Dealing with low-literate people - People who have trouble understanding information

Dealing with low-literate people - People who have trouble understanding information
When you know or notice that your patient has trouble giving clear information or understanding information, adjust your communication.

Dealing with low-literate people


When you know or notice that your patient has trouble giving clear information or understanding information, adjust your communication.


When people are ashamed of certain complaints, for example of the sexual organs, it can help to show the location of the complaint or the organ. And not in itself, but on an image of a whole body, for example on a plate of Then you look for a picture of the relevant body part or organ and let you point again where exactly the complaint is.


If your patient speaks poor English or can not properly handle the conversation, a family member or caregiver often comes along as an informal interpreter. It is important to have a conversation with the patient, even if the family member interprets or the family member largely does the story. Look and speak to the patient. Announce that you also like to talk to the family member or the supervisor. Below an overview of points of interest in communication.


Points of attention when communicating with low-literate people


 Basic rules

 - Make contact

 - Tune your communication to the person and what happens in the conversation


 - Make (eye) contact; greets people with a friendly face and an open attitude; show understanding for their question or concern

 - Put together 'the diary': determine which topics are discussed


 - Be alert to low literacy; ask for it in a respectful way

 - Speak clearly and not too quickly

 - Use simple words and short sentences, but do not talk childishly

 - Use the words that the patient uses; whether concepts are known

 - Pay attention to signs of dropping out or not understanding

 - Use the tell-show feel-do method

 - Clarify your information with illustrations, icons or demonstration material

 - Sometimes there is special information material for low-literate people available, or for migrants information in their own language; if the patient finds it childish, tell them that it helps you to explain it properly, or use digital means (they are found to be less childish)

 - Limit the information to the main two to a maximum of five points

 - The most important questions are: what is going on? what does the patient have to do himself? why is that important? when should he warn or come back?

 - Use the imperative wise: do this, use every day and so on; that is perceived as clear, not as patronizing

 - Promote the interaction:

 - A. Show that you listen and understand the patient, for example by summarizing or repeating what he says; go into what the patient says

 - B. Encourage to ask questions

 - Repeat the most important points and summarize

 - Use the teachback method: ask the patient to tell the most important things in their own words; say that you do that to check if you have explained it correctly


 - Round off

 - Make an appointment or indicate what a patient can do if...

 - Tell where a patient can find additional information

 - Make sure that the farewell is a good step to a next appointment or a subsequent conversation

 - When the patient has difficulty understanding the time ('ten before half past eleven'), then make an appointment on the whole hour




Assistants often find it uncomfortable to ask for certain things. Or they find it difficult to adjust their familiar way of doing things. In the next frame we give examples of how you can deal in uncomfortable situations with low-latency. The examples are about medication counseling.


Uncomfortable situations with medication counseling

1. Ask for understanding, reading and writing 


Many assistants find it uncomfortable to ask whether the patient has understood the explanation. They do not want to be patronizing. They find it even more difficult to ask whether a patient has trouble reading and writing.   




Explain the reason for your question to yourself. Instead of: "I want to know if you have understood correctly," you say, "I want to know if I have explained it correctly. Can you tell me how you will use the medication at home? "The first few times it may be uncomfortable, but then you notice how it happens and then it gets easier.          


You can bring up reading and writing by first saying that you would like to inform your patients well. 'I would like to give you information, but a lot of people find information on paper difficult. How is that for you? "This is called teach back or reclaim.   


2. It is busy                 


Pharmacy assistants sometimes find it difficult to take the time for additional explanation. Especially when it is busy, it is quite a bit of extra time for a patient to take. After all, many people are waiting and your colleagues are busy too.




Find a suitable moment. In the pharmacy, the mornings are often calmer. You could say, "Can you come back tomorrow morning? Then I can explain it properly. "And then you can take the patient to the doctor's office or instruction room.


It is good if you have made agreements about this in your team. Then everyone knows each other why you sometimes take extra time. Then it is easier to take the threshold.


3. Extra time


A third inconvenience is the time that requires extra explanation, regardless of when you do that.




Think of it as time you invest in the patient, in your care and ultimately in health. That's what you do it for. Eventually the patient will gain health. And come back less often or call with questions and problems. A lot can be gained from chronically ill people. Discuss it in your team. If the team is behind it, you work together. That works better than if you do that on your own.


4. Go to the doctor's office or the instruction room


Assistants often find it uncomfortable to invite a patient to the consulting room or instruction room, especially if there are other patients at the desk. As if something special is going on. What will the patient think if I ask him? And what will the other patients think?




If you ask your patient to come in the morning, it is usually easier to invite him to the doctor's office or instruction room. Explain that it is quieter there and that you have material at hand. If you give extra explanations as a team, it becomes more common for everyone.


You can use the consulting room or instruction room for many more situations than just for inhalation instructions. For example, also if a patient has to use multiple medicines, and for medication evaluation with chronic medication use. Discuss this in your team and make arrangements about it. Then you jointly offer better care.


5. Use icons


It gives pharmacist assistants an uncomfortable feeling to get hold of the desk icons, certainly digitally. You do not want to make anyone feel that he does not understand things. And certainly not if there are other patients.




Make an inventory of which medicines are prescribed a lot. Add some icons to the simple, written information. Print this information and prepare it.


At the counter you can now give information on the basis of the printed information with the icon. People who do not need the icon do not find it annoying that there are icons on the information. Other patients will help if you use icons with your explanation and give them on paper. Icons do not replace your explanation, but help the patient to remember the information at home (


6. Ask if there are any questions


At the end, after you have checked whether the patient has understood the information (teach back), do not ask if everything is clear, but: 'What questions do you still have?'



Supporting their own direction

People with limited health skills can have more trouble to take control and keep their health. You can see this especially with long-term health problems, such as COPD, diabetes, joint complaints and heart problems. Additional support may be required if the health requires extra attention, actions or lifestyle changes. All steps of the information arrow (being open, understanding, wanting, being able to do and continuing to do so) may require extra attention.


Supporting their own direction


 Basic rules

 - Make contact

 - Tune your communication to the person and what happens in the conversation


 - Pay regular attention to adherence and self-control

 - Check whether the patient participates in a care program, which information and guidance the program offers and who performs the support (GP, POH, ...?)

 - Check whether there is a personal health record in which the patient and the care providers work

 - See if there are specific support programs (district, municipality, GGD, social card settings, digital)


 - Be open

 - Make (eye) contact

 - Greet people with a friendly face and an open attitude; show understanding for their question or concern

 - Request permission: "Do you think it's good to talk about ..." or "Can I ask you about ...?" Or "Can I tell you about ...?"

 - Put together 'the diary': which topics will we discuss?

 Core part

 - Pay extra attention to the steps of behavioral change:

 - Go every time how it goes

 - Discuss what goes well and what does not; give compliments about what goes well

 - Find out which step you can strengthen

 - Understand 

 - Do not tell too much at once; repeat next time

 - Use any tools (objects or digital tools)

 - Check whether the patient has understood your information: "I want to know if I have explained it correctly; Would you like to tell me how you will use the medication at home, when you have to call, ...? '

 - Want (decisions, motivation)

 - Let the patient choose from a limited number of possibilities: 'you can do it ... or so ...'

 - Work with small steps that can be done

 - Can and do (skills and obstacles, appointments)

 - Incorporate repetition moments; explain why you do this ('there are easy mistakes in oral care, medication use'); ask the patient to suggest an action

 - Give a compliment for what goes well and correct if necessary

 - Keep doing

 - Discuss situations where it can be difficult to take good care of your own health

 - Consider together with the patient how he can best deal with this


 - If necessary, make a follow-up appointment for further support

 - Agree when the patient needs to contact (earlier)