information online. Keeping in contact with them would be important to answer any questions they have to keep them from becoming discouraged.
Emily, it is a great idea to have them research the disease before a meeting so that they can have some understanding when they come into the meeting. You also bring up a good point to make sure that they have appropriate resources because just googling a topic could lead the patient to reading all sorts of false information that could be confusing or even frightening.
Dietitians could do this by working with school districts to help them beef up their health education classes/reading workload. Also, R.D.s could work with populations that are receiving government aid and have to attend classes to help increase their health literacy. Finally, creating videos and pod casts to present information that can help teach consumers about health issues and increase their competency on health concepts. This could help with at least half of the health literacy problems seen.
The benefits of doing this would be better patient care, actual informed consent from the patients, increased quality of life, and more. The most beneficial of these is that patients would be able to play a more important role in deciding treatment options by understanding the options. Also, their quality of life would increase by being able to understand what they need to do to improve their current health status.
I like the idea that Stephanie about the grocery stores putting high numbers on foods that are healthy for you and low numbers on those that are not as good. I feel like this is a more realistic and applicable way to make changes in clients lives now! While ideally they would know why, be able to chose foods on their own, and be able to research topics to help their conditions. This would help to at least start getting the lay-patient to start buying good foods. From this they may learn trends of what foods are good for them.
Nate, I completely agree that improving a school's health education program is something an RD could assist with that would have a direct impact on the lives of a large number of people. The benefits of this would include a more widespread distribution of knowledge than the traditional one-on-one meeting with a patient, allowing children to choose and form healthier habits at an age that they are forming them, getting entire families interested in health, allowing children to make more informed food decisions when they're surrounded by unhealthy options, and simply more health and happiness of children.
Dietitians can help promote health literacy by first asking their clients/patients probing questions to determine their current level of health literacy. Once they are aware of an individual client's health literacy, they can recommend other appropriate materials from credible sources for the client to look at or make referrals to the necessary agencies that can help each particular client. There is no one size fits all answer to this question. Every client/patient is so different. This is why it is important for dietitians to be aware of what's out in the media as well as credible resources and the knowledge of other professionals/agencies that can help people become more aware. The benefits or health literacy promotion could be big but once again, the first question of income/employment also plays a role in whether or not people will actually act upon what they know to do.
Molly- I agree with your first idea about letting the client ask questions and speak freely. This patient/client centered atmosphere is typically more comfortable for people and it allows them to direct the session towards their concerns. The pay off of this is that if someone feels they are a part of the solution, they are more likely to act upon it and make a change.
I feel the easiest method of obtaining this information from clients would be to include a question about "highest level of education achieved" on the initial assessment document. This would prepare the dietitian for any potential learning barriers that may be presented. Stephanie I like the point you made about HyVees. Clearly, this store chain is thinking ahead in trends in society and they even hire dietitians to work for them!!!
I believe it would be great to begin raising awareness with other dietitians that we work with about the health literacy issues of our clients and work together to improve the education materials at the facility we work at. I agree that this problem is very often overlooked and some dietitians may not even realize it is a problem. I think that by raising the awareness of the need to improve nutrition and health literacy efforts, we will then hopefully in turn see better results in the understanding of nutrition related information in our clients and their long term ability to apply this information to their lifestyle to make better nutritional/health choices.
I think we can do this buy asking the patient what they think of the material. Do they understand what was given and if you can check back in with the pt. It is easy to rush an education on a busy day but a coumadin ed can be just as important as a diabetes ed. Pay attention to how the patient reacts to the handout if they look at for a second and seem overwhelmed maybe this wasn't the right tool for this patient. It can be helpful to have handouts at different education levels. I like to take 2 different handouts in when I educate a patients. I give the patient what handout is needed based on our discussions.
I think Jamie and Amanda brought up excellent points about either objectively (initial assessment document) or subjectively (ask probing questions)assessing the client's reading level from the get-go. From there, RDs should have enough knowledge of education materials to appropriately guide their client. While also remembering that we must not rely on these materials as the bulk of nutrition intervention, they are simply to supplement what we discuss with our clients.
Stephanie brought up Hy-Vee's use of scoring foods based on nutrition. I know that Whole Foods implements the ANDI (Aggregate Nutrition Density Index) and labels scores for their foods on a 1-1,000 scale (http://www.wholefoodsmarket.com/healthstartshere/andi.php). However, ANDI is only used for whole foods (green and nongreen vegetables, fruit, beans, nuts & seeds, whole grains). Also, people who shop at Whole Foods are typically more health literate than the average American. Nonetheless, this type of scoring should be implemented in more grocery stores!
I agree with Nate that RDs need to get into schools! And being in the kitchen doesn't count! We need to have face-time with kids, and it's about time kids learn what an RD does. Perhaps we could even let students view actual health education information and assess them in class. When learning about any particular topic, their regular textbook, etc. could be supplemented with an actual hand-out regarding that topic. This may foster a generation that is more comfortable with health education material, and more likely to seek it out and read it.
Pre and post tests I think can be very helpful. At Day Care Resources they require all the day care providers to complete their version of “CEUs” with a post test following each nutrition lesson. This not only helps the providers learn about nutrition but also shows the RD where many of the knowledge deficiencies are in this population. This aids the RD in creating handouts and newsletters that are directed to those gaps in nutritional knowledge.
I think a great place to start is talking directly with the patient about their condition. Afterall, we cannot assume that they know everything that we know. Some patients may research their condition because they are curious, want to become healthier, etc. Others may know about their condition because it runs in their family. As Jamie said, all patients are different. Undoubtedly, encourage patients to ask questions and seek answers. From there, credible materials can be provided in order to further their knowledge.
I think that Jordan's idea is great. Ask patients what they think of educational materials. What is clear? What is confusing? This is an easy way to identify trends and alter materials so they are more user-friendly!
I think being active in your community can be a way for dietitians to promote nutrition and health literacy. My only experience is with community and food service dietitians, but I have seen a number of avenues where a dietitian can have an impact. Wellness campaigns are becoming more prevalent in the workplace and would be a way to introduce messages to promote health literacy.
I agree with Emily, Nate and Taylor on being involved in nutrition education in schools. I think it can be hard for school food service directors to find the time to do this themselves. However, they do have access to the teachers and school nurses to collaborate on education initiatives for the classroom. I would REALLY love to see more of a connection between classroom education and school lunch promotions. My daughter's district highlights a fruit of veggie of the month on the lunch menu that is never served to the kids as part of their lunch.
I think one of the most important things to help improve nutrition and health literacy is to make the patients/clients comfortable with asking questions whenever there is something they do not understand or if there is something they want to know more about. Also, starting at very basic knowledge and working up will help with gauging how much the person already knows or understands.
I think using models/pitcures/videos are wonderful tools in helping individuals understand certain health issues. For example, I taught a class on Fats at the Wellness Center this week and one of the topics was about how plaque can clog our arteries. I started by asking if anyone had heard of this and most said yes. I then passed around and explained the same concept with a model that showed the progression of plaque build up. I was surprised with how many people said "Oh that's how that works" becuase they had already expressed they understood how it worked. I then chose to play a short video reiterating how plaque clogs arteries. I think these methods help individuals visualize certain concepts that can be vague or confusing if only explained verbally.
Jamie-
I agree with your comment that education depends on each individual client. We must ask probing questions (obviously in an open and non-threatening way) to understand their level of knowledge and then adapt our teaching methods to better assisst them.
Kevin-
Great idea about pre and post tests. We could also just ask the client questions regarding the information we went over to see if they are understanding it. I often see dietitians teaching exchanges as their patient's "this is one cup of milk, so how many exchanges will this be?" This is a great way to judge if the client is understanding the information.
I think the Hy-Vee NuVal system is awesome. We need to have more grocery stores like this! I went to Hy-Vee’s frequently back at home and often times I would look at these numbers while I was shopping. They are very simple to read and a little shocking when you see numbers in the single digits on a scale of 100. But hopefully people see these very low numbers and choose healthier options. All Hy-Vee’s have a dietitian on staff and often have classes where they would take people on a tour of the store and teach them what to look for. I think it would be a great idea if dietitians teamed up with local grocery stores and gave tours/classes.
I definitely agree with this statement because if clients won't understand what they are reading, they will never find practical uses for the information we are giving them. Ways to improve health literacy includes going over materials with clients and encouraging them to ask questions. You could also do some hands-on activities to help solidify information so that they can learn in different ways.
I agree with Nate that the addition of health educations in schools would be a great way to increase health literacy levels. I also agree with Alana that one key is to actually meet with the client face to face in order to gauge what their knowledge/health literacy level is and accommodate to them.
I think a main way to help clients increase their health literacy level is by providing resources such as websites, articles, journals, etc. Giving the client guidance on a specific disease or nutritional issue that they are dealing with can be a powerful motivator. However, not all people may have time to read these extra resources so it would be important to implement some activity or hobby in the client’s life that they enjoy and relate it to health and get them interested in being proactive.
I think that RD's need to be reminded of health literacy and should implement certain questions into their usual interviewing or counseling routine to determine the health literacy of that individual so they can tailor their education to that client specifically
Nate, I like your idea to encourage schools to "beef up" their health classes. Unfortunately health classes do not seem to be a priority in our school systems. Did anyone else have a health class before highschool?
Its tricky to evaluate your client's education level. If you assume that the client needs a simple education, you risk offending them if they are actually at a higher reading/comp. level. If you assume they are at a higher level when actually, they are not, then you risk not reaching them with the education. I think you just have to feel the situation out and really pay attention to how the person reacts. Are they listening? Are they comprehending?
I would also love to see more health education in school (as Nate, Emily, Angela and Taylor say)but I am not very optimistic about it happening in the near future. At least in Peoria, we have entire schools closing and consolidation of schools occurring. Teachers are losing their jobs left and right and a lot of kids don't even get P.E. anymore. I feel it is unrealistic to expect that health education will be a priority to those who determine where the budget will be appropriated.
Amanada,
I agree that there should be some method of indicating what the client’s highest level of education achieved. I find this to be highly important because the previous question discussed the idea of an assessment tools, and it would be extremely helpful to understand what level of knowledge client’s have in order to ensure that they will not only comprehend new nutrition ideas and tools but ultimately learn from them.
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