Most dietitians cringe when they hear that their patients were handed a piece of paper about their diet and diagnosis. As dietitians, we are trained to “get the back story” on a person’s culture, budget, food preferences, dietary intolerances and allergies, cooking skills, access to food and what equipment they have or don’t have at home to use.
Dietitians are uniquely poised to provide accurate, comprehendible diet, nutrition, and health information given our training in motivational interviewing, role playing, and counseling. Many dietitians are authors, professors, freelance writers, and teachers. Getting our words out in understandable terms is vital to our clients’ success. What good is diet and nutrition advice if it’s not understood? This is where health literacy is so important.
What is health literacy?
Health literacy is simply, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." 1 When healthcare professionals make the judgement that a person is “non-compliant” for not adhering to diet or health advice, it may be that the person didn’t comprehend the information. It’s not fair to blanketly blame populations for not following dietary advice if they don’t understand it.
How health literacy is handled in the US
Thankfully, the CDC offers health literacy activities by state in order to improve health outcomes. Health literacy advocates include state and local chapters within academic, government and non-profit spaces.
These agencies operate independently and some are associated with non-profit organizations and/or insurance companies such as Humana. Some states such as Kentucky partner with over 35 organizations to deal with problems and issues surrounding poor health literacy in the Blue Grass state. 2
A few examples of health literacy include offering health information in a person’s native language (such as Spanish or French) or providing information on health conditions using pictures, infographics, or simplified language.
SMOG to lift the FOG
Health literacy experts often use SMOG to put words into a readability formula to make otherwise difficult language (i.e. medical terminology), easier to read. SMOG was developed by G Harry McGlaughlin in 1969 and provides an estimate of the years of schooling an individual requires to comprehend a piece of writing. McGlaughlin utilized the work of Robert Gunning’s Fog Index (developed in 1952) as a basis for his formula. Gunning’s formula includes 6 steps to discover a readability score. According to Gunning, a score of 7 or 8 is ideal and anything in the 12 range is too difficult for most people.
The term SMOG is often seen as praise for Robert Gunning’s Fog Index, although it is often dubbed Simple Readability of Gobbledygook. You can utilize a free SMOG calculator to evaluate the readability of something you’ve written: https://readabilityformulas.com/free-readability-formula-tests.php The tool is designed to help you discover what grade your text is written for. 3
Several other formulas for readability are available including The Flesch Reading Ease Formula, The Flesch-Kincaid Grade Level, The Coleman-Liau Index, and The Linsear Write Formula, to name a few. Most formulas include number of words, sentences, and syllables in a passage to determine the readability score. 4
What can RDs do to improve health literacy?
Be aware that clients may not admit they cannot read or are having difficulty understanding information you’re providing. It may be helpful to ask them how they learn best- through hands on demonstration, oral instruction, infographics or written information.
Ask them about the equipment they have at home and what they’re comfortable cooking with. Inquire about their shopping habits- do they read and understand food labels or need help in this area? It may also be helpful to inquire about other family members and friends when it comes to diagnosis and diet. Do they have anyone in their circle that may be dealing with the same illness, and what do they already know about it? This is where motivational interviewing techniques are key. Less talking and more listening is required.
Dietitians can also utilize the health literacy agencies in their local area or state. You can find a list here: https://www.hrsa.gov/about/organization/bureaus/ohe/health-literacy/index.html