Health Literacy: What It Is & Why It Matters To Your Practice

Health Literacy: What It Is & Why It Matters To Your Practice Professor Christopher Trudeau,Western Michigan University Cooley Law School

Have you ever had a colonoscopy? Had a baby? Had surgery?Taken medication?Shopped for health insurance? Had your blood drawn? Gone to the hospital?Then Your Health Literacy Has Been Tested

What is health literacy? A persons ability to obtain, process, and understand basic health information . . . . Source: Institute of Medicine, Health literacy: A prescription to end confusion (2004)

Which of the following is the best predictor of an individuals health status? AgeIncomeRace/ethnicityEducation LevelLiteracy Skills 75% of patients who reported being in poor health also tested in the below-basic HL categorySource: Weiss BD. Health Literacy: A Manual for Clinicians. American Medical Association / American Medical Association Foundation, 2003. p. 7.

Source: U.S. Department of Education, Institute of Education Sciences 2003 National Assessment of Adult Literacy

Lets hear from some patients

Source: AMA Health Literacy Video (Short Version)

HHS, CDC, and FDA also care about improving health literacy:

Engage individuals and families as partners in their care by incorporating patient and caregiver preferences; using clear and productive communication strategies; improving the experience of care for patients, caregivers, and families; integrating health literacy principles; and promoting patient self-management.Strategic Goal #1 from HHSs 2011-2015 Strategic Plan:

Okay. I see why this is important in life, but how does this impact me as a health lawyer?

Health literacy impacts all sorts of health lawyers:Do you represent plaintiffs? You can use HL research as a sword in your malpractice litigation. HL research creates new territory for attacking the way a HCO communicates with patients. Do you represent hospitals, provider practices, medical device companies, drug companies, medical researchers, or health insurers? You can use HL as a shield to better protect your clients. HL should be factored in to almost everything you do.

Your clients care about health literacy? Patient-Centered Care is More than a Goal - it's a RealityYou and your well-being are the reasons we exist. Your needs are our priority, and your uniqueness will be recognized, respected, and appreciated in all that we do.From McLaren Northern Michigans website: http://www.mclaren.org/northernmichigan/McLaren-Patient-Centered.aspx Spectrum Health hospitals have developed Implementation Plans dedicated to improving health care access and improving health literacy, awareness and education as identified in the Community Health Needs Assessments conducted in each county throughout the Spectrum Health service area.From Spectrum Health website: http://www.spectrumhealth.org/community-health-needs-assessment

But our role as counsel is to legally protect our clients. How does health literacy fit in? We can help our clients meet their business objectives AND legally protect them. We can create win-wins for patients and HCOs.

Creating clear, patient-centered institutional processes and materials will help better shield your clients from marginal lawsuits over misunderstandings.

The law & health literacy are NOT mutually exclusive!

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Scary data for health lawyers

In one of the largest studies conducted on health literacy, researchers using patients from two public hospitals found that:Source: http://www.ncbi.nlm.nih.gov/pubmed/7474271

Speaking of informed consentThe typical informed consent document has an average 10th 12th grade reading level. But the average reading level of adults in the U.S. Falls between the 6th & 7th grade, depending on the study.

Guess the reading level needed to understand thisI consent to the performance of operations and procedures in addition to or different from those now contemplated, whether or not arising from presently unforeseen conditions, which the above-named doctor or his associates or assistants may consider necessary or advisable in the course of the operation.

Tips for your toolbox

First, consider patients what do we know about users of health docs? People decide for themselves how much attention to pay to a documentWe cannot assume people will work their way through a document because we think it is important! These documents are tools that are meant to be used for a purpose. They are not novels meant to be read from cover to cover.

People actively interpret as they read they dont wait until the end and then assess the big picture. So what we put up front matters greatly. And so does the way we draw a users attention e.g. text walls wont work.

Users interpret documents based on their own knowledge and expectations.User-testing high-stakes documents can help to ensure the documents message is reaching the intended audience. For more, read Redish, J.C. (1993). Understanding Readers, Chapter 1. In Barnum, C.M and Carliner, S. (Eds.) Techniques for Technical Communicators. New York: Macmillan.

Structure all health communications as if everyone has limited health literacy

You cannot tell by looking at someoneHigher literacy skills understandingAnxiety can reduce ability to manage health informationEveryone benefits from clear communicationsSecond, universal precautions are key

Third, written communication is no substitute for in-person conversationsEnsure your clients are trained teach-back training is very useful.

Help your clients design health-literate institutional processes not just forms.

Fourth, document design is as important as the documents wording

Fifth, pay attention to how you communicate risk (including statistics)

The U.S. ranks at the bottom in numeracy skills.

Pop Quiz on Numeracy A person taking Drug A has a 1% chance of having an allergic reaction. If 1,000 people take Drug A, how many would you expect to have an allergic reaction?Answer: ___ persons out of 1000

A person taking Drug B has a 1 in 1,000 chance of an allergic reaction. What percent of people taking Drug B will have an allergic reaction?Answer: ___%

Imagine that I flip a coin 1,000 times. What is your best guess about how many times the coin would come up heads in 1,000 flips?Answer: ___ times of 1000

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Pop Quiz on Numeracy - Answers A person taking Drug A has a 1% chance of having an allergic reaction. If 1,000 people take Drug A, how many would you expect to have an allergic reaction?Answer: 10 persons/1000 (46% missed this)

A person taking Drug B has a 1 in 1,000 chance of an allergic reaction. What percent of people taking Drug B will have an allergic reaction?Answer: 0.1% (80% missed this)

Imagine that I flip a coin 1,000 times. What is your best guess about how many times the coin would come up heads in 1,000 flips?Answer: 500/1000 (46% missed this) Source: Schwartz,Woloshin, Black, and Welch (1997)

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Example: Creating a health-literate consent process for colonoscopies

First, Design the consent process including all interactions and materials patients will receive. Patient & provider discuss the need for procedure including risks, benefits, alternatives;Patient then receives educational info and the consent form; Patient preps for procedure; (no small task)Patient goes to appointment;Patient & provider further discuss consent form, using teach back. (Before anesthetics)

Next, create the consent form (and any other educational materials you are producing in house). Consider your design strategy multi-column format? visuals?font size & typemonochrome or color?white spacelimited to 2 pages for content?space for office admin needs?signature linesConsider your contentprocedure descriptionrisks (numeracy?)alternativesrecovery issuesother disclosuresin plain language?high-frequency words?no text wallsshort sentences teachback? Test for reading level? User test?

And now for a completely redesigned consent form

(See the handout. Also available in the conference materials booklet)

Thank You!