[Re: https://www.hifa.org/dgroups-rss/improving-birth-preparedness-through-st... ]
Susan,
Thankyou for sharing this Standard Operational Procedure for birth plan counselling at 32 to 34 weeks gestation in Phnom Phen, Cambodia. I notice that the checklist includes the function of patients signing delivery consent forms in advance. A colleague is deeply involved in the development of the Greater Manchester Care record Home - GM Care Record - a digital cross service provider record of 2.8 million patients. This record includes the facility to include proactively created Lasting Powers of Attorney (LPA) for Health and wellbeing. These LPA's are nationally registered advanced wishes and donations of power of attorney of citizens for their legal attorneys (family members, friends, guardians etc) to enact on their behalf, should the patient become incapacitated and unable to make their own decisions. health wishes choices
I also note the integration of visual aids. Barry Weiss's "health Literacy - a manual for clinicians" has an evocative example of how a written leaflet can look to a patient of low literacy (30% of adult patients at least in any country - National Assessment of Adult Literacy (NAAL) - What is NAAL?
(“20% of the N American population at the lowest level of literacy skill, termed NALS level 1, s can only perform basic tasks such as signing their name or finding a word or fact in a short, written article. Individuals at NALS level 1 are often considered “functionally illiterate.” Although they can perform some reading and writing tasks, their limited literacy skills prevent full functioning in today’s society.
27.5% of individuals in NALS level 2 have somewhat more advanced skills but are still substantially limited in their ability to read and understand text. They are considered marginally literate.
In contrast, persons at NALS levels 3,(3%) 4, (16%) and 5 (3%0 have sufficient literacy skills to permit full functioning in society. Those at NALS level 5, the most advanced literacy level, have well[1]developed literacy skills that enable them to perform complex tasks, such as writing lengthy documents and extracting data from tables and graphs (Table 1).”)
*** "Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc."
Can you work it out?
Generally patients remember 10 to 20 % of what they are told at an outpatient appointment. They remember perhaps 30% if they are given appropriate written information, but 80% if they are given pictures and illustrations.
(*** Your physician has recommended that you have a colonoscopy. Colonoscopy is a test for colon cancer. It involves insertying a flexible viewing scope into your rectum. You must drink a special liquid the night before the examination to clean out your colon.)
Countries spend approximately 5% of their national budgets educating their children for 7 to 11 years, in which they assess and record children's literacy levels (schools!), yet no country that I know of inserts this information into patients' records. If literacy levels were inserted into patients digital notes appropriate levels of information could be selected automatically to suit the patient's literacy.
HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data Email address: richardpeterfitton7 AT gmail.com