Staying home saves lives is the theme for this COVID19 pandemic quarantine or self-isolation, social distancing process. The reason is to help stop the spread of the virus and “flatten the curve” also known as that exponentially rising number of cases on a bell curve. 

The ever-present challenge to this is people who don’t have an understanding of how and why this works and how lives can be saved. There’s the people who don’t want to ever be told what they can and cannot do; especially by the government or authorities. There’s the people who closely follow and believe everything the government is telling them and parroted Donald Trump calling COVID19 a hoax for weeks on end. 

Fortunately, he had to finally change his tune and begin to listen to the medical experts and see the numbers of cases rising in the US. Others are slow to catch on and precious time has been lost. Many are still not convinced despite rising numbers of cases and deaths. There’s the faction of the population in their teens and twenties who feel invincible to anything dangerous or lethal and see staying home as pure punishment for something they didn’t do. And then there’s the people who are basically health care illiterate. 

What is health care illiteracy?

Health literacy “is the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.” On the opposite end, health care illiteracy is the degree to which individuals struggle to obtain, process and understand basic health information and how the system works in order to make appropriate decisions for themselves. Sometimes they literally don’t know where to even begin. Health care illiteracy is most prevalent in the population that is medically underserved, lower socioeconomic groups, the elderly and minorities.  

All of these situations are presenting a huge challenge to slowing and ending the spread of the coronavirus. The longer people fight it, the longer it’s going to take. The virus doesn’t care. It’s quite happy expanding across the globe. 

Education and information are key

A major issue is going to be to educate the public about this disease and how and why staying home will work to slow and eventually stop the spread of this virus. It’s extremely inconvenient to say the least. Life as we know it in so many ways has been altered dramatically and a great deal of it will never return to what it was before. There will be silver linings, but those may take years to be evident. 

For the health care illiterate this is going to take a lot of extra effort and patience. People learn in many different ways. With the health care illiterate, the most ineffective way of teaching them is by giving them something to read. Not that they cannot read, but it’s not their best way to learn. They need to see the evidence and understand every step of the process. Spoken word is best, along with a question and answer session to validate and verify their understanding. This requires a lot of hand holding and laymen’s terms. 

Nurses are the best patient educators, but in these times where the need for nurses is at the bedside of critical patients, a large part of the education is going to have to be handled by medical assistants and lay persons. The information has to be clear and concise as well as transparent and honest. 

Is it a lack of understanding or non-compliance? 

Non-compliance is often an overlooked health care illiteracy situation. The patient took all of the pills in the prescription, but he doesn’t know that he needs to refill that medication and take it for the rest of his life. He’s only known short term antibiotic prescriptions. He feels better and thinks he’s done with that medication. Two weeks later, he’s back in the same predicament and the physician doesn’t understand why or how this happened. He presumes the patient is non-compliant. 

The same situation is happening with social distancing and self-isolation. The person stayed home a few days, but he has no symptoms and he thinks it’s safe for him to venture out. If he sees others doing so, he’ll be even more inclined to believe it’s safe to do so. If the President says it’s a hoax, it surely must be. 

Panic buying

Hoarding toilet paper will forever be the meme for this pandemic and how Americans responded to it. That quickly spread to emptying of the majority of shelves in the grocery and specialty stores. Then price gouging and scam artists weighed in. Much of this is based on fear of the unknown and an initial lack of honest, truthful news and information. Those with health care illiteracy have had a significant difficulty in understanding what to do and why and very little consideration. Panic buying for an apocalypse seemed reasonable and safe. 

Fear mongering is a great way to control people and keep them clamoring for tidbits of information, food and necessities. It also makes for very dangerous situations when infection control and self-preservation have to mix in order to manage the spread of a massive virus. With vital information is being withheld and spun for a variety of gains, the COVID19 has taken full advantage.

Where do we go from here?

As nurses we educate, we lead by example, and we dispel myths and lies. It’s important to remember that a good 40%+ of the population is not fully health care literate and needs some extra help. It’s vital that when leaving the hospital after a grueling 14 hours you don’t show up at the grocery store sporting your scrubs. People might smile and say thanks, but others are not going to understand that you’ve been (hopefully) covered up by PPE all day, and your scrubs are safe. Or that maybe you changed into these as you left for the day. You’re exhausted, just need a few things and can go home and shower and crash. They see a walking COVID19 virus! If they aren’t terrified and angry, they’re thinking maybe they’re over doing it themselves by being so careful. Do as I do and as I say is the message we want to convey!

The next thing is to responsibly partake in social media conversations and spread truthful information. Be careful, not everyone can handle to whole truth of your gory day! Have patience with those who struggle to comprehend. If you’re good at it, include pictures or videos. These can be very helpful to those who have some level of health care illiteracy. Check on your neighbors. Get rest, eat well, and hydrate! Practice self-care! Be an example and a resource to your frightened friends and neighbors. We’re all in this together and together we will prevail.