Practicing Asking Questions

Patient communication is a huge part of health literacy. While the doctor has a significant responsibility to make sure things are communicated effectively regarding procedures and impediments to a patient’s health, patients also have a responsibility to talk to their doctors to make sure they understand what is going on and to make sure it is the best course of action for them.

As a literacy provider, ABE or ESOL, take the moment to incorporate this aspect of health literacy into your curriculum. Have your students create dialogues to practice a conversation with a doctor, dentist, or nurse. Brainstorm which questions you would like to know the answers for. If you get stumped, check out the AHRQ list of 10 Questions You Should Know. AHRQ also has a list of questions to ask before, during, and after your appointment. They also put together a video of patients and clinicians discussing the importance of asking questions. It should help calm the nerves of anyone who is worried about questioning someone as smart as a doctor.

It is important to let your students know that it is okay to question a doctor. Their health and well being are very important. Also let them know that everyone gets nervous. Helen Osborne is a Health Literacy Consultant with a background in medicine. In one of her blog entries, she documents how even she felt lost and nervous talking to doctors when she was a patient. In that post, she also documents important information patients should keep with them when they go to appointments. It is a good list to suggest to your students.

If you still aren’t sure what to do, review the Virginia’s Adult Learning Resource Center’s toolkit on “Tips for Talking with the Doctor.” It is focused on ESOL learners, but the information is appropriate for all students.

Thank you to Florida Blue for providing FLC resources to improve health literacy. 

Health Insurance Literacy

The Affordable Care Act has created an opportunity for millions of people who were previously uninsured to receive health insurance at an affordable rate. Many of these people have never had insurance before, or had parents who received insurance through their job, and are not familiar with common insurance terms. While getting people enrolled is the main focus of navigators and community based organizations, understanding what you purchased and using it is another problem to tackle. Understanding your insurance plan will help your students save money. It will take time, and your students might need a cheat sheet when they look at their new insurance bill, but it is worth starting now as you are discussing health insurance.

Here are a few common insurance terms to start explaining. I got this from a packet created by the University of Maryland.

Essential Health Benefits
Your insurance must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventative and wellness services and chronic disease management; and pediatric services, including oral and vision care.

Preventative Services
Most health plans must cover a set of preventative services like annual check-ups, shots, and screening test at no out of pocket cost to you.

The facilities, providers and suppliers your health insurer or plan has contracted to provide health care services.

Primary Care Provider
A Doctor, nurse practitioner, clinical nurse specialist or physician assistant who provides , coordinates or helps a patient access a range of health care services.

A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.

Urgent Care
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.

The amount that must be paid for your health insurance plan. Premiums may be shared between you and your employer.

Out-of-pocket costs
Your expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus costs for services that aren’t covered.

The amount you owe for covered health services before your health insurance plan begins to pay.

A fixed amount you pay for a covered health service, usually when you get the service.

Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service.

HMO (Health Maintenance Organization)
A type of plan that usually limits coverage to care from doctors who work for or contract with the insurance company. It may require you to live or work in the insurance’s service area to be eligible for coverage. You may have to see your primary care provider before seeing a specialist.

PPO (Preferred Provider Organization)
A type of plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network, but you can use providers outside of the network for an additional cost.

POS (Point of Service)
A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plans network. They may also require you to get a referral from your primary care doctor in order to see a specialist.

Video explaining the changes to health care

A recent study shows that 40% of Americans do not know that the Affordable Care Act is a law. As community-based organizations and schools working with those who are affected the most by these monumental changes to our health system, it is important to relay accurate information.

Start by watching this video with your students. Charlie Gibson explains what the changes mean for different people. This should spark some discussion. From there, check out or other resources from the Kaiser Foundation to go into detail about the changes.

Health Literacy Resources- August 25, 2013

With the Health Insurance Marketplace opening in October, several public health organizations are putting together materials that will help people navigate the system. If you haven’t already done so, watch a webinar from the Centers for Medicaid and Medicare Services. They’ll go over what users can expect and the resources that will be available to help in the navigation. Watch it with your students and have them write down questions to ask a navigator. Go over the questions with your students to make sure they feel comfortable asking someone when the time comes.

Here are a few other resources available for your students-

Protect Yourself from Fraud in the Health Insurance Marketplace
English and Spanish

Department of Health and Human Services Launches Health Insurance Marketplace Educational Tools

Guide to Patient and Family Engagement in Hospital Quality and Safety


Thank you to Florida Blue for providing FLC resources to improve health literacy. 

FLC Hosts its First Health Literacy Summit

Health Literacy Summit Opening SessionLast Friday, FLC hosted its first ever Health Literacy Summit at the University of Central Florida’s Morgridge International Reading Center. About 175 professionals from the health care and education fields joined together to discuss strategies on how not only to better educate their patients and consumers, but how to better their systems as well.

Our keynote speaker, Dr. Andrew Pleasant, drew on this point when he compared the 2-page form banks had to complete to apply for a bailout to the 10+ page form which Florida residents must complete to apply for food assistance. He alluded to lengthy health forms containing gratuitous verbiage, much of which are incomprehensible to people with literacy skills below the 10th grade level. In fact, the most recent national survey’s results showed that less than 15% of Americans are among the highest level of health literacy required to navigate the health system successfully. Clearly, the system needs to be changed.

The discussion continued throughout the day as concurrent sessions broke out, giving individuals the freedom to choose which session they’d like to attend. Presenters from rather diverse backgrounds shared their knowledge, led discussions and provided health literacy resources to participants.

After lunch, attendees filed into the auditorium to join in the discussion with a panel before breaking out into one final round of concurrent sessions. Finally, Executive Director Greg Smith gave some last remarks and attendees were able to hear a an adult learner, Fatima Freire of GROWS Literacy in Apopka, share her story and experience with the Staying Healthy curriculum. Her words were inspiring and reminded everyone how important it is to address the issue of health literacy.

A special thanks to our presenters, keynote speaker Dr. Andrew Pleasant, attendees, our partner organizations, and of course our sponsors: Winter Park Health Foundation and Allegany Franciscan Ministries.

Eat This, Not That for Health Literacy

Several Florida Blue Grantees have been working with their students on healthy alternatives to household favorites. Students create recipe books and have started gardens with these new alternatives. Many students indicated in surveys at the end of the course that they were interested in more substitution suggestions. Substitutions and tasty alternatives to foods you already enjoy are a good way to transition into a healthy lifestyle. Switching to a limiting diet might help lose weight in the short run, but ultimately fails because its not a lifestyle switch. I also know several people who would get depressed eating bland food and binge on junk food once given the chance, neither of which are healthy or sustainable.

Eat This, Not That is a book created by Men’s Health that helps you choose between two similar items by evaluating nutrition facts. The key word is similar. It’s not asking you to choose between a fresh made black bean burger and a Big Mac, but between the Big Mac and Angus Deluxe at McDonalds. This might be a good book or website to go through with your students as you introduce the importance of nutrition labels. They also have a game if you want to make it fun 🙂

After you review a few of the food options, create your own Eat This, Not That. Ask your students where they like to eat or what types of foods they like to buy from the grocery store. Then go to the website for these brands and print out a few nutrition labels. Review the labels with your students by looking at calories, grams of fat, grams of saturated fat, carbs, protein, and sodium. Decide as a class which is the better option and why. You can then have them take the game home and report back which foods they substituted for others and their opinions on taste or even healthier options.

Join FLC for the First Annual Health Literacy Summit!

Join us for the 2013 Florida Health Literacy Summit.  This one-day event will provide a forum for educators, health professionals, and other interested stakeholders to engage in a dialog and share information and resources on how to effectively serve adults and families with low health literacy.
Topics covered will include:

  • Creating Plain Language Health Materials
  • The Teach-back Method for Effective Patient Communications
  • The High Cost of Low Health Literacy
  • The Health Literacy Universal Precautions Tool-kit
  • The Florida Health Literacy Initiative
  • Building Health Literate Organizations
  • The Implications of Health Literacy on Health Policy

Registration Fee:
$15 (includes lunch and parking)

Morgridge International Reading Center
University of Central Florida
4000 Central Florida Blvd. Bldg 122
Orlando, FL 32816

Date & Time:
July 26, 2013 • 9am – 3:30pm

This event is made possible through the generous support of

Health Literacy Summit Partners

Florida Nurses Association

Florida Blue

Tampa Bay Community Cancer Network (TBCCN)

Florida Department of Health-Hillsborough County

Suwannee River Area Health

Education Center, Inc.

Florida AHEC Network

Florida Public Health Association, Inc.

Florida State College at Jacksonville

West Area Adult School

Check back to this website in June for additional details on the Summit.

If you have questions, please contact Camille Davidson at
or by calling 407-246-7110.

Health Literacy and Sunscreen: The Important Letters to Know

Especially in Florida, summertime means sunscreen season.  It’s important to protect your skin when you’re outdoors, as well as knowing how to pick the correct sunscreen and how to apply it.  According to the American Academy of Dermatology, there are a few basics that you, your students, and their families need to know.

Always read sunscreen labels, and only use products that offer:

  • Broad-spectrum coverage (label may say “broad spectrum,” “protects against UVA/UVB” or “UVA/UVB protection”).
  • SPF of 30 or higher.
  • Water resistance.

Main messages to get across to students-

1.  Apply sunscreen (absolute minimum SPF 15) at least 15 minutes before you go outside.

2.  Re-apply sunscreen every two hours when outdoors.

3.  Use plenty of sunscreen to obtain maximum protection.  This is usually one ounce for the entire body, or the amount that can fill one shot glass.

3.  Whenever your shadow appears to be shorter than you are, find shade.

4.  It’s not just about sunscreen.  Wear protective clothing, including long sleeves, pants, a wide-brimmed hat and sunglasses.

5.  Avoid the sun between 10 A.M. and 2 P.M. if possible.

The Florida Health Literacy Initiative is accepting applications for the 2013 Health Literacy Grants




Florida Blue and the Florida Literacy Coalition are pleased to continue the Florida Health Literacy Initiative, providing grants up to $5,000 to support health literacy in adult ESOL and family literacy programs.

Low health literacy costs between $106 to $236 billion a year in the form of longer hospital stays, emergency room visits, increased doctor visits, and increased medication, according to a recent report from the University of Connecticut.  Adults with low literacy levels often fail to engage in early detection and preventive health care.  They also have significant difficulties navigating the health care system and following their doctor’s treatment plans.

The Florida Health Literacy Initiative provides training, resources, and funding to assist Florida ESOL and family literacy programs to integrate health education into their instruction.  The objective is to help students develop basic literacy and English language skills while gaining information to make informed choices regarding their health and nutrition.

Applicants must be nonprofit or government-based organizations providing adult ESOL and/or family literacy instruction in Florida.  Services may be delivered via classes, small groups, and one-to-one tutoring.

Click here for the application and grant guidelines.  Proposals must be received by March 19, 2013 by 5:00 pm.

A conference call will be conducted for prospective applicants on February 13, 2013 from 10 am to 11 am to provide an overview of the grant application and to answer questions.  Participation is optional.

Dial-in Number1-800-930-8721
Access Code6577983

If you have any questions, please contact Maribeth Buie at 407-246-7110 ext. 209 or via email at

Substitution Resolutions: Health Literacy and the Holidays

Dr. Maribeth Buie

Dr. Maribeth Buie

Season’s Greetings, or Season’s Eating?  This time of year is renowned for excess – excessive decorating, excessive gifts, and excessive eating.  Eating, however, is not only about the food.  Eating revolves around tradition, culture, and fellowship.  Traditional dishes vary from home to home, but the holiday season is an optimal time to help your students discover the joys of learning through cooking.

Recipes can be a great teaching tool for your students to impart measurement, math, and healthy eating skills.  Knowing how to measure food and medicine is important, such as knowing the difference between a tablespoon (T or Tbsp) and a teaspoon (t or tsp).  Recipes often require math skills, such as working with fractions when doubling ¾ cup of flour or converting 12 ounces to 1 ½ cups.  Healthy eating is only a step away when using easy substitutions to lighten up the calorie/fat load without losing flavor.  For example, unsweetened applesauce may be substituted for oil or butter in sweet or savory dishes.  Greek yogurt is a great base for creamy dips instead of mayonnaise or sour cream.  In addition, low-fat or fat-free dairy products (skim or 1%-milk, low-fat or fat-free sour cream, and low-fat or part-skim cheese) may easily be substituted for their higher fat counterparts.

Below are two examples of traditional holiday foods in my home (yes, I’m from the south) – the original recipe is provided alongside a lighter version.  In both cases, the lighter version tastes just as good without the guilt (you can eat them all year long)!  Try this substitution exercise in the classroom (and on your own), and reap the rewards of learning via class cooking demonstrations or a potluck dinner – bon appétit!

Sweet Potato Casserole
Original Recipe Lighter Version Recipe
2 cans yams, drained, mashed 3 cups sweet potatoes, cooked and mashed
1/2 cup sugar Honey or low-glycemic sweetener to taste
2 eggs 1/2 cup chopped nuts
5 Tbsp butter 3/4 cup unsweetened applesauce
1/2 cup raisins (plumped) 1/2 cup raisins (plumped)
2 Tbsp frozen orange juice 2 Tbsp frozen orange juice
Beat ingredients together, and place in a greased casserole Stir ingredients together. Serve Warm
Top with: 1/4 cup melted butter, 2 Tbsp flour, 1/2 cup brown sugar, 1/2 cup chopped nuts * Note: I use the microwave to cooke the potatoes, pegans for the nuts, and Splenda for sweetener- that is personal preference of course.
Bake at 350 degrees for 35-45 minutes
Frozen Cranberry Dessert
Original Recipe Lighter Version  Recipe
1-16 oz. can whole cranberreis with sauce 1-16 oz. can whole cranberries with sauce
1- 8 oz. package cream cheese 1-8 oz package fat-free cream cheese
3 Tbsp sugar 1/2 cup pecans chopped
2 Tbsp mayonnaise 1 small can crushed pineapple
1/2 cup pecans, chopped 1- 8 oz. container Cool Whip Free or alternative light whipped cream
1 small can crushed pineapple
8-oz. whipped cream
Beat cream cheese, sugar, and mayonnaise together. Add craberry sauce, drained pineapple, and nuts- mix well. Fold in whipped cream. Freeze. Beat cream cheese. Add cranberry sauce, drained pineapple, and nuts- mix well. Fold in whippped topping. Freeze.