Dr. Mike Smith (Host): This is Pediatric Insights: Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research.

I'm Dr. Mike. And with me is Diana Montoya, Program Director of patient Education at Children's Health. Today, we'll talk about how Children's Health is building a culture of health literacy to support safer and more equitable care. Diana, welcome to the show

Diana Montoya, RN: Thanks so much for having me.

Host: So, let's start off with can you just define health literacy for us and explain what it is and why it's so important in patient care?

Diana Montoya, RN: Really, the level that we like to focus in on is the organizational health literacy, and that is defined on how well an organization, a healthcare organization does in making it easy for patients and families to find, understand, and use their health information. So when they go home, they are well-equipped, they know what to do, and they can understand the things that we taught them in the organization.

Host: I love this idea of health literacy, because we've all experienced patients, family members, something's gone on and, you know, as doctors, we ask them, you know, "What did the doctor say?" And they just have no idea. They don't even know where to begin, you know, half the time. So, I think this is fantastic.

Now, there's a obviously a communication gap though between patients and physicians. You know, many adults struggle to understand routine health information. So, what are some of the common assumptions clinicians make about patient understanding, and how can those assumptions affect outcomes?

Diana Montoya, RN: Sure. I think one of the common assumption is that open-ended question at the end. You educate on a lot of different things. It's a new diagnosis. And at the end, you ask, "Do you have any questions?" And at that point, either the patient, family, their mind goes blank, or they really don't know what to ask, and they say no, or they just nod along. And you as the clinician think, "Hey, I'm doing a really good job of educating and communicating." When in actuality, it's really coming back to that teachback question of, "Hey, we went over a lot of information today, and I want to know that I did you a service by explaining it accurately. Can you show me how to use this spacer at home?" And that's really the only way we can validate that the patient or family understands what we communicated.

Host: Right there, just by the way you answered it, you made me feel better.

Diana Montoya, RN: Good. I'm glad.

Host: So now, the patient's relaxed. "Oh yeah, let me give it a shot. Let me show you what y I learned." I think that's a great approach. Can you share an example of how you would explain a diagnosis or, say, discharge instructions using plain language? Because this is a big thing for me. What are some simple ways clinicians can reduce getting too much into the medical jargon?

Diana Montoya, RN: That's a great question and one that we don't really even have a definition for what is plain language, right? Is this plain language? But we go back to we use a lot of medical terms and it becomes second nature for clinicians to use this. So, just thinking about acronyms, we use those all the time, so really defining that. Thinking about those different diagnoses that they need to know the diagnosis name, but going a little bit more in depth, what does this mean? And when I say more in depth, don't go into the pathophysiology. They don't need to know all of that. So, thinking about those key points that you want to make sure stick with that patient family before they go home.

And just really reflecting on the use of your words. So, did I use any acronyms? Maybe even medication is a medical jargon. It's medicine, that's the plain language. So really, reflecting on your practice, I would say after each encounter. But, you know, that's probably not reasonable. So at least once a week to think about did I do a good job with using plain language and teach-back.

Host: Yeah.

Diana Montoya, RN: It's hard.

Host: Yeah. I mean, you want to say it's just a medicine. But then, you'd like to let them know how it works and some of the side effects. So, you still got to go into some of that detail, you know? And that's definitely, I think, a challenge. There's something called teach-back.

Diana Montoya, RN: Yes.

Host: What is teach-back? What is that a method?

Diana Montoya, RN: It is. It's a method. It's one of the health literacy best practices, and it's kind of what I did earlier of show me. And one of the things that I really just want to point out is putting that responsibility back on how well you explain something and not making it perceived as a test for them. So, tell me what you're going to do at home can come across as a test. So, really putting that responsibility on how well you communicated, but asking the question in a way that they will validate that they understood what you just taught.

So, "Show me how you're going to use this spacer," or "Tell me about when you're going to take your Tylenol the next time or how you're going to alternate Tylenol and Motrin when you get home."

Host: So, the idea here is if the patient can teach it back to you, the clinician, obviously using probably plain language, which is fine, and as a clinician, you're listening and you're thinking, "Okay, yeah, that makes sense. They get it."

Diana Montoya, RN: Yeah, exactly. And then. z It provides that opportunity too, if there was any misunderstandings, then you can go back and say, "Hey, you know, I didn't really do a good job explaining this. Let's go back to, Tylenol when you're going to use it next, and then you're going to give Motrin three hours later." So, it gives that opportunity to then re-explain anything that could have been misunderstood.

Host: Yeah. It sounds like this is a great method or, you know, technique, especially when there's maybe, you know, detailed procedures involved, a lot of different medications. The teach-back seems like a great way to make sure that they do have a decent understanding. So, that sounds like a really good method.

When should clinicians get a medical interpreter involved, and how can providers better recognize the culture differences that may influence how patients understand health information?

Diana Montoya, RN: It has been noticeable that sometimes they say that, "Yeah, the English is fine." But then when you really get into the education piece of it, there might be some verbal cues that they don't truly understand and just picking up on those. But if they are at all limited English proficiency, if Spanish is their native language, it's always better to kind of fall back on getting a translator because, again, this is a lot of complex health information we're trying to explain to them. What better way is it than in their native language, right?

So, it is about the social cues. It's about developing that rapport so that you can pick up on those kind of small social cues. But at the first sign of, you know, misunderstanding or confusion, I would say, "Hey, this is a lot of information.Do you want to continue in English, or is it better if we get a translator? We have them available here, and I don't mind getting one."

Host: You gave the decision to the patient.

Diana Montoya, RN: Right.

Host: You're not just running out of the room saying, "Oh, I need an interpreter." You know, you're done with it, right? You're actually involving them in that whole process and asking. So, that was really good.

Can you share a patient story that demonstrates how improving communication made a meaningful difference in a patient outcome?

Diana Montoya, RN: Yeah, I have so many. I think the one that really sticks with me is we had a nurse who was educating on EpiPen. And so, this is for anaphylactic shock, which obviously it's a huge deal, right? It can lead to death if you're not getting your EpiPen on time. And it was a sixteen-year-old patient, so a teenager who would be administering that EpiPen by himself. And the nurse went through everything, showed it with the EpiPen trainer, and then said, "Hey, would you mind showing me how you would do this at home if you had anaphylaxis?" And so, he takes the EpiPen trainer, and he does everything except he injects it in his knee. And so, at that point in time, the nurse was able to say, "Hey, you did everything great, but we're going to do it again, and you're going to show me how to do it in your thigh." And then, she went in and explained the reason why it needed to be given there. So, a lot of things come down to why you need to do something. And so, having that was great to then re-explain it and then show him again and have him show the right way so we knew confidently he could do it at home.

Host: Yeah. And why the right way is the right way.

Diana Montoya, RN: Exactly.

Host: Yeah, the why being, I think, is the one thing in that story that makes that patient not feel like they got something wrong or they messed it up. Understanding that they'll be like, "Oh, okay, I get it now," rather than, "Oh, you're wrong and it's not in the knee." You know?

Diana Montoya, RN: Yeah.

Host: Yeah. No, these are some really great tips and methods that you're giving for all of us to better communicate. I want to talk a little bit about Children's Health specifically. How is Children's Health embedding health literacy into its cultural and clinical practices? and what advice would you give other healthcare organizations, looking to do the same?

Diana Montoya, RN: Literature and research shows us that we know best practices, but it takes about, seven to twelve, even twelve years, maybe even fifteen to really implement that at the bedside. And so, health literacy is not a new concept, but it's not one like teach-back, still newer to some people, and it's not being adopted into practice. So, how do we get it there?

And so, at Children's Health, we're really putting the emphasis on our Health Literacy Champion program. So, getting those peers at the bedside to then bring back education on health literacy best practices, but then taking it a step further and actually observing their peers when they are giving patient education and giving those kind of pointers of, "Hey, you did a really good job explaining. Next time, consider using a teach-back question like this." Or, "You did a really good job explaining, however, you did use some medical jargon that's super common, and I would encourage you to maybe use these plain language terms next time you teach." So, it's about knowing the practices, but then also having those champions at the bedside to champion them, and then also to give feedback and coaching on site and in real time.

Host: This has been absolutely fantastic. I know I learned a lot, Diana, just in a few minutes talking with you. Is there anything else you'd like to share?

Diana Montoya, RN: Like I said before, health literacy, it's not a new concept. It's just changing our way of thinking as we as clinicians use our medical jargon when we're talking to other clinicians and other medical professionals. So, changing the way that we are talking, we are going into patient education with these best practices and then taking it a step further.

I'm a visual person, so not only explaining something, but potentially giving a written document that again follows health literacy best practices by chunking information, bullet points, icons that make sense and kind of highlights of the material in the written document. But I think all that to say is there's so much to be done within the healthcare space to make it easier for patients to understand. And using these best practices, it's going to be our best tool at this time.

Host: Again, this has been wonderful information. I want to thank you so much for coming on the show today. You can find more information at childrens.com and at childrens.com/healthequity. If you found this podcast helpful, please rate, review, and share it, and follow Children's Health on your social channels.

This is Pediatric Insights: Advances and Innovations with Children's Health. I'm Dr. Mike. Thanks for listening.