Health Literacy Its importance to you Michelle Burda, MLS [email protected] (412) 624-1589 Network and...

Health Literacy Its importance to you

Michelle Burda, MLS

[email protected] (412) 624-1589

Network and Advocacy Coordinator

National Network of Libraries of Medicine

Middle Atlantic Region

Developed by NN/LM staff.

This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N-276-2011-00003-C with the University of Pittsburgh-Health Sciences Library System.

Created by Michelle Burda, M

LS, National N

etwork

Libraries of Medicine, M

iddle Atlantic Region

Agenda

#1 Raise Awareness

Define the meaning of health literacy

Identify the various types of literacy

Recognize the impact health literacy plays in healthcare

Examples to raise awareness

Affordable Care Act

Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

Objectives:At the end of the presentation you will be able to:

Recognize the affects health literacy has on health outcomes

Identify the “red flags” that signal a patient may have low literacy

Identify techniques to improve patient-provider communication skills

Recognize why health literacy is important in managing chronic illness

List sources of where you can find additional literacy tools and materials


Literacy skills are a stronger predictor of health status than: Age Income Employment status Education level Race or Ethnic group

Weiss, BD. Health Literacy: A Manual for Clinicians. AMA 2003 p.7.


What is Health Literacy?“The degree to which individuals have the capacity to obtain,

process, and understand basic health information and services needed to make appropriate health care decisions.”*

*Ratzan, S., and R. Parker. (2000); Healthy People 2010 and Healthy People 2020

Health Literacy = finding, understanding, evaluating, communicating, and using information to make decisions.* Applies to both public and health professionals

*Calgary Charter on Health Literacy

It is an emerging public health issue that effects all ages, race and income levels*.*National Patient Safety Foundation



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THE LITERACY PROBLEM

National Assessment of Adult Literacy (NAAL)http://nces.ed.gov/NAAL

Conducted in 2003

More than 19,000 adults >16yr. One-on-one administration

Goal: assess literacy in English


http://nces.ed.gov/NAAL

Results of NAAL: Literacy Statistics

Functionally illiterate = 23% of adults

Marginal literacy skills = 28% of adults

Proficient = Only 13% of adults

66% of adults over age 60 have inadequate or marginal literacy skills

Average reading level in the U.S. is 8th grade; 20% read at 5th grade level or below


What this means

Below basic Basic Intermediate Proficient


Three Types of Literacy

Prose Document Quantitative

Requires ability to search, comprehend, and use continuous text

Non-continuous textRequires ability to search, comprehend, & use information

Requires ability to identify & perform computations, using numbers within printed materials



Prose LiteracyExample of a surgical consent form


Document Literacy - NALS

Quantitative Literacy

Requires ability to identify and perform computations, using numbers within printed materials.


Differences between good and poor readers

Skilled Readers Poor Readers Managing the Problem

Interpret meaning Take words literally Explain the meaning

Read with fluency Read slowly – miss meaning

Use common words give appropriate ex.

Get help for uncommon word

Skip over words Use examples, review

Grasp the content Miss the content Explain content, use visuals

Persistent Reader Tire quickly Short segments, easy clear layout

Teaching Patients with Low Literacy Skills 2nd ed. by Doak, Doak, & Root, 1996

Factors affecting learning ability Stress

Illness

Age

Cultural Barriers

Language Barriers


What it is like to be a patient who doesn’t understand*?

*AMA Foundation Health Literacy Help Patients Understand 2nd ed. 2007

(short version)www.amafoundation.org/go/healthliteracyt Version


http://www.youtube.com/watch?v=BgTuD7l7LG8&feature=youtu.be&t=4s


http://www.amafoundation.org/go/healthliteracy


TESTING FOR READABILITY


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Overview

MethodWord countSyllables Sentence length

Readability of MaterialsFry SMOG

Patient Literacy (REALM, TOFHLA, Newest Vital Sign) Computer software (HeaLth Literacy Advisor)

SMOG

Simple Measure Of Gobbledygook

1. Count off 10 sentences near the beginning, 10 in the middle and 10 at the end of text.

2. Circle every word containing 3 or more syllables and total the number of words circled

3. Estimate the square root of the total number of words counted

4. Add three to the square root.

SMOG grade = 3 + Square Root of Polysyllable Count

http://www.readabilityformulas.com/smog-readability-formula.php





REALMRapid Estimate of Adult Literacy in Medicine

Asks patients to pronounce 66 words ranging from “fat” to “impetigo”

Test provides grade level scores for people who read below a ninth grade level

May be better suited for research

Realm SF – Formhttp://www.lsuhscshreveport.edu/HealthLiteracy/HealthLiteracyInfoFAQ.aspx Terry C. Davis, Ph.D.


http://www.lsuhscshreveport.edu/HealthLiteracy/HealthLiteracyInfoFAQ.aspx



What is the Newest Vital Sign? Also know as NVS

New tool for rapid assessment of health literacy skills

First published Dec. 2005 Annals of Family Medicine Quick Assessment of Literacy in Primary Care: The Newest Vital Sign by Barry D. Weiss, MD. Professor of family and community medicine at University of Arizona College of Medicine

3 minute assessment- Ice cream label

English & SpanishCreated by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

Newest Vital Sign


Interpretation of Scores Number of correct answers

Score : 0-1 suggest likelihood (50% or more ) of limited literacy

Score: 2-3 indicated the possibility of limited literacy

Score: 4-6 almost always indicates adequate literacy


Functional Health Literacy

“The ability to read and comprehend prescription bottles, appointment slips, and the other essential health related materials required to successfully function as a patient”*

*AMA Council of Scientific AffairsCreated by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

Task: Appointment Slip

Locate information in a simple document. When is your next appointment? Where?

CLINIC APPOINTMENT

CLINIC: Diabetic

DAY: Thursday DATE: April 2nd HOUR: 6:45

YOU MUST BRING YOUR PLASTIC CARD WITH YOU


Task: Prescription Label

Applying information in a document If you were going to eat lunch at noon, what time

should you take your medicine?

Bouvier, Patricia

FF9418262 Dr. Hibbert, Julius

DOXYCYCLINE 100 MG

Take medication on empty stomach one hour before or two to three hours after a meal unless otherwise directed by your doctor.

Medication Safety and Health LiteracyOnly about 50% of patients take meds as directed

What’s “plenty” of water?

“Take twice a day

“Don’t take medicine if you’ve been in the sun too long.”



Dosage using a spoon Kitchen spoons

Medication dispensing spoons

Reading a thermometer


Medical studies indicate most people suffer a 68% hearing loss when naked.


And, furthermore…

Up to 80% of patients forget what a doctor told them as soon as they leave the office!

Nearly 50% of what they do remember is remembered incorrectly!


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Improving Oral Communication

Communication is two-way

Use “teach back” instructions

Avoid medical jargon

Use commonly understood words

Limit information

Include visual aids- models, pictograms,

Videos


Invite questionsWe usually say – Do you have any questions? Better to say: What questions do you have?Implies you are expecting questions. Or…. Let me answer any questions you may have.

Assess understandingIf we ask - Do you understand? Easy to say yes.We are implying the patient understands or should understand what we just said to them. Better to use “teach back” techniquehttp://www.youtube.com/watch?v=_Vo9Q_EfBX8


http://www.youtube.com/watch?v=_Vo9Q_EfBX8

Summary Assess patients’ needs

Focus on 1-3 key “need-to-know” items

Use “plain language”

Use visual aids

Ask ”what questions do you have”

Use “teach back” to validate understandinghttp://healthliteracymn.org/sites/default/files/images/files/Teach-Back%20Program%20Guide.pdf

http://healthliteracymn.org/sites/default/files/images/files/Teach-Back%20Program%20Guide.pdf

http://healthliteracymn.org/sites/default/files/images/files/Teach-Back%20Program%20Guide.pdf

INTERNET RESOURCES

Tools and Resources


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TOOLS & RESOURCES Health Literacy Universal Precautions Toolkit Plain Language Teach Back

NLM Resources MedlinePlus SeniorHealth DailyMed


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http://medlineplus.gov

Easy-to-Read materials

Medical DictionaryUnderstanding Medical Words tutorial

Interactive tutorials

How to write easy-to-read materials: http://www.nlm.nih.gov/medlineplus/etr.html


http://www.nlm.nih.gov/medlineplus/etr.html

http://www.nlm.nih.gov/medlineplus/

HIV/AIDS INFORMATIONHTTP://AIDS.NLM.NIH.GOV/INDEX.PHP


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http://aids.nlm.nih.gov/index.php

http://nihseniorhealth.gov/

Developed with the National Institute on Aging Senior-friendly features:

Text SizeContrastShort segments of information


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ork Libraries of M

edicine, Middle Atlantic Region

http://nihseniorhealth.gov/

NLM Mobile http://www.nlm.nih.gov/mobile/

MyMedList


http://www.nlm.nih.gov/mobile/

PLAIN ENGLISH/PLAIN LANGUAGEhttp://www.plainlanguage.gov

Promote the use of plain language for all government communications

Examples, word suggestions, thesaurus

Separate section for health literacy


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etwork



http://www.plainlanguage.gov/

Health Literacy Universal Precautions Toolkithttp://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/ Experts recommend assuming everyone may have difficulty

understanding Systems are needed to be in place to promote better

understanding not only to those we think may need help Promoting health literacy improves health outcomes Areas that are important to address

Improve spoken communication Improve written communication Improve self-management & empowerment Improve supportive systems Tools to address these areas are included in the toolkit

http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/

http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/

KEY PLAYERS Partnership for Clear Health Communication/AskMe3

Initiative http://www.npsf.org/askme3/ Centers for Disease Control and Prevention – Simply Put

http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf

U.S. Department of Health & Human Services, Office of Disease Prevention and Health Promotion http://www.health.gov/communication/literacy

“Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites” (U.S. Dept. HHS)http://www.health.gov/healthliteracyonline/index.htm


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http://www.npsf.org/askme3/

http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf

http://www.health.gov/communication/literacy

http://www.health.gov/healthliteracyonline/index.htm

MORE KEY PLAYERS Hablamos Juntos – “Universal Symbols in Health Care

Workbook”http://www.rwjf.org/pr/product.jsp?id=15864

Clear Health Communications (Pfizer) http://www.pfizerhealthliteracy.com/

Health Literacy Consultinghttp://www.healthliteracy.com

Agency for Healthcare Research and Quality (AHRQ)http://www.ahrq.gov/browse/hlitix.htm

National Center for the Study of Adult Learning & Literacy ( end federal funding 2007 but all resources are online-training, teaching materials etc. http://www.ncsall.net/index.html@id=1.html


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http://www.rwjf.org/pr/product.jsp?id=15864

http://www.pfizerhealthliteracy.com/

http://www.healthliteracy.com/

http://www.ahrq.gov/browse/hlitix.htm

http://www.ncsall.net/index.html@id=1.html

http://www.ncsall.net/index.html@id=1.html

HTTP://NNLM.GOV/BHIC/Created by M

ichelle Burda, MLS, N

ational N

etwork Libraries of M

edicine, Middle Atlantic

Region

Future of Healthcare

What does this mean to you? You will need to review the design of outreach

campaigns, eligibility documents and forms

People without PCs or the internet will need a private alternative for accessing their healthcare records

There will be a need for non-web-based access

There will be a need for educational and outreach in developing skills in the areas of computer research, choosing and comparing cost of services, insurance benefits

Culturally appropriate


From: Health Coverage Under the Affordable Care ActJAMA. 2012;308(24):2556-2556. doi:10.1001/jama.2012.128713


Explaining deductible Complicated & technical If you can’t substitute a plain language word or phrase we must

explain what it means by example: What is a deductible?Your deductible is the amount of money you have to pay for your health care before your health insurance plan will start to pay for medical services. In other words, your health insurance plan “kicks in” only after you’ve paid the amount of your deductible out of your own pocket.

For example: Your health plan has a deductible of $1,000. That means that you need to spend $1,000 of your own money on health care before your health insurance plan will start to pay for things.

http://communicatehealth.com/ideas/we-heart-health-literacy/

10 120

10 Attributes of a Health Literate Organization

About the Middle Atlantic Region (MAR)http://nnlm.gov/mar/

The University of Pittsburgh Health Sciences Library System (HSLS) serves as the Regional Medical Library (RML) for the National Network of Libraries of Medicine, Middle Atlantic Region (NN/LM, MAR) under a 5-year contract with the National Library of Medicine. The MAR is one of eight regions in the National Network of Libraries of Medicine (NN/LM) and includes Delaware, New Jersey, New York and Pennsylvania.


http://nnlm.gov/mar/

http://nnlm.gov/mar/

http://www.hsls.pitt.edu/

http://www.hsls.pitt.edu/

http://nnlm.gov/

Our outreach efforts are directed toward libraries, health professionals and consumers. Throughout the 2011-2016 contract, our role is to develop, fund and manage a variety of outreach awards that support programs to:

Promote the changing role of librarians within their institutions and communities

Provide access to biomedical information to unaffiliated health professionals, including behavioral and mental health professionals, the public health workforce, minority health workers and rural, underserved hospitals

Improve health through access to reliable information for consumer groups, including soldiers, veterans and their families, senior citizens, caregivers, K-12 schools, community-based and faith-based organizations

Health Literacy Its importance to you Michelle Burda, MLS [email protected] (412) 624-1589 Network and...

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