Addressing health literacy through clear health communication: A training program for internal medicine residents

Objective: To develop, pilot, and test the effectiveness of a clear health communication curriculum to improve resident knowledge, attitudes, and skills regarding health literacy. Methods: Thirty-one internal medicine residents participated in a small group curriculum that included didactic teaching, practice with a standardized patient, and individualized feedback on videotaped encounters with real patients. Outcomes were assessed using a pre-post survey and a communication skills checklist. Results: Mean knowledge scores increased significantly from 60.3% to 77.6% (p <0.001). Residents also reported increased familiarity with the concept of health literacy (mean response 3.2 vs. 4.5 on a 5 point scale), importance placed on health literacy (4.2 vs. 4.9), frequency of considering health literacy in patient care (3.3 vs. 4.0), and confidence in communicating with low literacy patients (3.3 vs. 4.1) (all p <0.001). Use of plain language increased significantly from 33% to 86% (p = 0.023). There were nonsignificant increases in the use of teach-back (0-36%,p = 0.116) and encouraging questions (0-1.4%, p = 0.502). Conclusion: Training in clear health communication improves resident knowledge, attitudes, and skills regarding health literacy. Practice implications: The increased use of clear health communication techniques can significantly improve the care and outcomes of vulnerable patients with limited health literacy. (C) 2014 Elsevier Ireland Ltd. All rights reserved.