Given the complexity of the health care system, it is not surprising that limited health literacy is associated with poor health outcomes. Literacy Network's English for Health classes help people to take control of their health and is contributing to a healthier overall Madison community.
“We are now in our 5th year. We originally started as an ESL [English as a second language] civics class at Centro Guadalupe and got great feedback from it,” says English for Health Group Instruction Director Beth Gaytan. “I put a curriculum together to answer their questions. We ended the semester with a mock clinic and we recruited some nurses from St. Mary's [Hospital] and they came and took blood pressure for each student and pretended that the students were at a clinic appointment. The nurses really enjoyed it and went back to St. Mary's and just said that they had a great experience. Our students just loved it, too! So that started this great partnership. And the class has grown exponentially since then.”
According to research studies, persons with limited health literacy skills are more likely to skip important preventive measures such as mammograms, Pap smears, flu shots, and more. When compared to those with adequate health literacy skills, studies have shown that patients with limited health literacy skills enter the health care system when they are sicker.
Culturally, some people are afraid to ask questions of their doctors and are timid about questioning their authority. So they may spend their doctor's appointment just nodding as the doctor talks even if inside they are feeling unsure. “They don't want to feel stupid sometimes or they feel like they should be understanding everything, so they just say, 'yes, I understand,'” Gaytan says. “But we make sure that our students know that it's their right and their responsibility to ask questions. The doctor is a very smart person, but he or she is not a mind reader. It's the patient who helps the doctor do their job well.”
“Many people have had one negative experience with health facilities and that has colored their whole outlook. Some have never gone back,” Gaytan continues. “Or they have very specific concerns because of that one negative experience.”
Many learners, too, have problems understanding prescription labels and instructions from a medical professional. “There are some people who did not know how important it is to measure the medication for their kids,” Gaytan says. “We've had students who have cleaned out their medicine cabinets and thrown away medicine that has been four years expired. We do a lot of activities where the students are actually measuring their medicine and the importance of carefully reading medicine labels.”
The Literacy Network has approached the many health care challenges by developing a collaborative English for Health class that teaches adults how to access the health care system, communicate effectively with health care providers, use medications appropriately, and adopt healthier lifestyles. Most classes are very multilingual, although Spanish is always a popular language. English for Health is now a formal 12-week curriculum and is a promising practice for the state of Wisconsin.
“The program has grown and we now offer the class two to three times a year and we offer an English For Health 2 class,” Gaytan says. “On the second part, the focus is on nutrition, chronic disease prevention, maintenance, and healthy habits.”
The English for Health 2 class, held at St. Mary's Hospital, recently concluded its 12-week session with a Health Fair, the capstone project for the program. Through guest speakers and hands-on projects, students in this class learned about nutrition, the causes and prevention of chronic disease, and healthy living habits. By the end of the class, each student was able to express their goals for improving their personal health habits; including menu planning, an exercise plan, and relaxation techniques to reduce stress.
Literacy Network has partnered with the UW School of Medicine and Public Health since July 2011. Third-year UW-Madison medical students come to every single class session and spend a lot of time talking to students individually. Medical students offer English language learners a greater sense of confidence when communicating with health care professionals. Many English language learners are anxious or embarrassed to speak with healthcare providers, but interacting with a medical student during class is an invaluable way of breaking down some of the barriers learners feel.
“They take the students to a different room and do their BMI[Body Mass Index], blood pressure, nutrition counseling. It's just a lot of focus on students talking with real providers,” Gaytan says. “The feedback we get is very interesting. Our learners are amazed at how nice they are and they begin to build that trust as they become empowered to talk.”
The benefits are reciprocal: medical students report having gained many valuable insights through their work with the participants in the classes.
“The providers and the medical students will say, “Wow! I've been saying that for years and I didn't realize that that could be construed this way or that this could be a difficult explanation,'” Gaytan says.
Gaytan has found from the English For Health classes that the benefits of health literacy are evident across socioeconomic lines.
“I taught a class a couple years ago at Wingra [Clinic] and it was a class of all women who were spouses of visiting professors from universities. The women were from all over the country and most of them have Ph.D.'s themselves,” Gaytan says. “They had the same exact questions and concerns that every other student has had. It was fascinating for me. There were differences because it was such a highly educated group; but, in the end, there were so many similarities.”
The bottom line underlying the importance of English For Health classes is that poor health literacy is costly to Dane County. Limited health literacy skills are associated with an increase in preventable hospital visits and admissions. Studies have demonstrated a higher rate of hospitalization and use of emergency services among patients with limited literacy skills
“One of the biggest concerns that we try to cover in both of the classes is the use of the emergency room. When students start, they might have a child with a fever and, immediately, they are off to the ER,” Gaytan says. “Without even thinking. It's something that's scary. Your baby is sick and you don't know what to do, so you go straight to the ER. Even though it's not the best option and, financially, it's very, very costly.”
English For Health classes talk about how to get a primary care provider if you don't have insurance and they talk about the importance of a yearly physical. “We teach mothers about Dean On Call,” she says. “If it's something that's not life-threatening or if you just have questions, anybody in Wisconsin can use this. You call and discuss the symptoms and then the nurse walks you through it and tells you what you need to do.”
As a result of this class, students are going to the emergency room much less and saving Dane County taxpayers money. “Because it's not that people want to misuse the system. They don't want to cause taxpayers extra money,” Gaytan says. “They just don't know how to use the system effectively. And if your baby wakes up at two in the morning and has a fever and you don't speak the language well and you don't know the system very well, you're going to do what your gut reaction says if you don't have the knowledge.”
The English For Health classes have been well-recognized for their innovative efforts and effectiveness. In 2010, Literacy Network received the first Outstanding Achievement in Health Literacy award at a Wisconsin Literacy luncheon at Monona Terrace. This year, Literacy Network received a UW-Madison Community Partnership award for its ground-breaking work in the English for Health program. The Latino Health Council endorsed the program and provided feedback on the curriculum. Staff at Access Community Health Centers offered tours of their facility and instructed learners on how to become patients at the center.
“We've partnered with St. Mary's, GHC and offered the class at Dean [Health] East, UW Health West, Access, the Wingra Family Medical Center,” Gaytan says.
The next class session will start in September and will be a partnership with Group Health Cooperative.
Every class session has a mock clinic or a health fair where providers come in. Students have to call in and make an appointment and fill out a heath history form. They wait in the waiting area and read magazines in English before meeting with a nurse and then the physician.
Gaytan finds it very fulfilling when people realize that they can take charge of their health. Thanks to English for Health, students now have the confidence to make better decisions regarding their personal health and the health of their families.
“It's rewarding to see people for the first time feel like they have a grip on their health... that they are able to take good care of themselves and their kids,” Gaytan says. “Just seeing that parents want to take good care of their kids and that community members want to be responsible and be healthy. Oftentimes, they don't know what they don't know. So, after class, to have this, 'Wow! I honestly didn't know this. I wish I would have known this earlier!' That's what is so rewarding to see.”
For more information about English For Health classes, e-mail Beth@litnetwork.org or visit www.litnetwork.org.