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Health literacy — the ability to read, understand, and effectively use basic medical instructions and information — is the strongest predictor of a person's health, according to The Partnership for Clear Health Communication (PCHC).

But the average American reads at the eighth- or ninth-grade level, considerably below the reading level of most medical instructions and patient information. PCHC estimates 90 million people in the U.S. have difficulty understanding and acting on health information, putting their health at risk.

PCHC, of the National Patient Safety Foundation, launched the Ask Me 3 program to help improve health literacy through clear communication between patients and healthcare providers. Advocate Lutheran General Hospital in Park Ridge, Ill., the sixth largest hospital in the Chicago metropolitan area, successfully tested the program and is about to expand its use hospital-wide. Advocate Illinois Masonic Hospital in Chicago also is considering using the program.

Three simple questions

Ask Me 3 is based on three questions patients need to ask their healthcare providers. The questions originally were intended for outpatients to use in physicians' offices, but they work well in any healthcare setting.

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this?

Jean Mau, RN, APN, conducted two research studies at Lutheran General using the Ask Me 3 program. The first month-long study was conducted with patients in the cardiovascular unit. Mau reported a marked increase in patients' understanding of instructions and a decrease in instances of heart failure during the pilot.

A second study using the Ask Me 3 program focused on enhancing nurse-patient communication and helping nurses gain confidence in providing patient education. Throughout the three-month study, patient interactions were formatted using the questions on two different units. For example, explaining that a diabetic patient needs to test her blood sugar daily answers question No. 2, "What does she need to do?" If she doesn't, she needs to understand she may go into a coma, which answers question No. 3, "Why is it important for her to do this?"

Mau says the results of the three-month study included a statistically significant increase in patients' understanding of the education, an increase in the confidence the nurses felt in providing education, and a decrease in the re-admission rate. Once the program goes hospital-wide, all caretakers will need to know the three questions and use them as the main method of communicating with patients.

Building communication

Lorraine Hanson, RN, MSN, is the care manager of the neurological unit that piloted Ask Me 3. "Often we use the lingo we are familiar with and we forget that the patient might not be familiar with the terms we use," she says. "We emphasize there is no such thing as a stupid question, and these questions really help a patient think about what the issue is, what the provider can do about it, and what the patient can do to make it better.

"It is the best tool to equip patients to ask the questions they need to ask, whether they have a sore throat or a more serious medical condition," Hanson adds. "It helps the patient focus his or her thoughts better and allows the healthcare provider to focus on what the patient is really asking. It is an empowering tool that equips the patient to better take care of himself or herself."

Initially, Mau says there was concern the three simple questions would insult patients, but results have shown the opposite. "We have not had anyone who said this was below his or her education level," she says. "They are happy because it makes medical information so much easier to understand, and that's our goal."

Rev. Lee Joesten, MDiv, BCC, is a board-certified chaplain at Lutheran General and heads the hospital's interdisciplinary Health Literacy Task Force. When he learned of the American Medical Association's program to promote health literacy four years ago, he realized the negative impact of low health literacy and helped launch the task force composed of nurses, physicians, and pharmacists. The Ask Me 3 program is part of the task force's health literacy initiative.

"The Ask Me 3 program is promising because it shares the responsibility with patients to improve communication," Joesten says. "Patients can be hesitant to ask questions, but keeping it simple encourages them to ask. I see communication as a bridge that can be built from both directions. On the healthcare side, we can be clearer in our explanations, but we also can help patients ask the questions that will help them understand so they can build their side of the bridge."

Ask Me 3 educational materials are available in English and Spanish free of charge at www.npsf.org/askme3.

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Barbara Kois is a freelance writer. To comment, e-mail editorIL@nursingspectrum.com