Chronic pain is a common reason for patients to seek medical treatment from health professionals such as physical therapists. In fact, twenty percent of the United States adult population experiences chronic pain according to 2016 data (1). Pain is multifaceted, and the pain experience is unique to each individual, making it impossible to establish a “one size fits all” treatment course that is widely successful. So, how does an individual’s health literacy play into their treatment plan?  A person’s beliefs and understanding of their own condition is a crucial element of the pain neuromatrix and it is imperative that it is taken into account throughout treatment (2). A patient’s perception of their pain and what course of action they should take is one element of their health literacy.

WHAT IS HEALTH LITERACY?

The World Health Organization defines health literacy as “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” (3). Thirty six percent of adults in the United States are considered to have basic or below basic levels of health literacy (4). A person’s health literacy naturally influences the choices they make in managing their own health and when to seek out medical services. Lower health literacy is associated with decreased health-related knowledge and overall poorer health status (5).  

HOW PAIN AND HEALTH LITERACY ARE ASSOCIATED

A 2017 study in the Central European Journal of Medicine further investigated the possible relationship between health literacy, pain intensity, and pain perception. The study included 121 participants between the ages of 18-65 who experienced chronic pain, defined as pain lasting longer than three months. Participants answered health literacy screening questions, rated their pain intensity on a visual analog scale, and reported their pain perception through the Short-Form McGill Pain Questionnaire. Participants were also asked where they normally obtain information regarding their pain or condition.

Results of the study showed that lower levels of health literacy were associated with higher pain intensity ratings on a visual analog scale. Interestingly, there was no correlation found between literacy and pain perception or literacy and pain duration. Level of education was found to have an influence on health literacy, which is consistent with other research regarding the topic.

THE HEALTHCARE PROFESSIONAL’S IMPACT ON HEALTH LITERACY

In the previously mentioned study, the majority of participants reported they received most of their information regarding their condition from their doctors (6). This brings about a very important question:

Is the information provided to patients effective in enhancing their understanding of their condition and does it empower them to use this information to manage their health successfully?

Many patients struggle to understand instructions given to them from their physician (7). Many people have had an experience where it was easier to nod your head then to ask questions because you would not even know where to begin. Using medical terms, delivering too much information, and misinterpreting a patient’s understanding are some examples of communication missteps that occur when delivering patient education, which in turn shapes a patient’s health literacy. This is why healthcare professionals play an integral role in developing a patient’s health literacy (6). 

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5 WAYS TO ENHANCE COMPREHENSION AND HEALTH LITERACY FOR PEOPLE WITH PAIN

Delivering effective treatment to help improve a patient’s health literacy not only consists of education regarding their pain and condition, but also pain management strategies that encourage taking an active role in their healthcare. Passing the responsibility onto doctors in addition to personal motivation, and resistance in accepting their condition are all factors that inhibit the development of literacy (8). Better pain management and knowledge about it has been found to be associated with decreased pain intensity as well as higher levels of health literacy (6, 9, 10).

Here are five strategies and techniques to enhance patient comprehension and understanding (11)

1. Use of visual aids
2. Teach-back method
3. Stick to a few key points
4. Avoiding medical terminology
5. Utilize principles of CBT, motivation and behaviour change

Patients are more likely to adhere to self-management strategies when they understand the concepts behind them. In addition to these strategies, it is paramount to deliver care that is individualized toward the patient. Treatments will have increased meaning when tailored to a patient’s values, goals, and beliefs. Tools such as motivational interviewing can be utilized to dig deeper and explore why a patient may be resistant towards accepting their condition, or what may have led to non-compliance with previous self-management strategies. Open communication between a healthcare professional and their patient fosters trust and rapport and can bring about meaningful conversations that may not have occurred otherwise.

Shelby McClure is a third year Doctorate of Physical Therapy student at Augusta University in Augusta, Georgia and will be graduating in May of 2020. She completed her undergraduate education at Auburn University in Alabama where she earned a B.S. in Fitness, Conditioning, and Performance in addition to a B.S. in Nutrition and Wellness.

Shelby began dancing at a young age which helped to shape her initial interest in health. During college, she worked as a dance instructor as well as a group fitness instructor, which eventually led her to pursue a career in physical therapy. 

Throughout her time at Augusta University and subsequent clinical rotations, Shelby realized her passion for pain science and psychologically informed physical therapy. Shelby is currently completing a 4-week elective with the Integrative Pain Science Institute prior to her graduation.

Shelby is from the Atlanta, Georgia area where she currently resides with her husband of 2 years.

To learn more about Shelby, visit her LinkedIn.

REFERENCES

1. Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, Kerns R, Von Korff M, Porter L, Helmick C. Prevalence of chronic pain and high impact chronic pain among adults – United States, 2016. MMWR. September 14, 2018. [Epub ahead of print.]
2.  Louw, A., Schmidt, S., Puentedura, E. and Zimney, K., 2018. Pain Neuroscience Education. 2nd ed. Minneapolis, MN: OPTP, pp.1-30.
3. WHO. Health literacy and health behavior. 2009. http://www.who.int/healthpromotion/conferences/7gchp/track2/en/. Accessed 31 March 2020
4. National Centre for Education Statistics. The national assessment of adult literacy (NAAL);2003.
5. BerkmanND, SheridanSL, DonahueKE, HalpernDJ, Crotty K.Low Health Literacy And Health Outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. https://doi.org/10.7326/0003-4819-155-2-20110719000005.
6. Köppen PJ, Dorner TE, Stein KV, Simon J, Crevenna R. Health literacy, pain intensity and pain perception in patients with chronic pain. Wien Klin Wochenschr. 2018;130(1-2):23–30. doi:10.1007/s00508-017-1309-5
7. Briggs AM, Jordan JE, Buchbinder R, Burnett AF, O’Sullivan PB, Chua JYY, et al. Health literacy and beliefs among a community cohort with and without chronic low back pain. Pain. 2010;150:275–83.
8. Edwards M, Wood F, Davies M, Edwards A. The development of health literacy in patients with a long-term health condition: the health literacy pathwaymodel. BMC Public
9. Devraj R, Herndon CM, Griffin J. Pain awareness and medication knowledge: a health literacy evaluation. JPainPalliat Care Pharmacother. 2013;27(1):19–27. https://doi.org/10. 3109/15360288.2012.751955.
10. Joplin S, Van der Zwan R, Joshua F, Wong PKK. Medication adherence in patients with rheumatoid arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. BiomedResInt. 2015;https://doi.org/10.1155/ 2015/150658.
11.  Kountz DS. Strategies for improving low health literacy.Postgrad Med. 2009;121(5):171–7. https://doi.org/10. 3810/pgm.2009.09.2065.