Overview
According to , almost one quarter of working-age adults in the United States have low literacy, and a third have trouble with basic math. The proportions are higher for older adults. For these patients, referral to an adult learning center for literacy and math classes can be a life-changing event. Patients are unlikely to mention limitations in their literacy or math skills unless you initiate a conversation.
Practice Experiences
"I was surprised that patients were overwhelmingly receptive to questions like, 'Are you interested in improving your reading skills?' Our eyes were really opened up by the literacy resources in our community and how easy it is to talk to people about them."
—Rural family medicine practice
Action
Identify community resources.
- The identifies local resources to provide help with reading, math, GED, and English for speakers of other languages.
- Contact resources in your community to verify their services and how to make referrals.
- Regularly update resource information.
Assess interest.
- Ask everyone, "Are you interested in improving your reading or math skills?" Research has shown that clinicians are not good at identifying which patients have limited literacy. Asking directly eliminates guesswork. Adding a question to intake forms is not enough, since patients with literacy challenges may leave forms incomplete.
- Offer to assist. For example: "I know of some resources in the community. Would you like more information?"
- Document patients' responses in a consistent place in the medical record.
Connect patients to literacy and math resources.
- Make a referral. Two methods of referral are:
- Direct referrals. You may be able to send an electronic referral from your electronic health record (EHR) or other online platform. If not, you can call the agency, preferably in the presence of the patient. Give patients a Community Referral Form to record the details.
- Self-referral. Patients may not be ready to commit. Give them a Community Referral Form to provide essential information about available programs.
- Document the referral. Identify a place to document referrals to literacy and math programs in the medical record, and train staff to document referrals consistently.
- Follow up. Find out if the referral was completed by contacting the service provider. Document the outcome in the patient’s record. Go to Tool 6: Follow Up with Patients for more information about different ways to follow up.
Research Findings
Depression symptoms lessened among patients with low literacy after a clinic referred them and they participated in adult basic literacy education.
—. 2007
Track Your Progress
Test whether your community resource list is up to date. Call four service providers and verify their contact information.
Before implementing this tool, choose at least 20 medical records at random of patients seen in the past week, and check whether they record information about literacy and math skills. Repeat in 2, 6, and 12 months to see if the medical records are more complete.
Track how many referrals are made in a month and then again 2, 6, and 12 months after implementing this tool. If you have an EHR, you can generate a tracking report from the system. Otherwise, collect copies of the Community Referral Forms to track referrals.
Note five literacy or math referrals you made. Check the medical record after 1 month to see if the outcome of the referral is documented. Repeat in 2, 6, and 12 months to see if the medical records are more complete.
Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions. Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.
