Implementation of Health Literacy Strategies in a Pediatric ENT Clinic

Background: Patients and families visiting our pediatric otolaryngology (ENT) clinic often call for clarification of plan of care, post-appointment questions, and post-surgical concerns that were previously reviewed. Additionally, there is frequent improper utilization of the emergency department due to lack of understanding of normal post-operative outcomes. Evidence suggests that implementation of health literacy strategies can increase patient understanding and decrease emergency department visits and re-hospitalizations. However, healthcare professionals often fail to employ health literacy techniques.
Purpose: This study sought to improve the effectiveness and retention of diagnoses and surgical education in a specialty clinic setting by implementing health literacy strategies.
Methodology: Baseline, six-month, and twelve-month post-implementation surveys were completed by staff to measure comfort, consistency, and perceived feasibility of health literacy strategies. Strategies were introduced to ENT staff through routine lessons from a health literacy liaison, role-play opportunities, in-clinic coaching, and debrief discussions. Additionally, two project champions were appointed to work with an external facilitator with expertise in health literacy to minimize staff resistance and promote comfort and consistency in utilization of strategies. Strategies included teachback, “chunking” information, and reducing medical jargon.
Results: Baseline data was collected from 36 ENT staff members. Follow-up surveys were conducted 6 months and 12 months after implementing strategies in the clinic. 33 staff members completed the six-month survey and 26 completed the twelve-month survey. The baseline survey found that only 40% of staff had used teachback within the past six months of practice, while the six-month post-implementation data showed an increase to 61%, then to 73% at twelve-month post-implementation. At the time of baseline data collection, 57% of staff felt highly confident (score of 7 or greater out of 10) utilizing teachback techniques, while the six-month post-implementation data showed an increase to 75%, which then slightly decreased to 65% at twelve-months post-implementation. After proper training, use of project champions, removal of identified barriers to implementation, and education on health literacy tools, staff reported feeling more comfortable utilizing the strategies and report doing so more consistently.
Implications: 15-59% percent of patients within the United States have limited health literacy, impacting patient understanding of medical needs, compliance with treatment, active participation in care, and escalating healthcare costs. Utilizing health literacy strategies can improve patient outcomes and increase understanding of care. Prior to implementing health literacy techniques, staff did not consistently or confidently use strategies such as teachback. Anecdotally, staff are working to overcome fears while more frequently integrating teachback strategies into their clinical interactions and workflow, leading to the dip in confidence data. Because of this, the decrease in staff confidence, correlating with an increase in utilization at the twelve-month mark, is understandable. Health literacy champions and project coordinators will continue to assess barriers to implementing health literacy strategies in the clinic, provide reassurance to staff as they work to change behaviors, and continue to adapt practices to improve provider and staff comfort and consistency in applying these strategies to patient care.