Part I: The Hallway Curriculum

Picture yourself in a hospital hallway or the corner of your loved one's room. The discharge nurse starts talking. School has started. Before you know it, you've received a folder of papers and a list of medications (mostly new ones), and additional relevant documents. You are expected to absorb everything. It might be wound care, warning signs, follow-ups, and perhaps a pharmacy change. And then that's it. School is over.

My "health literacy" began in a similar hallway, in the middle of a crisis. I didn't have a teacher and there was no make-up test. I had to "figure it out." Back then, I wouldn't have called it curriculum, but it is. And it is one delivered at the worst time to an audience managing exhaustion, fear, and the hope that they can keep a loved one safe.

A study in Nepal poses a radical question: what if we taught these "health literacy" skills earlier in life? What if the ability to access, understand, appraise, and apply health information was treated as part of a secondary school curriculum instead of a set of lessons learned in the heat of the moment?

What If We Taught It Earlier

Researchers from Tribhuvan University and the WHO Collaborating Centre for Health Literacy at the Technical University of Munich ran a seven-week program with ninth graders in community schools in Surkhet, Nepal. The study wasn't a facts-first course about illness. Instead, students practiced four transferable skills: accessing, understanding, appraising, and applying health information. This was experienced through discussion, role-play, case studies, storytelling, and games. Facilitators included teachers, nurses, doctors, public health officers among others.

At the conclusion of the program, participating students demonstrated gains in health literacy across the four skills, in self-efficacy, and in most health-promoting behaviors. This study was published in the BMC Public Health last year. It was a quasi-experimental study. The participating schools couldn't be randomized, and the follow-up test came a week after the program ended.

You're probably thinking, what does a caregiver standing in the hallway have to do with a study about ninth graders? It shows the skills can be taught and measured. Also, it serves as a directional concept for us.

The hospital hallway will always be the hallway, carrying uncertainty. But now we can ask ourselves what we are bringing into it.

This post is the first of three posts on moving the start of caregiving conversations in the mainstream. My next post looks at the skills these students learned and how they map to what caregiver do. The series concludes with a practical tool linking those skills to the questions caregivers need to ask.