Project – Nurses’ Experiences of Communicating with Patients Who Have Limited Health Literacy: A Study of Selected Medical Wards in Federal Medical Centre, Asaba

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Health literacy has become an important issue in contemporary healthcare because patients are increasingly expected to obtain, understand, evaluate and apply health information in making decisions about their health. Health literacy is not limited to the ability to read medical information; it involves the knowledge, skills and capacities required to access, understand, communicate and use health information and health services appropriately. Liu et al. (2020), in a systematic review and qualitative synthesis of health-literacy definitions, identified knowledge of health and healthcare systems, the ability to process and use health information, and the capacity to maintain health through self-management and partnership with healthcare providers as central dimensions of health literacy. The World Health Organization (WHO, 2022) similarly conceptualises health literacy as a social practice influenced not only by individual capabilities but also by social, cultural and organisational environments. These perspectives indicate that communication between healthcare professionals and patients is a central component of health literacy because patients depend on healthcare providers to explain diagnoses, medications, procedures, treatment instructions and health-related decisions.

Effective communication is particularly important in nursing because nurses interact with patients continuously during assessment, treatment, medication administration, health education, discharge planning and follow-up care. Through these interactions, nurses are expected to obtain information from patients and provide information that patients can understand and use. When patients have limited health literacy, however, communication may become more complicated because medical terminology, unfamiliar procedures, written instructions and complex treatment regimens can be difficult to understand. Murugesu et al. (2022), in a study involving 396 healthcare providers, found that 76% reported at least one challenge associated with communicating with patients with low health literacy, while providers also reported difficulties recognising limited health literacy, adapting communication and assessing patients’ understanding. This evidence demonstrates that limited health literacy is not solely a patient-related issue but also presents practical communication demands for healthcare professionals.

Nurses are particularly exposed to these communication challenges because of their central role in patient education and direct care. In addition to carrying out clinical responsibilities, nurses frequently explain medications, procedures, investigations, dietary instructions, discharge plans and self-care activities. Consequently, nurses must often adjust their communication to patients’ educational backgrounds, language abilities, cultural contexts and levels of understanding. A study of nurses’ communication challenges found that nurses identified language differences and limited health literacy as important barriers and that checking patients’ understanding was considered important but was not always easy to incorporate into routine practice. The study further suggested that nurses may require continuing communication training and organisational support to identify and respond effectively to patients with limited health literacy (Coleman et al., 2017).

The problem of limited health literacy is also relevant within the Nigerian healthcare environment. Nigeria has substantial variations in educational attainment, language, socioeconomic circumstances and access to health information, all of which can influence how individuals interact with healthcare services. Olabanji (2023), in a systematic review of interventions to improve health literacy in Nigeria, identified limited functional, communicative and critical health-literacy competencies as important challenges to health-literacy development in the country. The review found evidence that health-literacy interventions can improve different aspects of health literacy but also noted the need for broader and more coordinated interventions involving government, healthcare professionals, communities and other stakeholders. Within this context, nurses occupy an important position because they are frequently responsible for translating complex clinical information into understandable instructions for patients and their families.

Communication with patients who have limited health literacy may involve challenges relating to language, medical terminology, cultural beliefs, comprehension, recall and patients’ willingness or ability to ask questions. These difficulties can become more pronounced in hospital medical wards, where patients may be dealing with acute or chronic illnesses, multiple medications, diagnostic procedures and unfamiliar clinical environments. Murugesu et al. (2022) reported that healthcare providers experienced communication challenges before, during and after consultations with patients with low health literacy and identified the need for strategies such as adapting communication, improving recognition of limited health literacy and assessing patient comprehension. Such challenges may require nurses to use plain language, repetition, visual explanations, demonstrations, family involvement and teach-back approaches rather than relying solely on conventional verbal explanations.

The communication responsibilities of nurses may also be influenced by organisational conditions within hospitals. Effective communication requires sufficient time, appropriate educational materials, supportive policies, adequate staffing and opportunities for nurses to interact with patients without excessive interruption. Recent qualitative evidence involving nurses working in acute-care settings identified systemic barriers such as inadequate resources, time constraints, unclear policies and organisational limitations alongside interpersonal barriers such as language differences and patients’ foundational knowledge gaps. The same study found that nurses employed strategies including simplified language, visual demonstrations, teach-back and involvement of patients’ social networks when communicating with patients with limited health literacy (Alyahya et al., 2026). These findings are particularly relevant to medical wards because nurses may need to balance patient education and communication with medication administration, documentation, monitoring, procedures and other clinical responsibilities.

The issue is relevant to Federal Medical Centre, Asaba, because the institution provides healthcare services to patients with different backgrounds and needs, while its Nursing Services Department has responsibility for providing individualised, holistic and evidence-based nursing care. Information provided by the Centre indicates that its nursing service places emphasis on individualised care, informed choice, patient input into decision-making, open communication and respect for patients’ diversity. The Centre’s Nursing Services Department also reports a large nursing workforce working across different areas of specialisation. These institutional responsibilities make nurse-patient communication particularly important because nurses are positioned at the point where complex clinical information is translated into practical information that patients can understand and use. Examining nurses’ actual experiences can therefore provide evidence concerning the communication difficulties, strategies and organisational conditions encountered in selected medical wards of the Centre.

Although the importance of health literacy and effective healthcare communication is increasingly recognised, there remains a need to understand the issue from the perspective of nurses who experience these interactions directly. Much of the health-literacy literature focuses on patients’ knowledge, health behaviours and outcomes, whereas fewer studies examine how nurses perceive, interpret and manage communication with patients who have limited health literacy in specific hospital settings. Murugesu et al. (2022) identified a need for better support for healthcare providers in recognising limited health literacy, adapting communication and assessing patient understanding, while Alyahya et al. (2026) demonstrated that nurses’ experiences involve not only communication techniques but also workload, resources, organisational policies and emotional demands. In Nigeria, Olabanji (2023) similarly highlighted gaps in health-literacy development and the need for stronger professional and institutional interventions. Therefore, investigating nurses’ experiences in selected medical wards of Federal Medical Centre, Asaba, is important for generating context-specific evidence that can guide communication practices, nursing education and organisational support for patients with limited health literacy.

1.2 Statement of the Problem

Limited health literacy creates a significant communication challenge within healthcare because patients who have difficulty understanding or applying health information may not fully comprehend explanations concerning their illness, medications, investigations or treatment. Although health literacy is influenced by individual characteristics, it is also shaped by the way healthcare systems and professionals communicate information. The WHO (2022) emphasises that health literacy is influenced by organisational and social environments, while Liu et al. (2020) identify the processing and use of health information and the ability to work in partnership with healthcare providers as central components of health literacy. Consequently, when communication is not appropriately adapted to patients’ level of understanding, there may be difficulties in achieving meaningful patient participation in care.

A further problem concerns the practical difficulties nurses encounter when communicating with patients with limited health literacy. Nurses may need to identify patients who have difficulty understanding health information, simplify complex medical terminology, repeat explanations, verify comprehension and provide appropriate education while simultaneously performing other clinical duties. Evidence from healthcare providers shows that such difficulties are common. Murugesu et al. (2022) reported that 76% of healthcare providers in their study experienced at least one challenge related to patients’ limited health literacy, while 31% reported difficulty recognising patients with low health literacy and 50% rarely used health-literacy-specific materials. These findings suggest that healthcare providers may recognise the importance of effective communication but may not always have adequate tools, training or resources to address patients’ health-literacy needs consistently.

The Nigerian context presents an additional concern because health-literacy challenges occur within a healthcare environment characterised by diverse languages, educational backgrounds and socioeconomic circumstances. Olabanji (2023) found that limited functional, communicative and critical health-literacy competencies constitute important challenges to health-literacy development in Nigeria. For nurses, these circumstances can make communication particularly demanding when patients have difficulty understanding medical terminology or when cultural and linguistic differences influence how illness and treatment are understood. Moreover, the effectiveness of communication may be affected by institutional conditions such as workload, time limitations, staffing and availability of appropriate educational materials. Recent qualitative evidence confirms that organisational constraints can substantially affect nurses’ ability to communicate effectively with patients with limited health literacy (Alyahya et al., 2026).

Despite growing international attention to health literacy and nurse-patient communication, there is limited context-specific evidence describing Nigerian nurses’ experiences of communicating with patients who have limited health literacy in medical wards, particularly at Federal Medical Centre, Asaba. Existing studies have examined health-literacy interventions in Nigeria and communication challenges internationally, while recent qualitative research has shown that nurses’ experiences can involve communication barriers, adaptive strategies, workload pressures, resource limitations and emotional demands (Olabanji, 2023; Murugesu et al., 2022; Alyahya et al., 2026). However, evidence specific to selected medical wards in Federal Medical Centre, Asaba is needed to establish the communication challenges nurses encounter, the strategies they employ, the factors that facilitate or hinder effective communication and the support they require. This gap provides the justification for the present study.

1.3 Purpose of the Study

The main purpose of this study is to explore nurses’ experiences of communicating with patients who have limited health literacy in selected medical wards of Federal Medical Centre, Asaba.

Specifically, the study seeks to:

1. examine the communication challenges experienced by nurses when caring for patients with limited health literacy in selected medical wards of Federal Medical Centre, Asaba;
2. identify the communication strategies used by nurses when interacting with patients who have limited health literacy in selected medical wards of Federal Medical Centre, Asaba;
3. determine the factors that facilitate or hinder effective communication between nurses and patients with limited health literacy in selected medical wards of Federal Medical Centre, Asaba; and
4. examine the relationship between nurses’ professional experience and the communication challenges they encounter when caring for patients with limited health literacy in selected medical wards of Federal Medical Centre, Asaba.

1.4 Research Questions

The following research questions will guide the study:

1. What communication challenges do nurses experience when caring for patients with limited health literacy in selected medical wards of Federal Medical Centre, Asaba?
2. What communication strategies do nurses use when interacting with patients who have limited health literacy in selected medical wards of Federal Medical Centre, Asaba?
3. What factors facilitate or hinder effective communication between nurses and patients with limited health literacy in selected medical wards of Federal Medical Centre, Asaba?
4. What relationship exists between nurses’ professional experience and the communication challenges they encounter when caring for patients with limited health literacy in selected medical wards of Federal Medical Centre, Asaba?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between nurses’ professional experience and the communication challenges they encounter when caring for patients with limited health literacy in selected medical wards of Federal Medical Centre, Asaba.

1.6 Significance of the Study

Nurses

The study will be significant to nurses because it will provide an opportunity to examine the practical realities of communicating with patients who have limited health literacy. The findings may help nurses identify communication barriers and recognise strategies that can improve patient understanding. The study may also encourage greater use of patient-centred communication approaches, including plain language, appropriate questioning, repetition, visual explanation and teach-back techniques.

Patients

The study may benefit patients with limited health literacy by contributing to improved communication practices within the hospital. Effective communication can help patients understand their conditions, treatment instructions, medications, follow-up requirements and self-care responsibilities. This is particularly important because health literacy involves the ability to process and use health information and participate effectively in healthcare decisions (Liu et al., 2020).

Nursing Management

The findings may be useful to nursing administrators and managers at Federal Medical Centre, Asaba by identifying organisational conditions that influence nurse-patient communication. Evidence concerning workload, time constraints, educational materials, staffing and training needs may assist nursing management in developing appropriate support systems. Recent evidence suggests that communication effectiveness is influenced not only by individual nurses’ skills but also by organisational resources, policies and working conditions (Alyahya et al., 2026).

Hospital Management

The study may provide useful information to hospital management concerning the need for institutional approaches to health literacy. This could include development of patient-education materials in accessible language, communication protocols, staff training and systems for identifying patients who require additional communication support.

Nursing Education

The findings may be useful to schools of nursing and continuing professional-development programmes by highlighting specific communication competencies that nurses require when caring for patients with limited health literacy. Health-literacy education can strengthen nurses’ capacity to communicate complex information in ways that are understandable and useful to patients.

Policymakers

The study may provide evidence relevant to healthcare policymakers and professional nursing bodies concerning the incorporation of health-literacy principles into nursing practice and hospital communication policies. This is consistent with evidence from Nigeria showing the need for broader interventions to strengthen functional, communicative and critical health literacy (Olabanji, 2023).

Future Researchers

The study will contribute to the growing literature on health literacy, nursing communication and patient-centred care in Nigeria. It may serve as a reference for researchers investigating health literacy among patients, communication competencies among healthcare professionals, patient education, shared decision-making and quality of nursing care.

1.7 Scope of the Study

The study focuses on nurses’ experiences of communicating with patients who have limited health literacy in selected medical wards of Federal Medical Centre, Asaba.

Geographical Scope

The study will be conducted at Federal Medical Centre, Asaba, Delta State, Nigeria.

Population Scope

The population will comprise registered nurses working in the selected medical wards of Federal Medical Centre, Asaba.

Content Scope

The study will concentrate on four major areas:

1. communication challenges experienced by nurses;
2. communication strategies used by nurses;
3. factors facilitating or hindering effective communication; and
4. the relationship between nurses’ professional experience and communication challenges.

The study will focus on nurses’ experiences rather than attempting to clinically diagnose the health-literacy level of individual patients.

1.8 Operational Definition of Terms

Communication: The process through which nurses and patients exchange information, ideas, instructions, concerns and feedback for the purpose of promoting understanding and effective healthcare.

Health Literacy: The knowledge, skills and capacity required by individuals to access, understand, evaluate and use health information and health services appropriately.

Limited Health Literacy: A situation in which a patient experiences difficulty obtaining, understanding, evaluating or applying health information required for appropriate healthcare decisions and self-management.

Nurse-Patient Communication: The interpersonal exchange of health-related information between a nurse and a patient during the provision of nursing care.

Nurses’ Experiences: The perceptions, observations, difficulties, feelings, practices and responses reported by nurses based on their interactions with patients who have limited health literacy.

Medical Ward: A hospital unit in which patients with medical conditions are admitted and receive nursing, diagnostic, therapeutic and supportive care.

Communication Challenges: Difficulties experienced by nurses when attempting to exchange information effectively with patients, including language barriers, misunderstanding, medical terminology, limited patient comprehension, time constraints and other related barriers.

Communication Strategies: Techniques used by nurses to improve patients’ understanding, such as use of simple language, repetition, visual aids, demonstrations, questioning, teach-back and involvement of family members.

Teach-Back: A communication method in which a healthcare professional asks a patient to explain in their own words what they have understood about the information provided.

Patient Education: The process through which nurses and other healthcare professionals provide patients with information and skills needed to understand their conditions, participate in treatment and manage their health.

Professional Experience: The length of time a nurse has worked as a registered nursing professional, measured in years.

Patient-Centred Communication: A communication approach that recognises patients’ individual needs, preferences, values, understanding and participation in healthcare decisions.

Project – Nurses’ Experiences of Communicating with Patients Who Have Limited Health Literacy: A Study of Selected Medical Wards in Federal Medical Centre, Asaba