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Darren DeWalt
As a chemical engineering student at UCLA, Darren DeWalt was interested in health care helping people. As a medical student at Vanderbilt, he became passionate about studying the relationship between socioeconomic status and health. Then he came to Carolina for a combined residency in internal medicine and pediatrics.
“I was very interested in why poor people were always sicker than rich people and understood that it wasn’t just a question of access to care. There were other things going on, which we needed to understand,” says DeWalt, assistant professor of medicine in UNC’s Division of General Medicine.
At Carolina, he came across the concept of health literacy – how well people understand doctors’ instructions and other health information. Studies conducted nearly two decades ago showed a correlation between low literacy levels and poor health outcomes.
At the same time, researchers realized that patients of all literacy levels were struggling to understand health-care issues. Some patients remember about half of what their doctors say, and the part they remember is often not entirely correct, DeWalt says. “We realized we needed to think about how patient care in general is designed. Could we make everything we do more user friendly?”
Fast forward to March 2010 when the Health Literacy Universal Precautions Toolkit, developed by UNC School of Medicine faculty members for the federal Agency for Healthcare Research and Quality (AHRQ), was released. DeWalt was the lead author for the toolkit, designed to help primary care doctors and their staffs communicate more effectively patients.
The researchers worked with nine different community practices around North Carolina to develop and test the toolkit in various health-care settings. Within the first month of its release, the toolkit received 15,000 hits online.
“If I’m trying to explain to you how to take care of your blood pressure or diabetes, the only way I can know if you understand is to ask you to teach it back to me, to tell me what you’re going to do when you get home and how you’re going to take these medicines,” DeWalt says.
Helping patients become better informed and take an active role in managing their health leads to better outcomes, he says. Patients with diabetes don’t have to understand how the pancreas makes insulin, but they need basic information and understandable instructions for keeping their blood sugar levels in check, DeWalt says.
“As a doctor, you have to ask yourself if the patient really understands what they need to know and to do. To me, that changes the whole conversation.”
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