Health Literacy: Helping Patients

Understand Their Care

Community Health Integrated Partnership Webinar

Nancy WeberJacqueline Hill

Ray & Associates, LLC

Our Agenda

Understanding health literacy

Assessing health literacy

Employing health literacy techniques

Enhancing the patient-friendliness of your clinic

Wrap-up

Understanding Health Literacy

Basic Health Literacy Is…

The ability to read, understand, and act on medical information.

It is also:

Cultural competency

Plain language

Patient-friendly written materials

Cultural Competency

Ability of professionals to work across cultures

Appropriately recognizing these factors can produce positive health outcomes:

Contributes to health literacy by improving communication and building trust

Attitudes Language

Preferences

Cultural Beliefs Values Traditions

Prevalence of Limited Health Literacy

Affects 1/3 of American adults

More common among patients who:

Are older

Are of minority background

Have less education

Have low income/are unemployed

Source: Kutner, Greenberg, Jin & Paulsen. 2006. The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy. US Department of Education.

Prevalence of Limited Health Literacy

Source: Weiss. 2007. Health literacy and patient safety: Help patients understand. Manual for clinicians, 2nd edition. American Medical Association Foundation.

Consequences of Limited Health Literacy

Patients with low health literacy may have difficulty with the following:

Understanding medication directions

Completing medical forms

Managing chronic conditions

Understanding consent forms

Consequences of Limited Health Literacy

Low literacy is associated with the following:

Higher health care costs

Poorer health status

Higher probability of hospitalizations

Less health knowledge

Source: Weiss & Palmer. 2004. Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population. Journal of American Board of Family Practice, 17, 44-47.

Patient Coping Strategies

Patients having problems with reading and understanding health information may cope in the following ways:

Bring someone who can read with them

Watch and copy others’ actions

Tell you they can’t read or forgot their glasses

They will NOT ask for help from staff

Patient Abilities

Patient forms and instructions are typically written above the average adult reading level

Adults with adequate literacy skills are generally unable to read and understand similar materials with unfamiliar vocabulary and concepts

Compromised health decreases patients’ ability to understand and act on health information

Why Is Health Literacy Important?

The more health literate patients are, the more likely they are to:

Navigate the healthcare system, including locating providers/services and completing forms

Share personal and health information with providers

Engage in self-care and disease management techniques

Adopt health promoting behaviors, such as exercising and healthy eating

Act on health-related news and announcements

Why Is Health Literacy Important?

More health literate patients are likely to have:

Improved health outcomes

Reduced health care costs

Better quality of care

Higher satisfaction

Providers of health literate patients are likely to have:

Decreased stress and frustration

Improved job satisfaction

Assessing Health Literacy

Red Flag Behaviors

Incomplete or inaccurate patient registration form

Frequently missed appointments

Medication regimen noncompliance

Lack of follow-up with tests & referrals

Patient reported taking medications, but physical indicators do not improve

Red Flag Responses

“I forgot my glasses, I’ll read this when I get home.”

“I forgot my glasses, can you read this to me?”

“Let me take this home to discuss with my family.”

Unable to name medications

Unable to explain medication purpose

Unable to explain medication administration regimen/schedule

Health Literacy Assessment Strategies

Social history

What is the best way for you to learn new things?

How happy are you with the way you read?

How often do you need to have someone help you read instructions or complete medical forms?

Health Literacy Assessment Strategies

Brown bag medication review

Ask patients to bring all medications (Rx, OTC, herbs, vitamins) to clinical visit

During visit, ask patients to name each medication, its purpose, and describe how it is taken

Health Literacy Assessment Strategies

Source: caglecartoons.com

Health Literacy Assessment Strategies

Rapid Estimate of Adult Literacy in Medicine (REALM)

Word recognition test to identify patients at risk for limited health literacy skills

Ask patient to pronounce the following words:

Source: Bass, Wilson & Griffith. 2003. A shortened instrument for literacy screening. Journal of General Internal Medicine, 18(12), 1036-38.

Fat Flu Pill Osteoporosis

Allergic Jaundice Anemia Fatigue

Directed Colitis Constipation

Consider This…

During a medication review, Nurse Practitioner Welden asks Ms. Diaz, who has hypertension and coronary artery disease, to explain the name of each pill, its purpose, and how it should be taken. She is on Lipitor, Lisinopril, topral, Plavix and a diuretic.

What responses would you expect when conducting medication reviews with patients who have limited health literacy?

Inability to state the medication’s purpose

Inability to describe when to take the medicine

Inability to explain importance of medication

Employing Health Literacy Techniques

It’s Not What You Say…

It’s how you say it

Importance of tone and body language

Source: Mehrabian, 1981.

Behaviors to Improve Understanding

Slow down

Use plain, non-medical language

Show or draw pictures

Limit amount of information provided and repeat it

Use the “teach-back” technique

Create a shame-free environment by encouraging questions (e.g., “ask me three”)

Behaviors to Improve Understanding

Use orienting statements

Encourage patients to ask questions or probe to find out if they have unaddressed concerns

Ask patients to explain their understanding of the medical problem and treatment

Sit rather than stand

Listen rather than speak

Plain Language

Technique for making written and oral information easier to understand

Break down complex information

Organize information so that most important points come first

Source: Bliss by Harry Bliss, 5/9/09.

Explaining concepts to patients without medical terms can be challenging.

Sometimes pictures, analogies, and models help.

Plain Language

COPD Cardiologist Asthma Monitor

Arthritis Hypoglycemia Anti-

inflammatory Cholesterol

Teach Back Method

Have patients explain/demonstrate how they will perform their treatment or take their medication.

If patients do not answer correctly, state that you YOU have not explained something correctly.

Restate instructions in a different way and check for comprehension.

Ask Me 3

What is my main problem?

What do I need to do (about the problem)?

Why is it important to do this?

Enhancing the Patient-Friendliness of Your Clinic

Patient-Friendly Practice

Clear signage and directions

Plain language written materials Consent forms

Health history questionnaire

Patient education materials

Alternative non-written materials

Patient-Friendly Written Materials

Benefit all patients

Basic principles Depth and detail of content

Complexity of text

Format of material

User testing

Source: Environmental Protection Agency, 2006.

Patient-Friendly Non-Written Materials

Graphic illustrations Pictures

Pictograms

Models

Computer modalities Static and interactive

internet websites

Remember…

Assess for literacy Social history

Medication review

Improve understanding and compliance Make practice patient friendly

Use plain language

Draw a picture

Have patient “teach back” instructions

Ensure patients can “Ask me 3”

RAY & ASSOCIATES, LLC

Nancy Webernancy@rayllcmail.com

Jacqueline Hilljacqueline@rayllcmail.com

Community Health Integrated Partnership (CHIP)

Peggy Oehlmannpoehlmann@chipmd.org