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Health literacy focus of program at Tufts

November 02, 2015

By Michelle Manchir

Communication skills: 18 dental students at Tufts University School of Dental Medicine participated in a health literacy program initiated in part by Dr. Nicole Holland.

Dr. Holland
Eric Ricci, a third-year dental student at Tufts University School of Dental Medicine, knows when he begins his career at a family practice, most of his patients won’t be scientists.

To talk about treatment and prevention with them in a way that they’ll understand, Mr. Ricci decided to take his education at Tufts a step beyond the required curriculum.

Mr. Ricci was among the 18 students at Tufts who in June became the first cohort at the school to complete a Healthy Literacy Intensive program.

"Communication is how we compress the chemistry of dentistry into a language that results in meaningful actions by our patients," Mr. Ricci said. “True healthcare literacy is having someone understand not that they have a cavity and need a filling, but how to prevent the next cavity.”

Students in the program met for 10 months with faculty for monthly group discussions and assignments including the National Institutes of Health’s plain language training, developing articles for a local newspaper and observing adult education classes or talking with adult education instructors.

The goals for the program — which students applied for and participated in on top of their full course load — included understanding the intersection of language, culture and literacy and also the role of health literacy in relation to oral health and the health care system, according to the course’s developer, Dr. Nicole Holland, an assistant professor and director of Health Communication, Education and Promotion at Tufts. Dr. Holland also serves on the ADA Council on Access, Prevention and Interprofessional Relations’ National Advisory Committee on Health Literacy in Dentistry.

The U.S. Department of Health and Human Services defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness.”

Dr. Holland said she sees dentists as having a unique role in reaching their patients in this way.

“Many oral health diseases are preventable, so what can we do at the front end?” Dr. Holland said. “Literacy and communication are two things that can expand the spectrum of care.”

That’s why Dr. Holland developed the seminar, along with help from other Tufts faculty, Dr. Wanda Wright and Kathryn Dolan, a registered dental hygienist.

One of the assignments included contributing oral-health related words to a plain language thesaurus for oral health professionals. Contributions included “sealants: protective material placed on teeth to prevent cavities” and “caries: tooth decay and/or cavities.”

Students also tracked oral health messages on TV and the Internet, taking notes and analyzing commercials for teeth whitening products and mouthwash, and created a patient journey map by simulating patient experiences as they attempt to access dental care.

“We learned how to better communicate the complexities of dentistry and to better navigate the healthcare system,” Mr. Ricci said.

Dr. Holland said it was clear to her the students were engaged in the program.

“I could see the effort that they put into the assignments,” she said. “They weren’t just thrown together; they put thought and work into it.”

Dr. Holland discussed the program at a September meeting of ADA National Advisory Committee on Health Literacy on Dentistry.

Advisory committee member Dr. Lew Mitchell, who represents the ADA Council on Access, Prevention and Interprofessional Relations, said it’s essential that dentists and their patients be on the same page when discussing health.

“We sometimes get distracted with the scientific terms because that’s our background and these terms are not unfamiliar to us,” Dr. Mitchell said. “When we’re in the community, with the public, we must communicate in a way that is completely understandable for them.”

Mr. Ricci said he believes the program will help him do that after he graduates when he will be practicing with his father, Dr. John Ricci, at his office in Providence, Rhode Island.

“Each patient comes from different life experiences, and cultures. As such, a competent communicator needs to be able to adapt to each person, and ‘read’ them in real time,” Mr. Ricci said.

Meanwhile, Dr. Holland said applications are being accepted now at Tufts for the second cohort.

For more information on the Tufts program, contact Dr. Holland by email,

For more information about health literacy, visit