To each of the doctor’s questions, Hamid Mounkid nodded. Sometimes he looked confused. He couldn’t repeat the doctor’s instructions to his wife, Tisha Sawyer.
Shortly after they were married six years ago, Sawyer realized she would have to serve as a patient advocate for her husband, who had emigrated from Morocco. An immigrant’s life is riddled with confusing encounters and language barriers, but doctor’s offices pose particular dangers.
For many patients, a visit to the doctor’s office brings anxiety and confusion. For patients of low literacy or non-native English speakers, miscommunication can lead to serious health problems. In the worst scenarios, confusion over dosages or doctor’s instructions can land patients in the emergency room.
The problem dogged Joan Peterson, executive director of Literacy for Life, for years until she secured grant funding in 2012 to introduce health literacy classes.
“I’ve had it in my mind since I started here five years ago,” she said Thursday. “I’ve always seen the connection between low literacy and poor health outcomes, but society is just now catching up.”
Literacy for Life introduced H.E.A.L (Health Education and Literacy) classes last fall, with two sets of classes aimed at attacking the problem of low health literacy from both sides.
Teacher Sandy Menaquale visits medical professionals, training them to recognize signs when their patients don’t fully understand what’s being said.
Sawyer, who was inspired by her husband’s experience to volunteer with Literacy for Life, teaches classes for patients. Together, the teachers are helping to build understanding they hope leads to a healthier Williamsburg.
Menaquale, a former pharmaceuticals rep, was already volunteering with Literacy for Life when Peterson asked if she would be interested in leading the courses for medical professionals. She uses materials from the American Medical Association Foundation, including manuals and DVDs. She also distributes buttons for doctors to pin to their white coats that say, “Ask me. I can help.”
Her classes are modeled after her previous visits as a pharmaceuticals rep. She brings small prizes — lottery tickets, free smoothies — to entice staff to participate. So far, she’s reached 150 people at a dozen practices in the Williamsburg area.
In the sessions, doctors and nurses have swapped stories about when literacy barriers have presented problems.
There was the Williamsburg mother who nearly killed her baby when she didn’t understand she should dilute a prescription formula. And the patient who thought “oral” meant “aural,” and put penicillin in an ear. One local OBGYN had treated a non-native English speaker who didn’t realize the implications of her hysterectomy until it was too late.
One of Menaquale’s visits was to the Angels of Mercy Medical Clinic in Norge. She provided a one-on-one teaching session to the clinic’s collaborating physician, Dr. Monique Sessler, and conducted a staff session, highlighting “red flags” of limited health literacy.
Angels of Mercy, a nonprofit clinic serving the financially disadvantaged, became the host site for the H.E.A.L classes for patients. Sawyer has taught four classes out of eight planned for this year; topics have included healthy living; dealing with stres; aches and pains; and self-medication and First Aid. She modeled her curriculum on a health education program at Charlottesville’s Adult Learning Center.
Angels of Mercy Program Manager Jeff Black enlists patients to attend the sessions. At last week’s session on self-medication and First Aid, 10 people attended. Sawyer opened with a quiz, used to evaluate how much attendees knew before the class. At the end of the class, they took the same quiz again, providing Literacy for Life a way to track the success of the session.
One activity challenged participants to write down information from a pill bottle or medicine package. They had to find the active ingredient, dosage, special instructions, side effects and warnings, https://mentalhealthinnovation.org/valium-diazepam/.
The exercise illustrated several challenges to health literacy proficiency. Tiny print on pill bottles was too small for some to read; acronyms, such as “OTC,” had to be translated into “over the counter.” Many, including Sawyer and Black, were surprised to learn Cold-Eeze lozenges have a prescribed dosage.
“You have this assumption that if you get it at the grocery store, it’s alright,” Black said, prompting nods from the other students.
At the end of the class, the attendees received door prizes, but many said they would have come without the promise of free gifts.
The classes fit perfectly with Angels of Mercy’s participation in the Williamsburg Community Health Foundation’s five-year chronic care initiative, which aims to improve care for those suffering from chronic illnesses, such as diabetes and hypertension. “All of our patients can benefit,” Black said. “We knew this wasn’t just for people who don’t speak a lot of the language.”
The majority of Americans are not proficient at discussing or understanding health matters. Twelve percent of adults were rated as having proficient health literacy by the 2003 National Assessment of Adult Literacy. More Americans have low health literacy, according to the assessment, which shows 14 percent have a less-than-basic understanding of health.
In racial subgroups, 41 percent of Hispanics, 24 percent of blacks, 25 percent of Native Americans, 13 percent of Asian/Pacific Islanders and 9 percent of whites showed below-basic health literacy.
In the Williamsburg area, 5,000 adults older than 25 never completed high school, Peterson said. The 2010 American Community Survey showed 6,523 James City County residents, 6,642 York County residents and 1,145 Williamsburg residents were born outside of the United States. Those numbers show Literacy for Life’s staff that a significant portion of Williamsburg’s citizens likely need help understanding what they hear from doctors.
For now, Peterson has one simple goal for the program: identify those people. “The tipping point,” she said, “is when we see doctors making referrals and patients start coming to us. That will be the important leap.”
