June 4, 2025 • 47 mins
“They just told me I had a stroke—but no one ever explained what that means.”
In this eye-opening episode, Theresa chats with with bilingual SLP and educator Jackie Rodriguez to unpack one of the most overlooked drivers of poor outcomes: health literacy.
Episode Page: https://syppodcast.com/371
The post 371 – When Care Misses the Mark: How Health Literacy Impacts Our Patients appeared first on Swallow Your Pride Podcast.
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Episode Transcript
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(00:10):
Welcome to the Swallow Your Pride podcast. I'm
your host, Teresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders
and founder of the MediSLP Collective and MediSLP
Education.
This podcast is dedicated to delivering the latest
evidence based practice to medical SLPs everywhere while
also recognizing that medical SLPs everywhere are doing
(00:31):
the best with what they've got. Whether you
are a new clinician seeking tangible tools for
therapy or a seasoned vet stuck in a
rut, my goal is simple, to help you
advance your practice without feeling overwhelmed or underappreciated.
This means that together, we'll build confidence, broaden
your knowledge, and reignite your passion for our
fields. So if you're listening, I encourage you
(00:51):
to swallow your pride and be open to
new ideas because at the end of the
day, you and your patients deserve that kind
of support. Just a quick disclaimer that all
statements and opinions expressed in this episode do
not reflect on the organizations associated with the
speakers and are their own opinions solely. With
that, let's dive in.
Welcome to the Swallow Your Pride podcast. I
(01:12):
am really excited to do this episode today.
We have an awesome, awesome, awesome guest. We
have miss Jackie Rodriguez with us, and she's
a bilingual SLP based in Atlanta, Georgia. She
graduated from Georgia State University and has extensive
experience working across the lifespan and continuum of
care. She's passionate about bilingualism and multi multiculturalism
across the lifespan, health literacy, and dementia care.
(01:35):
She's a recipient of the ASHA Early Career
Professional Award. Jackie serves as the director of
communications for the Bilingual Empowerment
through Allied Mentorship Program, BEAM SLP,
an organization that provides mentorship for bilingual CSD
students and clinical fellows.
Jackie enjoys educating others about race, ethnicity, and
the field of speech language pathology on her
(01:56):
Instagram account at unlearn with me dot theslp.
So, Jackie, welcome to the show.
Thank you for having me. Yes. Thank you
so much for joining us. So tell tell
the people a little bit more about what
you do. I know you're super passionate. I
always learn so much from you whenever I
read your post. I've I've always learned so
much from you, and you've always been outspoken
about things, but always in just a very
(02:18):
respectful way. And I I I genuinely appreciate
that so much about you. So thank you
for being you.
Thank you. Thanks for having me.
So, a little bit more about me. So
I actually started,
in pediatrics. I started in the schools as
a bilingual diagnostician,
and I evaluated children who were learning English
(02:40):
and,
as their second language. And I think
that first,
job that I had really exposed me to
health disparities
and,
issues with health literacy that we're gonna get
into later. And then I chose the perfect
time to transition to medical SLP. I transitioned
to medical SLP
(03:01):
in 2020 in Sniffs as a traveler, so
it was just lovely.
And then,
happened during that time as well. You know,
I was working in a lot of facilities
where,
they couldn't get coverage. It was in a
rural area. So lots of health disparities as
well.
And I really started to become passionate about
(03:21):
dementia care during that time of my career.
And then now I moved back to Atlanta,
and I really enjoyed that flexible,
traveler lifestyle. So now instead of having one
full time job, I work full time PRN,
primarily in inpatient rehab and outpatient, but I
still, do a little bit of sniff work
(03:42):
here and there and acute care. So I
have experience in a lot of different areas
in our field. And then,
my mom had, rheumatoid arthritis. So growing up,
I kinda grew up going to therapy. So
I have
almost, you know, I would say, truly more
experience
being on the other side of health care
(04:02):
than I do as a speech language pathologist
just because my mom had rheumatoid arthritis for
thirty one years of my life. So that
informs a lot of what I'm passionate about
as well. Yeah. Yeah. And I was sharing
with you, you know, before we hit record
here, I've just been going through some insane
things with my son lately. So we did
we chose to get him a feeding tube
a few weeks ago. Tomorrow is actually one
month. We have his one month post op
(04:24):
tomorrow.
Oh, wow.
And the and the experience
of going through that, like, this is stuff
that I actually work in, but, like,
we still don't have full supplies for everything.
Like, the amount of times I sit on
these one eight hundred hotlines, talk to nine
people that have no idea what's going on,
like,
it's just an act of tenacity. Like and
(04:46):
and it's so sad that this is just
really where we are as a society. And,
you know, I was I was actually thinking
of you last night when and I was
like, I don't know how I actually understand
the system, and I'm having so much trouble.
Like, if I didn't understand the system,
there's no way I would do this. You
know? And no matter how much you love
your child or a family member, some things
(05:06):
are just not worth
the stress and frustration. Like, I think I've
I've literally gained, like, 10 pounds in the
last month just because I'm so stressed out
and frustrated with
the system for my you know? And it's,
like, actually getting it for him has been
so helpful. Like, it's been game changing for
us and for him, but the hoops I've
had to jump through
(05:26):
is just so stressful. So
that being
said, Jackie, tell the people why you're on
the episode today and what we're gonna talk
about.
Sure. So today, we are going to talk
about health literacy.
So if you're not familiar with what health
literacy is, health literacy is essentially,
our understanding
of our body in order to make
(05:48):
decisions about our health. And so,
there are two types of health literacy. There's,
personal health literacy. So, like, for example, let's
say that you are diagnosed with dysphagia.
So personal health literacy is,
maybe you'll go home and you might Google
dysphagia, and maybe you find,
(06:09):
an article on WebMD
or Healthline.
You might join a Facebook group for, a
support group for people with dysphagia,
and it's the things that you do outside
of the doctor's office or outside of the
SLP's office to learn about your disability or
your medical condition.
Then,
(06:30):
speech pathologist,
we play an important role in organizational
or sometimes you'll hear institutional
health literacy. And so that is what we
as health care professionals
do to make sure that our patients
understand their bodies and understand the medical condition
or disability that they have.
And so, health literacy is informed
(06:52):
by, these things that we call social determinants
of health. So you'll see them abbreviated as
SDOH.
And,
there are various social determinants of health. So,
your
reading literacy, like how well you can read,
and if you have access to read in
English is one,
(07:14):
social determinant of health.
Your race, your ethnicity, and how that either
matches or does not match the health care
professionals that you work with and the bias
and how bias can play a role in
your interactions with health care professionals,
is another
area. You all also have built community. So
when you look at historically,
(07:37):
segregation,
redlining,
displacement of Native Americans,
the way that
politics have informed,
the way that our country is structured,
that also plays a big role in your
access to resources.
So if you live in a rural area,
you might let you know, in your rural
(07:57):
area, there might be one SLP, and she
might be
the SLP that sees everyone across the lifespan.
As opposed to if you live in a
big city,
you might have access to,
not only, you know, specifically
adult specialized SLPs versus pediatric specialized SLPs, but
you might have access to a specialty clinic.
(08:20):
So if you have ALS, you might have
access to an ALS clinic, whereas people who
live in rural areas,
because of the structure, their community might not
have access to that.
So all of these social determinants of health
work together
to help us to better understand
our,
body and our own health. Yeah. Jackie, you
(08:41):
mentioned something that admittedly I don't know much
about, and and I would love for you
to tell the people,
explain it in your beautiful words a little
bit more, but the the topic, the term
of redlining.
Sure. So redlining
was this policy that started in the nineteen
thirties.
So,
there was this government program that created redlining.
(09:04):
And essentially, it was a racist policy that
zoned neighborhoods
based on,
just simply based on race. So there were
four different zones. There were red, yellow,
green, and blue. So green
was the highest level. And so if you
lived in a green lined neighborhood, typically, that
was a predominantly white neighborhood and, like, a
(09:26):
wealthy white neighborhood.
Then a blue zoned neighborhood would be maybe,
like, a more,
like, middle class to working class, but still
predominantly white neighborhood.
Then your yellow lined neighborhood would be,
immigrant to, like,
are from European countries. So people like,
(09:48):
Italians,
Irish people,
Jewish people. Remember, this is in nineteen thirties,
so this is before, you know, our racial
and ethnic categories of people looked very different
than what it looks like today.
And so they were categorized into,
yellow zoned neighborhoods, and then red zoned neighborhoods
(10:08):
were your black neighborhoods,
and sometimes Asian neighborhoods and Latino neighborhoods and
Native American neighborhoods. And so,
basically, this this
organization and this policy of Redlining,
zoned these neighborhoods by race, and then they
said,
depending on what kind of zone your neighborhood
was in, you could get a mortgage. And
(10:31):
so this is the reason why today,
men the, like,
public housing is often associated with African Americans
because African Americans couldn't get mortgages, so they
couldn't get homes. So they had to rely
on public housing.
Oftentimes,
you know, if you were one of the
few black people who could afford to build
(10:51):
a home,
you often could not get a loan to
repair your home. So homes often fell into
disrepair or cheap materials that have, like,
asbestos or other cancer causing materials were used
to build these houses.
And, redlining neighborhoods also dictated
how grocery stores moved into neighborhoods and hospitals
(11:13):
moved into neighborhoods because these redlined
neighborhoods
were seen as undesirable
or poor neighborhoods.
And so grocery stores and hospitals would not
build in those areas because they felt like
they couldn't make money like they could in
a green zoned a green lined neighborhood.
And all of this has led even though,
you know, red lining is now no longer
(11:33):
legal,
it was outlawed,
it is the reason why one of the
reason why is today in this country, we
still continue to live segregated by race. And
it's the reason why we stereotypically
see black neighborhoods as being bad neighborhoods because
redlining
set the standard for that.
One last thing that,
(11:55):
also happened as a result of redlining is
so these redlined neighborhoods
farms would be built on the borders
of these,
redlined neighborhoods. So
what ends up happening, and this continues to
happen in 2025,
(12:16):
is in these redlined neighborhoods or formerly redlined
neighborhoods,
they are not grocery stores.
There are,
you have a lot of, like,
environmental,
you have high a higher risk of developing
environmental,
diseases. So think of things like COPD, emphysema,
if you're living right next to a factory
(12:37):
and you're exposed to smoke all the time.
And then because there are not grocery stores,
you're at a higher risk of
things like diabetes,
high blood pressure, high cholesterol because your these
communities often rely on,
corner stores that we know don't have healthy
foods.
So one experiment that I've done in some
(13:00):
of my presentations
is I will have my participants,
Google grocery stores in a white,
and wherever they live, in the white area
where they live. And then Google grocery stores
in the black area of wherever you live.
And you'll see that this still continues to
happen. You'll see that in mostly white areas.
(13:21):
That's where you'll see things like whole foods
and fresh markets and places that sell fresh
organic produce. And then in majority black neighborhoods,
you'll see things like corner stores that sell
a lot of highly processed foods,
not a lot of,
fresh fruits and vegetables. And that leads to
a lot of these disparities that we're seeing,
(13:44):
with our patients who come in and have,
you know, these who end up having strokes
because of hypertension, high blood pressure, cholesterol,
things like that. So fascinating, Jackie.
What led you down this, for lack of
a better term, rabbit hole of of exploring
all? I mean, that it makes perfect sense
the way you just explained it. But, yeah,
it's really fascinating to me.
(14:06):
I think it's just because of my, like,
own personal interest, just from coming from, like,
a multicultural background. So my dad's Puerto Rican.
My mom was African American.
And I've always been really interested in, like,
race and culture and also black history. And
so sometimes I'll just see things, and I'm
like,
some there's, like, something that just seems very
racist about this situation, and then I'll look
(14:27):
it up. And, historically, there's my answer. So
that's that's a honest answer.
Talk to me a little bit more about
how low health literacy what what exactly should
SLPs know about that? How how is that
manifest in swallowing disorders?
Okay. That's a great question. So,
let's imagine that
(14:47):
you are a patient that has had a
stroke and now you have dysphasia.
So,
and let's say that you have a third
grade education. So you don't read very well.
Maybe you've taken, like,
a couple of science classes, but you don't
have a very strong background. Right?
So now, you know, we there have been
(15:09):
so many conversations about informed consent and how
we want patients to,
we're kinda moving away even from modified diets
and moving towards,
like, what do the patients want and just
following in their direction. But
we if you don't
it it's there's so many factors here. So
(15:32):
let's start with a stroke. So,
for example, I have a patient right now
who,
this particular patient had an aneurysm,
which led to his stroke, and
it manifested in a seizure and a fall.
And so he was brought in after having
a seizure, and then they,
did his imaging, and they realized that he
(15:53):
had one stable aneurysm, and then he had
had a stroke on the other side of
his brain. And so I was
one for one, this is was a Spanish
speaking patient.
By the time he got to me, he
had been in the hospital for over a
month, and no one had explained to him
what happened to him. All he knew was
the word stroke. And so for many people,
(16:15):
if you have a low level of health
literacy,
like, when you think about a stroke, that's
a very complex medical event that happens.
And to many people with low health literacy,
a stroke might just mean, well, it's something
that my grandma had, and, like, she needed
a lot of help afterwards. But they don't
actually know, like, what does a stroke mean.
(16:37):
So then, like, with this particular patient,
we're having I was, like, trying to explain
to him what his blood vessels are and
how blood vessels bring oxygen
up and blood up from the heart to
the brain, and that's like food for the
brain. And then,
with an aneurysm, an aneurysm is kind of
(16:58):
like a bubble in your blood vessel, and
it exploded.
And now the blood is not flowing up
to the brain and the brain tissue dies
because the brain is not getting that food
from the blood and oxygen.
And so
to him, he like, after having this conversation,
this you could tell things were starting to
(17:18):
click. So he wanted to know, like,
what could cause,
a lack of flow of blood up to
the brain. And so we talked about, like,
other factors too, how, like, things like cholesterol,
high blood pressure, those are other things that
can lead to a stroke.
And then he was like, well,
what causes
high cholesterol and what causes, like, high blood
(17:39):
pressure?
And,
we talked about foods that you eat and
how that could,
cause changes to your blood pressure. And he
was like, okay, I understand. Well, you know,
like, I eat like this food, like pork
has a lot of, like, fat in it,
and that could cause high blood pressure. And
I was like, yes. Yes.
And then towards the end, he was like,
but
this whole thing that happened to my brain,
(18:01):
like, it's all because I fell. Right? Like,
I had the seizure and I hit my
head, and, like, that injury to my head
is what caused the fall. And so to
him,
like, to me, that made a lot of
sense. Because to him, like,
the
the physical action
of a fall is, like, causing a stroke
makes a lot more sense to someone who
(18:21):
might not have a very high level of
health literacy
as opposed to, like, oh, you have all
these blood vessels moving through your body, and
that's what's leading, you know, an interruption of
blood flow has caused this stroke. That's much
more of of, like, a higher level,
concept to understand. And so then,
you know, I was talking to some other
(18:43):
coworkers,
and they said, well, I don't know why
you had to explain to him that he
had a stroke because I already told him
that. And I was like, okay. But
did you actually
explain, like, in detail
all these different facts and all about all
these different parts of the body and how
they work together collectively to lead to a
stroke? Or did you just say, like, hey.
(19:05):
You had a stroke, and, like, this is
why you can't
move this side of your body, or this
is why your attention is not like it
used to be. So,
what we really need to think about,
our patient's level of education,
their access to, you know, maybe they're not
understanding the purpose of our therapy because they've
(19:27):
never they're not familiar with our health care
system. They've never been to therapy before. They
don't,
maybe they live in an area where they
have to take the bus and it takes
two hours to get to the doctors. They
don't go to the doctor frequently. And it's
not necessarily that they don't want to, but
that all these social determinants of health are
barriers.
So
(19:47):
let's go back to, like, our theoretical stroke
patient that now has dysphagia. Right?
So we had to spend all that time
just for the patient to understand what a
stroke is. Right? And now we get to
dysphagia,
and this person is aspirating.
How do you explain what aspiration is to
a patient that does does not understand
(20:09):
what their lungs do or doesn't understand what
the esophagus is or the larynx or all
these other, like,
very complicated
body parts that even maybe your average person
might not be familiar with, but let alone
someone that has very, very limited education.
So sometimes we have to take a step
back and we need to do some education
(20:31):
about the anatomy
before we can even get to the conversation
about, well, you're aspirating. This is what aspiration
means. What do you want to do?
What medical decision do you want to make?
So that's how low health literacy is gonna
show up in our therapy sessions. Yeah. Thank
you. I one thing that that struck me
while you were explaining that is I remember
(20:53):
we had a course,
in my PhD
work last semester, and it's it was a
course all about health care education. And there
was one thing that they constantly
stressed was these brief checks for understanding.
And that just made me think of that.
How often do we do that with our
patient? Stop blabbing or stop assuming
(21:14):
or stop going on our rants and literally
just stop and check for their understanding
and not, oh, do you know what a
stroke is? But, like, do you actually understand
what happened, why you're here?
So, yeah, thank you. That that's just made
that made that correlation for me. So thank
you.
Yeah. Totally. And I one question that I
(21:35):
often get is people will say, well, how
do you assess health literacy?
And there are some formal health literacy assessments.
But to be honest,
I prefer to just use
informal conversational
interviewing
to,
to your point about, like, asking people what
they understand because then you get,
(21:57):
more information that is directly related to our,
our role as speech language pathologist.
So, like, usually, when I get a patient,
like, the first thing I'll say is, you
know, what tell me, like, a little bit
about what happened to you, why are you
here.
And I'm,
you know, most of the time in inpatient
rehab, but often in outpatient. So I'm seeing
(22:19):
a lot of,
stroke patients. So that's kind of my frame
of reference, stroke traumatic brain injury. And and
every once in a while, I'll see other
populations. But I would say that's my
main,
typical demographic of patients.
And then I'll say I'll ask them to,
you know, well, what led to this stroke?
Do you did the doctors tell you, like,
(22:40):
what happened?
And so,
then I can kinda get an idea of,
okay, what's that's about how much of,
you know, their body they understand. I I
also like to talk about,
the blood vessels and also the nerves. And
so I'll ask my patients, like, do you
understand what your nerves do? And, like, 90%
(23:01):
of the time, my patients will tell me
no.
And then I'll ask them too. I'll say,
well, you know, tell me a little bit
about,
why are you hearing speech? Like, what's what's
happening? And so they might say, well, I'm
having trouble swallowing. And I'll say, has anyone
told you, like, what the name of this
disorder is? Because I wanna make sure that
they know the words,
(23:22):
dysphagia,
aphasia,
apraxia,
dysarthria, cognitive communication disorder because they might leave
me
and they might go to the next level
of care, or they might just see another
health professional. And that other health professional might
say, well,
your, you know, your aphasia is really improving.
And they're like, well, what are you talking
about? Because no one has ever actually used
(23:45):
the medical term. So you wanna make sure
that, like, when you're educating people, you know,
you're asking these questions, you're listening,
and then you're not excluding information.
You're just breaking information
all the way down and but still at
the same time
using those medical terms because they that is
how
(24:05):
people with disabilities
can self advocate if they have that language.
That language is so powerful. So Yeah. Yeah.
Thank you for sharing that. It it's an
interesting
dynamic because it's, like, sometimes are we, you
know, talking down to our patients or are
we being too elementary? But I've looked at
it as it's actually being much more respectful
(24:25):
to
helping them get the care that they actually
need. You know? And I I just was
thinking of it. And since I had with
my son of trying
to get connected with this one nurse that
was doing some stuff for us, and,
you know, I said, how how can I
can I call you? Like, can I you
know, what's the best way for me to
call you? And she's just don't, like, don't
even deal with the hospital system phones. Like,
(24:47):
she's like, just go through the app and
send me a message, and it literally comes
right to my phone. And I said, okay.
But, like, can you show me how to
set up the app? And she's like, you
want me to show you how to set
up the app? And I was like, yeah,
I do. Like, I'm smart, but also, like,
I know that a million things can go
wrong when I leave here and I can't
get in the app. So I, like, downloaded
the app and I was like, Okay, what
do I do now? And she's like, Oh,
(25:08):
you have to type this code in. And
I was like, How would I have known
that? Right. She's like, Yeah, I guess you
probably wouldn't have
Like so I sat there for ten minutes,
like, got it set up, and there was
other little tricks too that she's like, oh,
yeah. Just click here
and, like, just text right there. And I
was like, I never would have. Like,
that's not how I would have done this.
(25:29):
And to me, it was a lesson in,
like, we owe this to our patients
to have these conversations,
walk them through this stuff. Like, it's not
that I'm stupid, but they some of this
stuff is just so complicated. Complicated.
Like Right.
Yep. And then too, like, imagine if, you
know, you didn't
(25:49):
you weren't very literate
in using a smartphone
or if you didn't read very well or
even if you don't speak English and that
application was completely in English.
And what ends up happening so often is
because we are not doing our job with
organizational
health literacy,
we end up blaming it on the patient
(26:10):
and saying, like, oh, the patient was noncompliant.
And it's like, yeah. And it's like, were
were they noncompliant,
or were we, like,
not meeting them where they're at and giving
them the support that they really need? There's
just a million barriers that we're not helping
with. And, look, it was something else too.
Like,
she went by I'm just making up a
name. Like, she went by Judy or something,
(26:32):
but her name was, like, Lauren inside the
app. So I'm like, I never would have
texted you like that. And she's like, oh,
I didn't realize that's how it came up.
Like, she didn't even realize that was how
it came up on the user side. You
know? So there's so many it was just
such a big lesson to me and, like,
hey. Let's exactly what you're saying. Let's not
blame these people for being,
you know,
noncompliant. Let's actually see if they can figure
(26:54):
out this super complex system that
that we live in. Okay. So we've we've
talked about, you you know, with without doing
this justice, we've talked about just
mainstream English speakers. Okay. I know there's a
lot of other dialects. I know there's a
lot of other languages.
Let's dive into that.
Yeah.
So, this is something that I see at
(27:16):
work a lot as well. And even when,
I'm interacting with people at different conferences or
on Instagram,
that's a question that comes up a lot.
So people will say, I I just feel
really uncomfortable
working with
people who speak another language or people who
speak another dialect. And I honestly feel like
(27:37):
it's our dialect
speakers whose needs are often not being met,
whereas our and that's not to say that
there are not health care disparities that are
impacting our
people who speak other languages, just that there
are more formal
structured measures in place to support,
speakers of other languages
(27:59):
that there are not necessarily in place for
dialect speakers of English.
And so what I mean by that is
oftentimes
you know, I'm based in Atlanta,
and Atlanta is really a unique area in
that,
we're a pretty large metro area. And when
you think about the Deep South, we're probably
(28:19):
one of the biggest cities in the Deep
South.
So you get a lot of people who
come from,
like, some of the bigger cities in the
Northeast and have moved down to Atlanta because
it's more affordable, but you still get the
big city vibes.
You also get a lot of people from
rural,
(28:40):
South Georgia and other smaller towns in the
South that have now moved into the city.
And then you have your native Atlanans, which
are a dying breed. And so you have
all these different dialects
going on.
And
with our black patients in particular, with our
black patients who are African American English
(29:01):
speakers,
one thing that I often see is a
dialectal mismatch between,
the speech language pathologist and the patient themselves.
And that puts our patients in a very
vulnerable position to where they could be overdiagnosed
with things like dysarthria,
apraxia,
or even
I've had patients who have,
(29:23):
pretty significant,
not just, like,
verbal apraxia, but also oral and physical apraxia.
And I will see,
bias with our, African American,
patients
with them, like, having an attitude or not
wanting to cooperate when I'm like, okay. Let's
let's take a step back and let's think
about have you, like, fully assessed
(29:45):
all areas of motor planning. Are do they
have an attitude or are they physically not
able to engage in this activity at the
level that you're wanting them to engage in?
And so
this there's this concept
of dialect density.
And,
dialect density
when I went to Georgia State, I worked
(30:06):
under doctor Julie Washington, and she's very well
known in the speech world for her work
that she's done
on African American English in children and how
that impacts African American children's
ability
to learn
to read in mainstream
American English. And so
she has this concept of,
(30:27):
dialogue density, which is how many features
of African American English your speech has. So
many of us,
African Americans and other ethnic groups of black
people in The United States
use elements of African American English, but not
all of us use the syntactic and the
(30:47):
phonemic features of African American English. Some of
us might use just expressions,
or sayings, but might not actually use the
some of the grammatical features.
But then you have others, or
you might be a person who does use
a lot of grammatical features, but you code
switch depending on what areas you're in. Then
(31:08):
you have people who don't code switch, who
always just use, like, highly,
syntactic or grammatical,
features of African American English.
And if you're not familiar with that dialect
and you get someone that comes in with
a stroke and you're struggling to understand them,
is it truly dysarthria,
or is it that they're a dialect speaker?
(31:31):
So that's one example.
And then another thing that I'll see too
with these patients is sometimes,
because they are
they have such high dialect density,
there's a lot of bias there. And so
instead of looking at all these fat these
social determinants of health
(31:51):
so,
you know, you might have a an AAE
speaker who has high dialect density, who comes
from a redlined area,
who maybe
does not have good access to health care
or who shops in those corner stores like
what I mentioned earlier. And they come in
and they have diabetes that's very poorly controlled,
hypertension
that's uncontrolled or poorly controlled, maybe they didn't
(32:14):
know they have it, and now they've had
a stroke.
And
these patients, because
they're they speak with such high dialect density
and are so different
from the person who is evaluating them and
have much different life experiences.
These patients are at risk of being,
die or not diagnosed, but labeled as quote
(32:37):
unquote noncompliant
or,
that
you know, there's I just don't see the
same type of,
effort being put into their care as I
do speaker
people who,
one, are not black, our patients who are
black, our patients who are not African American
English speakers, and our patients who come from,
(32:57):
you know, more wealth or better access or
who have better high higher health literacy.
Another issue that I see
in Atlanta, and I'm so curious to know
too with some of your listeners based on
where they're at in The United States, what
they see.
We get a lot of,
patients from The Caribbean. So I see a
(33:18):
lot of, Jamaican patients, Haitian patients.
We also get there's a large West African
population
in Atlanta, so we'll get a lot I'll
have a lot of patient to,
they speak English, but they speak a different
dialect
of English. And so whereas when I get
a Spanish speaker, there's always the assumption that,
(33:41):
okay. Like, we need to get an interpreter.
We need to be you know, do we
have a Spanish version of this test, or
are we gonna do informal measures? We're gonna
consider Spanish. I don't always see that same
effort being put into,
these,
speakers of English who speak dialects from other
countries. And so,
again, you see the same risk factors. So
(34:03):
they're very high risk of being,
you know, incorrectly diagnosed with a neurogenic communication
disorder, whether it's cognitive impairment or a dysarthria
or anaphasia,
due to cultural differences.
And there's always that assumption too that just
because we speak the same language that we
have the same life experiences, and we tend
(34:25):
to not look at culture in our dialect
speakers. So I think that's also really important
when we bring it back to that,
when we are doing our assessments or when
we're trying to get a gauge of what
our patient's level of health literacy is, making
sure that we're asking a lot of questions
(34:45):
before we make assumptions. And so asking, you
know, is this patient who
you know, I'm doing this activity with this
patient. They really don't seem to understand.
Is it because of cognitive problems and because
of reasoning issues, or is it because this
activity that I'm doing with this patient is
not culturally appropriate?
(35:07):
And then, obviously, the same things are gonna
apply to our Spanish speakers and to and
let let me not say Spanish speakers because
there's so many other languages spoken, but to
our non English speakers.
So
and just and and I think too that
the gaps in health literacy
are often much wider with our patients who
(35:29):
are from other countries because
you have,
depending on what country they're from, you could
have a health care system that is completely
different
(35:52):
socioeconomic level. So, like, working class in The
United States versus working class in whatever country
they're from looks
very, very different.
So,
and just, you know, familiarity with our health
care system,
understanding of the body, educational level. So it's
(36:12):
really important that we're thinking about all these
things,
especially when we're gonna about to give a
person a diagnosis,
of a neurogenic communication disorder. We wanna make
sure that we're not
accidentally
diagnosing
low health literacy
as a disorder.
Yeah. Talk to me, Jackie. I I know
you're you're always very well spoken in responses
(36:35):
to questions like this, so I would love
to have this on the air.
What do we do in those situations? Like,
what what you know, me, Theresa Richard, I'm
going in
working with somebody that has one of these
West African dialects.
Mhmm. What suggestions
do you do in those situations?
So,
what I always start out with is,
(36:59):
so I'll ask my patients, you know, tell
me a little bit about where you're from,
where you know, starting with figuring out do
they live in The United States or were
they visiting The United States? I've had patients
who I had a lady one time who
had a layover in Atlanta and had a
massive stroke during her layover from a country
(37:21):
in Africa. She was on her way to,
another state to visit her daughter and had
a massive
stroke. And so just making sure was and
and also see patients who are visiting family
ended up having a stroke. So that's a
lot different than
someone who has lived in this country for
years
and speaks a different dialect of English. Right?
(37:43):
So starting there, I know that sounds very
basic, but it it can make a big
difference.
Or,
also, you know, how how long have you
lived in The United States?
Tell me a little bit about how familiar
are you with our health care system. Have
you ever done rehab before?
(38:03):
Tell me a little bit about,
what is your what languages do you speak
at home? Because often what I will see
is,
especially, like, with some of my West African
patients,
so there are, like,
Pidgin languages. So it's like a
mix of
(38:24):
native West African languages
and English.
So kind of similar to, like,
creoles, like, what are spoken in Jamaica.
But it's not it would not be intelligible
with a native English American
American English speaker.
So asking, you know, when you're with your
(38:45):
family,
what language do you use? Are there any
other languages that are spoken in the home?
And then also just when you're doing activities.
So
I'll ask my patients as well.
Let's say that we're doing
we've got a cog patient, and we are
working on calculations,
(39:07):
math, things like that.
So and I know this is not exactly
a direct answer to your question about dialect
speakers, but if you've got someone who might
speak more than one language. So I will
ask my patients. I'll say,
like, if you're in an area where
you know,
there's a large population
of whatever
(39:28):
cultural background your patient is from, I might
ask, like, tell me a little bit about,
like, when you go to the doctor,
does your doctor
speak your language, or do you have to
have an interpreter that comes with you, or
do you bring a family member that comes
with you? And when you go to the
doctor, are you just sitting there and your
family member is doing all the talking for
(39:48):
you because you don't feel comfortable speaking in,
in English? Or are you advocating for yourself?
Like, what, you know, what's the change there?
Or even with, grocery shopping. So,
I had a patient who was from an
Asian country that spoke multiple languages, and
he mostly shopped in
(40:09):
a grocery store that was from his that
was run by people from his community.
So when he would go grocery shopping, he
was only speaking in his language from his
country.
So we might want to target the skills
that we work on for grocery shopping in
his language if that's gonna be what's culturally
appropriate for him.
(40:29):
And then again, you know, when you have
that breakdown,
asking lots of questions. Tell tell me a
little bit more about
why you're thinking this or expand on what
you mean by this. Or,
tell me a little bit more about why
why do you why do you not understand
this? Like, I don't like to say it
that way.
I'm trying to think of a specific example.
(40:50):
So okay.
I had a patient from another country, and
you'll probably notice right now that I'm trying
not to say what country my patients are
from. Because one thing that I've noticed is
that when I'm educating people
about multiculturalism,
it's so easy to be like, okay. Well,
every time I get a patient from Mexico,
I need to do x, y, and z.
(41:12):
Every time I get a patient from Haiti,
I need to do x, y, and z.
But we're not actually using, like, the same
critical thinking skills that we use for when
we suspect that a patient has hypokinetic dysarthria
or suspect that a patient has pharyngeal anesthesia.
Like, we shouldn't just say, you know, with
this culture, we need to do this. With
this culture, we need to do that.
(41:32):
So, anyway, back to my story.
So I had a patient from another country,
and, we were doing a task where some
of those, like, cards so this is a
lower level cog patient, and I'm showing her
cards that have something odd.
And she has to tell me, like, what's
the problem in the picture. And,
it was a picture of a bathroom with
(41:54):
a tree
in the middle of the bathroom. And she
was like, there's nothing wrong with this picture.
And so I could have just been like,
okay. Well, this lady's problem solving skills are
not there. So I was like, okay. Tell
me more, like,
why, you know, with this picture tell me
more about I I see this tree in
the middle
(42:14):
of the bathroom and, like, at my house,
like, that's that's weird to me that there's
a tree in the bathroom. Like, would why
why is it is that not odd to
you? And then it's like, well, yeah, it's
not odd to me because in my country
that I grew up with,
bathrooms are typically in the backyard.
It's like an outdoor type of thing. So
(42:34):
this tree
is like what it was like in my
country.
So asking questions and leaning on the side
of, like, oh, maybe there is a cultural
breakdown that's happening here that's leading to why
this patient is not understanding
instead of just jumping to, like, oh, this
lady's cognition is not is not great, or,
(42:55):
oh, this patient does not want to participate,
or, oh, this patient has an attitude. Let's
see if we could figure out where the
breakdown is.
Awesome. I love that. Thank you. That's a
great example.
Jackie, thank you so much. This has just
been such a lovely, wonderful,
insightful conversation. I I like I said, every
time I talk to you, I learn something
(43:16):
more. Every time I read your post, I
learn something more, and and you just have
a way of breaking down the information in
such a easy
easy to understand way, but also a way
that's sort of like, duh, I should have
known that or I should have
like, okay. So, anyways, thank you for being
you. I I really, really appreciate all the
work that you do.
Oh, you're welcome. Thank you for the compliment.
Any any final thoughts? I realized I just
(43:38):
closed this down. Any any final thoughts on
your end?
No. It's okay. So one other thing that
I wanted to mention earlier,
and it's something that I've been trying to
bring awareness to in my presentations is,
so there is a research study.
I'll make sure that you have it so
we could put it in the show notes.
And,
(43:59):
it looks at the athena
health care documentation
system, so, like, their EMR.
And it assessed how long
doctors
are spending time with their patients. And so,
this health care this EMR, the way that
it works is it was looking at primary
care visits too. So the the doctor walks
(44:21):
in.
The doctor
starts his time. The doctor does his assessment,
counsels the patient, and then from there, the
doctor,
orders prescriptions and then closes out the time.
And so they have found that the average
time for all of this to happen for
doctors was eighteen point nine minutes.
(44:42):
So when we think about our patients, especially
our neuro patients, that it's so rare that
you get a patient who's had a stroke
that doesn't have, like, a million underlying diagnoses.
And we're thinking about if you've got a
patient who's got kidney disease,
high blood pressure, diabetes,
eighteen point nine minutes is not enough time
(45:05):
to
incorporate
education for all of these different factors. And
so
one thing that I have really started doing
with my therapy is shifting,
the things that I work on and incorporating,
health literacy.
And so I
the American Health Association I mean, I'm sorry.
(45:26):
The American Heart Association
has some amazing resources.
They have a,
handout called Let's Talk About High Blood Pressure
and Stroke.
I always read that with my patients, and
I teach them how to sequence the steps
to taking their blood pressure.
So,
think I want I hope that listeners think
about high about health literacy
(45:47):
and ways that they can incorporate that into
their therapy. So
we could either do,
you know, things like walkbooks
or things like games,
or we could actually
incorporate
ways to help a person learn more about
their body. And I think that with
(46:09):
cognition and of, you know, and,
communication disorders, aphasia, dysarthria,
it's so you can literally target
anything.
And so,
think about ways that you can help your
patients better advocate for their needs in your
therapy instead of just doing the run of
the mill
(46:29):
drilling and things that we work on. So
It's, like, so meta. Like,
yeah. Mind blowing. Yeah. Yeah. Awesome.
Anyways, thank you. Thank you. Thank you again,
Jackie. Super appreciate this conversation. And, yeah, we'll
make sure that Thanks for having me. Some
really great show notes because I think you
just gave some really
tactical, practical things that SLPs can do today.
(46:49):
Because I think when you think about how
do I explain health literacy, it sounds like
a mountain that no one even knows where
to start. So thank you for showing some
practical tips to that.
Sure.
Thanks for having me. Yeah. Of course.
And that's a wrap for this episode. As
always, thank you so much for listening. And
if you'd like to download the show notes
(47:10):
from this episode, please visit swallowyourpridepodcast.com.
There, you can also sign up for our
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If you do like what you hear, then
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If you'd like to be a guest, share
(47:32):
feedback or request a topic to be discussed
on the show, please email podcast@TeresaRichard.com.
Thank you so much for listening and we'll
catch you next week.
Welcome to the Swallow Your Pride podcast. I'm
your host, Teresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders
and founder of the MediSLP Collective and MediSLP
Education.
This podcast is dedicated to delivering the latest
evidence based practice to medical SLPs everywhere while
also recognizing that medical SLPs everywhere are doing
(00:31):
the best with what they've got. Whether you
are a new clinician seeking tangible tools for
therapy or a seasoned vet stuck in a
rut, my goal is simple, to help you
advance your practice without feeling overwhelmed or underappreciated.
This means that together, we'll build confidence, broaden
your knowledge, and reignite your passion for our
fields. So if you're listening, I encourage you
(00:51):
to swallow your pride and be open to
new ideas because at the end of the
day, you and your patients deserve that kind
of support. Just a quick disclaimer that all
statements and opinions expressed in this episode do
not reflect on the organizations associated with the
speakers and are their own opinions solely. With
that, let's dive in.
Welcome to the Swallow Your Pride podcast. I
(01:12):
am really excited to do this episode today.
We have an awesome, awesome, awesome guest. We
have miss Jackie Rodriguez with us, and she's
a bilingual SLP based in Atlanta, Georgia. She
graduated from Georgia State University and has extensive
experience working across the lifespan and continuum of
care. She's passionate about bilingualism and multi multiculturalism
across the lifespan, health literacy, and dementia care.
(01:35):
She's a recipient of the ASHA Early Career
Professional Award. Jackie serves as the director of
communications for the Bilingual Empowerment
through Allied Mentorship Program, BEAM SLP,
an organization that provides mentorship for bilingual CSD
students and clinical fellows.
Jackie enjoys educating others about race, ethnicity, and
the field of speech language pathology on her
(01:56):
Instagram account at unlearn with me dot theslp.
So, Jackie, welcome to the show.
Thank you for having me. Yes. Thank you
so much for joining us. So tell tell
the people a little bit more about what
you do. I know you're super passionate. I
always learn so much from you whenever I
read your post. I've I've always learned so
much from you, and you've always been outspoken
about things, but always in just a very
(02:18):
respectful way. And I I I genuinely appreciate
that so much about you. So thank you
for being you.
Thank you. Thanks for having me.
So, a little bit more about me. So
I actually started,
in pediatrics. I started in the schools as
a bilingual diagnostician,
and I evaluated children who were learning English
(02:40):
and,
as their second language. And I think
that first,
job that I had really exposed me to
health disparities
and,
issues with health literacy that we're gonna get
into later. And then I chose the perfect
time to transition to medical SLP. I transitioned
to medical SLP
(03:01):
in 2020 in Sniffs as a traveler, so
it was just lovely.
And then,
happened during that time as well. You know,
I was working in a lot of facilities
where,
they couldn't get coverage. It was in a
rural area. So lots of health disparities as
well.
And I really started to become passionate about
(03:21):
dementia care during that time of my career.
And then now I moved back to Atlanta,
and I really enjoyed that flexible,
traveler lifestyle. So now instead of having one
full time job, I work full time PRN,
primarily in inpatient rehab and outpatient, but I
still, do a little bit of sniff work
(03:42):
here and there and acute care. So I
have experience in a lot of different areas
in our field. And then,
my mom had, rheumatoid arthritis. So growing up,
I kinda grew up going to therapy. So
I have
almost, you know, I would say, truly more
experience
being on the other side of health care
(04:02):
than I do as a speech language pathologist
just because my mom had rheumatoid arthritis for
thirty one years of my life. So that
informs a lot of what I'm passionate about
as well. Yeah. Yeah. And I was sharing
with you, you know, before we hit record
here, I've just been going through some insane
things with my son lately. So we did
we chose to get him a feeding tube
a few weeks ago. Tomorrow is actually one
month. We have his one month post op
(04:24):
tomorrow.
Oh, wow.
And the and the experience
of going through that, like, this is stuff
that I actually work in, but, like,
we still don't have full supplies for everything.
Like, the amount of times I sit on
these one eight hundred hotlines, talk to nine
people that have no idea what's going on,
like,
it's just an act of tenacity. Like and
(04:46):
and it's so sad that this is just
really where we are as a society. And,
you know, I was I was actually thinking
of you last night when and I was
like, I don't know how I actually understand
the system, and I'm having so much trouble.
Like, if I didn't understand the system,
there's no way I would do this. You
know? And no matter how much you love
your child or a family member, some things
(05:06):
are just not worth
the stress and frustration. Like, I think I've
I've literally gained, like, 10 pounds in the
last month just because I'm so stressed out
and frustrated with
the system for my you know? And it's,
like, actually getting it for him has been
so helpful. Like, it's been game changing for
us and for him, but the hoops I've
had to jump through
(05:26):
is just so stressful. So
that being
said, Jackie, tell the people why you're on
the episode today and what we're gonna talk
about.
Sure. So today, we are going to talk
about health literacy.
So if you're not familiar with what health
literacy is, health literacy is essentially,
our understanding
of our body in order to make
(05:48):
decisions about our health. And so,
there are two types of health literacy. There's,
personal health literacy. So, like, for example, let's
say that you are diagnosed with dysphagia.
So personal health literacy is,
maybe you'll go home and you might Google
dysphagia, and maybe you find,
(06:09):
an article on WebMD
or Healthline.
You might join a Facebook group for, a
support group for people with dysphagia,
and it's the things that you do outside
of the doctor's office or outside of the
SLP's office to learn about your disability or
your medical condition.
Then,
(06:30):
speech pathologist,
we play an important role in organizational
or sometimes you'll hear institutional
health literacy. And so that is what we
as health care professionals
do to make sure that our patients
understand their bodies and understand the medical condition
or disability that they have.
And so, health literacy is informed
(06:52):
by, these things that we call social determinants
of health. So you'll see them abbreviated as
SDOH.
And,
there are various social determinants of health. So,
your
reading literacy, like how well you can read,
and if you have access to read in
English is one,
(07:14):
social determinant of health.
Your race, your ethnicity, and how that either
matches or does not match the health care
professionals that you work with and the bias
and how bias can play a role in
your interactions with health care professionals,
is another
area. You all also have built community. So
when you look at historically,
(07:37):
segregation,
redlining,
displacement of Native Americans,
the way that
politics have informed,
the way that our country is structured,
that also plays a big role in your
access to resources.
So if you live in a rural area,
you might let you know, in your rural
(07:57):
area, there might be one SLP, and she
might be
the SLP that sees everyone across the lifespan.
As opposed to if you live in a
big city,
you might have access to,
not only, you know, specifically
adult specialized SLPs versus pediatric specialized SLPs, but
you might have access to a specialty clinic.
(08:20):
So if you have ALS, you might have
access to an ALS clinic, whereas people who
live in rural areas,
because of the structure, their community might not
have access to that.
So all of these social determinants of health
work together
to help us to better understand
our,
body and our own health. Yeah. Jackie, you
(08:41):
mentioned something that admittedly I don't know much
about, and and I would love for you
to tell the people,
explain it in your beautiful words a little
bit more, but the the topic, the term
of redlining.
Sure. So redlining
was this policy that started in the nineteen
thirties.
So,
there was this government program that created redlining.
(09:04):
And essentially, it was a racist policy that
zoned neighborhoods
based on,
just simply based on race. So there were
four different zones. There were red, yellow,
green, and blue. So green
was the highest level. And so if you
lived in a green lined neighborhood, typically, that
was a predominantly white neighborhood and, like, a
(09:26):
wealthy white neighborhood.
Then a blue zoned neighborhood would be maybe,
like, a more,
like, middle class to working class, but still
predominantly white neighborhood.
Then your yellow lined neighborhood would be,
immigrant to, like,
are from European countries. So people like,
(09:48):
Italians,
Irish people,
Jewish people. Remember, this is in nineteen thirties,
so this is before, you know, our racial
and ethnic categories of people looked very different
than what it looks like today.
And so they were categorized into,
yellow zoned neighborhoods, and then red zoned neighborhoods
(10:08):
were your black neighborhoods,
and sometimes Asian neighborhoods and Latino neighborhoods and
Native American neighborhoods. And so,
basically, this this
organization and this policy of Redlining,
zoned these neighborhoods by race, and then they
said,
depending on what kind of zone your neighborhood
was in, you could get a mortgage. And
(10:31):
so this is the reason why today,
men the, like,
public housing is often associated with African Americans
because African Americans couldn't get mortgages, so they
couldn't get homes. So they had to rely
on public housing.
Oftentimes,
you know, if you were one of the
few black people who could afford to build
(10:51):
a home,
you often could not get a loan to
repair your home. So homes often fell into
disrepair or cheap materials that have, like,
asbestos or other cancer causing materials were used
to build these houses.
And, redlining neighborhoods also dictated
how grocery stores moved into neighborhoods and hospitals
(11:13):
moved into neighborhoods because these redlined
neighborhoods
were seen as undesirable
or poor neighborhoods.
And so grocery stores and hospitals would not
build in those areas because they felt like
they couldn't make money like they could in
a green zoned a green lined neighborhood.
And all of this has led even though,
you know, red lining is now no longer
(11:33):
legal,
it was outlawed,
it is the reason why one of the
reason why is today in this country, we
still continue to live segregated by race. And
it's the reason why we stereotypically
see black neighborhoods as being bad neighborhoods because
redlining
set the standard for that.
One last thing that,
(11:55):
also happened as a result of redlining is
so these redlined neighborhoods
farms would be built on the borders
of these,
redlined neighborhoods. So
what ends up happening, and this continues to
happen in 2025,
(12:16):
is in these redlined neighborhoods or formerly redlined
neighborhoods,
they are not grocery stores.
There are,
you have a lot of, like,
environmental,
you have high a higher risk of developing
environmental,
diseases. So think of things like COPD, emphysema,
if you're living right next to a factory
(12:37):
and you're exposed to smoke all the time.
And then because there are not grocery stores,
you're at a higher risk of
things like diabetes,
high blood pressure, high cholesterol because your these
communities often rely on,
corner stores that we know don't have healthy
foods.
So one experiment that I've done in some
(13:00):
of my presentations
is I will have my participants,
Google grocery stores in a white,
and wherever they live, in the white area
where they live. And then Google grocery stores
in the black area of wherever you live.
And you'll see that this still continues to
happen. You'll see that in mostly white areas.
(13:21):
That's where you'll see things like whole foods
and fresh markets and places that sell fresh
organic produce. And then in majority black neighborhoods,
you'll see things like corner stores that sell
a lot of highly processed foods,
not a lot of,
fresh fruits and vegetables. And that leads to
a lot of these disparities that we're seeing,
(13:44):
with our patients who come in and have,
you know, these who end up having strokes
because of hypertension, high blood pressure, cholesterol,
things like that. So fascinating, Jackie.
What led you down this, for lack of
a better term, rabbit hole of of exploring
all? I mean, that it makes perfect sense
the way you just explained it. But, yeah,
it's really fascinating to me.
(14:06):
I think it's just because of my, like,
own personal interest, just from coming from, like,
a multicultural background. So my dad's Puerto Rican.
My mom was African American.
And I've always been really interested in, like,
race and culture and also black history. And
so sometimes I'll just see things, and I'm
like,
some there's, like, something that just seems very
racist about this situation, and then I'll look
(14:27):
it up. And, historically, there's my answer. So
that's that's a honest answer.
Talk to me a little bit more about
how low health literacy what what exactly should
SLPs know about that? How how is that
manifest in swallowing disorders?
Okay. That's a great question. So,
let's imagine that
(14:47):
you are a patient that has had a
stroke and now you have dysphasia.
So,
and let's say that you have a third
grade education. So you don't read very well.
Maybe you've taken, like,
a couple of science classes, but you don't
have a very strong background. Right?
So now, you know, we there have been
(15:09):
so many conversations about informed consent and how
we want patients to,
we're kinda moving away even from modified diets
and moving towards,
like, what do the patients want and just
following in their direction. But
we if you don't
it it's there's so many factors here. So
(15:32):
let's start with a stroke. So,
for example, I have a patient right now
who,
this particular patient had an aneurysm,
which led to his stroke, and
it manifested in a seizure and a fall.
And so he was brought in after having
a seizure, and then they,
did his imaging, and they realized that he
(15:53):
had one stable aneurysm, and then he had
had a stroke on the other side of
his brain. And so I was
one for one, this is was a Spanish
speaking patient.
By the time he got to me, he
had been in the hospital for over a
month, and no one had explained to him
what happened to him. All he knew was
the word stroke. And so for many people,
(16:15):
if you have a low level of health
literacy,
like, when you think about a stroke, that's
a very complex medical event that happens.
And to many people with low health literacy,
a stroke might just mean, well, it's something
that my grandma had, and, like, she needed
a lot of help afterwards. But they don't
actually know, like, what does a stroke mean.
(16:37):
So then, like, with this particular patient,
we're having I was, like, trying to explain
to him what his blood vessels are and
how blood vessels bring oxygen
up and blood up from the heart to
the brain, and that's like food for the
brain. And then,
with an aneurysm, an aneurysm is kind of
(16:58):
like a bubble in your blood vessel, and
it exploded.
And now the blood is not flowing up
to the brain and the brain tissue dies
because the brain is not getting that food
from the blood and oxygen.
And so
to him, he like, after having this conversation,
this you could tell things were starting to
(17:18):
click. So he wanted to know, like,
what could cause,
a lack of flow of blood up to
the brain. And so we talked about, like,
other factors too, how, like, things like cholesterol,
high blood pressure, those are other things that
can lead to a stroke.
And then he was like, well,
what causes
high cholesterol and what causes, like, high blood
(17:39):
pressure?
And,
we talked about foods that you eat and
how that could,
cause changes to your blood pressure. And he
was like, okay, I understand. Well, you know,
like, I eat like this food, like pork
has a lot of, like, fat in it,
and that could cause high blood pressure. And
I was like, yes. Yes.
And then towards the end, he was like,
but
this whole thing that happened to my brain,
(18:01):
like, it's all because I fell. Right? Like,
I had the seizure and I hit my
head, and, like, that injury to my head
is what caused the fall. And so to
him,
like, to me, that made a lot of
sense. Because to him, like,
the
the physical action
of a fall is, like, causing a stroke
makes a lot more sense to someone who
(18:21):
might not have a very high level of
health literacy
as opposed to, like, oh, you have all
these blood vessels moving through your body, and
that's what's leading, you know, an interruption of
blood flow has caused this stroke. That's much
more of of, like, a higher level,
concept to understand. And so then,
you know, I was talking to some other
(18:43):
coworkers,
and they said, well, I don't know why
you had to explain to him that he
had a stroke because I already told him
that. And I was like, okay. But
did you actually
explain, like, in detail
all these different facts and all about all
these different parts of the body and how
they work together collectively to lead to a
stroke? Or did you just say, like, hey.
(19:05):
You had a stroke, and, like, this is
why you can't
move this side of your body, or this
is why your attention is not like it
used to be. So,
what we really need to think about,
our patient's level of education,
their access to, you know, maybe they're not
understanding the purpose of our therapy because they've
(19:27):
never they're not familiar with our health care
system. They've never been to therapy before. They
don't,
maybe they live in an area where they
have to take the bus and it takes
two hours to get to the doctors. They
don't go to the doctor frequently. And it's
not necessarily that they don't want to, but
that all these social determinants of health are
barriers.
So
(19:47):
let's go back to, like, our theoretical stroke
patient that now has dysphagia. Right?
So we had to spend all that time
just for the patient to understand what a
stroke is. Right? And now we get to
dysphagia,
and this person is aspirating.
How do you explain what aspiration is to
a patient that does does not understand
(20:09):
what their lungs do or doesn't understand what
the esophagus is or the larynx or all
these other, like,
very complicated
body parts that even maybe your average person
might not be familiar with, but let alone
someone that has very, very limited education.
So sometimes we have to take a step
back and we need to do some education
(20:31):
about the anatomy
before we can even get to the conversation
about, well, you're aspirating. This is what aspiration
means. What do you want to do?
What medical decision do you want to make?
So that's how low health literacy is gonna
show up in our therapy sessions. Yeah. Thank
you. I one thing that that struck me
while you were explaining that is I remember
(20:53):
we had a course,
in my PhD
work last semester, and it's it was a
course all about health care education. And there
was one thing that they constantly
stressed was these brief checks for understanding.
And that just made me think of that.
How often do we do that with our
patient? Stop blabbing or stop assuming
(21:14):
or stop going on our rants and literally
just stop and check for their understanding
and not, oh, do you know what a
stroke is? But, like, do you actually understand
what happened, why you're here?
So, yeah, thank you. That that's just made
that made that correlation for me. So thank
you.
Yeah. Totally. And I one question that I
(21:35):
often get is people will say, well, how
do you assess health literacy?
And there are some formal health literacy assessments.
But to be honest,
I prefer to just use
informal conversational
interviewing
to,
to your point about, like, asking people what
they understand because then you get,
(21:57):
more information that is directly related to our,
our role as speech language pathologist.
So, like, usually, when I get a patient,
like, the first thing I'll say is, you
know, what tell me, like, a little bit
about what happened to you, why are you
here.
And I'm,
you know, most of the time in inpatient
rehab, but often in outpatient. So I'm seeing
(22:19):
a lot of,
stroke patients. So that's kind of my frame
of reference, stroke traumatic brain injury. And and
every once in a while, I'll see other
populations. But I would say that's my
main,
typical demographic of patients.
And then I'll say I'll ask them to,
you know, well, what led to this stroke?
Do you did the doctors tell you, like,
(22:40):
what happened?
And so,
then I can kinda get an idea of,
okay, what's that's about how much of,
you know, their body they understand. I I
also like to talk about,
the blood vessels and also the nerves. And
so I'll ask my patients, like, do you
understand what your nerves do? And, like, 90%
(23:01):
of the time, my patients will tell me
no.
And then I'll ask them too. I'll say,
well, you know, tell me a little bit
about,
why are you hearing speech? Like, what's what's
happening? And so they might say, well, I'm
having trouble swallowing. And I'll say, has anyone
told you, like, what the name of this
disorder is? Because I wanna make sure that
they know the words,
(23:22):
dysphagia,
aphasia,
apraxia,
dysarthria, cognitive communication disorder because they might leave
me
and they might go to the next level
of care, or they might just see another
health professional. And that other health professional might
say, well,
your, you know, your aphasia is really improving.
And they're like, well, what are you talking
about? Because no one has ever actually used
(23:45):
the medical term. So you wanna make sure
that, like, when you're educating people, you know,
you're asking these questions, you're listening,
and then you're not excluding information.
You're just breaking information
all the way down and but still at
the same time
using those medical terms because they that is
how
(24:05):
people with disabilities
can self advocate if they have that language.
That language is so powerful. So Yeah. Yeah.
Thank you for sharing that. It it's an
interesting
dynamic because it's, like, sometimes are we, you
know, talking down to our patients or are
we being too elementary? But I've looked at
it as it's actually being much more respectful
(24:25):
to
helping them get the care that they actually
need. You know? And I I just was
thinking of it. And since I had with
my son of trying
to get connected with this one nurse that
was doing some stuff for us, and,
you know, I said, how how can I
can I call you? Like, can I you
know, what's the best way for me to
call you? And she's just don't, like, don't
even deal with the hospital system phones. Like,
(24:47):
she's like, just go through the app and
send me a message, and it literally comes
right to my phone. And I said, okay.
But, like, can you show me how to
set up the app? And she's like, you
want me to show you how to set
up the app? And I was like, yeah,
I do. Like, I'm smart, but also, like,
I know that a million things can go
wrong when I leave here and I can't
get in the app. So I, like, downloaded
the app and I was like, Okay, what
do I do now? And she's like, Oh,
(25:08):
you have to type this code in. And
I was like, How would I have known
that? Right. She's like, Yeah, I guess you
probably wouldn't have
Like so I sat there for ten minutes,
like, got it set up, and there was
other little tricks too that she's like, oh,
yeah. Just click here
and, like, just text right there. And I
was like, I never would have. Like,
that's not how I would have done this.
(25:29):
And to me, it was a lesson in,
like, we owe this to our patients
to have these conversations,
walk them through this stuff. Like, it's not
that I'm stupid, but they some of this
stuff is just so complicated. Complicated.
Like Right.
Yep. And then too, like, imagine if, you
know, you didn't
(25:49):
you weren't very literate
in using a smartphone
or if you didn't read very well or
even if you don't speak English and that
application was completely in English.
And what ends up happening so often is
because we are not doing our job with
organizational
health literacy,
we end up blaming it on the patient
(26:10):
and saying, like, oh, the patient was noncompliant.
And it's like, yeah. And it's like, were
were they noncompliant,
or were we, like,
not meeting them where they're at and giving
them the support that they really need? There's
just a million barriers that we're not helping
with. And, look, it was something else too.
Like,
she went by I'm just making up a
name. Like, she went by Judy or something,
(26:32):
but her name was, like, Lauren inside the
app. So I'm like, I never would have
texted you like that. And she's like, oh,
I didn't realize that's how it came up.
Like, she didn't even realize that was how
it came up on the user side. You
know? So there's so many it was just
such a big lesson to me and, like,
hey. Let's exactly what you're saying. Let's not
blame these people for being,
you know,
noncompliant. Let's actually see if they can figure
(26:54):
out this super complex system that
that we live in. Okay. So we've we've
talked about, you you know, with without doing
this justice, we've talked about just
mainstream English speakers. Okay. I know there's a
lot of other dialects. I know there's a
lot of other languages.
Let's dive into that.
Yeah.
So, this is something that I see at
(27:16):
work a lot as well. And even when,
I'm interacting with people at different conferences or
on Instagram,
that's a question that comes up a lot.
So people will say, I I just feel
really uncomfortable
working with
people who speak another language or people who
speak another dialect. And I honestly feel like
(27:37):
it's our dialect
speakers whose needs are often not being met,
whereas our and that's not to say that
there are not health care disparities that are
impacting our
people who speak other languages, just that there
are more formal
structured measures in place to support,
speakers of other languages
(27:59):
that there are not necessarily in place for
dialect speakers of English.
And so what I mean by that is
oftentimes
you know, I'm based in Atlanta,
and Atlanta is really a unique area in
that,
we're a pretty large metro area. And when
you think about the Deep South, we're probably
(28:19):
one of the biggest cities in the Deep
South.
So you get a lot of people who
come from,
like, some of the bigger cities in the
Northeast and have moved down to Atlanta because
it's more affordable, but you still get the
big city vibes.
You also get a lot of people from
rural,
(28:40):
South Georgia and other smaller towns in the
South that have now moved into the city.
And then you have your native Atlanans, which
are a dying breed. And so you have
all these different dialects
going on.
And
with our black patients in particular, with our
black patients who are African American English
(29:01):
speakers,
one thing that I often see is a
dialectal mismatch between,
the speech language pathologist and the patient themselves.
And that puts our patients in a very
vulnerable position to where they could be overdiagnosed
with things like dysarthria,
apraxia,
or even
I've had patients who have,
(29:23):
pretty significant,
not just, like,
verbal apraxia, but also oral and physical apraxia.
And I will see,
bias with our, African American,
patients
with them, like, having an attitude or not
wanting to cooperate when I'm like, okay. Let's
let's take a step back and let's think
about have you, like, fully assessed
(29:45):
all areas of motor planning. Are do they
have an attitude or are they physically not
able to engage in this activity at the
level that you're wanting them to engage in?
And so
this there's this concept
of dialect density.
And,
dialect density
when I went to Georgia State, I worked
(30:06):
under doctor Julie Washington, and she's very well
known in the speech world for her work
that she's done
on African American English in children and how
that impacts African American children's
ability
to learn
to read in mainstream
American English. And so
she has this concept of,
(30:27):
dialogue density, which is how many features
of African American English your speech has. So
many of us,
African Americans and other ethnic groups of black
people in The United States
use elements of African American English, but not
all of us use the syntactic and the
(30:47):
phonemic features of African American English. Some of
us might use just expressions,
or sayings, but might not actually use the
some of the grammatical features.
But then you have others, or
you might be a person who does use
a lot of grammatical features, but you code
switch depending on what areas you're in. Then
(31:08):
you have people who don't code switch, who
always just use, like, highly,
syntactic or grammatical,
features of African American English.
And if you're not familiar with that dialect
and you get someone that comes in with
a stroke and you're struggling to understand them,
is it truly dysarthria,
or is it that they're a dialect speaker?
(31:31):
So that's one example.
And then another thing that I'll see too
with these patients is sometimes,
because they are
they have such high dialect density,
there's a lot of bias there. And so
instead of looking at all these fat these
social determinants of health
(31:51):
so,
you know, you might have a an AAE
speaker who has high dialect density, who comes
from a redlined area,
who maybe
does not have good access to health care
or who shops in those corner stores like
what I mentioned earlier. And they come in
and they have diabetes that's very poorly controlled,
hypertension
that's uncontrolled or poorly controlled, maybe they didn't
(32:14):
know they have it, and now they've had
a stroke.
And
these patients, because
they're they speak with such high dialect density
and are so different
from the person who is evaluating them and
have much different life experiences.
These patients are at risk of being,
die or not diagnosed, but labeled as quote
(32:37):
unquote noncompliant
or,
that
you know, there's I just don't see the
same type of,
effort being put into their care as I
do speaker
people who,
one, are not black, our patients who are
black, our patients who are not African American
English speakers, and our patients who come from,
(32:57):
you know, more wealth or better access or
who have better high higher health literacy.
Another issue that I see
in Atlanta, and I'm so curious to know
too with some of your listeners based on
where they're at in The United States, what
they see.
We get a lot of,
patients from The Caribbean. So I see a
(33:18):
lot of, Jamaican patients, Haitian patients.
We also get there's a large West African
population
in Atlanta, so we'll get a lot I'll
have a lot of patient to,
they speak English, but they speak a different
dialect
of English. And so whereas when I get
a Spanish speaker, there's always the assumption that,
(33:41):
okay. Like, we need to get an interpreter.
We need to be you know, do we
have a Spanish version of this test, or
are we gonna do informal measures? We're gonna
consider Spanish. I don't always see that same
effort being put into,
these,
speakers of English who speak dialects from other
countries. And so,
again, you see the same risk factors. So
(34:03):
they're very high risk of being,
you know, incorrectly diagnosed with a neurogenic communication
disorder, whether it's cognitive impairment or a dysarthria
or anaphasia,
due to cultural differences.
And there's always that assumption too that just
because we speak the same language that we
have the same life experiences, and we tend
(34:25):
to not look at culture in our dialect
speakers. So I think that's also really important
when we bring it back to that,
when we are doing our assessments or when
we're trying to get a gauge of what
our patient's level of health literacy is, making
sure that we're asking a lot of questions
(34:45):
before we make assumptions. And so asking, you
know, is this patient who
you know, I'm doing this activity with this
patient. They really don't seem to understand.
Is it because of cognitive problems and because
of reasoning issues, or is it because this
activity that I'm doing with this patient is
not culturally appropriate?
(35:07):
And then, obviously, the same things are gonna
apply to our Spanish speakers and to and
let let me not say Spanish speakers because
there's so many other languages spoken, but to
our non English speakers.
So
and just and and I think too that
the gaps in health literacy
are often much wider with our patients who
(35:29):
are from other countries because
you have,
depending on what country they're from, you could
have a health care system that is completely
different
(35:52):
socioeconomic level. So, like, working class in The
United States versus working class in whatever country
they're from looks
very, very different.
So,
and just, you know, familiarity with our health
care system,
understanding of the body, educational level. So it's
(36:12):
really important that we're thinking about all these
things,
especially when we're gonna about to give a
person a diagnosis,
of a neurogenic communication disorder. We wanna make
sure that we're not
accidentally
diagnosing
low health literacy
as a disorder.
Yeah. Talk to me, Jackie. I I know
you're you're always very well spoken in responses
(36:35):
to questions like this, so I would love
to have this on the air.
What do we do in those situations? Like,
what what you know, me, Theresa Richard, I'm
going in
working with somebody that has one of these
West African dialects.
Mhmm. What suggestions
do you do in those situations?
So,
what I always start out with is,
(36:59):
so I'll ask my patients, you know, tell
me a little bit about where you're from,
where you know, starting with figuring out do
they live in The United States or were
they visiting The United States? I've had patients
who I had a lady one time who
had a layover in Atlanta and had a
massive stroke during her layover from a country
(37:21):
in Africa. She was on her way to,
another state to visit her daughter and had
a massive
stroke. And so just making sure was and
and also see patients who are visiting family
ended up having a stroke. So that's a
lot different than
someone who has lived in this country for
years
and speaks a different dialect of English. Right?
(37:43):
So starting there, I know that sounds very
basic, but it it can make a big
difference.
Or,
also, you know, how how long have you
lived in The United States?
Tell me a little bit about how familiar
are you with our health care system. Have
you ever done rehab before?
(38:03):
Tell me a little bit about,
what is your what languages do you speak
at home? Because often what I will see
is,
especially, like, with some of my West African
patients,
so there are, like,
Pidgin languages. So it's like a
mix of
(38:24):
native West African languages
and English.
So kind of similar to, like,
creoles, like, what are spoken in Jamaica.
But it's not it would not be intelligible
with a native English American
American English speaker.
So asking, you know, when you're with your
(38:45):
family,
what language do you use? Are there any
other languages that are spoken in the home?
And then also just when you're doing activities.
So
I'll ask my patients as well.
Let's say that we're doing
we've got a cog patient, and we are
working on calculations,
(39:07):
math, things like that.
So and I know this is not exactly
a direct answer to your question about dialect
speakers, but if you've got someone who might
speak more than one language. So I will
ask my patients. I'll say,
like, if you're in an area where
you know,
there's a large population
of whatever
(39:28):
cultural background your patient is from, I might
ask, like, tell me a little bit about,
like, when you go to the doctor,
does your doctor
speak your language, or do you have to
have an interpreter that comes with you, or
do you bring a family member that comes
with you? And when you go to the
doctor, are you just sitting there and your
family member is doing all the talking for
(39:48):
you because you don't feel comfortable speaking in,
in English? Or are you advocating for yourself?
Like, what, you know, what's the change there?
Or even with, grocery shopping. So,
I had a patient who was from an
Asian country that spoke multiple languages, and
he mostly shopped in
(40:09):
a grocery store that was from his that
was run by people from his community.
So when he would go grocery shopping, he
was only speaking in his language from his
country.
So we might want to target the skills
that we work on for grocery shopping in
his language if that's gonna be what's culturally
appropriate for him.
(40:29):
And then again, you know, when you have
that breakdown,
asking lots of questions. Tell tell me a
little bit more about
why you're thinking this or expand on what
you mean by this. Or,
tell me a little bit more about why
why do you why do you not understand
this? Like, I don't like to say it
that way.
I'm trying to think of a specific example.
(40:50):
So okay.
I had a patient from another country, and
you'll probably notice right now that I'm trying
not to say what country my patients are
from. Because one thing that I've noticed is
that when I'm educating people
about multiculturalism,
it's so easy to be like, okay. Well,
every time I get a patient from Mexico,
I need to do x, y, and z.
(41:12):
Every time I get a patient from Haiti,
I need to do x, y, and z.
But we're not actually using, like, the same
critical thinking skills that we use for when
we suspect that a patient has hypokinetic dysarthria
or suspect that a patient has pharyngeal anesthesia.
Like, we shouldn't just say, you know, with
this culture, we need to do this. With
this culture, we need to do that.
(41:32):
So, anyway, back to my story.
So I had a patient from another country,
and, we were doing a task where some
of those, like, cards so this is a
lower level cog patient, and I'm showing her
cards that have something odd.
And she has to tell me, like, what's
the problem in the picture. And,
it was a picture of a bathroom with
(41:54):
a tree
in the middle of the bathroom. And she
was like, there's nothing wrong with this picture.
And so I could have just been like,
okay. Well, this lady's problem solving skills are
not there. So I was like, okay. Tell
me more, like,
why, you know, with this picture tell me
more about I I see this tree in
the middle
(42:14):
of the bathroom and, like, at my house,
like, that's that's weird to me that there's
a tree in the bathroom. Like, would why
why is it is that not odd to
you? And then it's like, well, yeah, it's
not odd to me because in my country
that I grew up with,
bathrooms are typically in the backyard.
It's like an outdoor type of thing. So
(42:34):
this tree
is like what it was like in my
country.
So asking questions and leaning on the side
of, like, oh, maybe there is a cultural
breakdown that's happening here that's leading to why
this patient is not understanding
instead of just jumping to, like, oh, this
lady's cognition is not is not great, or,
(42:55):
oh, this patient does not want to participate,
or, oh, this patient has an attitude. Let's
see if we could figure out where the
breakdown is.
Awesome. I love that. Thank you. That's a
great example.
Jackie, thank you so much. This has just
been such a lovely, wonderful,
insightful conversation. I I like I said, every
time I talk to you, I learn something
(43:16):
more. Every time I read your post, I
learn something more, and and you just have
a way of breaking down the information in
such a easy
easy to understand way, but also a way
that's sort of like, duh, I should have
known that or I should have
like, okay. So, anyways, thank you for being
you. I I really, really appreciate all the
work that you do.
Oh, you're welcome. Thank you for the compliment.
Any any final thoughts? I realized I just
(43:38):
closed this down. Any any final thoughts on
your end?
No. It's okay. So one other thing that
I wanted to mention earlier,
and it's something that I've been trying to
bring awareness to in my presentations is,
so there is a research study.
I'll make sure that you have it so
we could put it in the show notes.
And,
(43:59):
it looks at the athena
health care documentation
system, so, like, their EMR.
And it assessed how long
doctors
are spending time with their patients. And so,
this health care this EMR, the way that
it works is it was looking at primary
care visits too. So the the doctor walks
(44:21):
in.
The doctor
starts his time. The doctor does his assessment,
counsels the patient, and then from there, the
doctor,
orders prescriptions and then closes out the time.
And so they have found that the average
time for all of this to happen for
doctors was eighteen point nine minutes.
(44:42):
So when we think about our patients, especially
our neuro patients, that it's so rare that
you get a patient who's had a stroke
that doesn't have, like, a million underlying diagnoses.
And we're thinking about if you've got a
patient who's got kidney disease,
high blood pressure, diabetes,
eighteen point nine minutes is not enough time
(45:05):
to
incorporate
education for all of these different factors. And
so
one thing that I have really started doing
with my therapy is shifting,
the things that I work on and incorporating,
health literacy.
And so I
the American Health Association I mean, I'm sorry.
(45:26):
The American Heart Association
has some amazing resources.
They have a,
handout called Let's Talk About High Blood Pressure
and Stroke.
I always read that with my patients, and
I teach them how to sequence the steps
to taking their blood pressure.
So,
think I want I hope that listeners think
about high about health literacy
(45:47):
and ways that they can incorporate that into
their therapy. So
we could either do,
you know, things like walkbooks
or things like games,
or we could actually
incorporate
ways to help a person learn more about
their body. And I think that with
(46:09):
cognition and of, you know, and,
communication disorders, aphasia, dysarthria,
it's so you can literally target
anything.
And so,
think about ways that you can help your
patients better advocate for their needs in your
therapy instead of just doing the run of
the mill
(46:29):
drilling and things that we work on. So
It's, like, so meta. Like,
yeah. Mind blowing. Yeah. Yeah. Awesome.
Anyways, thank you. Thank you. Thank you again,
Jackie. Super appreciate this conversation. And, yeah, we'll
make sure that Thanks for having me. Some
really great show notes because I think you
just gave some really
tactical, practical things that SLPs can do today.
(46:49):
Because I think when you think about how
do I explain health literacy, it sounds like
a mountain that no one even knows where
to start. So thank you for showing some
practical tips to that.
Sure.
Thanks for having me. Yeah. Of course.
And that's a wrap for this episode. As
always, thank you so much for listening. And
if you'd like to download the show notes
(47:10):
from this episode, please visit swallowyourpridepodcast.com.
There, you can also sign up for our
email list so that you'll never miss another
episode.
If you do like what you hear, then
please subscribe and leave a review on iTunes
or share it on social media with your
friends and colleagues, because that is what keeps
these episodes coming.
If you'd like to be a guest, share
(47:32):
feedback or request a topic to be discussed
on the show, please email podcast@TeresaRichard.com.
Thank you so much for listening and we'll
catch you next week.
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