Patient Education Exam 1

Louisa is a 34 year old client who reports a good knowledge of knowing why she should quit smoking and yet she reports that she is still smoking. Louisa is a very bright woman and expresses some frustration with herself because she just can't seem to "make it happen." 1) Which stage of change do you think that Louisa is at? 2) What are some characteristics of clients in this stage? 3) What type of information would you focus on with Barbara at this stage of change?

1) Contemplation stage 2)In the contemplation stage, people begin to think of possible goals they want to set. It is a time when people begin to weigh the advantages and disadvantages of change, to identify reasons for unhealthy habits, and to assess possible obstacles to change. People in the contemplation stage often say they are thinking of changing in the next six months. 3)Some of the ways that a health care professional can help a client work through this stage of change would be to help clients work through activities such as: • Outlining Personal Priorities • Listing Possible Lifestyle Goals • Listing Advantages of Change • Listing Disadvantages of Change • Weighing the Advantages and Disadvantages of Change

Ella has been smoke free for 102 days. She is extremely proud of her success and is continuing to troubleshoot new ways to continue to be smoke free. 1) What kind of anticipatory guidance would you give Ella regarding the maintenance stage of change? 2) What kind of feed back would you give Ella on her success? 3) How would you describe the relapse and recycled stages of change to Ella?

1) People in this stage have been able to put their plan into action for at least six months. While this accomplishment of six months is wonderful, it is still easy to fall back into old ways if people stop paying attention to their progress. In this stage, you want to ask yourself some questions that might help to stop you from going back to old habits. Questions such as "What is working and why?" and "How can I keep this up?" can be helpful to keep you on track. 2) Congratulate Ella on her success this far. Ella has successfully maintained her lifestyle change for 102 days, allowing her to remain in the Action stage of change. 3)Sometimes people do fall back into old habits, despite the best laid plans. For example, research on smoking shows that many people take six attempts to quit before they are finally successful on a long-term basis. Even though it can be disappointing to go back to bad habits, it is important to remember that the client has learned many things about change along the way. The next time the client tries to make the same change in habit or behavior, it will be a little easier and they will know more about themselves.

Barbara is a single mother who has been smoking a pack of cigarettes per day for the last fifteen years. Upon meeting with her for the first time, she makes it very clear that she has not even begun to start thinking about quitting smoking. She is very concerned at present about putting food on the table for her family and spends little time thinking about her health. 1) What stage is Barbara in? 2) What are some characteristics of clients in this stage? 3) What type of information would you focus on with Barbara at this stage of change?

1) Pre-contemplation 2)People in this stage have not even begun to think about changing unhealthy habits, often because they do not have enough information about what needs to be changed. In other words, individuals might not even be aware of risk factors for heart disease nor that they have the risk factors. People in pre-contemplation see no need to change and say they don't want to change. 3)At this stage of change providing information about risk is very important, however the most important role of the health care professional is to keep the lines of communication open. By fostering open communication, when to client is ready for change they will likely seek turn to a healthcare professional who they feel they can communicate with.

Limited health literacy affects approximately what percentage of the US adult population?

50% - over 90 million people (nearly half of American adults) have limited health literacy.

Being anxious affects a person's ability to absorb, recall, and use health information effectively. ☐ A. True ☐ B. False

A. True

It is a good health literacy practice to assume that each patient you communicate with has limited health literacy. ☐ A. True ☐ B. False

A. True

What is the best reading level for written materials used with patients? ☐ A. 3rd-4th grade ☐ B. 5th-6th grade ☐ C. 7th-8th grade ☐ D. 9th-10th grade ☐ E. 11th-12th grade

B. 5th-6th grade Language should be as plain and simple as possible.

You can tell how health literate a person is by knowing what grade he or she completed in school. ☐ A. True ☐ B. False

B. False

Groups most commonly affected by low health literacy levels include all of the following except: A. Ethnic minorities B. High school graduates C. Recent immigrants D. The elderly

B. High school graduates Adults who did not graduate from high school are another group commonly affected by low health literacy levels.

What is the average reading level of U.S. adults? ☐ A. 4th-5th grade ☐ B. 6th-7th grade ☐ C. 8th-9th grade ☐ D. 10th-11th grade ☐ E. 12th grade

C. 8th-9th grade

Which of the following may suggest that your patient is impacted by low health literacy? A. Appropriately completed intake forms B. Brings a well-researched list of questions to the visit C. Frequently "forgets their glasses" D. Provides detailed history of present illness

C. Frequently forgets their glasses

How is cognitive change different from behavioral change?

Cognitive is self re-evaluation, social liberation, environmental re-evaluation and dramatic relief. Behavioral is helping relationships, reinforcement, management, self-liberation and stimulus control.

What are the PEARLS used to aid in behavior change?

Cognitive restructuring Postive perspective Relaxation Response Goal setting- SMART

What is the grade level at which health-related information (like a diabetes brochure) is typically written? ☐ A. 4th-5th grade ☐ B. 6th-7th grade ☐ C. 8th-9th grade ☐ D. 10th grade or higher ☐ E. 11th grade or higher ☐ F. 12th grade or higher ☐ G. college level

D. 10th grade or higher

In educating patients with low health literacy, which of the following strategies may be most effective? A. Having them "call if they have any questions" B. Having them listen to you explain the procedure as you walk out the door C. Having them read a three-page handout D. Having them watch a video that explains the information

D. Having them watch a video that explains the health information Video instruction has been shown to be an effective patient education tool. Other important methods of instruction include asking the patient to "tell me what I just told you." Patients learn best with interaction and repetition.

Which of the following health outcomes have been linked to low health literacy? A. Delays in diagnosing medical problems B. Increased use of alcohol among boys C. Longer hospitalizations D. Lower rates of breastfeeding E. All of the above

E. All of the above

Limited health literacy is associated with: A. Higher mortality rates B. Lower levels of health knowledge C. Greater use of inpatient and emergency department care D. Poor medicine adherence E. B and D F. All of the above

F. All the above

Which of the following skills are considered to be components of health literacy? ☐ A. Ability to understand and use numbers ☐ B. Reading skills ☐ C. Speaking skills ☐ D. Ability to understand what is said ☐ E. Writing skills ☐ F. All the above

F. All the above

Health literacy issues should be considered separate from those of cultural competency? True or False?

False - respect and knowledge of a patient's culture goes hand-in-hand with effective communication and patient education. All are necessary to insure best health outcomes.

It is difficult to quantify an individual's health literacy skills as no objective assessment tools exist.

False. Many well-researched, easy to use tools are available for health literacy assessment. These include NVS, REALM, TOFHLA and others outlined in this module and readily available online.

Patients with limited English proficiency are likely to let you know when they are unable to follow the conversation. True or False?

False. Patients often wish to be amiable and not call attention to their deficits. They may also not know enough English to tell you that they don't understand what you are saying. A smile and a nod should not be construed as agreement or comprehension.

What is health literacy?

Is a person's ability to gather, process and understand health information in order to make sound health care decisions.

Bill is a successful businessman and reports to you that he is ready to quit smoking. Bill also mentions that he has a specific plan he wishes to use to help him quit smoking. As on of the health care professionals in Bill's life you congratulate him about this plan for change. What considerations might you take into account with this stage of change?

Planning is often one of the stages of change that is undervalued. Change is hard! Change requires planning, and planning should include back up plans for when things do not go how we anticipate that they should.To be successful with lifestyle change it is important to plan for it and to make appropriate arrangements. This may include setting up personal supports so that when you feel like you are going to need a smoke you have a friend that you can call on to talk with and help you get through the situation.

Health literacy is a better indicator of an individual's health status than either ethnicity or education level? True of False?

TRUE. Health literacy is also a better forecaster of one's health status than age, income, or employment.

To use good health literacy practices, staff and clinicians should use which of the following words/phrases when talking to or writing instructions for a patient or family member? a. Bad OR Adverse b. Hypertension OR High Blood Pressure c. Blood Glucose OR Blood Sugar d. You have the flu. OR Your flu test was positive. e. The cardiologist is Dr. Brown OR The heart doctor is Dr. Brown. f. Your appointment is at 11:00 AM. Check in 20 minutes early. OR Arrive at 10:40 AM to check in.

a. BAD b. High Blood Pressure c. Blood Sugar d. You have the flu e. The heart doctor is Dr. Brown f. Arrive at 10:40 to check in