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Consumer Health: Clear: Conversations: A Project to Help Patients Improve Their Health Visits

Submitted by Michelle Eberle, AHIP, National Network of Libraries of Medicine, New England Region, University of Massachusetts Medical School–Worcester; Margot Malachowski, Health Sciences Library, Baystate Medical Center, Springfield, MA; Judith Kronick, Healthnet: Connecticut Consumer Health Information Network, Library, University of Connecticut Health Center–Farmington; Monina Lahoz, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA; Linda McIntosh, Boston, MA; Bradley Moore, Boston Public Health Commission, Boston, MA; Alberta Richetelle, Healthnet: Connecticut Consumer Health Information Network, Library, University of Connecticut Health Center–Farmington; and Jen Searl, Maxwell & Eleanor Blum Patient and Family Learning Center, Massachusetts General Hospital, Boston, MA

The Health Literacy Community of Interest of the National Network of Libraries of Medicine, New England Region (NN/LM NER), conducted Health Literacy Missouri’s Clear: Conversations project from August 2012 to May 2013. Five organizations were awarded the materials and the opportunity to meet regularly via teleconference to plan their programs and learn from each other’s experiences. Awardees included the Boston Public Health Commission, a Boston area registered nurse, the Massachusetts College of Pharmacy and Health Sciences, the Massachusetts General Hospital Blum Patient and Family Learning Center, and Healthnet, the University of Connecticut Health Center Library’s consumer health program.

The Clear: Conversations program brings together patients to learn important health literacy skills including how to ask for simple language, slow down the provider, use teach-back, get need-to-know information, and bring medications or supplements for review [1]. The highlight of the program is role playing of a health care visit. Participants observe the role playing and share their thoughts on how to improve the experience. Health Literacy Missouri’s Clear: Conversations Guide includes a training guide, checklists, cases, materials, and resources.

The Clear: Conversations program was offered at a variety of venues in New England including the Boston Healthy Start Initiative, the Maxwell and Eleanor Blum Patient and Family Learning Center, a family life education center, and several senior centers. Each organization altered the Clear: Conversations program to better meet the needs of their own events. Some events attracted a large number of participants; others were more intimate. At all events, the role playing with the health care provider actor was identified as a peak experience. The role of health care provider actor was filled by a mix of professionals, including doctor of pharmacy candidates, a third-year medical student, and a retired physician. The health care provider actors expressed how this experience was meaningful and would make a difference in how they provide care.

Fifty-nine participants completed pretests at the Clear: Conversations programs. An additional fifty participants attended one class but did not complete the pretests. Of fifty-nine participants completing the pretest, the following percentages responded yes when asked:

  • When you left the doctor’s office did you:
    • feel you and your doctor truly understood each other: 71%
    • feel satisfied with the conversation your had with your doctor: 66%
    • feel you knew 2–3 important things to do to take care of your health: 75%
    • wish you had asked more question: 59%
  • Of 44 participants completing post-tests, the following percentage responded that the workshop improved their comfort level with:
    • having a list of questions to ask their doctor: 95%
    • asking questions: 98%
    • asking their doctors to slow down when they were speaking too fast: 91%
    • asking their doctors to repeat something they did not understand: 95%
    • asking their doctors to use words they can understand: 88%
    • repeating what they think the doctor said to make sure they understood: 90%
    • bringing medicines and supplements they regularly take to explain to their doctors how they took each medicine: 90%

Twenty four participants shared a specific action they would take as a result of the workshop. Specific actions shared included:

  • Ask my doctors to explain medical terms I do not understand and to use words I understand.
  • Make a list and prioritize it.
  • Go prepared. Make sure I’m given enough time. Make sure I have adequate follow up.
  • Ask more about what I don’t understand.
  • Repeat back what the doctor said to make sure I understood it. Be more assertive with questions to ask the doctor.
  • Have a better relationship with my doctor.

NN/LM NER’s Clear: Conversations project provided the opportunity for collaboration between a cross-disciplinary group of health information providers. Several of the project leaders have continued to offer the program in their communities. Together, the group cultivated their health literacy training skills and empowered patients and families with tools and skills to create better health care visits.


  1. Health Literacy Missouri. Clear: conversations, a guide to delivering Health Literacy Missouri’s exciting interactive workshop that teaches patients to take control of their health visits. St. Louis, MO: Health Literacy Missouri; Mar 2012.

The project was funded under contract HHS-N-276-2011-00010C with the University of Massachusetts Medical School and awarded by the US Department of Health and Human Services, National Institutes of Health, National Library of Medicine.