Amrita Mukhopadhyay*, Hila Calev*, Jill Huded, MD** · 2017. 9. 5. · Amrita Mukhopadhyay*, Hila...
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Amrita Mukhopadhyay*, Hila Calev*, Jill Huded, MD** Background Results Conclusions What is health literacy? It is de(ined as the ability to understand and navigate one’s healthcare environment. Literacy is one of the strongest predictors of health status. Low health literacy is associated with poorer health outcomes, higher health service utilization, and dif(iculty understanding written medical instructions. 1,2 How prevalent is low health literacy? More than 33% of American adults do not have adequate health literacy to navigate preventive care or treatment 3 , with a higher risk in limited English pro(iciency populations. Our population at high risk: The largest volunteerHbased free clinic in IL serving those under 250% of the poverty level, many with limited English pro(iciency: • 50% Latino, 15% Polish immigrants. • 30% with less than 8 th grade readingHlevel, 30% with a 9H12 th grade readingHlevel. An interdisciplinary team: physician, nurse practitioner, medical students, health education coordinators, intern, dietician, nurses, and social worker. Our process: See diagram. Assuring quality using the Suitability Assessment of Materials (SAM): a validated, 21Hitem tool requiring a score of greater than 70% to be “superior”. 4 Patient feedback: a verballyH administered, 8Hquestion survey assessing readability, vocabulary, graphics, layout, learning, motivation, and cultural appropriateness on threeH point scales, as well as an overall preference for the old handout versus the new handout. Barriers Methods Patients 1. Needs assessment surveys Allied Health Professionals Topic of Greatest Interest 2. Online search for materials Only accept if “superior” SAM Score 3. Adapting materials to our patient population Staff Providers Nurse Patients Social Worker Dietician 4. Translation Two trained native speakers per handout High quality translation Tailored Handouts Demographics • There is a scarcity of publicallyHavailable patient education handouts to meet the needs of our lowH income, lowHhealth literacy patient population. • The SAM tool can be used to assess document quality of such materials. • We used a replicable, interdisciplinary method to create handouts in 3 languages with strongly positive patient feedback. ACKNOWLEDGEMENTS: Anna Ruman, Nicole Potempa, Audrey Schield, Adelle White, Stacy Smrz, Miguel Barajas, Ewa Wojciechowska, Bozena Tybor, Ornella Razetta REFERENCES: 1. Weiss BD et al. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract.1992. 2. Baker D et al. The relationship of patient reading ability to selfYreported health and use of health services. Am J Public Health.1997. 3. Weiss, B., 2007. Removing Barriers to Better, Safer Care: Health Literacy and Patient Safety. Help Patients Understand. Manual for Clinicians, 2 nd ed. Chicago, AMA Found. 4. Doak CC, Doak LG, Root JH. Philadelphia, Pa: JB Lippincott Company; 1996. Teaching Patients with Low Literacy Skills. 2nd ed. 94.6% 5.2% 0.2% 0% 20% 40% 60% 80% 100% Positive Neutral Negative Percent of Responses 120/80 140/90 Have your blood pressure checked often (at the doctor’s of7ice or local pharmacy). NORMAL PRE*HYPERTENSION You are more likely to end up with high blood pressure. HIGH Source: Translated from "Keep the Beat: Control Your High Blood Pressure" at h=p://www.nhlbi.nih.gov/health/public/heart/other/laCno/hbp/bloodpressure.pdf (Accessed 03/3/2014). NaConal Heart, Lung, and Blood InsCtute; NaConal InsCtutes of Health; U.S. Department of Health and Human Services. (Note: The NHLBI is not responsible for this document or any error it may contain. "Keep the Beat" was modified in format but not in content or conclusions. The pictorial presentaCon of "What Do Your Blood Pressure Numbers Mean" was created based on informaCon in the above document.) High blood pressure—also called hypertension— is known as the “silent killer” because it often has no symptoms. If not treated, high blood pressure raises your chances of • Stroke. • Heart attack. • Kidney problems. • Eye problems. • Death. Content in serif font. Shorter words and sentences. Punctuation after listed terms. Smaller chunks of information. Cartoons > photographs. Pictures closely linked to text. More pictures. Color > grayscale. • Lack of appropriate publicallyHavailable materials. • Copyright challenges in adapting existing materials and translating into other languages. • Lack continuity due clinic staff turnover. • Native speakers to translate materials. Patients N (%) Total Participants 30 Female 19 (63%) SpanishHspeaking 20 (67%) EnglishHspeaking 10 (33%) Health Professionals Total Participants 11 Female 11 (100%) Patient Feedback; • New handouts universally preferred to old ones, except “High Cholesterol” (3 of 7 preferred old), which was reworked on the basis of patient feedback. • Free response feedback centered on clarity of graphics (7 comments) and wording (8 comments). Figure 1: Needs Assessment. Percent of participants interested in each health topic, with each group equally weighted. New handouts were created for the eight most popular topics (red boxes), with four topics combined into a “Women’s Health” handout. Figure 2: Feedback. Responses to 8Hquestion feedback surveys (22 patients, 60 surveys). Designing Education Materials Example 0 10 20 30 40 50 60 70 80 90 Percent of interested participants (weighted) English-speaking Patients (N=10) Spanish-speaking patients (N=20) Allied Health Professionals (N=11) Women’s Health Handout Project Aim We aimed to improve health education materials used in providerHpatient encounters in 8 topics, focusing on appropriateness for patients with low health literacy. Provide translations of these materials in English, Spanish and Polish while incorporating aspects of culture and community into the documents. Provide team education on health literacy. Table 1. Demographics of patients and allied health participants in initial needs assessment. Final Handout
Transcript of Amrita Mukhopadhyay*, Hila Calev*, Jill Huded, MD** · 2017. 9. 5. · Amrita Mukhopadhyay*, Hila...
Amrita Mukhopadhyay*, Hila Calev*, Jill Huded, MD**
Background+ Results+
Conclusions+
What+is+health+literacy?++It#is#de(ined#as#the#ability#to#understand#and#navigate#one’s#
healthcare#environment.##Literacy#is#one#of#the#strongest#predictors#of#health#status.##
Low#health#literacy#is#associated#with#poorer#health#outcomes,#higher#health#service#
utilization,#and#dif(iculty#understanding#written#medical#instructions.1,2#
+
How+prevalent+is+low+health+literacy?++More#than#33%#of#American#adults#do#not#have#
adequate#health#literacy#to#navigate#preventive#care#or#treatment3,#with#a#higher#risk#in#
limited#English#pro(iciency#populations.##
#
Our+population+at+high+risk:++The#largest#volunteerHbased#free#clinic#in#IL#serving#those#
under#250%#of#the#poverty#level,#many#with#limited#English#pro(iciency:#
• 50%#Latino,#15%#Polish#immigrants.#• 30%#with#less#than#8th#grade#readingHlevel,#30%#with#a#9H12th#grade#readingHlevel.#
#
#
An+interdisciplinary+team:++physician,#
nurse#practitioner,#medical#students,#
health#education#coordinators,#intern,#
dietician,#nurses,#and#social#worker.#
#
Our+process:++See#diagram.#
+
Assuring+quality+using+the+Suitability+
Assessment+of+Materials+(SAM):++a#
validated,#21Hitem#tool#requiring#a#score#
of#greater#than#70%#to#be#“superior”.4#
#
Patient+feedback:#a#verballyH
administered,#8Hquestion#survey#
assessing#readability,#vocabulary,#
graphics,#layout,#learning,#motivation,#
and#cultural#appropriateness#on#threeH
point#scales,#as#well#as#an#overall#
preference#for#the#old#handout#versus#
the#new#handout.#
Barriers+Methods+
Patients#
1.+Needs+assessment+surveys+
Allied#Health#
Professionals#
Topic#of#
Greatest#
Interest#
2.+Online+search+
for+materials+Only#accept#if#
“superior”#SAM#Score#
3.+Adapting+materials+
to+our+patient+
population+
Staff#
Providers#
Nurse#
Patients#
Social#Worker#
Dietician#
4.+Translation+
Two#trained#
native#speakers#
per#handout#
High#quality#
translation#
Tailored#
Handouts#
Demographics#
• There#is#a#scarcity#of#publicallyHavailable#patient#education#handouts#to#meet#the#needs#of#our#lowH
income,#lowHhealth#literacy#patient#population.#
• The#SAM#tool#can#be#used#to#assess#document#quality#of#such#materials.#
• We#used#a#replicable,#interdisciplinary#method#to#create#handouts#in#3#languages#with#strongly#
positive#patient#feedback.###
ACKNOWLEDGEMENTS:##Anna+Ruman,+Nicole+Potempa,+Audrey+Schield,+Adelle+White,+Stacy+Smrz,+Miguel+Barajas,+Ewa+Wojciechowska,+Bozena+Tybor,+Ornella+Razetta#REFERENCES:+
1.+Weiss+BD+et+al.+Health+status+of+illiterate+adults:+relation+between+literacy+and+health+
status+among+persons+with+low+literacy+skills.++J+Am+Board+Fam+Pract.1992.+
2. +Baker+D+et+al.+The+relationship+of+patient+reading+ability+to+selfYreported+health+and+use+of+health+services.+Am+J+Public+Health.1997.+
3. +Weiss,+B.,+2007.+Removing+Barriers+to+Better,+Safer+Care:+Health+Literacy+and+Patient+Safety.+Help+Patients+Understand.+Manual+for+Clinicians,+2nd+ed.+Chicago,+AMA+Found.+
4. +Doak+CC,+Doak+LG,+Root+JH.+Philadelphia,+Pa:+JB+Lippincott+Company;+1996.+Teaching+Patients+with+Low+Literacy+Skills.+2nd+ed.+
94.6%
5.2% 0.2% 0%
20% 40% 60% 80%
100%
Positive Neutral Negative
Per
cent
of
Res
pons
es
120/80& 140/90&
Have%your%blood%pressure%checked%often%%(at%the%doctor’s%of7ice%or%local%pharmacy).%
NORMAL'
PRE*HYPERTENSION'You%are%more%likely%to%end%up%with%high%blood%pressure.% HIGH'
Source:(Translated(from("Keep(the(Beat:(Control(Your(High(Blood(Pressure"(at(h=p://www.nhlbi.nih.gov/health/public/heart/other/laCno/hbp/bloodpressure.pdf((Accessed(03/3/2014).(NaConal(Heart,(Lung,(and(Blood(InsCtute;(NaConal(InsCtutes(of(Health;(U.S.(Department(of(Health(and(Human(Services.(((Note:(The(NHLBI(is(not(responsible(for(this(document(or(any(error(it(may(contain.(("Keep(the(Beat"(was(modified(in(
format(but(not(in(content(or(conclusions.((The(pictorial(presentaCon(of("What(Do(Your(Blood(Pressure(Numbers(Mean"(was(created(based(on(informaCon(in(the(above(document.)(
High%blood%pressure—also%called%hypertension—is%known%as%the%“silent%killer”%because%it%often%has%no%symptoms.%If%not%treated,%high%blood%pressure%raises%your%chances%of%%
• Stroke.%• Heart%attack.%• Kidney%problems.%• Eye%problems.%• Death.%
Content#in##
serif#font.##
#
Shorter#words#
and#sentences. Punctuation#after##
listed#terms.#
#
Smaller#chunks#
of#information.#
#
Cartoons#>##
photographs.#
#
Pictures#closely##
linked#to#text.#
#
More#pictures.#
#
Color#>#
grayscale.#
• Lack#of#appropriate#publicallyHavailable#materials.#• Copyright#challenges#in#adapting#existing#materials#and#translating#into#other#languages.#
• Lack#continuity#due#clinic#staff#turnover.#• Native#speakers#to#translate#materials.#
Patients+ N+(%)+
Total#Participants# 30#
Female# 19#(63%)#
SpanishHspeaking# 20#(67%)#
EnglishHspeaking# 10#(33%)#
Health+Professionals+
Total#Participants# 11#
Female# 11#(100%)#
Patient+Feedback;#
• New#handouts#universally#preferred#to#old#ones,#except#“High#Cholesterol”#(3#of#7#preferred#old),#which#was#
reworked#on#the#basis#of#patient#feedback.#
• Free#response#feedback#centered#on#clarity#of#graphics#(7#comments)#and#wording#(8#comments).#
Figure+1:++Needs+Assessment.##Percent#of#participants#interested#in#each#health#
topic,#with#each#group#equally#weighted.##New#handouts#were#created#for#the#
eight#most#popular#topics#(red#boxes),#with#four#topics#combined#into#a#
“Women’s#Health”#handout.###
Figure+2:+Feedback.#Responses#to#8Hquestion#
feedback#surveys#(22#patients,#60#surveys).#
Designing+Education+Materials+Example+
0 10 20 30 40 50 60 70 80 90
Per
cent
of i
nter
este
d pa
rtic
ipan
ts (w
eigh
ted)
English-speaking Patients (N=10) Spanish-speaking patients (N=20) Allied Health Professionals (N=11) Women’s#Health#Handout#
Project+Aim+
+We#aimed#to#improve#health#education#materials#used#in#providerHpatient#encounters#
in#8#topics,#focusing#on#appropriateness#for#patients#with#low#health#literacy.#
#
Provide#translations#of#these#materials#in#English,#Spanish#and#Polish#while#
incorporating#aspects#of#culture#and#community#into#the#documents.#
#
Provide#team#education#on#health#literacy.#
#
#
Table+1.++Demographics#
of#patients#and#allied#
health#participants#in#
initial#needs#assessment.#
Final+Handout+
