By Leslie Canham, CDA, RDA
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.1 The National Adult Literacy Survey conducted in 1992 revealed that almost half of the U.S. population is either functionally illiterate or marginally literate.
When patients first visit the dentist, they are given a medical history form to complete. The dental team should review each medical form upon completion to confirm that a patient has signed, dated, and answered all the questions on the form. If the form is not complete, the dental team should assist the patient in completing the form. An incomplete medical form may be an indication of an underlying problem. Therefore, the dental team needs to be aware that certain obstacles could exist that prevent some patients from being able to complete forms. These obstacles could include language barriers, poor eyesight, or limited literacy.
In case of language barriers, there are free, downloadable medical history forms in 40 different languages, along with information on understanding the translation of the forms, available on the University of the Pacific, Arthur A. Dugoni School of Dentistry website.
Patients with poor eyesight may need assistance from the dental team to complete the medical forms. For those who forgot their glasses or need magnification, consider providing them with a magnifying glass or offering your help in completing the form.
Approximately 90 million American adults are functionally illiterate or have marginal reading skills.
According to the National Adult Literacy Survey:
- 42 million adult Americans can't read.
- 50 million recognize few printed words and are limited to a fourth or fifth grade reading level.
- One out of every four teenagers drops out of high school.
- Of those who graduate, one out of every four has the equivalent of an eighth grade education.
In today’s busy dental practices, patients with low literacy skills may be very difficult to identify unless there are warning signs. An incomplete medical history form or one filled in with obvious mistakes may be a sign of low literacy. The dental team should be aware of this possibility and verbally review the questions with a patient. The dental team can then document the patient’s responses. If patients have limited literacy, they may not be able to name the medications they are taking, or they may misunderstand the instructions for any prescribed medications. They may have trouble understanding treatment plans, financial arrangements, and post-treatment instructions. They may also fail to follow through with referrals to specialists.
When someone exhibits signs of low literacy, steps should be taken by the dentist and team to continually confirm that they understand all written communications from the dental office. Misinterpretation of treatment recommendations or other important instructions could result in harm to patients.
Steps to improve patient communication
- Use plain “layman” words.
- Some words hold different meanings, so be concise and use examples.
- Slow down and speak clearly.
- Repeat information.
- Ask patients to repeat back to you what you said.
- Assess whether patients understand the information provided.
- Assist patients in filling out written forms.
- Create a supportive and helpful environment for low-literacy patients.
Health literacy means other types of standard precautions must be used. Low literacy can be a silent epidemic, and patients with low literacy skills are at risk for errors in treatment choices and medication instructions. It is important for the dental team to learn how to recognize and identify patients who have difficulty understanding. Improving communication with patients can improve dental outcomes. Dental professionals can improve communication and eliminate gaps in understanding by learning how to recognize and assist patients with language barriers, poor vision, hearing impairment, or limited literacy.
Leslie Canham is a dental speaker and consultant specializing in infection control and OSHA compliance. She has more than 36 years of experience in dentistry. Canham is the founder of Leslie Canham Seminars, providing in-office training, mock inspections, consulting, and online seminars and webinars to help the dental team navigate state and federal regulations. Reach Canham at (888) 853-7543 or Leslie Canham.
1. Kleinma D, Horowitz A. Oral health literacy. Woman Dentist Journal. 2007; 25-28. Print.