For the past 30 years, Drs. Terry C. Davis and Connie Arnold, both Professors of LSU Health Shreveport, have conducted research on health communication and health literacy. Our goal is to help people understand what they need to do to take care of their health and to be able to access and understand the health system,” said Dr. Davis. Dr. Davis is a Professor of Internal Medicine and Pediatrics and is Co-Chief of the Division of Health Disparities. Dr. Arnold is a Professor of Medicine and Co-Chief of the Division of Health Disparities and is a medical sociologist in the Department of Internal Medicine.
“In the last 15 years, we’ve focused on rural health, and have learned that many people living in these areas do not have access to the care they need. This occurs because there are a very limited number of specialists in rural areas and is complicated by the fact that many individuals do not have transportation to drive to Monroe or Shreveport,” shared Dr. Arnold. Dr. Davis added “We’ve done a lot of research with federally qualified health centers in rural areas all over the state and one of the issues that has come to light is rural health disparity. Connie and I have dedicated these past 15 years specifically trying to improve the health outcomes and health care of Louisiana citizens in rural areas, particularly cancer care.”
“The challenge in rural areas is expected to continue as there are not only are a limited number of specialists but a limited number of people to staff health centers and community hospitals – many of which are closing”, stated Dr. Davis. “And the more we’ve invested in technology, the greater the divide on what people might have access to,” Dr. Arnold said. “And the information that’s out there tends to be complicated, and people can’t always understand or decipher what that information means.” That’s where these two doctors come in, to make it easier to understand and to be able to use that information.
The duo noted the huge challenge in communication because patients or their caregivers now must know even more to take care of their health and are often expected to do so from their homes as insurance coverage limits in-patient days. “The reality is that self-management of chronic disease is a huge task, and people need a lot of help. Despite the upside, there are challenges with electronic portals for health-care systems. Our research has shown that patients like and appreciate access to health portals which allow things like messaging their doctors, but they still struggle with the written communication provided in health portals. It all goes back to making health information understandable,” stated Dr. Davis. Another example shared regarding portals is the fact that a patient often learns of their lab results before his doctor but the information they obtain is typically not designed for the patient. “Our approach is to teach medical students, residents, faculty and nurses all over the country about slowing down, using plain language, and making sure the patient understands the information shared. “I think a lot of doctors don’t realize that just because they say something, it doesn't mean that the patient understood it and can act on it,” shared Dr. Davis.
“Unfortunately,” said Dr. Arnold, “what happens, particularly with patients with low literacy, is they are less likely to ask questions because they don’t want the doctor figuring out that they didn’t understand what he or she said, so they will sit there and nod their heads. Unfortunately, when they leave the office, they may not have understood the majority of what the doctor said. For a patient with low literacy, they don’t want the doctor to think that they’re stupid. “
Dr. Davis reflected on a paper she worked on in the Department of Surgery at the University of Alabama-Birmingham which was based on audiotaped physician/patient encounters. “The findings showed that the physician spoke at a lot faster rate than normal conversation. People with low literacy had an average visit time of 5.8 minutes compared to 12 minutes for people with adequate literacy because they were asking more questions.”
Drs. Arnold and Davis are working with patients to find out what they need, what makes sense to them and then creating understandable patient education all while impressing on the doctors of the future how important it is that they communicate well. They credit the future generation of doctors as doing a better job in communicating in an understandable way because this has been incorporated into their curriculum. “For years medical schools have done a really good job of teaching medical students how to diagnose a problem and what medication the patient needs to be on. It’s a different ball of wax to communicate that so that the patient understands it and accepts it and will adhere to it,” Dr. Davis shared.
In response to how their work has been accepted by their colleagues, Dr. Davis remarked, “Most understand the problem and ask how can I be a better communicator? And it’s not just the doctor. How can the health system do a better job? The desire to do better is evident.”
Originally, health literacy referred to the ability of somebody to get information, understand it, and use it to make informed health decisions. Currently, the Department of Health and CDC have a two-pronged definition. The first prong is individual health literacy which refers to a patient's ability to obtain, understand and use health information and services to make informed health decisions. The second is organizational health literacy, where it’s up to the health system to make understandable information and easy to access services so patients can use them, so the burden is not just on the patient but the health system.
Both women are nationally recognized experts in health literacy with more than 170 publications on the subject. They have extensive experience working with simplifying patient education documents and clinical trial materials, including surveys and consent forms with much of their work being federally funded research. In fact, Dr. Arnold serves as a reviewer of grants submitted to the National Institutes of Health.