1

Health Literacy:A Crisis In Health CareMinnesota Rural Health Conference

July 19, 2005Duluth, MN

Developed by Stratis Health with the Permission of the American Medical Association Foundation and the American Medical Association

2

Definitions

General Literacy:

“ An individual’s ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.”

National Literacy Act of 1991Health Literacy:“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

Healthy People 2010

3

Implications of low health literacy on patient care

33% Unable to read basic health care materials

42% Unable to comprehend directions for taking medication on an empty stomach

26% Unable to understand information on appointment slip

43% Unable to understand rights and responsibilities section of Medicaid application

60% Unable to understand standard informed consent

Williams et al., JAMA 12/6/95

4

Cost of poor health literacy: Estimate >$50 billion annually*

We all pay! 39% paid by Medicare (FICA taxes on workers)

17% paid by employers

16% paid by patients, out-of-pocket

14% paid by Medicaid

14% from other public and private sources *Estimated by National Academy on an Aging Society using 1998 figures

5

National Adult Literacy Survey (NALS)

Conducted in 1992 N=26,000 Most accurate portrait of literacy in the US Scored on 5 levels Not accounted for:

Patients who have adequate language skills, but do not have adequate health literacy

6

Results: National Adult Literacy Survey (NALS)

21%

27.5%

31.5%

16%

3%

0

5

10

15

20

25

30

35

1 2 3 4 5

(Kirsh I, Jungeblut A, 1993)

Level

7

NALS: Results

48%, or 90 million, US adults have inadequate or marginal literacy skills

Does not account for patients who have adequate language skills, but do not have adequate health literacy

Only 25% of those in Level 1 were new immigrants. Those at levels 1 and 2 did not necessarily

perceive themselves as being ‘at risk’

(Kirsh I, Jungeblut A, 1993)

8

Why are patients at risk?

Reliance on written word for patient instruction Increasingly complex health care system

More medications More tests and procedures Growing self-care requirements Esoteric language

Aging population More culturally diverse patient population

9

Understanding the problem

What is it like?The following passage simulates what a

reader with low general literacy sees on the printed page

Read the entire passage out loudYou have 1 minute to read

(Hint: words are written backwards and the first word is “cleaning”)

10

GNINAELC – Ot erussa hgih ecnamrofrep, yllacidoirep naelc eht epat sdaeh dna natspac revenehw uoy eciton na noitalumucca fo tsud dna nworb-der edixo selcitrap. Esu a nottoc baws denetsiom htiw lyporposi lohocla. Eb erus on lohocla sehcuot eht rebbur strap, sa ti sdnet ot yrd dna yllautneve kcarc eht rebbur. Esu a pmad tholc ro egnops ot naelc eht tenibac. A dlim paos, ekil gnihsawhsid tnegreted, lliw pleh evomer esaerg ro lio.

11

Understanding the problem

Hear a few examples from: “As Patients See It” A video created in 2003 by AMA Real patients and real physicians talking

about literacy issues

12

Mr. Day

Diagnosed with hypertension

Reads at second-grade level

13

Mr. Bell

Reads at fifth-grade level

Gets agitated filling out paperwork

14

Mrs. Cordell-Seiple

Film maker Graduated from

high school reading at a fifth-grade level

Didn’t know she had undergone a hysterectomy

15

What do we know?

Low Health Literacy (LHL) is prevalentLHL leads to:

Lower health knowledge and less healthy behaviors

Greater health costs Poorer health outcomes

Techniques and approaches may be used to address health literacy

16

Three strategies

I. Create a “shame-free” environment

II. Improve interpersonal communication

III. Use patient-friendly educational materials and forms

17

Strategy: Create a shame-free environment

Recognize red flags: “I forgot my glasses…” Incomplete forms Seeking help only when illness is advanced

Convey an attitude of helpfulness, caring, and respect (by all staff): What is it like being a patient in your setting? Are there forms or instructions that could be

confusing?

18

Strategy: Improve interpersonal communication

Slow down Use plain “living room” language Focus on key messages (www.askme3.org):

What is my main problem? What do I need to do? Why is it important for me to do this?

Use “teach back” techniques

19

Strategy IIImprove interpersonal communication

Mrs. Greigar (reads at third-grade level)

Dr. Alvarez

Slow down Use analogies Use plain “living

room” language

20

Strategy II (continued)

Brown bag review Mrs. Tilsley reads at

seventh-grade level

Dr. Williams

21

Strategy IIIDevelop patient-friendly materials/forms

Keep content concise and focused: Focus only on key points Emphasize what the patient should do Keep anatomy and physiology basic Show or draw simple pictures to

enhance interaction

22

Strategy III

Tips for easy-to-read materials: Simple words (1-2 syllables) Short sentences (4-6 words) Short paragraphs (2-3 sentences) Limit medical jargon Use headings, bullets, and lots of white

space

23

What can you do by next week?

1. Explain things clearly in plain non-medical language/analogies.

2. Focus on the key messages using “Ask Me 3”.

3. Use a “teach back” or “show me” technique to check for understanding.

4. Use patient-friendly educational materials to enhance interaction.

5. Create a shame-free environment.

24

What can you do in the future?

Form a team to determine a long-term strategy Develop a plan to educate all staff about low

health literacy Discuss methods for improving communication

skills with providers and staff Do role play and/or identify key

terms/messages commonly encountered in your practice

Incorporate “Ask Me 3” components into patient information

25

“Understanding is a two-way street.”

Eleanor Roosevelt

26

For more information:

www.amafoundation.org

www.askme3.org

27

Karla Weng, MPH, CPHQ

Project Manager

(952) 853-8570

kweng@mnqio.sdps.org

28

Brought to you by Stratis HealthMinnesota’s Medicare Quality Improvement Organization

Stratis Health is a non-profit independent quality improvement organizationthat collaborates with providers and consumers to improve health care.

This presentation was created by Stratis Health under a contract with the Centers for Medicare & Medicaid Services (CMS).

The contents do not necessarily reflect CMS policy.