Teaching health literacy in the undergraduate curriculum: beyond traditional methods.

Whether in hospitals, long-term care facilities, clinics, or public health settings, nurses provide care to more than 90 million Americans who struggle to locate, comprehend, and appropriately use health information (Zarcadoolas, Pleasant, & Greer, 2006). Participants in improving health literacy as a public health objective represent all parts of the health care arena (Schloman, 2004). In Healthy People 2010, health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (US Department of Health and Human Services, 2000, section 11, p. 20). The term also refers to the ability of individuals to understand, make decisions, and act on spoken, written, and visual health information in order to lower risk and improve health status. Adequate knowledge about health behaviors is considered prerequisite in behavior change (Seligman et al., 2007). National nursing organizations have called for better integration of health literacy content and activities into the nursing curriculum. As part of its accreditation criteria, the National League for Nursing Accrediting Commission (NLNAC) calls for all levels of the undergraduate nursing curriculum to include "cultural, ethnic, and socially diverse concepts" (2008, Standard 4.4, p. 76). The American Association of Colleges of Nursing, in its Essentials of Baccalaureate Education for Professional Nursing Practice, identifies health literacy as an important content area for baccalaureate programs under "Essential VII Clinical Prevention and Population Health" (2008, p. 25). Nurse educators recognize the need for curricular standards in the area of health literacy. Health Literacy Focus in the Curriculum ACTIVE TEACHING STRATEGIES Active strategies that engage students as participants in the process of learning serve as models for students to use in teaching patients with low health literacy. For example, teaching students how to role-play using a simple video and audio podcast to model a teaching episode with a patient (peer) and having the patient (peer) teach back what has been learned is an effective strategy that incorporates active learning and newer technology. When this strategy is followed by in-depth analysis in a class or seminar, students learn not only from the content of the podcast, but from analysis of the strengths and limitations of the teaching method. That knowledge is then transferred to actual teaching situations in the clinical setting. Table 1 outlines selected learning objectives, teach ing strategies, and activities in health literacy that can be used in the nursing curriculum. CONTENT Speros (2005) suggests that "nurses should be educated about health literacy, its prevalence across all segments of society, and its relationship to health outcomes" (p. 638). According to Speros, the long-term consequences of this focus will be nurses who can identify people with low literacy skills and then appropriately adapt patient education methods and materials. Experts offer the following content areas for health literacy education: * Definitions of low literacy and health literacy, the scope of the health literacy problem, at-risk populations, and the relationship between health literacy and health outcomes (Bastable, 2008; Schloman, 2004; Speros, 2005; Thobaben, 2007) * Assessment of literacy levels in clients (Bastable, 2008; Cutilli, 2005; Owens & Walden, 2007; Speros, 2005) * Observed client behaviors related to low literacy (Speros, 2005). * Plain language communication (Osborne, 2005; Owens & Walden, 2007; Schloman, 2004) * Interpersonal skills (Thobaben, 2007) * Cultural sensitivity (Andrulis & Brach, 2007; Chang & Kelly, 2007) * Common myths and health literacy (Bastable, 2008) A wide variety of information on health literacy is also available on the Internet. …