Health Communication

Universal Precautions

Adequately evaluating the health literacy level of every client or patient you see is neither feasible nor effective. As a result the Agency for Healthcare Research and Quality (AHRQ) recommends taking a Universal Precautions approach to health literacy: 

Assume all patients or clients may have
difficulty comprehending health
information and accessing health services

To help clinicians, the AHRQ has put together a Health Literacy Universal Precautions Toolkit.

Health Communication Basics

Effectively communicating with your clients, patients, and the general public is a crucial part of improving their health and well being. 

So what is Health Communication?

• Verbal Communication
  • the words you use to talk about health topics and your patients/clients lives
  • printed materials (information sheets, discharge orders, etc.)
  • healthcare facility signs
     
• Non-verbal Communication
  • eye contact
  • facial expression
  • body positioning
  • tone of voice
  • talking speed
  • demeanor (patience level, mood, etc.)
     
• Communication Boosters
  • images used in handouts or displays
  • models and devices for demonstration

Plain Language

Plain language is clear communication that the general public can easily understand. The Agency for Healthcare Research and Quality (AHRQ) has a great page explaining the details about plain language. 

Plain Language Basics

• replaces technical and complex words with everyday language
• provides the important information without unnecessary extras
• explains technical terms clearly when they are necessary
• engages listeners and readers with personal pronouns and active voice

Testing your Materials for Plain Language

Use the tools below to help you figure out whether your handouts, displays, etc. use any language that might be hard for your audience to understand.

CDC Clear Communication Index

More Education about Plain Language

Plain Language Medical Dictionary

Teach Back

The Teach Back Method 

• Helps clinicians be sure they communicated information and instructions clearly
• Is a shame-free method, focusing on how well the clinician communicated and is not a test of the patient/client
• Asks the client or patient to explain or demonstrate the information that was just provided
• Gives clinicians a chance to verify understanding and correct any miscommunications.

Here are some documents that will help you learn and improve your own teach back practice.

Creating Handouts

Before You Begin

• What is the purpose of your handout? Try to stay focused on one or two messages.
• Who is the audience?
• How much information are you trying to convey (is the amount appropriate for a handout)?

Preparing the Content

• Find evidence for the recommendations, data, or other information in your handout
• Identify the key points
• Identify need for images

Writing

• Follow plain language recommendations
• Use short sentences (15-20 words) and short paragraphs
• Use positive recommendations

Layout

• Separate paragraphs and sections with white space
• Use headings to introduce sections
• Use lists and bullets to display information

Images

• Use them, but make sure they are relevant
• Tables and charts can be more effective than data in paragraphs

Readability

• Use clear, unadorned fonts
• Be sure copies/print-outs are of good quality

(Adapted from OSU College of Medicine's In Plain Words: Creating Easy to Read Handouts and  Plain Language at AHRQ)

Health Communication Theories

Evidence shows that grounding your health promotion activity in a communication theory leads to more effective outcomes (Corcoran, 2007).

Cognitive Theories

Corcoran, N. (2007). Theories and models in communication health messages. In N. Corcoran (Ed.) Communicaing health: Strategies for health promotion. Thousand Oaks, CA: Sage. 

Communicating with Children

Tips

All of the principles on this page apply to children as well, but here are some additional tips for communicating with this population.

• Be age appropriate
  Find out your audience's typical reading level as well as the level of conceptual difficulty they can handle. Consider the appropriate image to text ratio.
• Incorporate audience participation into any learning activity, even if you cannot directly interact with your audience.
• Address the whole child in your learning activities
  Compartmentalizing is not a strong skill for most children; therefore consider any physical, emotional, social, and cognitive needs that may be present and incorporate them into your approach.
• Use positive messages that focus on strengths.
  Let children imagine what they can be, not what they shouldn't be. This includes using images that let children see themselves in positive ways.

Knowing the typical developmental stages of children is crucial to preparing appropriate and effective communication. UNICEF has a great site to help you navigate this critical information. 
 

(adapted from UNICEF's Communicating with Children)

Articles

Communicating with Older Adults

Tips

All of the principles on this page apply to older adults as well, but here are some additional tips for communicating with this population.

• Beware of the tendencies to stereotype older adults or use patronizing speech.
• Sit face-to-face and speak clearly 
• Minimize background noise
• Ask open ended questions and LISTEN
• Address your older patient/client even if a companion is in the room
• Engage in shared decision making
• Ensure recommendations make sense to your patient/client's specific living situation
• Verify comprehension - your own and theirs.

(adapted from The Gerontological Society of America's Communicating with Older Adults: An Evidence-Based Review of What Really Works)

General

Methods and Recommendations

Borrow from the Library

Communicating Across Cultures

All of the principles on this page apply to working with clients/patients who have cultural backgrounds different from your own, but here are some additional tips for working with these populations.

• Observe and Listen carefully - you may need to pick up on subtle cues to help you determine whether your patient/client understands and is communicating openly.
   
• Be aware of your own non-verbal tendencies (eye contact, personal space, touch, etc) and whether those tendencies make your patient/client uncomfortable.
  
  
• Deference and reserve do not automatically indicate agreement. Provide your clients/patients extra opportunities and prompts for questions.
   
• Explore your patient/client's perspective, being particularly sensitive to belief systems and customs.

"How has your condition impacted your daily life?"

"What do you know about your condition and how it works?"

• Respect family dynamics. If a client/patient is accompanied by one or more family members, include them in introductions, but ask your client/patient how she or he would like them included in decision making.
   
• Be sensitive to differing views on sexuality and gender roles. Be up front about the typical questions and examinations that might occur, but ask permission before proceeding. 

(Based on Betancourt, Green, & Carillo's Cross-Cultural Care and Communication, Up To Date, 2016)

For more details and recommendations about communicating across cultures, take a look at Better Communication, Better Care: Provider Tools to Care for Diverse Populations.

Articles

Cross-Cultural Communication and Language Differences

Aspects of culture such as norms and attitudes may impact provider-client communication, both verbal and non-verbal. In addition to the the resources on this page, the information sources on the Cultural Knowledge tab can help you learn more about such cultural factors.

Culturally effective providers are able to communicate with Limited English Proficiency (LEP) clients in culturally and linguistically appropriate ways. This means using an interpreter whenever possible and providing translated health information. The following resources have information on using interpreters, sources of translated health information handouts, and additional tools for communicating with LEP clients.

Please visit our Health Literacy and Communication guide for more resources and best practices for communicating with clients.

Language Apps

Resources for Patients

Immigrants and Refugees

Deaf Health and Sign Language

Health Information in Different Languages

Other Resources for Communication Challenges

Working with Interpreters