Consumer Education Initiatives in Financial and Health Literacy. Lessons Learned Relating to the Source of the Initiative


Health educators and financial educators have different training, backgrounds, culture, and capabilities affecting the way in which they inform and support individuals. Clinical providers (e.g., doctors, nurses, pharmacists) as well as dieticians, and health educators, have rigorous and consistent training across the country (HHS, CDC, National Center for Health Statistics [NCHS], 2010). Financial educators, although they have on average 12 years of experience (Lyons, Palmer, Jarayatne & Scherpf, 2006), do not have training that is comparable to that of clinical providers or other key health educators. While there is certainly financial education certification, someone who provides financial education does not need certification, and the certification process is not consistent. This is not to say that, by default, clinical providers always inform and engage consumers and financial educators do not, but clinical providers are more consistently and rigorously trained and thus have the knowledge to educate patients.

Medical and financial problems are generally communicated in very different ways. In the case of financial literacy, news such as a rejection of credit or other problems with credit may be conveyed by letter, over the phone, or in person. The individuals delivering this information may be experienced  or not  and they may not be trained to provide the information, regardless of experience. The individuals delivering this information may perceive that training, educating, or counseling consumers is not their role or responsibility. The individuals delivering the news may not provide potential solutions or strategies to improve the situation, and these individuals typically lose interest in serving the client. Interactions with the financial industry are relatively impersonal and fragmented. If a person seeks a credit card, it is typically through the mail or online. While opening a bank account generally involves face-to-face interaction, it is a one-time event and the bank staff is likely to be focused on gathering the required information rather than encouraging questions and providing education.

In contrast, in health literacy, those providing news such as diagnosis of a chronic or life-threatening disease or problematic lab work results are typically trained clinicians and usually give the news in person or over the phone and also in writing afterward as a confirmation, although they may not communicate well. In many cases when giving serious or potentially upsetting news, clinicians are trained to provide support and/or options (although they may not provide the support or options). Data from the consumer perspective also supports a related finding: Almost 70% of participants in the Health Information National Trends Survey stated that they trusted the information from their doctors a lot (HHS, NCI, 2009).

Another example of the difference between financial and health educator culture is fraud: Both have fraud, but within medicine, fraud and abuse are typically aimed at the payer (e.g., health insurance agency, Medicare, Medicaid) and not the individual. Much of the fraud in financial literacy is aimed at the consumer (e.g., investment fraud and mortgage information). Thus, there are some core differences between financial and health educators perceived roles and culture.

Training clinical providers improves outcomes. Four research studies exemplify the benefits of training clinical providers to improve the health literacy of patients. Valente, Murray, and Fisher (2007) instituted a program in which nurses and pharmacists encouraged patients to report allergy concerns, and found that both nurses and patients increased awareness and reporting of allergies. Patients increased their reporting of medication allergies by 30%, and the number of reports of adverse drug events by nurses rose from an average of 3 to an average of 48 per month. AHRQ funded a study of the Patient Safe-D program, designed to increase safe discharges through the use of standardized tools (Williams & Maleque, 2009). Patients in the treatment group received a form describing their needs after discharge, discussed it with a nurse, and received a discharge patient education tool for later use as a reference; patients in the control group received the standard discharge information. Patients knowledge was then assessed using teach-back techniques, and a pharmacist reviewed a medicine reconciliation form with the patient. After individual counseling, program participants were twice as likely as those in the control group to understand their diagnoses and 50% more likely to understand their treatment (Williams & Maleque, 2009). In addition, having a nurse advocate work directly with patients and then follow up after discharge reduces readmission rates. In six hospitals, nurses in the position of heart failure advocate worked individually with patients to teach them how to manage their disease, and discussed relevant topics. Nurse advocates followed up with patients after discharge to address problems with self-management. Patients managed by nurse advocates were more than 5 times less likely to be readmitted within 28 days (5.5%, compared with 28.6%) than were those without nurse advocates (Hostetter, 2008). Christie et al. (2008) also found that using trained nurse advocates increased colonoscopy rates among low-income minority patients. Similarly, Khankari et al. (2007) found improved colonoscopy rates, from 12% to 28%, among low-income individuals through sending out a letter to patients about the reasons for a colonoscopy and through provider training on communicating with patients about the importance of colonoscopies. Rochon (2007) found that after involving physicians in a three-pronged program to help health literacy, reports of confidence in taking medications increased from 63% to 80% in older adults and from 50% to 73% in neighborhood clinics. Based on these findings, training financial educators using an evidence-based training would be promising to improve outcomes.

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