Communication between individuals, health professionals and health authorities
The lack of adequate communication between patients and health professionals may hamper patient-centred care and shared decision-making. This requires attention to promoting understandable two-way health dialogue and efforts by health professionals and health authorities to find better ways to reach all people.
Context
Improving communication between individuals, health professionals and health authorities is likely to improve equity. It can help build trust in public institutions and save lives (e.g., during public health crises, well-developed health communication which is clear and transparent can, for instance, encourage compliance with public health measures).
The creation of spaces for equal communication and genuine dialogue between patients and health professionals is key to ensuring that both options for available care and the care provided are understood, relevant and applicable to patients’ lives. The communication should be open and honest in what is known and unknown, and be consistent, simple, and understandable, as well as empathetic.
Clear and participatory (two-way) communication empowers people (groups and communities) to make choices. This requires a shared language, including the use of words, concepts, opportunities to ask clarifying questions and to obtain responses at the same level. The communication style of the care provider is linked with better patient self-management and empowerment. Patients’ understanding of care and confidence in self-care abilities can enhance the impact of the provider’s communication.
Health authorities should find the best ways to reach all people, especially those in vulnerable situations and those who are difficult to reach, such as homeless persons and the digitally disadvantaged with mobility restrictions.
Challenge
On average in Europe, 15% of adults report difficulties in understanding what the doctor is saying, 18 % of adults report difficulties in reflecting and assessing if the information provided by the doctor is applicable to one’s life, and 28 % of adults report difficulties in understanding the leaflets that come with prescribed medicine . These difficulties echo a clear mismatch between an individuals’ competencies and the communication styles of health system providers and health authorities. Doctors may be overestimating their communication skills. However, the challenges of increasing workloads for healthcare professionals and shortages in doctors across Europe, may also be impacting on the effectiveness of communication between individuals, health system providers and health authorities.
The complexity of communication and the lack of common language, either due to different spoken languages or the use of words not commonly understood, are obstacles to effective patient-provider communication.
Communication challenges are especially evident when a patient has complex communication needs that should be considered carefully. Planning different ways to communicate, in addition to oral communication, are of paramount importance.
Medical terms, such as the concept of risk, and medical jargon used either by health professionals or expressed in printed materials offered to patients are likely to result in the misunderstanding of information by patients. Also, limited time allocated for appointments may lead to an instruction that does not allow space for questions and dialogue which is an integral part of the process of care. This is a particular concern in situations when extra time would be necessary due to complex communication needs, such as those associated with developmental or acquired disabilities, or when people lack sufficient skills in communicating with health professionals, in general.
Actions
Clear communication is the basis for people to understand and act on health information. Regardless of the level of health literacy, it is important that staff ensure that patients understand the information they have been given.
For communication to be effective and appropriate between individuals, health professionals and health authorities, people need sufficient knowledge about their health conditions and the ability to link information to their daily lives. Health systems should ensure that their communication is clear and transparent, meeting the needs of different people, including those with cognitive impairments or language difficulties. Common tools to improve interaction and communication include Communicate for All, Ask Me 3®, Teach-Back and use of Plain Language principles (below).
Individuals need:
Systems have the responsibility to:
to be informed that they have the right to communication, in a manner that is appropriate to one’s capacity for understanding;
knowledge about their health condition and relevant concepts to be able to understand what health professionals are saying, and what is communicated in printed materials;
an ability to communicate clearly (also on online) and to seek clarifications;
an ability to assess the appropriateness of care and the applicability of instructions from a personal perspective, to apply the instructions and decisions in practice, in daily life.
adapt transparent and open ways of communicating, also on uncertainties related to health risks;
create spaces for communication that consider the special communication needs and cultural background of patients, providing professional translators or consider using cultural mediators if needed;
develop the availability of digital eHealth sites and services for people with different communication needs, and to complement face-to-face appointments;
avoid medical jargon and difficult words (shared language) in their communications;
offer training for health professionals about various ways of communicating with patients with or without complex communication needs and their caregivers, and to communicate in digital environments in a way that supports shared decision-making.
The establishment of the “Unit of Patient Education for Medicine Use” is an example of a local health literacy project in Şanlıurfa Training and Research Hospital, which is located in the province of Ş.Urfa in the southeastern Anatolian region of Türkiye.
Aim and objectives:
To ensure correct drug use and effective treatment results for hospital in-patients who are prescribed medication.
Target group:
All patients, including children (and their parents) undergoing treatment.
Method:
After being examined, a physician may prescribe medication which must be followed by the patient. Patients are therefore directed to the “Unit of Patient Education for Medicine Use” where nurses work under the supervision of a pharmacist. The Unit, which is located in the centre of the hospital for easy access, teaches patients how to use their medicines. Patients with chronic illnesses are incentivised to visit the Unit because they may be issued with a ‘medication report’ by a specialist physician which allows for medicines to be prescribed by a family doctor, thereby helping to reduce the number of hospital visits.
Outcome:
improved patient health outcomes;
reduced possible side effects due to incorrect drug use;
reduced emergency service admissions, hospitalisations and repeated applications.
Added value:
The correct use of medication reduces health costs and improves patient outcomes.
The system to inform patients diagnosed with an illness was a measure introduced in the early 2000s, as part of the first cancer plan. The aim of this system (which responds to a request made by patients in the context of general meetings with them) is to provide patients (and their families) with better conditions when being informed of the diagnosis of their disease and the proposed treatment. This system encourages adherence to the proposed treatment and the strategies for adapting to the disease. It is based on the provision of clear and appropriate information that respects patients and their wishes, leading to real support.
Target group:
All cancer patients are targeted by the system, starting from the initial diagnosis of a histologically confirmed cancer to relapse of the disease.
Method:
The system is centred on the hospital and is composed of four phases:
informing a patient of the diagnosis and proposed treatment of an illness;
accompanying the patient, identify his/her needs;
referral/access to support care (notably in the event of preserving fertility);
coordination between the town of residence and the hospital.
Various documents are provided to the patient to help him/her navigate the health system, such as the possibilities for personalised care and its pathway, which sets out the stages of treatment, the corresponding timetable, and information on supportive care as well as a list of useful contacts.
The system is based on multidisciplinary care, primarily involving doctors and paramedical staff. The National Cancer Institute has published recommendations and guidelines to help health establishments and professionals set up the system. The professionals concerned (both hospital and private practitioners) receive ad hoc continuing education.
The system has evolved with successive cancer plans, taking into account the diversification of care (increasing the role of so-called "town" medicine) and the situations of certain groups, such as children and people with intellectual disabilities.
Outcome:
The system to inform patients diagnosed with an illness is implemented in all health establishments authorised to provide cancer treatment. Its organisation is described in the National Cancer Institute's guidelines and is identical throughout the country. The implementation of the system is one of the transversal quality conditions that all establishments concerned with cancer treatment must apply.
Added value:
The added value of the system lies in the provision of clear and appropriate information that respects patients and their wishes, leading to real multidisciplinary support. The fact that it has been developed throughout the country, in accordance with a reference system, is a major asset.
The lack of knowledge of the French language by patients during medical consultations is an obstacle to quality care. Promoting understanding during exchanges between health professionals and patients thus allows:
improving access to prevention, screening and medical care;
the reduction of irrelevant, unnecessary and costly examinations;
the reinforcement of the person's autonomy and the respect of his or her rights (information, confidentiality, free and informed consent)
The aim is therefore to give health professionals the opportunity to use health interpreting services.
Target group:
All non-native speakers in the North-East region are concerned, as well as all private doctors and midwives who may be consulted by them.
Method:
Private practitioners and midwives in the North-East region can request telephone (and/or face-to-face) interpreting services from a service provider chosen and financed by the Agence Régionale de Santé via a call for tenders. To do so, they must first register for the scheme, which offers 185 languages. Professionals are provided with a user guide, which invites them to prepare consultations in advance and in writing, in order to optimise the interpreter's contribution. This interpreting service is free of charge for both the professional and the patient. Interpreters are bound by professional secrecy.
Outcome:
An interpreter who speaks the patient's language is available within 5 minutes of the request by the health professional, even without a scheduled appointment.
Added value:
As mentioned above, access to professional health interpreting helps to promote quality access to care for non-native speakers and thus their integration into the health system. Telephone interpreting also helps to reduce territorial disparities in access to this service.
Ask Me 3® is an educational program developed by the Institute for Healthcare Improvement that encourages patients and families to ask three specific questions of their providers to better understand their health conditions and what they need to do to stay healthy.
Target group:
Designed by health literacy experts, Ask Me 3® is a quick, effective tool designed to improve health communications between patients, families, and health providers and help patients become more active members of their health care team.
Method:
Ask Me 3® promotes three simple but essential questions that patients should ask their providers in every health care interaction and providers should always encourage their patients to understand the answers to:
what is my main problem?
what do I need to do?
why is it important for me to do this?
Outcome:
Ask Me 3® is simple to use, inexpensive to implement and facilitates simple communication.
Added value:
Active participation empowers patients and makes the conversation easier for the health provider. Questions prompted by patients give health providers clues to the level of understanding, acceptance, and insight of the condition which in turn may guide the health professional to deliver timely and appropriate information.
The Health Literacy Tool Shed is hosted by Boston University. It is an online database of more than 200 health literacy measures. The site contains information about measures, including their psychometric properties, based on a review of peer-reviewed literature.
Target group:
It is a database for researchers, decision-makers, and health providers. It helps them identify the most relevant measurements to use in health literacy research, needs assessments, evaluations, etc.
Method:
It is an open-source database, freely available to all users.
Outcome:
It enhances the opportunities for choosing the most relevant tool for a certain research purpose.
Added value:
The Health Literacy Tool Shed makes it possible to gain access to cutting-edge measurement tools. Previously, the review of such tools was published in scientific journals. The Health Literacy Tool Shed democratised accessibility to these measurements and accelerated the speed of knowledge-sharing and use of appropriate measurement tools.
Teach-Back is an activity in which learners teach each other what they have learned, for instance, by using verbal explanations, demonstrations, and skits.
Target group:
According to the US Agency for Healthcare Research and Quality, Teach-back is a technique for health care providers to ensure that they have explained medical information clearly so that patients and their families understand what is communicated to them. This intervention includes several materials to support adoption.
Method:
The method is a way of checking understanding by asking patients to state in their own words what they need to know or do about their health and to confirm that things have been explained in a manner that patients understand. Teach-back can be applied whenever explaining important and complex concepts to patients about their health care, such as a new diagnosis, medication, home care instructions, treatment plans, behavioural change recommendations, the use of new devices, treatment options and follow-up instructions.
Outcomes:
The resources needed for Teach-back are modest. Health providers can implement Teach-back as part of their regular duties. The time of implementation using this practice is minimal in the short run and can save much time in the long run.
Added value:
Using Teach-back systematically will help remove barriers and challenges to improve communication and processes.
Most text-based health information continues to be too hard for most adults to read. While plain language is only one of many broad-based solutions needed to address limited health literacy, the benefits to everyone call for increased use by health organisations.
Target group:
Given that clinical research communications can be very technical and complex, using plain language can help clearly explain information so that the target audience has a better chance of understanding. The target group can be patients, caregivers, other actors in the health eco-system involved in solving health challenges.
Method:
Plain language helps the reader to:
find what they need;
understand what they find;
use what they find to meet their needs.
Outcomes:
Applying plain-language principles facilitates relevant health information for the audience, keeping it simple, making sure its readable, and making it timely and actionable.
Added value:
Plain language supports access to information, equity, and participation in society. It also improves efficiency and builds brand trust.
Mapping linguistic landscapes is used to gain insights in how people navigate health systems and to improve health system environments.
Target group:
It is a tool for health providers, managers, and decision-makers to enhance service design and user journeys.
Method:
Using linguistic landscape analysis as a diagnostic, relevant questions may include:
how many and what languages occur on signs in a specific public space?
are the signs monolingual, bilingual, multilingual and in what ways, i.e. what combinations of languages occur?
are different languages used for different contents and in different domains?
in what forms do signs occur (notice boards, traffic signs, billboards, shop windows, posters, flags, banners, graffiti, menus, T-shirts, Facebook, Twitter, Instagram, Blogs, Websites)?
what about the language in terms of normativity: orthography, handwriting conventions, lexicon, syntax, literacy level?
A next step would include a more in-depth analysis and interpretation of the signs. Looking at deeper layers of meaning connected to the signs that can explain what they refer to in addition to their referential meaning is also called the indexicality. Examples include to study the past (e.g., the conditions of production), the future (e.g., the conditions for uptake), and the present (e.g., at the specific placement of the sign among other signs).
Outcome:
Mapping linguistic landscapes is a way to study visible semiotic signs in public spaces and to study how language includes or excludes people from communication and full participation in social and societal contexts.
Figure : Example of linguistic landscapes - signposting in hospitals
Data visualisation, such as the use of infographics and graphs, has become a meaningful way to present medical data that impacts decision-making on a collective and individual level to enhance health literacy.
Target group:
Applying visual elements and plain language help bring an individual with limited health literacy and numeracy skills to an outcome that equates to better health behaviours and practices.
Method:
Data visualisation involves breaking down the data points in terms of time, place, and elements of which people are familiar with, or personalising/localising numbers to make them more digestible and meaningful. Data dashboards may be effective visualisation tools for tracking and visualizing data from multiple sources including e.g., tables, pie charts and stacked bar charts, line graphs and area graphs, histograms, scatter plots, heat maps and tree maps. It might also be combined to infographic including icons and minor text to show a visual narrative.
Outcome:
Storytelling with data through simple graphs, comparative charts and representational icons often helps to make the implicit explicit to enhance individual and population health.
Added value:
Data visualization can improve understanding and analyses, as well as enabling better and faster decision making.
“Communicate for all: a guide to accessible communication” is a guide developed by a French health agency (Santé Publique France) based on the concept of literacy.
Target group:
The guide is intended for all actors involved in designing and sharing information accessible to all, regardless of their audiences and literacy skills: general population, migrants, people in illiteracy situations, older persons, people with disabilities. This reference framework has, among other actors, been designated for health and medico-social facilities and services, to help these organisations become pro-literacy organisations. It is of relevance to health professionals and health promotion professionals.
Method:
This guide is a very practical tool, illustrated with many examples, as an aid to conceive written, oral, digital, pictorial communication, whatever the patient’s level of health literacy. The guide also identifies pitfalls to avoid and share good practices.
Outcome:
The guide meets the needs of actors, depending on whether they want to design printed documents, design and/or use images, design web sites or other digital media, design oral communication. It also proposes ways to better consider differences in literacy skills within an organisation.
Added value:
The guide has been designed in such a way that the actors who consult it are guided, accompanied step by step in the design of their communication, with the ultimate objective of being understood by all.
Aim and objectives:
