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Cultural Competence in Health Care

Ask Me 3

Clear communication is the foundation for patients to be able to understand and act on health information. DHSS recommends Ask Me 3 developed by the Partnership for Clear Health Communication. Ask Me 3 is a quick, effective tool designed to improve health communication between patients and providers. Developed by leading health literacy experts, Ask Me 3 promotes three simple but essential questions that patients should ask their providers in every health care interaction. Providers should always encourage their patients to understand the answers to:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

Using these techniques can improve patient participation in the treatment plan.

What Can Providers do? Health literacy is essential for good patient care and positive health outcomes.

  • Give patients the answers to their 3 questions
  • Along with encouraging your patients to use the Ask Me 3 approach, simple techniques can increase your patients' comfort level with asking questions
  • Create a safe environment where patients feel comfortable talking openly with you
  • Use plain language instead of technical language or medical jargon
  • Sit down (instead of standing) to achieve eye level with your patient
  • Use visual models to illustrate a procedure or condition
  • Ask patients to "teach back" the care instructions you give to them
  • Provide patients with information about the Ask Me 3 program

Teach Back

Studies have shown that 40-80 percent of the medical information patients receive is forgotten immediately and nearly half of the information retained is incorrect. One of the easiest ways to close the gap of communication between clinician and patient is to employ the “teach-back” method, also known as the “show-me” method or “closing the loop.” Teach-back is a way to confirm that you have explained to the patient what they need to know in a manner that the patient understands. Patient understanding is confirmed when they explain it back to you. It can also help the clinic staff members identify explanations and communication strategies that are most commonly understood by patients.

  • Start Slowly. Initially, you may want to try it with the last patient of the day.
  • Plan your approach. Think about how you will ask your patient to teach-back information based on the topic you are reviewing. Keep in mind that some situations will not be appropriate for using the teach-back method.
  • Use handouts. Reviewing written materials to reinforce the teaching points can be very helpful for patient understanding.
  • Clarify. If patients cannot remember or accurately repeat what you asked them, clarify your information or directions and allow them to teach it back again. Do this until the patient is able to correctly describe in their own words what they are going to do, without parroting back what you said.
  • Practice. It may take some getting used to, but studies show that once established as part of a routine, it does not take longer to perform.

Taken from the Indian Health Service (IHS) website:

Plain Language

Plain language (also called Plain English or lay language) is communication that your audience can understand the first time they read or hear it. Language that is plain to one set of readers may not be plain to others.

President Obama signed the Plain Writing Act of 2010 [PDF - 124 KB] on October 13, 2010. The law requires federal agencies to use "clear Government communication that the public can understand and use." The Act imposes several requirements on federal agencies:

  • Write all new or substantially revised "covered documents" in plain writing
  • The Act specifies that "covered documents" are those that:
    • are necessary for obtaining any Federal Government benefit or service, or filing taxes;
    • provide information about any Federal Government benefit or service; or
    • explain to the public how to comply with a requirement that the Federal Government administers or enforces.

The Act requires agencies to use plain writing in every paper or electronic letter, publication, form, notice, or instruction. While regulations are exempt, the Office of Information and Regulatory Affairs encourages plain writing in the preambles of regulations.

Taken from the Indian Health Service (IHS) website: