When facing ongoing health issues or a life-changing diagnosis, overwhelmed patients can struggle to process guidance from health care providers.

“Somebody says ‘cancer’ to you, and you quit thinking. Your brain shuts off,” says Vernon Rose, executive director of the Nashville General Hospital Foundation (NGHF), which supports essential hospital Nashville General Hospital (NGH). “You need your brain firing on all cylinders and it’s not going to do it.”

Contrary to common belief, a patient’s ability to understand information about their health and health care often has little to do with their education, but it can be compounded by social and economic challenges, Rose says. “Low health literacy is not a new concept, but what was shocking to me is how few people in this country even understand what it is or the impact it has not only on the health of my community, but the entire nation,” she says.

October is Health Literacy Month, a time for health care providers to recognize and reevaluate how to convey vital information to patients who need it most — a critical responsibility for essential hospitals, which serve populations that face socioeconomic challenge that contribute to low health literacy.

Essential hospitals nationwide are working to empower their patients, including through state initiatives in which nearly 60 percent of essential hospitals participate.

Empowering Patients

NGHF’s health literacy work kickstarted with the launch of its food pharmacy six years ago as an oncology program intended for patients undergoing chemotherapy.

Rose recalls the food pharmacy puzzled many patients, as they had never prepared several of the nutrient-dense foods offered, including certain fruits and vegetables.

“You’re thinking, ‘Okay, what else do they not know?’” she explains.

Rose recognized that patients’ cultural backgrounds and food practices hadn’t been considered, and she knew something had to be done.

“The physician’s never going to know [of a patient’s doubts] unless they ask, which is why we started screening,” she says. Patients received follow-up questions regarding their visit, asking them if they felt their needs and questions were addressed. This opened patient-provider communication and helped mitigate recurring patient concerns.

Rose gathered a team of NGH professionals to determine proactive ways to educate their patient population and analyze other health literacy issues. “I said, ‘Let’s start with a list of the things that you hear the most often. What are the topics where you think the patients had the least understanding?’”

Nashville General Hospital staff prepare food totes for patients at the food pharmacy.

Nashville General Hospital staff prepare food totes for patients at the food pharmacy. Photo courtesy of Nashville General Hospital Foundation.

The food pharmacy since has evolved, offering curated, no-cost food totes of fresh produce and shelf-stable food to patients with other medical issues, such as diabetes and hypertension, as well as patients facing food insecurity.

NGHF leaders also acknowledged that many patients, particularly those undergoing cancer treatments, struggled to understand the purpose of their prescription medications and how to take them properly.

“It’s not enough to say, ‘We’re going to give you what you need,’ if you don’t focus on the people you are giving it to,” Rose explains. “You’ve got to look at what you’re giving them, each patient, and their situation. Without that partnership, all you’re doing is talking at people, and that’s no good.”

She developed a chart that broke down each medication, its purpose, and when to take it — a solution that expanded beyond oncology. NGH also offers health information sheets in English, Spanish, and Arabic about other general health topics, including high blood pressure, diabetes, COVID-19 vaccines, and what to do if you’re uninsured.

Often featuring graphics and step-by-step instructions, the information sheets proved extremely beneficial in helping patients experience some control over their health.

One of the several information sheets offered in Arabic by Nashville General Hospital.

Nashville General Hospital offers health information sheets in several languages, including Arabic. Photo courtesy of Nashville General Hospital Foundation.

“‘I’ve got to give myself these injections and, oh my God, I don’t know if I want to do this’ became, ‘I get it, I know I can do this,’” says Rose. “That, for a patient, is a huge turnaround.”

A Community Effort

Rose also underscores the importance of community-based and -centered literacy initiatives, highlighting the domino effect poor health and health literacy can have on entire communities.

“Poor health affects employers. It affects Medicare, it affects Medicaid,” she explains. “When you end up looking at who pays the price of low health literacy, we do. Whoever you are, we collectively pay the price.”

NGHF has hosted an annual Nashville Health Literacy Forum since 2020 in collaboration with numerous local and national organizations, including the Nashville Chamber of Commerce, the Hispanic Family Foundation, and Nashville Cares. The forum convenes more than 100 community organizations to discuss best practices, recognize recurring health literacy issues across the nation, and seek solutions together.

Rose says NGHF plans to expand its informational resources and continue targeting recurrent health literacy issues, including cancer survivorship and numeracy.

“If you have hypertension or if you’ve got diabetes, you have to understand numbers, and that is a specific skill that a lot of people don’t have,” she explains.

NGHF also sends follow-up postcards to hospital patients with QR codes linking to NGHF’s resources. The postcards also give patients the opportunity to write back with any concerns.

“Your ultimate goal, all of us, whatever role you’re in in health care, is that you want to get that patient and their family to better understand how to self-manage their own health. That’s everybody’s goal,” she says.