Just a quick response.  While red flags or cues are good, I generally
find that everyone appreciates a picture along with an oral explanation.
When I draw them I put it on the back of the paper that our patients are
going to be taking home anyway so that they have it at hand to look at
later. Barbara Bayldon 

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
Sent: Friday, October 19, 2007 12:48 PM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 1414] Re: Use of pictures for Deaf and
hearingpatients

Howard,

Thanks for bringing up the issue of different learning styles, such as
visual, auditory, and kinesthetic. This is something that teachers are
often aware of, but the medical community may not be. (This is one
reason why collaborations between adult literacy programs and health
programs can be so helpful to everyone involved!)

I would love to know how you became aware of this phenomenon, and how
you learned to recognize when you are talking with a visual learner?
What cues do you look for?

I love that you draw pictures during an explanation, and agree that this
act is a "symbol of personal care", AND will help the patient to retain
the information better. But for those clinicians who are not comfortable
doing that, how else could they access visuals quickly to help with an
explanation? 

Such as...
* lots of posters on wall
* collection of good brochures/fact sheets with pictures to point to
* index card file with variety of pictures you could refer to
* other ideas?

Thanks again for a great example of clear communication!

Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> "Zeitz, Howard" <hzeitz at uic.edu> 10/19/07 11:55 AM >>>

When working as a clinician doctor (Latin root = teacher), I "teach" all
day long. (In my world, teach=helping someone understand something.)

I hand-draw pictures most of the time, and I use file pictures once in a
while. The common phrase is "a picture is worth a thousand words"; in
the medical world, a picture is worth a million words. Teachers
sometimes talk about people either as visual learners, auditory learners
or kinesthetic learners. Pictures are ESSENTIAL/MANDATORY for visual
learners. Through practice I can now recognize easily when I am having a
conversation with a "visual learner"; I immediately start drawing
pictures, then talk from the pictures--adding labels as I talk. Finally,
the act of creating the picture on the spot carries the symbol of
personal care (this is not an off-the-rack picture that everyone
receives, this is MY picture). The picture then goes home with the
individual to help them share what they learned with other family
members.

Kinesthetic learners need models they can touch and/or manipulate.
Auditory learners do not need pictures and/or models, but their learning
is deeper and broader with pictures and/or models. Individuals with
auditory disabilities MUST have pictures and/or models.

There are several reasons why these strategies are not used more often.
The most commonly cited reason is the time it takes to help someone
truly understand something; time is money in the modern world and
reimbursement for healthcare education is not reimbursed well if at all
in most healthcare scenarios. Perhaps an even more common but
unacknowledged reason is that most clinicians have little if any
training in teaching and LEARNING. If the clinician knows nothing about
learning, s/he cannot possibly appreciate the value of pictures in
medical/health education.
Both of these root causes are remediable---but only with the development
of the political will to make it happen.

Howard J Zeitz, MD
Co-Chair, Rockford Regional Partnership for Health Literacy (RRPHL)

Medical Director, Asthma and Allergy Services University of Illinois
College of Medicine--Rockford

========================================================================
====

On Fri, October 19, 2007 7:48 am, Julie McKinney wrote:

> Thank you, Nancy, for sharing with us this eye-opening information 

> about health literacy issues for the Deaf community. It certainly 

> seems like more efforts need to be initiated in this area. I have many



> questions, but for now I want to stick to those that relate to 

> communication between the patient and the health team.

>

> How effective is it with Deaf patients to pair pictures with the 

> information that is being translated? It has been shown in hearing 

> patients that the use of pictures can improve compehension and 

> especially recall of the information.

> (See:  http://healthliteracy.worlded.org/doaks_houts_article.pdf )

>

> This is a question that I want to bring up for everyone now. We have 

> not yet talked about the use of pictures while communicating, yet they



> have been found to be enormously effective not just in take-home 

> materials, but during a clinical encounter as well. How many of you 

> (whether as a patient or health professional) have experienced using 

> pictures during a visit while communicating? How well has it worked 

> for you? Why don't we do it more often?

>

> I would love to hear some responses to these questions!

>

> Thanks all,

> Julie

>

> Julie McKinney

> Discussion List Moderator

> World Education/NCSALL

> jmckinney at worlded.org

>

>>>> "Nancy Meyers" <njmeyers at gmail.com> 10/17/07 4:43 PM >>>

> I would like to briefly comment on a couple of the topics that have 

> come up.

> My primary experience has been with the Deaf Community in the area of 

> health education and health literacy. First, health literacy assumes 

> English literacy for non-English users. It helped a great deal when I 

> told an audience of Deaf people that most medical terms are from 

> Latin. We break the long words apart. Cario=heart, 

> pulmonary=breathing/lungs etc. This helps expand their knowledge "in 

> context" of one topic. Second, "Teach Back" is not as effective or 

> reliable when the physician/health professional is completely 

> dependent on an interpreter. It is difficult to measure comprehension 

> when all that is happening is the information is coming back through 

> an interpreter. With American Sign Language this is particularly true.



> In 2002, Sinai Health System in Chicago interviewed (in ASL) 204 

> adults here are examples of the results: "Forty percent of respondents



> could not list any symptoms of a heart attack, while over 60% could 

> not list any symptoms of a stroke. Less than half of respondents 

> identified chest pain/pressure as a symptom of a heart attack. Only 

> 61% reported that they would call 911 in response to cardiovascular 

> disease symptoms." Some people's health literacy is so low, that 

> nothing short of someone from the culture teaching in the native 

> language can fill the gap. For Deaf people, that means more Community 

> Health Workers (3 in the whole of the US is not much), ALL health 

> information in ASL which means video. Finally, the issue of people 

> learning more about how to advocate for themselves. Deaf people do not



> want to ask too many questions because if the physician comes back 

> with another question, they will not be able to answer it. Without 

> knowledge and access to information we cannot expect people to 

> advocate...complain sometimes...but not advocate. With HIPPA and other



> "restrictions" health advocates and even chaplains are finding it 

> difficult to visit and serve as support people. I recently was with a 

> Deaf breast cancer survivor who is in her 3rd bout with cancer. She 

> attended a conference we organized with oncologists etc. One topic the



> Deaf women wanted to learn about was lymphedema. Sitting there with 

> her arm and hand swollen she asked, "Do you think that is what I 

> have?" How could she have cancer for the 3rd time and no one has 

> explained to her what that is. Currently we are making a documentary 

> about Deaf Breast Cancer Survivors and interviewing these women.

> Their stories are eye openers into all the questions posed about the 

> environment. I think the lessons and learnings with this population 

> are transferrable to many.

>

> Nancy Meyers, MS

> Consultant to the Deaf Community

> Founder of the Deaf Hospice Education & Volunteer Project

>

>

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>> --

>> Archie Willard

>> URL - http://www.readiowa.org/archiew.html

>>

>>

>>

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>> National Institute for Literacy

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>>

>>

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>>

>>

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>> National Institute for Literacy

>> Health and Literacy mailing list

>> HealthLiteracy at nifl.gov

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>

> ----------------------------------------------------

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> Email delivered to hzeitz at uic.edu

>

>



Howard J Zeitz, MD
University of Illinois
1601 Parkview Ave
Rockford, IL 61107
T: 815-395-5964
F: 815-395-5671

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