Communication & accessibility 

Health literacy is the language spoken by health care providers. They are tasked with having to maneuver quickly between what seems to be two different languages. The medical terminology represented in communications with other medical professionals and medical charts and files, and the use of plain language used to translate this medical information to the patient and their families.

What is plain language?

Plain language is described by Health Quality Ontario as “the practice of communicating – verbally or written – in clear, simple terms that a majority of audiences can easily understand” [1].  Using plain language ensures information passed to the patient is easily understood. A lack of health literacy can affect the patient’s health care outcomes and increase costs to the health care system [2].

Importance of using plain language

The use of plain language is important for several reasons.

“Roughly 60% of Canadian Adults and 88% of Canadian Seniors have low health literacy” [3]. Health literacy is “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions” [4]. Additionally, there can be language barriers to be aware of as well.

A patient’s understanding and comprehension of their health will drive their decision-making process and influence their participation in rehabilitation [5]. It is important to note that in many cases, family members, friends and community members may be included in the decision-making process. Therefore, it is important to be able to communicate with all members effectively.

Health illiteracy is “associated with reduced access to health information, poorer health status, limited understanding and use of preventive services, medication errors, increased health care costs and hospitalizations, increased mortality, decreased self-efficacy, and inadequate knowledge and self-care for chronic health conditions” [6]. Because of these disparities, the use of plain language is an important part of patient-centred care.

Communicating with individuals with brain injury

Many brain injury survivors, regardless of severity, experience some form of cognitive impairment. This can impact comprehension of new information as well as decision-making abilities. It is important to note that cognitive disability does not equate to lack of intelligence. The patient’s intelligence has not been impacted by the brain injury or cognitive impairment.

There may be difficulty in processing and understanding language including verbal, visual, and written communication styles. Comprehension can also change from day to day. They may be aware of a word meaning one day and unaware the next [7]. Communication difficulties due to brain injury can also be seen in “word finding difficulties, excessive talkativeness, difficulty staying on the topic, difficulties thinking of questions to sustain a topic, tactlessness, repetitiveness, and difficulties keeping track of topics in group situations [8].

Keeping in mind the patient-centred care model, health care workers should demonstrate patience and compassion when having to repeat instructions or information.

Tools to communicate with patients effectively and respectfully

Because families and caregivers are instrumental in the patient’s rehabilitation program, including them in the communication process and ensuring they are provided the opportunity to ask questions is important [9].  To maximize patient communication and accessibility to health literacy, Health Quality Ontario suggests that healthcare worker follow these practices [10]:

  • Focus on communication
  • Be concise
  • Speak and write at a grade 8 level
  • Use bullet points
  • Use images
  • Avoid using jargon – language that is specific to you and co-workers
  • Avoid using acronyms

In Health Literacy Manual for Clinicians, B.D. Weiss offers the following strategies for simple language and accessibility in communication [11]:

  • Slow down
  • Use plain, nonmedical language
  • Show or draw pictures to enhance patient understanding and recall
  • Limit the amount of information given at each visit — and repeat it
  • Use the teach-back and show-me techniques
  • Create a shame-free environment: Be respectful, caring, and sensitive
  • Creating and using patient-friendly written materials

Assistive technology can also be utilized to assist patients with communication. “Augmentative and Alternative Communication involves the use of external materials, such as pictures, electronic devices, books, or boards with text, to assist the person in expressing his or her wants, needs, and opinions” [12].

Assistive technology for communication can come in many forms and will be determined in collaboration with the patient, families, caregivers and health care providers. It’s important for the health care provider to be knowledgeable about communication devices and to encourage their use to maximize effective communication between all parties.

Health illiteracy is an ongoing concern with real implications. Patients and their families require plain language to be used to educate and communicate effectively with the health care team. The communication and information network may differ depending on the patient’s communication style and abilities. However, it is the health care providers’ responsibility to understand the best method of communication and provide materials which deliver the information to the patient and their caregivers, so they may best participate in their rehabilitation plan.

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