Do patients understand what they hear?

Much of the research on functional health literacy looks at how well patients understand printed instructions. One group of researchers looked at the extent to which listeners understood critical concepts in spoken messages. about cancer prevention and screening. They concluded that we cannot assume that listeners understand critical health concepts even if the words themselves seem simple. Comprehension depends on foundational knowledge, which even educated lay people may be missing.

The study had 44 adults watch brief media clips about cancer prevention and screening, and then asked them to paraphrase the key concepts and main points. (This technique is called “teach back.”) They found most participants generally understood most messages. But nine could not define the term “at risk.” Some participants had trouble distinguishing between “screening” and “prevention,” apparently believing that screening is inherently preventive. Some had difficulty understanding the strength of research evidence and the value of multiple studies.

What does this mean? Always watch your assumptions. Always evaluate understanding. Level of education or a nod of the head does not mean the learner understands what you are saying. We sometimes forget that we spent years of study to come to understand what we are trying to communicate in minutes. Have the learner teach back the essential content to you, so you can be sure it is understood.

Source: Mazor, K., Saccoccio, L., Calvi, J., Cowan, R., Roblin, D., Williams, A., et al. (2009, April 26-29, 2009). Media Messages About Cancer: What Do People Understand? Paper presented at the 15th Annual HMO Research Network Conference, Danville, Pennsylvania.

2 Responses to “Do patients understand what they hear?”

1. Sandy Cornett says:

   March 28, 2010 at 6:56 am

   Fran:
   This is an excellent point! There has been a vigorous discussion on the NIFL health literacy listserv about this point. It concludes that with oral communication we are dealing with different skills/processes and that we need to be moving toward evaluating people’s ability to understand the spoken word in health literacy.
   Sandy
2. NoTime_author says:

   March 29, 2010 at 6:08 pm

   Thanks Sandy. If you hear of any advances in this area, please post the references here.