Background: Low health literacy contributes to preventable complications, poor chronic disease management, increased emergency department and hospital utilization, and reduced patient safety (1). These challenges are amplified among uninsured, homeless, and medically underserved populations, many of whom leave clinical encounters without a clear understanding of their diagnosis, prognosis, or treatment plan (2). To address this gap, we developed P.L.A.N. (Problem, Life Impact, Actions, Need for Help), an adaptable health-literacy framework designed to structure clinical conversations, enhance shared decision-making, and improve patient comprehension across specialties. Early pilots in a musculoskeletal and hypertension clinic demonstrated that P.L.A.N. helps address communication barriers, clarifies follow-up recommendations, and improves patients’ ability to recognize red-flag symptoms.
Methods: We aimed to evaluate the efficacy and versatility of P.L.A.N., a novel patient-centered counseling framework designed to translate complex clinical concepts into actionable steps. The study investigated whether this tool could improve objective disease knowledge and subjective self-management confidence across different clinical contexts. We implemented a pre-post interventional study design across two cohorts. The first cohort included fifteen adult male residents at a homeless shelter who received one-on-one hypertension counseling utilizing the P.L.A.N. worksheet. The second cohort included ten patients seen at a charity musculoskeletal clinic who, after evaluations by both a physician and a physical therapist, completed a baseline assessment, a facilitated P.L.A.N. session, and a post-treatment assessment.
Results: Quantitative analysis revealed robust improvements in both settings. In the MSK cohort, assessment scores improved from 58.3% to 79.3% (p = 0.0034), with patients demonstrating better understanding of their medical conditions and a more accurate recall of their treatment steps. In the HTN cohort, objective knowledge scores increased from 66% to 89.3% (p = 0.000110), and self-confidence in managing hypertension rose from 65% to 83% (p = 0.00474). Across both groups, 100% of participants reported both that the worksheet improved their understanding of the visit and that they would use the tool again on a future visit.
Conclusions: The P.L.A.N. framework is a scalable, low-resource tool to improve health literacy, strengthen patient engagement, and reduce communication-related safety risks in underserved populations by enhancing clarity around diagnosis and self-management expectations. Its early success across diverse clinical settings supports broader implementation and positions P.L.A.N. as an effective tool for strengthening disease understanding and enhancing patient self-management. Ongoing expansion into inpatient and specialty care will further clarify its impact on adherence, follow-up completion, readmission, and safety events.