Implementation of the Ask Me 3 Program in a Pediatric Clinic

Failures in health literacy and communication result when patients do not understand their health problems, what they can do to manage their disease and why it is important for them to do so. In addition, navigation of the healthcare system can be complicated, confusing and intimidating; particularly if patient's struggle with lower health literacy. Parents with low health literacy struggle in making decisions about their child's healthcare, following provider instructions, dosing medications and managing disease. These challenges can lead to medical errors, higher utilization of emergency departments and poor health outcomes. In the United States, 87 million people have basic or below basic prose literacy and costs related to low health literacy are estimated between $106-$238 billion dollars annually. Very few studies investigate the impact of health literacy on the well-being of children Studies that do exist emphasize increasing knowledge but few focus on promoting behavior change that could influence health outcomes for children. There are tools aimed at promoting health literacy and communication, but they are underutilized by pediatric providers. The Partnership for Clear Health Communication joined with the National Patient Safety Foundation to develop the Ask Me 3 (AM3) program, a practical solution to help patients understand medical conditions and follow instructions by asking 3 simple but essential questions. This program has been utilized in several healthcare systems and primary care practices but has little evaluation in pediatric practice. My first objective was to implement the AM3 program in a pediatric practice in an attempt to enhance health literacy, improve parent/caregiver (parent) satisfaction and change the question-asking behaviors of parents. Initially, I assessed the satisfaction with the visit and current question-asking by parents through paired questionnaires for parents and providers. I shared the pre-implementation data with the clinic staff and providers in a training session on health literacy and the AM3 program. After all staff completed the training, the AM3 program was implemented in the clinic with posters, reading materials and staff encouragement of the parents to ask the questions with each visit. Following implementation, paired questionnaires were again given to parents and providers to ask about their satisfaction with the visit and the parent question asking behaviors. Comparisons of parents to providers and pre to post implementation of visit satisfaction and parental question-asking was evaluated for trends, frequencies and statistical significance. Structured implementation of the AM3 program increased parent and provider satisfaction, promoted communication between parents and providers by increasing parent question-asking and enhanced parent knowledge about their child's health. Providers also felt that the AM3 helped them to structure communication with parents. The increased question-asking by parents optimizes understanding and may influence health outcomes for pediatric patients. In addition, educating clinical and office staff will ultimately benefit pediatric patients and their families.