Renee Kinder
Renee Kinder

Ask any parent managing kids, work and pandemic life, “How’s the summer going?” and you are likely to get a response along the lines of …“I just need the kids to go back to some form of school in the fall.”

School as we know it will look very different in the coming year.

Children will experience literacy lessons well beyond the typical phonics, whole word, or context supported methods used to train skilled readers. 

Literacy training will need to be multifaceted and require a shift from traditional curricula to those with added focus on individual health, prevention, and healthcare literacy.

Being literate and accountable for your own health in the current climate could, in fact, be a life or death decision. Not to be overly dramatic, but at a minimum, understanding our own risks can allow for prevention of disease contraction and transmission to ourselves, our loved ones, and the individuals we care for daily. 

COVID-19, in the post-acute world and as outlined in a recent JAMA article, has resulted in an increased understanding of pathophysiology, transmission, diagnosis and treatment of Coronavirus Disease.

Conclusions of this article are as follows:

As of July 1, 2020, more than 10 million people worldwide had been infected with SARS-CoV-2. Many aspects of transmission, infection, and treatment remain unclear. Advances in prevention and effective management of COVID-19 will require basic and clinical investigation and public health and clinical interventions.

In short, we still have so much more to learn. We are not yet completely literate. 

Some positives, please?

Well I would maintain that the overarching need to understand specifics in regard to risk and spread of disease seems to have caused some encouraging change in us all due to an enlightened focus on disease in general and our self-responsibility.

So, which training approach supports full comprehension with written word and spoken language to the level of literate?

This is debatable in the world of education. However, the best approaches, as with our methods to care in the post-acute world, are the ones that are person centered and individualized for the receiver of knowledge. 

Phonemic methods of learning to read teach us by focusing on the recognition of letters as symbols and sounds. This awareness of sound is thought to support blending of letters into words and the ability to speak, hear and process language. 

Whole word methods promote a focus on instant recognition of a word based on its shape, is thought to enable fluency, and does not promote phonics to decipher words. 

Healthcare literacy for our patients requires both, a granular phonemic understanding of current illness or injury merged with broader whole word appreciation of complexities, comorbidities, and precursors related to genetic and life choices. 

CMS, in a 2016 Quality Strategy document, outlined similar plans with a distinct appreciation of the need for patients to serve as partners, and engaged, literate learners during their course of care and beyond. 

These concepts, similar to those we learned in kindergarten, are not new. However, now seems timely for us to refresh and advance their ideas. 

How is the strategy defined?

The document outlines a person-centered approach that considers the individual as multifaceted, not merely as a “receiver” of services.

The initial 3-tiered approach focuses on the following:

  • Better Care: Improve the overall quality of care by making healthcare more person-centered, reliable, accessible, and safe. 
  • Smarter Spending: Reduce the cost of quality healthcare for individuals, families, employers, government and communities. 
  • Healthier People, Healthier Communities: Improve the health of Americans by supporting proven interventions to address behavioral, social and environmental determinants of health, and deliver higher-quality care. 

To advance its three aims, the National Quality Strategy also identified six priorities: 

1. Making care safer by reducing harm caused in the delivery of care; 

2. Ensuring that each person and family is engaged as partners in their care; 

3. Promoting effective communication and coordination of care; 

4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease; 

5. Working with communities to promote wide use of best practices to enable healthy living; and 

6. Making quality care more affordable for individuals, families, employers, governments and communities by developing and spreading new healthcare delivery models. 

Long-term impacts are also discussed including the positive results which healthcare literacy can achieve regarding reducing risk for rehospitalization and a greater ability to promote aging in place. 

So, what are some approaches care providers can use to support the learning of their patients?

Remember, often the simplest approaches can make the largest impact. While we do not need to revert entirely to basics of literacy lessons from our school days, we can derive a few nuggets from them.

First, consider the benefits of a granular “phonemic” approach to training.

To say, Break. Down. Your. Teaching. 

Bite-size pieces of information are best. Do not overwhelm and do not assume that your patient is understanding your training. Aim to change your approach to support return demonstration of areas.

For example, if you are providing care to an individual with a new onset of CVA and an active diagnosis of COPD, he or she will need to understand how to best manage ADLs upon transition to the next setting. Perhaps with some residual paresis, and perhaps also knowing how to effectively measure oxygen saturations during functional tasks. 

Now to what we know about chronic conditions. Literacy cannot be achieved if we target them in silos.

More than 133 million Americans report at least one chronic condition, while many have multiple chronic conditions (MCC) — two or more chronic conditions that affect a person at the same time. 

Multiple chronic conditions are important because: 

• MCCs are associated with approximately 66% of the total healthcare spending in the United States. 

• As many as three out of four Americans aged 65 or older have MCC and approximately two out of three Medicare beneficiaries have MCC. 

• Approximately 1 in 4 Americans in any age group has MCC, including one in 15 children. 

• People with MCCs are also at increased risk for mortality and poorer day-to-day functioning 

In our case study, both conditions have risk for lifelong impacts. Neither can simply be considered a transient even or treated in isolation. How do you promote literacy for the impact of how the conditions interact with one another?

Bring in a whole word approach to target integration. 

A whole word approach, training patients to have an “instant” understanding of their conditions allows for lifelong literacy and daily accountability for minimizing their impacts on function. 

In closing, as we soak up the summer heat, look longingly for the days of normal life, and seek the structure back to school season provides, let us refocus on the lessons learned. Let us become the best of teachers ourselves to our patients.

Like youngsters who look up to their educators, our patients are counting on us. Their learning and understanding depends on our approaches, and we owe it to them to train fully to the level of mastery, literacy, and full condition comprehension. 

Renee Kinder, MS, CCC-SLP, RAC-CT, is Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association’s Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).