August 2019 Blog: What is effective communication?

What is effective communication?

The ability to communicate effectively is a key skill for any pharmacist. In fact, standard three of the GPhC’s Standards for Pharmacy Professionals states:

“Effective communication is essential to the delivery of person-centred care and to working in partnership with others. It helps people to be involved in decisions about their health, safety and wellbeing.”

But what does this mean in practice when speaking to a patient or carer? You know which key information would benefit the patient, but do you adapt what you say to meet the needs of the person you are communicating with? You may not get your message across as often as you might think, because the recipient may not have sufficient “Health Literacy” to fully understand what you are saying. For example a common instruction to: “Take two tablets in the morning with breakfast” could mean that NO tablets are taken when the patient misses breakfast!

A definition of “Health Literacy” by the World Health Organisation (WHO) defines it as: “The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.”

A recent survey commissioned by Stoke-on-Trent City Council Public Health (working in conjunction with Health Literacy Group UK from Keele University) on the levels of health literacy across Stoke-on-Trent concluded that 49% of the adult population had inadequate health literacy levels. I suspect that other areas wouldn’t fare much better, which means that roughly every other adult you speak to may not fully grasp the information you are giving.

Unfortunately, those adults with poorer health literacy are significantly:

• More likely to rate their general health as fair, bad or very bad;
• Less likely to be close to relatives or friends whom they speak to or see regularly;
• More likely to be aged 65 and over;
• Less likely to have access to the internet;
• Less likely to have qualifications;
• More likely to be retired or not working due to long-term illness or disability and less likely to be working as an employee;

If we can encourage and support our patients to be more health literate it will help improve their health outcomes and promote concordance with their medication.

Health Education England (HEE) has published a helpful “Health literacy ‘how to’ guide” which describes practical tools and techniques for health practitioners in a variety of settings. It offers advice on how to implement and enhance approaches and practice in a way which effectively supports people with low levels of health literacy. It’s quite detailed and provides a lot of CPD opportunities!

I would like to introduce you to one of these tools right now, one called ‘teach back.’ It’s a simple technique, which gets even easier with practice. It works by asking the patient to repeat or ‘teach back’ the information they have just received in their own words. If they can do this accurately you will know that they have understood you. If not, you should clarify or modify the information and repeat the technique until they’ve ‘got it’. Asking a question such as: “To check that I’ve explained everything properly, can you tell me how you are going to take your tablets?” is very different to: “Is what I have told you clear?”.

You should also be mindful of not overwhelming the patient with a stream of information. A technique called ‘chunk and check’, which can be used with ‘teach back’, involves breaking the information down into small ‘chunks’ and then checking that the patient has understood at each stage, before moving on, rather than waiting until the end. The conversation may take a little longer initially, but this is about setting the patient up for success and reducing the need for repeat conversations every time you see them.

So, remember – listen carefully to what your patient says, use simple ‘living room’ language, avoid medical jargon and explain things clearly in plain language.

Now, any questions?