From Health Literacy…
After two questions last week, a moment to pause on this single, key question – Question 6 in The Eight Great Questions from The Explain Pain Assessment*.
Health literacy is the ability to seek, understand and utilise health information, and is important for good health. By extension pain literacy is the degree to which a person is able to obtain and process pain related health information. In Australia where there has been large population studies, we are aware that around 60% of Australians have less than optimal health literacy. There’s no population data specific to pain literacy but many people hold fundamental misconceptions about pain – for example that pain is a direct measure of tissue injury, with pain receptors sending pain signals to the pain centre in the brain (and it’s not just patients who hold these misconceptions…).
…To Pain Literacy
It’s not easy to determine an individual’s pain literacy – there’s no single measure for it (although the Revised Neurophysiology of Pain Questionnaire may be part of a larger assessment). But there are a few questions to add that will help you form a sense of where a patient might be coming from. No surprises – the key is to listen, really listen, to the responses:
Tell me what you understand about the problem?
What’s your theory about what is making you hurt?
What do you know about your diagnosis?
How do you think I can help?
Most patients have answers to these questions, although it can take some careful and respectful questioning to elicit them as some people will be worried about being made to look silly (perhaps based on past experience within the health system).
But caveat questioner – here’s a common response that we’ve found – I don’t know what’s causing it – you’re supposed to be the expert… You’ve probably heard this from time to time? We might respond, respectfully, with something like:
Thanks! I am also very interested in what you think is going on because this is a really helpful indicator of how your brain will be processing all kinds of information from, and about, your body
That last response is also a gentle way to start introducing some Explain Pain content – do you see what we did there!
What’s your experience of patients’ health literacy? How have you dealt with difficult responses to questions when you’ve tried to elicit a patient’s understanding of pain? Comments welcome below.
Knowledge driving health