If you use informational handouts as a primary education method for your chronic care clinics or nurse sick calls, you may be assuming that your patients understand when they do not. Misinformation or lack of information can sabotage your efforts to improve the health of the patients you serve. 

Health Literacy

Health literacy, the ability to understand medical information, is a challenge in all healthcare settings. According to the Agency for Healthcare Research and Quality, “low literacy is associated with several adverse health outcomes, including low health knowledge, increased incidence of chronic illness, poorer intermediate disease markers, and less than optimal use of preventive health services.”

The incarcerated population have additional barriers to understanding that should be considered by correctional nurses. Interaction with the incarcerated patient can be overshadowed by mental illness, cynicism and even fear of reprisal. Although some incarcerated persons have higher education levels, research indicates a majority have not reached basic literacy level. How will that impact your patient teaching?

Review your current informational handouts from a low literacy perspective. If you are using prepared information from other sources, you are likely to find medical terminology and complex sentence structure.  When educational materials from low income clinics were reviewed by nurse researchers in this study, they found a majority had a literacy level higher than the recommended 5^th grade reading level.

Check Readability

If you have digital versions of your information handouts, you can test readability from this handy website.  Preprinted materials can be visually reviewed for words with many syllables and medical terminology above grade school level.

Non-English Speaking Inmates

Determine the most common languages spoken by your patient population and begin to gather teaching resources in these languages. Spanish is the most commonly available alternative language for printed materials. You may be challenged if you have a large subpopulation of Middle Eastern  or Laotian speakers, and may have to reach out to the community for translation assistance.

Verbally Check for Understanding

When using patient teaching information sheets, always review the information with the patient and then check for understanding. Don’t just ask “Do you understand?” Even a confused person is likely to answer yes. A hurried “Do you have any questions?” is also likely to get an automatic ‘no’. Your patient might think he (or she) understands when, in fact, they do not. Instead, provide a scenario and ask how they would respond. For example, you could ask “So, how would your wound look if you needed to come back to sick call for me to check it before your scheduled appointment next week?”

Provide Later Opportunity for Answers

Patients can be overwhelmed by information and need time to adjust and process. This can be true if you are sharing life-impacting information such as a positive HIV result or a new-onset diabetes diagnosis. Be sure the patient knows how to get back in touch with you to get later questions answered. Sometimes it is prudent to schedule another Nurse Sick Call appointment a few days later in anticipation of additional questions.

Our patient population can come from marginalized communities with limited education, low English skills, low incomes and ethnic or racial minority backgrounds. These social determinants of health have been shown to result in low literacy levels. Correctional nurses can improve health outcomes through the use of written educational materials at the appropriate level for their patient population.

Finally, keep in mind that some of our patients may not know how to read, either English or their native language, and you must verify this skill before giving them written patient education materials.

Have you created patient education materials for your inmate population? Share your experiences in the comments section of this post.