Iowa Health System's Health Literacy Collaborative

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Iowa Health System's Health Literacy Collaborative

Our state wide health care system (Iowa Health System) has had a very active Health Literacy Collaborative for the past 2 1/2 years. This has included 7 senior affiliate hospitals, home health care and physician clinics. We just recently kicked off a Health Literacy Collaborative with 12 of our critical access hospitals. We have tested and implemented a number of interventions to help improve health literacy. Some of those include:

  • Creating easier to read and understand printed education materials
  • Use of teach back to check for patient understanding
  • Creating reader friendly consent forms
  • Involving patients and new readers in printed materials review
  • Wayfinding
  • Ask Me 3


We did a pilot study at one of my hospitals with Ask Me 3. The pilot involved putting a poster we developed based on Ask Me 3 on the wall in each patient room and a putting smaller version in the patients admission packet. During the admission assessment the admitting nurse review the poster information with the patient (took about 30 seconds). To measure the affect for 2 months before introducing the program we gave all patients discharged from the pilot unit a 9 question survey based on questions from our Press Ganey patient satisfaction survey. We implemented the program and continued the survey for 2 more months. We saw improvement in every question on the survey. Two of the questions and the results overall showed statistically significant improvement at the 95% confidence level. We are now in the process of implementing this in all patient care areas of our Des Moines hospitals. Ask Me 3 can be very helpful depending on how it is implemented.

One of the most challenging areas has been getting physicians more engaged and actively involved.

I agree that the burden of effective communication should not be the sole responsibility of the patient. I would venture to say most health care providers either aren't aware of or don't think about issues related to health literacy until it is drawn to their attention. In addition most will likely not change how they do things unless they can see the value in it and that value impacts them directly. Health literacy fundamentally affects patient safety and quality of care (quality from an outcomes perspective and from a perception perspective).

For me one of the most valuable experiences in my work with health literacy was attending a meeting held in Des Moines, Iowa 2 years ago. That meeting was a conference jointly sponsored by the New Readers of Iowa and the IHS Health Literacy Collaborative. Regular people (new readers) and health care providers had the opportunity to interact, hear each others experiences and stories and work together to develop recommendations to help improve the communication gap that creates the health literacy problem. I only wish this type of coming together could happen more often and that we could get more health care providers involved.

The health care system (which I am part of and includes: hospitals, physician clinics, payers, etc) has been the biggest contributor to the health literacy problem. We have to keep working together (the health care system with patients) to get the word out that we have to change the way we are communicating with patients. Yes there are people who may feel empowered to hold their health care providers accountable for clear communication. I suspect that the vast majority of people do not feel empowered or comfortable doing this. We need to continue to support this in every way possible. Ask Me 3, if properly used, is one tool to help with this. Meeting such as the New Readers of Iowa meeting I attended are another way.

Thanks very much for the opportunity to comment and share.

Bob Dickerson, MSHSA, RRT
Clinical Resource Coordinator, Clinical Quality
Iowa Health - Des Moines
Des Moines, Iowa
Phone: (515) 263-5792
Fax: (515) 263-5415
E-mail: DICKERR2@ihs.org Website: www.ihsdesmoines.org