Breaking Communication Barriers in Healthcare

36% of Americans 16 and over have below basic or basic health literacy, 2003 National Assessment of Adult Literacy. 

“We all have within us the capacity to share our knowledge and skills with somebody else and build somebody up from there,” Bridget Saffold, Founder of Focus on Diabetes.

When we are experiencing an illness, we become vulnerable and need the assistance of others. Nothing can help more than the words of expertise from a healthcare professional, but when there is a gap between what the medical personnel has to say and what the patient understands, a communication barrier arises making it more difficult for the patient to regain full health.

Bridget Saffold is a registered nurse who has witnessed firsthand the struggles that the members of her community have suffered due to the communication barriers between patients and doctors.

“There were some real gaps in information and understanding among people in the community especially in minority populations, but in patients in general, a gap in coming to the doctor but leaving with an understanding,” says Bridget. “While working in healthcare myself, I have witnessed some of the vices that people use against other folks. Like not providing them with complete information and choosing not to tell people something because they think they don’t have the money or they are on Medicaid. So some healthcare professionals are not even sharing complete information so people can make decisions and judgments about their health and that isn’t fair, it’s not right.”

A study reviewed by the institutional review board of Johns Hopkins Medical Institutions which comprised federally qualified health centers in Baltimore, Maryland; Washington, DC; and the Northern Virginia metropolitan area found that physicians were 33% less engaged in patient-centered communication and 23% more verbally dominant with African American patients than with White ones, according to the article Patient Race/Ethnicity and Quality of Patient–Physician Communication During Medical Visits. 

Furthermore, in the article, Testimonial Injustice: Linguistic Bias in the Medical Records of Black Patients and Women it has been noted that 600 clinic notes from the 9,251 analyzed in the context of ambulatory processes in 2017 revealed linguistic features suggesting disbelief in the form of quotes, specific judgment words, and a sentence construction where patients’ words were reported as hearsay and Black patients had higher odds of containing at least one quote, judgment word or evidential when compared to clinical notes from White patients.

In 2003, the government of the United States conducted the first National Assessment of Adult Healthcare Literacy which revealed that 36% of Americans 16 and over have below basic or basic health literacy no matter what their ethnic background. When divided into ethnic groups, Hispanics presented the lowest score in health literacy, followed by Black. The White and Asian Pacific Islanders had the highest scores in health literacy. The highest percentage of below-basic health literacy were Hispanics at 41%, followed by American Indians or Alaska Natives at 25% and Blacks at 24%, as noted in The Health Literacy of America’s Adults Results From the 2003 National Assessment of Adult Literacy.

Bridget Saffold was born in Waterloo, a town in Iowa with an estimated population of 67,312 by 2020, where 72.4% of its population is Caucasian, 17.3% is African American, 7.1% is Hispanic and 2.5% is Asian, according to the City of Waterloo.   

Bridget has lived in Waterloo all of her life. It is the place she calls home. It is where she grew up with her 6 siblings, raised her 4 children and niece, and now enjoys watching her 6 grandchildren grow. She has a bachelor’s degree in Nursing from Upper Iowa University in Fayette, Iowa, and a master’s degree in Nursing from Aspen University in Phoenix, Arizona, with a specialization in public health. 

“I have worked at the same hospital for 15 years,” says Bridget. “My father was the director of human rights for the City and he worked in the state capital for the Civil Rights Division before working in Transportation, so I come from a family background of service.” 

Bridget moved from working as a clinic nurse to being a clinic administrator and during her 15 years in healthcare, she noticed how often people would go to the doctor and still leave with many unanswered questions as well as a need for more information. 

“I live in the community where I work, with the people that I serve, and I just get asked so many questions outside of work,” says Bridget. “People that have just been to see a doctor still have so many questions. So that made me feel like there was a gap in there somewhere. I thought that maybe if we had conversations in a different setting where patients had more time, being a little less stressed, a little less nervous, and being able to hear from a doctor the information again, it would carry a different feel from going to the doctor’s office.”

After expressing these feelings to some friends and colleagues. Bridget decided to create a nonprofit organization that would help the patient community communicate better called: Focus on Diabetes.

In 2015, Bridget began her nonprofit organization called Focus on Diabetes with the help of just 5 friends and colleagues. 

“We are a health promotion and disease prevention organization. Although we started with diabetes we have grown to engage about cancer, risk factors,  and screening guidelines. As we grow, the core components of our program remain. Education, advocacy, and screenings that fill essential gaps in patient care for our community. The first year we did this, what we learned was if we invite those doctors who are willing to give up their time and come out of those clinical settings into the community, people would just receive that information a lot differently and just help them to be healthier. Once we did it we realized the impact of it. That was our motivation.”

Being a new nonprofit and not being registered made it very hard for Bridget to obtain funds for her projects, but an acquaintance talked to her about The Pollination Project and she decided to apply for a seed grant. 

“When we started the organization, we were not incorporated yet and that made it very hard to be able to receive funds to continue to do our work. In those times, I got donations from my parents, some friends, and even doctors,” recalls Bridget. “Someone told us about The Pollination Project. When TPP invested in our vision, it was the catalyst we needed. The seed grant helped us so much to be able to buy the essential things we needed for our work. They made us feel that somebody believed in the work instead of the paper, they gave us a boost so we could have flyers, feed our volunteers, and much more”.

Eight years after the foundation of Focus on Diabetes, Bridget’s group of volunteers has grown from 5 to 30 and they have a yearly event where they provide vital information to patients in a welcoming setting without time restrictions as well as free screenings. Focus on Diabetes has helped over 2,000 people since its foundation. 

“We have an event once a year, every 2nd Saturday of September where we receive over 150 people. And in between we do, Let’s Talk About Health, with small monthly groups of 15 to 20 people where we talk about health-related issues and have questions and answer sessions,” says Bridget. “Since Covid, we started to do these small talks by streaming on Facebook and recordings on YouTube. This allowed us to engage with people across the country and even in places like England and Switzerland.”

Bridget’s organization focuses on 3 main pillars: First, education and advocacy, by inviting healthcare professionals and world-class organizations to provide education and free screenings. People can get blood tested, have an oral examination, and have their feet examined as well as their visual acuity. Second is Project Health, they provide education across Northeast Iowa about prostate cancer specifically and are starting to look at breast cancer screening. Third is their mentorship program, Empower Me, for middle and high school students who volunteer paired with Medical students and may guide their pathways through college  – if the teens wish to do so  – through a mentee relationship. 

“What worries me the most is limiting people’s information, which is sad and scary at the same time,” says Bridget. “What gives me hope is that there are a lot of good people with good hearts who are willing to give their knowledge, their skills and give them freely. We all can do that no matter what your profession is, no matter what your professional background or your life experience is. We all have within us the capacity to share that with somebody else and build somebody up from there.”

Bridget‘s plan for Focus on Diabetes is to expand this model to other cities and countries in the coming years because she believes that breaking healthcare communication barriers is everyone’s right.

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