Patients May Not Understand Our Guidance
Patients May Not Understand Our Guidance
Jeffrey S. Berns, MD: Hello. This is Jeffrey Berns, editor-in-chief of Medscape Nephrology. A couple of days ago, I was putting together some material for a talk I'm going to be giving at the National Kidney Foundation Spring Clinical Meeting in March, and I ran across an interesting article in Nephrology Dialysis Transplantation published in 2013 by Fraser and colleagues. It was a systematic review of the prevalence of limited health literacy in patients with chronic kidney disease.
Just in case you're not aware—and I really didn't think about the definition very much—health literacy is defined as "the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions." That definition comes from a report from the Institute of Medicine.
Doing a little bit of reading, it seems like limited health literacy is associated with a reading ability at maybe the fifth or sixth grade level, perhaps a little bit higher.
We think about all of the things that our patients have to do that require a reasonable degree of health literacy: filling out forms; assessing risks and benefits of therapies; self-management; self-care; shared decision-making; understanding what kidneys are and what chronic kidney disease is; and understanding what the medications are for and when to take them, how to take them, and so forth.
There's a robust body of literature to indicate that limited health literacy is associated with poorer health outcomes. I was a little surprised to read that, on average, about 25% of patients with chronic kidney disease have limited healthcare literacy. It ranges from substantially limited to somewhat better, depending upon the specific patient population being examined. But, certainly, it's common among our chronic kidney disease patients to have limited health literacy.
The next question that arises: How well prepared are the materials that we provide our patients for kidney disease education? Do they give patients the message that we want them to receive?
A couple of studies have looked at this. One was published in the American Journal of Nephrology in 2013. The authors looked at printed patient educational material for patients with chronic kidney disease from 19 different organizations. They concluded that about half were pitched at a reading level that was above sixth grade.
Somewhere around the fifth or sixth grade level or lower would be considered appropriate for individuals with limited health literacy. So, fully half of the patient materials were pitched at a level that was too high for a substantial fraction of our patients.
Of note, the printed material that was considered best overall was that which came from the National Kidney Disease Education Program through the federal government and from the American Kidney Fund, the Kidney School, and, I'm glad to say, the National Kidney Foundation.
The second paper is just in press now by Morony and colleagues in the American Journal of Kidney Disease. These investigators also looked at the reading level of a host of printed materials and found that most were pitched at individuals with a reading level of ninth grade or higher. Only 5% were pitched at patients with a reading level at the recommended fifth grade level. So, again, most of the materials would not be useful to someone with limited health literacy.
Finally, there was a paper that came out in 2014 in Nephrology Nursing Journal that looked at 40 different websites providing educational material for patients with chronic kidney disease and their families. Only 3 of the 40 were thought to be fairly easy to read. At least half, in fact, were considered either difficult or very difficult to read and understand.
I think this is important information for us to be aware of as we provide material for our patients. We should think about what their health literacy is and make sure that we're providing them with educational material that is appropriate for their level of literacy.
At the same time, we should make a pitch to those who provide educational materials for patients and families with chronic kidney disease to examine those materials and make sure that they're prepared at an appropriate reading level and can be understood by many of our patients with chronic kidney disease who have limited health literacy.
Again, this is Jeffrey Berns, editor-in-chief of Medscape Nephrology, from the Perelman School of Medicine in snowy Philadelphia. Thanks for listening.
Jeffrey S. Berns, MD: Hello. This is Jeffrey Berns, editor-in-chief of Medscape Nephrology. A couple of days ago, I was putting together some material for a talk I'm going to be giving at the National Kidney Foundation Spring Clinical Meeting in March, and I ran across an interesting article in Nephrology Dialysis Transplantation published in 2013 by Fraser and colleagues. It was a systematic review of the prevalence of limited health literacy in patients with chronic kidney disease.
Just in case you're not aware—and I really didn't think about the definition very much—health literacy is defined as "the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions." That definition comes from a report from the Institute of Medicine.
Doing a little bit of reading, it seems like limited health literacy is associated with a reading ability at maybe the fifth or sixth grade level, perhaps a little bit higher.
We think about all of the things that our patients have to do that require a reasonable degree of health literacy: filling out forms; assessing risks and benefits of therapies; self-management; self-care; shared decision-making; understanding what kidneys are and what chronic kidney disease is; and understanding what the medications are for and when to take them, how to take them, and so forth.
There's a robust body of literature to indicate that limited health literacy is associated with poorer health outcomes. I was a little surprised to read that, on average, about 25% of patients with chronic kidney disease have limited healthcare literacy. It ranges from substantially limited to somewhat better, depending upon the specific patient population being examined. But, certainly, it's common among our chronic kidney disease patients to have limited health literacy.
The next question that arises: How well prepared are the materials that we provide our patients for kidney disease education? Do they give patients the message that we want them to receive?
A couple of studies have looked at this. One was published in the American Journal of Nephrology in 2013. The authors looked at printed patient educational material for patients with chronic kidney disease from 19 different organizations. They concluded that about half were pitched at a reading level that was above sixth grade.
Somewhere around the fifth or sixth grade level or lower would be considered appropriate for individuals with limited health literacy. So, fully half of the patient materials were pitched at a level that was too high for a substantial fraction of our patients.
Of note, the printed material that was considered best overall was that which came from the National Kidney Disease Education Program through the federal government and from the American Kidney Fund, the Kidney School, and, I'm glad to say, the National Kidney Foundation.
The second paper is just in press now by Morony and colleagues in the American Journal of Kidney Disease. These investigators also looked at the reading level of a host of printed materials and found that most were pitched at individuals with a reading level of ninth grade or higher. Only 5% were pitched at patients with a reading level at the recommended fifth grade level. So, again, most of the materials would not be useful to someone with limited health literacy.
Finally, there was a paper that came out in 2014 in Nephrology Nursing Journal that looked at 40 different websites providing educational material for patients with chronic kidney disease and their families. Only 3 of the 40 were thought to be fairly easy to read. At least half, in fact, were considered either difficult or very difficult to read and understand.
I think this is important information for us to be aware of as we provide material for our patients. We should think about what their health literacy is and make sure that we're providing them with educational material that is appropriate for their level of literacy.
At the same time, we should make a pitch to those who provide educational materials for patients and families with chronic kidney disease to examine those materials and make sure that they're prepared at an appropriate reading level and can be understood by many of our patients with chronic kidney disease who have limited health literacy.
Again, this is Jeffrey Berns, editor-in-chief of Medscape Nephrology, from the Perelman School of Medicine in snowy Philadelphia. Thanks for listening.
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