June 6, 2024 • 15 mins
Welcome to the latest episode of JAT Chat, presented by the Journal of Athletic Training, the official journal of the National Athletic Trainers Association. In this episode, Dr. Shelby Baez and Dr. Kara Radzak are joined by Dr. Meredith Madden, an assistant professor in the Athletic Training Education Program at the University of Southern Maine.
Dr. Madden, the lead author of "Become a Health Literacy Champion," discusses the importance of health literacy in enhancing patient care and outcomes. She explains the concepts of personal and organizational health literacy, emphasizing the role athletic trainers play in advocating for these principles within the healthcare system.
Full Article: https://tinyurl.com/bdcpn3s7
Guest Biography: Dr. Madden is an assistant professor in the athletic training education program at the University of Southern Maine. She earned her BS in Athletic Training and EdD from Boston University, MA in Psychology from Washington College; and a Certificate of Graduate Study in Healthcare Quality and Patient Safety from the University of Southern Maine’s Muskie School of Public Service. In 2022 earned the national Certified Healthcare Simulation Educator® credential in 2022. Meredith has experience providing athletic training services in diverse clinical backgrounds, including high school, collegiate (DI & DIII), and semi-professional (women’s tackle football). Dr. Madden’s research interests include concussion education with an emphasis on individuals with neurodiverse needs and individuals with intellectual and developmental disabilities, simulation in athletic training education, interprofessional education, and healthcare quality and patient safety in athletic training/athletic training education, specifically health literacy and quality improvement.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Music.
(00:13):
Welcome to JAT Chat, presented by the Journal of Athletic Training,
the official journal of the National Athletic Trainers Association.
I'm Dr. Shelby Baez, an assistant professor in the Department of Exercise and
Sports Science at UNC Chapel Hill, and the co-host of JAT Chat with Dr. Kira Radzak.
Today, I have the pleasure of being joined by Dr. Meredith Madden,
who is an assistant professor in the Athletic Training Education Program at
(00:36):
the University of Southern Maine.
Dr. Madden is the lead author of Become a Health Literacy Champion,
Strategies to Promote Health Literacy in Athletic Training, and the Diversity,
Equity, Inclusion, and Access Special Issue of the Journal of Athletic Training.
Meredith, thank you so much for joining me today. Thanks for having me.
So starting off with a very broad question for our listeners here,
(00:58):
what is health literacy and why is this concept so important for our overall
health and well-being? Thanks for the question.
So I'd like to start by addressing kind of the last part first,
as it's a topic that I am particularly passionate about.
So health literacy plays an essential role in enhancing patient care.
(01:20):
And I really believe that athletic trainers can truly make a difference,
you know, by advocating for health literacy within our health care system.
And, you know, all health care providers have the potential to learn evidence-based
practices and implement them effectively and efficiently to enhance our patient outcomes.
(01:41):
And in the field of athletic training, we have this unique opportunity to provide
care across the continuum where patient education and quality care principles,
you know, such as that patient safety, patient centeredness,
and equity can be prioritized and addressed early on.
So in terms of what is health literacy, I think there are a few ways to look
(02:04):
at this question, but I always think it's really important to start,
you know, at the beginning at that strong foundation.
You know, that's how we build a house, right? Like, so we build that foundation first.
So I always go back to that lens of what's the definition of health literacy
and kind of break it down.
So there are a few definitions available, but in the article we offer one that's
(02:29):
kind of widely used and accepted by a lot of federal and public health organizations.
So personal health literacy is the degree to which individuals have the ability to find, understand,
and use information and services to inform health-related decisions and actions
(02:50):
for themselves and others.
But again, this is the definition of personal health literacy,
or that's the perspective of of the patient or the individual.
So there is another side to health literacy, and that's organizational health
literacy, or that's the responsibility of the healthcare provider.
So that definition is the degree
(03:11):
to which organizations equitably enable individuals to find, understand,
and use information and services to inform health-related decisions and actions
for themselves and others.
So if we look at, you know, the two definitions, we can see that there are similarities
and, you know, that it's about empowering patients to be active in their care.
(03:35):
And organizational health literacy definition focuses on enabling patients, right, to find, use,
understand, right, to make those decisions and take actions for health-related
decisions and, you know, for themselves or others.
But that other key word was the concept of emphasizing equity,
(03:57):
right, and through quality care.
So two words that you just said that really stood out to me was empowering and
enabling in our patients.
And I think that's so important and impactful as we're thinking about how we
can enhance our patient outcomes, but just how we can just help our patients
in general and our athletes.
So you alluded to the difference between personal health literacy and organizational health literacy.
(04:22):
As I was reading through, you mentioned reading through the article,
there are 10 attributes of a health literate healthcare organization.
And for the paper, you all identified four of those 10 attributes to be approached
in this athletic training setting.
Can you just provide us a brief overview of those four attributes of a health
(04:43):
literate healthcare organization?
Organization so my my hope was
to sort of bring a practical approach
for athletic trainers and so i drew my background in
athletic training and public health to bring kind
of this concept that's already out there of health literate health care model
and it's really what inspired kind of the title of the manuscript right to be
(05:06):
a health literacy champion and it's like what does that So to promote these
ideas and these concepts with this kind of positive intention,
this positive effort and advocacy in daily clinical, you know,
and organizational practice to just kind of move towards our optimal patient
(05:26):
and healthcare outcomes. And that includes our health equity policy.
And the message of that hope was kind of for athletic trainers and for athletic
training programs and staffs to, for us to feel empowered too, right?
To feel part of the broader healthcare system and to contribute to the national
health literacy goals and objectives that kind of already exist.
(05:49):
You know, and we as athletic trainers, we play a critical role in interprofessional,
educational education and collaborative teams.
And health literacy and health equity are a shared responsibility for patient outcomes.
And these factors don't exist in isolation for patients.
(06:09):
Just because they see the athletic trainer, they go see their primary care provider.
Those aren't in isolation, right?
So every patient has health literacy, right? Every patient has social determinants of health.
And even if the athletic trainer is the primary kind of care provider, they see us first,
you know, we also have that responsibility to be aware or be kind of confident practitioners,
(06:38):
you know, in health literacy.
So the four that you've asked me to describe the four.
So the first one was attribute number three, and this is starting,
you know, educating the workforce. And that's simply,
adding education opportunities that are specific to health literacy,
social determinants of health, health equity.
But I think this can be incredibly impactful, right? Because we can generate
(07:00):
enthusiasm and we can have a foundational understanding of the principles and
information to then be able to build the next steps.
And I would encourage athletic trainers to be creative about our educational resources.
Look for podcasts, right? Look for articles from other fields that do health
(07:24):
literacy and health equity research frequently and consistently.
So public health, pharmacy, they've been doing this for quite a while and they
have great resources. So find where that overlap is.
Attributes six and eight, they were specific to verbal and written materials.
I want to talk about them together.
(07:44):
So as athletic trainers, we do these things quite often, right?
It's our patient education. It's our patient engagement. That's all the time, right?
But in terms of presenting them as starting points for assessing or enhancing
our practice to move towards becoming that health literate healthcare model,
one form of communication might feel either more exciting or more doable to
(08:07):
tackle as a quality improvement initiative.
However, not all ATs have control over maybe updating or changing written forms,
so that might take a little bit more advocacy or partnering with administration
or leadership if you want to change a consent form or something.
So maybe that's not the entry point quite yet, but you can always supplement
(08:29):
those written materials with other strategies to check for patient understanding.
And research shows that pairing verbal and written communication improves patient
health literacy outcomes.
So even thinking about them together or separately, you know,
can be a good way to kind of start.
And then lastly, attribute five is a little broader when we think about the
(08:50):
other ones, but I think it's a really important one and it's a good place to
start or like a good kind of rule of thumb.
And it essentially emphasizes this idea of health literacy universal precautions so that,
you know, healthcare provider can implement evidence-based health literacy techniques
with all patients because research shows that nine out of 10 patients or people,
(09:14):
individuals are going to experience low health literacy at some point,
regardless of their background,
of their health literacy level, because so many different factors can influence
health literacy in healthcare situations,
the patient's environment, right?
It's distracting, it's loud, whatever it might be, or their personal factors,
because these things are so dynamic.
(09:37):
Yeah. And thank you for that overview. I think that was really helpful context
when we're thinking about some of the components of the health literate healthcare
organization that we can start to implement or start to consider in our practice.
One of the attributes that I found particularly interesting while I was reading
the manuscript was the section on effective communication between the patient and provider.
(10:01):
I was just hoping maybe you could discuss a little bit more about the different
areas where we can see these communication strategies.
For example, I think you said some things about plain language and how we can
help with medication safety and review and encouraging questions.
If you could just elaborate a little bit more there, that'd be great.
I think one of the first things that we can do is to self-assess your practice,
(10:27):
right, and see where this is even happening.
And then see where you can implement of these evidence-based techniques or tools.
And so if you're thinking about using a plain language dictionary,
and there are great ones that are web-based, and you can just easily like.
Pull it up and you can use it in your patient education. You're talking to a patient.
(10:53):
Maybe you're checking in. And I think this too is where we have to remember
that I think we're smarter than we realize sometimes, right?
And we have that expert bias.
And so patients often aren't comfortable asking questions or questioning providers.
(11:14):
And so I think, again, this is where Attribute 5 comes in, using health literacy
universal precautions, and always just checking in with ourselves and implementing these tools.
So even if we don't think a patient needs it, we should just implement it.
So during patient education, you know, have the plain language dictionary pulled
(11:37):
up and, you know, check in, You know, do we need to define that or give it to the patient, right?
So that they can check in, you know, if they're not comfortable questioning
at the time, they can look it up later.
The other thing that we can implement for our tools is, you said asking questions.
(12:01):
So we do that all the time, but a more effective way is open-ended,
right? Right. So instead of saying, do you have questions?
Most people are going to be like, nah, I'm good. Right. So asking it,
what questions do you have for me?
And that is more helpful. Right. Because now they feel like you want them to
(12:21):
ask questions and adding it in throughout.
So you can chunk and check. Right. So doing it every three to five pieces of information.
And that's more useful that with the teach back,
making sure that you are using an evidence-based structure with it and like
seeking feedback right from your patients is really important because it's again,
(12:45):
that partnering piece is really helpful.
So along the lines of what you were just saying about challenging our own selves
and how we can grow, if an athletic trainer wanted to learn more about health
literacy, I know you plugged the podcast a little bit earlier,
but what are some other resources that an athletic trainer can explore in order
(13:08):
to learn more about this topic and how they can apply it to their practice?
There's a lot of great translation and utility from other professions and fields
that athletic trainers can kind of select from and adapt to meet the needs of
their patients and organizations.
And I think that's a really important piece, too, because in the public health field and especially.
(13:33):
Plug it a little bit, but the Agency for Healthcare Quality and Research, So that AHRQ,
the Health Literacy Universal Precautions Toolkit, and that health literacy,
health literate health care model, that's the purpose is that it can be modified a little bit.
Take what resumes, right? Like look through, get the evidence, right?
(13:56):
See what's going to fit and use what you can.
And then looking for those modules. So once you understand like what the principles
are, you can then look for education about those specific tools or techniques.
And so there are ones that are like what's informed consent,
right? Like that's health literacy too.
(14:18):
And so I think understanding that it's a really broad concept and then that's
where you build like the next rooms, like you build the next levels of it.
And looking for the pieces for your practice that are going to be really helpful,
right? What do you need to learn?
And then what do you want to enhance, right, in your own practice that's going to be really helpful?
(14:41):
Because different settings, right, are going to need more depth in different things.
Thank you so much again for joining me today.
And as a reminder to our listeners, this article is available free of charge
by the Journal of Athletic Training. And I highly recommend everyone go and
download this manuscript right
now in the current special issue for the Journal of Athletic Training.
(15:03):
Again, thank you so much. And we will see you all next time.
Music.
Music.
(00:13):
Welcome to JAT Chat, presented by the Journal of Athletic Training,
the official journal of the National Athletic Trainers Association.
I'm Dr. Shelby Baez, an assistant professor in the Department of Exercise and
Sports Science at UNC Chapel Hill, and the co-host of JAT Chat with Dr. Kira Radzak.
Today, I have the pleasure of being joined by Dr. Meredith Madden,
who is an assistant professor in the Athletic Training Education Program at
(00:36):
the University of Southern Maine.
Dr. Madden is the lead author of Become a Health Literacy Champion,
Strategies to Promote Health Literacy in Athletic Training, and the Diversity,
Equity, Inclusion, and Access Special Issue of the Journal of Athletic Training.
Meredith, thank you so much for joining me today. Thanks for having me.
So starting off with a very broad question for our listeners here,
(00:58):
what is health literacy and why is this concept so important for our overall
health and well-being? Thanks for the question.
So I'd like to start by addressing kind of the last part first,
as it's a topic that I am particularly passionate about.
So health literacy plays an essential role in enhancing patient care.
(01:20):
And I really believe that athletic trainers can truly make a difference,
you know, by advocating for health literacy within our health care system.
And, you know, all health care providers have the potential to learn evidence-based
practices and implement them effectively and efficiently to enhance our patient outcomes.
(01:41):
And in the field of athletic training, we have this unique opportunity to provide
care across the continuum where patient education and quality care principles,
you know, such as that patient safety, patient centeredness,
and equity can be prioritized and addressed early on.
So in terms of what is health literacy, I think there are a few ways to look
(02:04):
at this question, but I always think it's really important to start,
you know, at the beginning at that strong foundation.
You know, that's how we build a house, right? Like, so we build that foundation first.
So I always go back to that lens of what's the definition of health literacy
and kind of break it down.
So there are a few definitions available, but in the article we offer one that's
(02:29):
kind of widely used and accepted by a lot of federal and public health organizations.
So personal health literacy is the degree to which individuals have the ability to find, understand,
and use information and services to inform health-related decisions and actions
(02:50):
for themselves and others.
But again, this is the definition of personal health literacy,
or that's the perspective of of the patient or the individual.
So there is another side to health literacy, and that's organizational health
literacy, or that's the responsibility of the healthcare provider.
So that definition is the degree
(03:11):
to which organizations equitably enable individuals to find, understand,
and use information and services to inform health-related decisions and actions
for themselves and others.
So if we look at, you know, the two definitions, we can see that there are similarities
and, you know, that it's about empowering patients to be active in their care.
(03:35):
And organizational health literacy definition focuses on enabling patients, right, to find, use,
understand, right, to make those decisions and take actions for health-related
decisions and, you know, for themselves or others.
But that other key word was the concept of emphasizing equity,
(03:57):
right, and through quality care.
So two words that you just said that really stood out to me was empowering and
enabling in our patients.
And I think that's so important and impactful as we're thinking about how we
can enhance our patient outcomes, but just how we can just help our patients
in general and our athletes.
So you alluded to the difference between personal health literacy and organizational health literacy.
(04:22):
As I was reading through, you mentioned reading through the article,
there are 10 attributes of a health literate healthcare organization.
And for the paper, you all identified four of those 10 attributes to be approached
in this athletic training setting.
Can you just provide us a brief overview of those four attributes of a health
(04:43):
literate healthcare organization?
Organization so my my hope was
to sort of bring a practical approach
for athletic trainers and so i drew my background in
athletic training and public health to bring kind
of this concept that's already out there of health literate health care model
and it's really what inspired kind of the title of the manuscript right to be
(05:06):
a health literacy champion and it's like what does that So to promote these
ideas and these concepts with this kind of positive intention,
this positive effort and advocacy in daily clinical, you know,
and organizational practice to just kind of move towards our optimal patient
(05:26):
and healthcare outcomes. And that includes our health equity policy.
And the message of that hope was kind of for athletic trainers and for athletic
training programs and staffs to, for us to feel empowered too, right?
To feel part of the broader healthcare system and to contribute to the national
health literacy goals and objectives that kind of already exist.
(05:49):
You know, and we as athletic trainers, we play a critical role in interprofessional,
educational education and collaborative teams.
And health literacy and health equity are a shared responsibility for patient outcomes.
And these factors don't exist in isolation for patients.
(06:09):
Just because they see the athletic trainer, they go see their primary care provider.
Those aren't in isolation, right?
So every patient has health literacy, right? Every patient has social determinants of health.
And even if the athletic trainer is the primary kind of care provider, they see us first,
you know, we also have that responsibility to be aware or be kind of confident practitioners,
(06:38):
you know, in health literacy.
So the four that you've asked me to describe the four.
So the first one was attribute number three, and this is starting,
you know, educating the workforce. And that's simply,
adding education opportunities that are specific to health literacy,
social determinants of health, health equity.
But I think this can be incredibly impactful, right? Because we can generate
(07:00):
enthusiasm and we can have a foundational understanding of the principles and
information to then be able to build the next steps.
And I would encourage athletic trainers to be creative about our educational resources.
Look for podcasts, right? Look for articles from other fields that do health
(07:24):
literacy and health equity research frequently and consistently.
So public health, pharmacy, they've been doing this for quite a while and they
have great resources. So find where that overlap is.
Attributes six and eight, they were specific to verbal and written materials.
I want to talk about them together.
(07:44):
So as athletic trainers, we do these things quite often, right?
It's our patient education. It's our patient engagement. That's all the time, right?
But in terms of presenting them as starting points for assessing or enhancing
our practice to move towards becoming that health literate healthcare model,
one form of communication might feel either more exciting or more doable to
(08:07):
tackle as a quality improvement initiative.
However, not all ATs have control over maybe updating or changing written forms,
so that might take a little bit more advocacy or partnering with administration
or leadership if you want to change a consent form or something.
So maybe that's not the entry point quite yet, but you can always supplement
(08:29):
those written materials with other strategies to check for patient understanding.
And research shows that pairing verbal and written communication improves patient
health literacy outcomes.
So even thinking about them together or separately, you know,
can be a good way to kind of start.
And then lastly, attribute five is a little broader when we think about the
(08:50):
other ones, but I think it's a really important one and it's a good place to
start or like a good kind of rule of thumb.
And it essentially emphasizes this idea of health literacy universal precautions so that,
you know, healthcare provider can implement evidence-based health literacy techniques
with all patients because research shows that nine out of 10 patients or people,
(09:14):
individuals are going to experience low health literacy at some point,
regardless of their background,
of their health literacy level, because so many different factors can influence
health literacy in healthcare situations,
the patient's environment, right?
It's distracting, it's loud, whatever it might be, or their personal factors,
because these things are so dynamic.
(09:37):
Yeah. And thank you for that overview. I think that was really helpful context
when we're thinking about some of the components of the health literate healthcare
organization that we can start to implement or start to consider in our practice.
One of the attributes that I found particularly interesting while I was reading
the manuscript was the section on effective communication between the patient and provider.
(10:01):
I was just hoping maybe you could discuss a little bit more about the different
areas where we can see these communication strategies.
For example, I think you said some things about plain language and how we can
help with medication safety and review and encouraging questions.
If you could just elaborate a little bit more there, that'd be great.
I think one of the first things that we can do is to self-assess your practice,
(10:27):
right, and see where this is even happening.
And then see where you can implement of these evidence-based techniques or tools.
And so if you're thinking about using a plain language dictionary,
and there are great ones that are web-based, and you can just easily like.
Pull it up and you can use it in your patient education. You're talking to a patient.
(10:53):
Maybe you're checking in. And I think this too is where we have to remember
that I think we're smarter than we realize sometimes, right?
And we have that expert bias.
And so patients often aren't comfortable asking questions or questioning providers.
(11:14):
And so I think, again, this is where Attribute 5 comes in, using health literacy
universal precautions, and always just checking in with ourselves and implementing these tools.
So even if we don't think a patient needs it, we should just implement it.
So during patient education, you know, have the plain language dictionary pulled
(11:37):
up and, you know, check in, You know, do we need to define that or give it to the patient, right?
So that they can check in, you know, if they're not comfortable questioning
at the time, they can look it up later.
The other thing that we can implement for our tools is, you said asking questions.
(12:01):
So we do that all the time, but a more effective way is open-ended,
right? Right. So instead of saying, do you have questions?
Most people are going to be like, nah, I'm good. Right. So asking it,
what questions do you have for me?
And that is more helpful. Right. Because now they feel like you want them to
(12:21):
ask questions and adding it in throughout.
So you can chunk and check. Right. So doing it every three to five pieces of information.
And that's more useful that with the teach back,
making sure that you are using an evidence-based structure with it and like
seeking feedback right from your patients is really important because it's again,
(12:45):
that partnering piece is really helpful.
So along the lines of what you were just saying about challenging our own selves
and how we can grow, if an athletic trainer wanted to learn more about health
literacy, I know you plugged the podcast a little bit earlier,
but what are some other resources that an athletic trainer can explore in order
(13:08):
to learn more about this topic and how they can apply it to their practice?
There's a lot of great translation and utility from other professions and fields
that athletic trainers can kind of select from and adapt to meet the needs of
their patients and organizations.
And I think that's a really important piece, too, because in the public health field and especially.
(13:33):
Plug it a little bit, but the Agency for Healthcare Quality and Research, So that AHRQ,
the Health Literacy Universal Precautions Toolkit, and that health literacy,
health literate health care model, that's the purpose is that it can be modified a little bit.
Take what resumes, right? Like look through, get the evidence, right?
(13:56):
See what's going to fit and use what you can.
And then looking for those modules. So once you understand like what the principles
are, you can then look for education about those specific tools or techniques.
And so there are ones that are like what's informed consent,
right? Like that's health literacy too.
(14:18):
And so I think understanding that it's a really broad concept and then that's
where you build like the next rooms, like you build the next levels of it.
And looking for the pieces for your practice that are going to be really helpful,
right? What do you need to learn?
And then what do you want to enhance, right, in your own practice that's going to be really helpful?
(14:41):
Because different settings, right, are going to need more depth in different things.
Thank you so much again for joining me today.
And as a reminder to our listeners, this article is available free of charge
by the Journal of Athletic Training. And I highly recommend everyone go and
download this manuscript right
now in the current special issue for the Journal of Athletic Training.
(15:03):
Again, thank you so much. And we will see you all next time.
Music.
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