D406 Task 1 Health Literacy Resource Example

Five Things to Do Every Day: A Plain-Language Home Oxygen Guide for a Father With COPD and the Daughter Who Helps Him, With the Reasoning Behind Its Design

Student Name

Leavitt School of Health, Western Governors University

D406: Health Literacy for the Client and Family, Task 1

Course Instructor

Month Day, Year

Five Things to Do Every Day: A Plain-Language Home Oxygen Guide for a Father With COPD and the Daughter Who Helps Him, With the Reasoning Behind Its Design

The Client and Family

Harold Beck is a composite 72-year-old widower with chronic obstructive pulmonary disease (COPD). After a hospital stay for a flare of his disease, his lung specialist prescribed oxygen at home at 2 liters per minute through a nasal cannula, day and night. A supplier delivered a stationary oxygen concentrator, a long tube and portable tanks for trips out of the house. Mr. Beck left school after the eighth grade to work on road crews, reads slowly and says he "never was much for paperwork." He smoked for 50 years and quit last spring, and he heats his living room with a wood stove. His daughter Tina lives ten minutes away, works days as a school bus driver and stops by each evening. His 15-year-old grandson visits on weekends.

At discharge, Mr. Beck received eleven pages of printed instructions from the hospital and a nine-page manual from the supplier. When the home health nurse visited, the pages were still in the bag. He told her, "I figured Tina would read it." Tina said she had skimmed it but was not sure what mattered most.

Assessing Health Literacy Needs

Limited health literacy is common, and it is most common among older adults. In the last national assessment of adult health literacy, about 36% of American adults had basic or below basic skills, and adults 65 and older had lower average health literacy than any younger age group (Kutner et al., 2006). Mr. Beck's schooling, his comments and the unopened pages all suggest limited literacy, and the nurse confirmed it by asking him to read the dial on the concentrator and tell her what the number meant. He read it correctly but did not know whether 2 was a little or a lot, or whether he could turn it up when he felt short of breath.

The assessment identified four needs. Mr. Beck needs a small number of actions he can remember, not explanations. He needs numbers shown as pictures, because the flow setting is a number he must match. He needs the fire risk made concrete, because he lives with a wood stove and a history of smoking. And Tina needs to know which problems require a call and to whom, since she is the one who will notice them. The grandson, who may be alone with his grandfather on weekends, needs to know the fire rules too.

The Resource: Your Oxygen at Home

The resource is a single page, printed large, for the refrigerator door. Its full text follows.

Your oxygen at home: 5 things to do every day.

1. Keep it on. Wear your oxygen all day and all night. Even when you feel fine. Your body needs it when you sleep.

2. Check the number. The dial should point to 2. [Picture of the dial with the ball at 2.] Do not turn it up. Do not turn it down. If you feel short of breath, sit down and call your nurse.

3. No fire near your oxygen. Stay 10 feet from the wood stove. That is about 3 big steps. No smoking in the house. Not you. Not anyone. [Picture of a lit match with a red line through it.] Oxygen makes fire burn fast and hot.

4. Watch the tube. Keep the tube out of doorways. Do not trip on it. If it gets a kink, the air stops. Straighten it.

5. Keep a spare. Keep one full tank by the door. If the power goes out, use the tank. Call the oxygen company.

Call the nurse if: your lips or fingers look blue, you are more short of breath than usual, or you feel very sleepy or mixed up. Call 911 if you cannot catch your breath or there is a fire.

Nurse: [number]. Oxygen company: [number].

Why the Resource Is Designed This Way

Five actions, not every fact. The hospital and supplier documents were accurate but covered dozens of topics. The guide keeps only the actions that prevent the most serious harm: low oxygen from not wearing it, the wrong flow setting, fire, falls over the tubing and loss of oxygen in a power outage. Everything else can be taught in person over several visits.

Plain words and short sentences. Most lines are under ten words, use one or two syllables and give one instruction each. The resource avoids terms such as liters per minute, concentrator and cannula, and calls things what the family calls them: the dial, the tank, the tube. Run through the Flesch-Kincaid formula, the guide's text scores below the third-grade level, well below the sixth- to eighth-grade range usually recommended for patient materials.

Pictures for numbers and danger. The dial is shown with the ball at 2, so Mr. Beck matches a picture rather than interpreting a number. The fire rule has its own symbol because it is the rule with the most severe consequences.

Repetition and specifics for the fire rule. Home oxygen fires are a growing problem: a national review found injuries from oxygen therapy fires increasing by about 14% per year over a decade, and common household ignition sources can start fires that burn hotter and spread faster in oxygen-rich air (Klas et al., 2026). A review from a Swedish expert taskforce identified smoking as a major burn and fire risk for people on home oxygen and recommended that smoking be assessed and addressed whenever home oxygen is considered (Ahmadi et al., 2024). The guide therefore says no smoking by anyone, not only by Mr. Beck, and translates 10 feet into 3 big steps, a distance he can picture in his own living room.

Cultural and Family Fit

The Beck family speaks English and values independence, and Mr. Beck dislikes being told what to do. The guide is therefore written as instructions to him, in the second person, rather than as rules for his caregivers, and it avoids warnings that sound like blame about his smoking history. Tina asked for a line telling her when to worry, so the call list is written for anyone in the house. The page lists the nurse's and supplier's numbers, since in a crisis the family is unlikely to look them up in a manual.

Confirming Understanding With Teach-Back

Giving the guide is not the end of the teaching. The nurse would use teach-back, asking Mr. Beck and Tina to explain each action in their own words or show it, then clarifying and asking again until each can do so. In a systematic review of 20 studies, teach-back was effective in 19, with benefits ranging from better knowledge recall to fewer hospital readmissions and better quality of life (Talevski et al., 2020).

In practice, the nurse would ask Mr. Beck to point to where the ball on the dial should be, to walk three steps from the stove and to show what he would do if the power went out. She would ask Tina which changes mean a call and which mean 911. She would ask the grandson, on a weekend visit, why no one may smoke in the house. Any answer that is wrong or uncertain tells the nurse which line of the guide to teach again, and possibly which line to rewrite.

Conclusion

Mr. Beck was given twenty pages of accurate information and used none of it. A one-page guide that his family can read in a minute, built around five actions, pictures and a clear call list, and confirmed through teach-back with each person who shares his home, gives him a far better chance of staying safe on oxygen. The same approach applies to any family: begin with what they need to do, write it the way they speak and check that they can do it.

References

Ahmadi, Z., Björk, J., Gilljam, H., Gogineni, M., Gustafsson, T., Runold, M., Ringbæk, T., Wahlberg, J., Wendel, L., & Ekström, M. (2024). Smoking and home oxygen therapy: A review and consensus statement from a multidisciplinary Swedish taskforce. European Respiratory Review, 33(171), 230194. https://doi.org/10.1183/16000617.0194-2023

Klas, K. S., Coffey, R., Sheckter, C. C., Savetamal, A., & Wibbenmeyer, L. (2026). Preventing oxygen therapy-related fires and burn injuries: A comprehensive national strategic approach. Journal of Burn Care & Research, 47(1), 120-129. https://doi.org/10.1093/jbcr/iraf125

Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). U.S. Department of Education, National Center for Education Statistics.

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350