PowerPoint Presentation · Cos’è la Health Literacy 2 ... Il test REALM - Rapid Estimate of...
Transcript of PowerPoint Presentation · Cos’è la Health Literacy 2 ... Il test REALM - Rapid Estimate of...
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LE BASI PER COMUNICARE CON I GENITORI
ESITANTI.
Pier Luigi Lopalco
Bari, 16 Dicembre 2017
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Cos’è la Health Literacy
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• La health literacy indica le abilità cognitive e sociali che motivano gli individui e li rendono capaci di accedere, comprendere e utilizzare le informazioni in modo da promuovere e preservare la propria salute
• Correlata al livello d’istruzione ma NON coincidente
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Livelli di alfabetizzazione
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• Alfabetizzazione di base/funzionale– Abilità di leggere, scrivere in maniera funzionale alle attività di ogni
giorno
• Alfabetizzazione di tipo interattivo/comunicativo– Abilità più avanzate che possono essere usate per estrarre
informazioni e trarre significati da differenti forme di comunicaizoneper partecipare in modo attivo alle attività quotidiane;
• Alfabetizzazione critica– Abilità cognitive più avanzate che servono ad analizzare in modo
critico le informazioni e possono essere usate oer avere maggior controllo su eventi e situazioni quotidiane
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Un modello integrato di HL
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Sørensen K., et al. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1), 80.
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La matrice del modello integrato di HL
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Accesso Comprensione Interpretazione Uso
Cura Capacità di accedere ad informazioni sulla propria salute
Capacità di capire le informazioni mediche
Capacità di interpretare le informazioni mediche
Capacità di prendere decisioni informate su problemi medici
Prevenzione Capacità di accedere ad informazioni suifattori di rischio
Capacità di capire le informazioni su fattori di rischio
Capacità di interpretare e valutare le informazioni sui fattori di rischio
Capacità di prendere decisioni informate suifattori di rischio
Promozione della salute
Capacità di accedere ad informazioni suideterminanti di salute
Capacità di capire le informazioni sui determinanti di salute
Capacità di interpretare e valutare le informazioni sui determinanti di salute
Capacità di prendere decisioni informate suideterminanti di salute
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Come si misura la HL?Il test TOFHLA – Test of Functional HL in Adults
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• Richiede un operatore• 18-22 minuti per test
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Come si misura la HL?Il test REALM - Rapid Estimate of Adult Literacy in Medicine
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“Per favore legga ad alta voce le seguenti parole”
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Come si misura la HL?Il test SILS – Single Item Literacy Screener
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Il test si considera positivo se >2
”Quante volte hai bisogno che qualcuno ti aiuti quando leggi istruzioni, opuscoli
o altro materiale che ti è stato consegnato dal medico o dal farmacista?”
1 - mai 2 - raramente 3 - talvolta 4 - spesso 5 - sempre
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HL in Europa
9R. Palumbo et al. Health Policy, 2016
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10
Few studies on communicable diseases (concerned only HIV, with
medication adherence as an outcome)
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Atteggiamento comune nei confronti dellemalattie infettive
Allarmismo Incoscienza
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Vaccine Literacy
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Accesso Comprensione Interpretazione Uso
Prevenzione Capacità di accedere ad informazioni suifattori di rischio
Capacità di capire le informazioni su fattori di rischio
Capacità di interpretare e valutare le informazioni sui fattori di rischio
Capacità di prendere decisioni informate suifattori di rischio
Ratzan SC, Journal of Health Communication, 16:227–229, 2011 - Vaccine Literacy: A New Shot for Advancing Health
Fadda M et al. BMC Public Health (2015) 15:836 –
Biasio LR - Vaccine hesitancy and Health Literacy - HV&I
empowerment
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Accesso alle informazioni sul web
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Accesso alle informazioni sul web
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Uso dei social media
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Il termometro di Google
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Rel
ativ
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arch
Vo
lum
e (R
SV)
vaccine measles autism vaccines autism vaccine autism MMR autism vaccine measles mumps rubella autism
Aquino, F., Donzelli, G., De Franco, E., Privitera, G., Lopalco, P. L., & Carducci, A. (2017). The web and public confidence in MMR vaccination in Italy. Vaccine, 35(35), 4494–4498.
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Cosa troviamo su YouTube in italiano
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2007 2009 2010 2011 2012 2013 2014 2015 2016 2017
negative 1 4 18 5 18 28 27 46 96 147
positive 0 0 0 1 0 0 13 18 42 54
neutral 0 0 0 0 2 1 8 3 5 23
0
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n°
of
vid
eos
Comunicazione personale, dati non pubblicati
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Capacità di comprendere e interpretare le informazioni su vaccini e malattie infettive
18
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Luce e oscurità
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Vaccinate gli extracomunitari!
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Non sono contro i vaccini, ma…
21
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Echo chambers
Comilva
VaccinarSì
“borderline”
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Capacità di prendere decisioni
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chi rifiuta i vaccini?
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Cognitive Style Possible approach
Denialist Provide consistent messaging repeatedly over time from trustworthy sources, provide educational materials, solicit questions, avoid “hard sell” approach, use motivational interviewing approaches
Innumerate Provide nonmathematical information, analogies, or comparators using a more holistic “right brain” or emotive approach
Fear-based Understand source of fear, provide consistent positive approach, show risks in comparison to other daily risks, demonstrate risks of not receiving vaccines, use social norming approaches
Heuristic Point out inconsistencies and fallacy of heuristic thinking, provide educational materials, appeal to other heuristics
Bandwagoning Understand primary influencers, point out logical inconsistencies, use social norming and self-efficacy approaches
Analytical Provide data requested, review analytically with patient
Poland CA, Poland GA. Vaccine education spectrum disorder: the importance of incorporating psychological and cognitive models into vaccine education. Vaccine. 2011
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Fattori cognitivi che determinano la scelta
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• Anchoring
• Availability heuristics
• Representativeness heuristics
• Status quo bias
• Herd mentality
• Emotions
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Le componenti della Vaccine Hesitancy
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5A model
1. Access2. Affordability3. Awareness4. Acceptance5. Activation
1. Confidence2. Complacency3. Convenience
Thomson A., et al. The 5As: A practical taxonomy for the determinants of vaccine uptake. Vaccine, 2016WHO, SAGE working group on Vaccine hesitancy
3C model
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Esistono evidenze che HL e vaccine hesitancy siano correlate?
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731 genitori di bambini israeliani di età compresa tra 3 e 4 anni: associazione inversa
fra livello elevato di HealthLiteracy e propensione a
vaccinare
506 madri di Philadelphia (USA) con bambini
da tre e sette mesi di età:nessuna associazione
significativa tra l’Health Literacy e lo stato di immunizzazione dei
bambini è stata rilevata.
467 genitori di bambini olandesi di 6 settimane:associazione positiva tra
Health Literacy e accettazione da parte dei genitori della
vaccinazione contro rotavirus.
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Valutazione della HL in un campione di studenti pisani (test I-METER)
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studenti areabio-medica
studenti altre discipline
Comunicazione personale, dati non pubblicati
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Valutazione della HL e VH in un campione di studenti pisani
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Punteggio IMETER< 35
Punteggio IMETER> 35
Coeff. Esitaz. Vax > 1 41 16Coeff. Esitaz. Vax < 1 455 488totale 496 504
Chi square: 12,04p< 0, 001
Comunicazione personale, dati non pubblicati
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Valutazione della HL in un campione di mamme pisane (test I-METER)
31
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
critica (0-20) marginale (21-34) funzionale (35-40)
5,0%
36,5%
58,5%
Comunicazione personale, dati non pubblicati
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HL a confronto nel campione di studenti e di mamme
32
Punteggio I-METER
Mamme Totale 33,5
italiane 34,3
straniere 22,5
Studenti Totale 33,4
area bio-medica 35,3
altre discipline 31,5
Comunicazione personale, dati non pubblicati
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HL e vaccine confidence nel campione di mamme pisane
33
Vaccine Confidence
Index
Punteggio I-METER
Mamme Totale 3,6 33,5
italiane 3,5 34,3
straniere 4,9 22,5
Comunicazione personale, dati non pubblicati
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Fonte informativa principale e intenzione a vaccinare
34
89%
24%
Comunicazione personale, dati non pubblicati
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Vaccine Literacy
35
Accesso Comprensione Interpretazione Uso
Prevenzione Capacità di accedere ad informazioni suifattori di rischio
Capacità di capire le informazioni su fattori di rischio
Capacità di interpretare e valutare le informazioni sui fattori di rischio
Capacità di prendere decisioni informate suifattori di rischio
Ratzan SC, Journal of Health Communication, 16:227–229, 2011 - Vaccine Literacy: A New Shot for Advancing Health
Fadda M et al. BMC Public Health (2015) 15:836 –
Biasio LR - Vaccine hesitancy and Health Literacy - HV&I
empowerment
Disponibilità di informazioni
autorevoli
Programmi di medio-lungo termine di alfabetizzazione
Ricostruire la fiducia
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Il counselling vaccinale
36
• Chi comunica?
• Chi è il cliente?
• Cosa comunica?
• Come comunica?
• Dove comunica?
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Equilibrio fra informazioni e emozioni: l’allagamento emotivo
Informazione
Emozione
Informazione
Emozione
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Il processo di cambiamento
Incompetenza Inconsapevole
Incompetenza Consapevole
Competenza Consapevole
Competenza Inconsapevole
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Empatia
• Mettersi nei panni dell’altro
• Far comprendere all’altro lo sforzo che si sta facendo per mettersi nei suoi panni
• Entrare nel mondo dell’altro, inclusi i suoi valori, le sue convinzioni, i suoi significati, anche se (e soprattutto se) sono diversi dai nostri
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Comunicazione verbale – paraverbale – non verbale
10%
30%
60%
verbale
paraverbale
non verbale
effetto persuasivo della comunicazione
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Possibile fare counselling utilizzando internet?
41
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Echo chambers
Comilva
VaccinarSì
“borderline”
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La difficoltà di comunicazione in chat
43
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44
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45
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46
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47
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48
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49
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50
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51
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Comunicare con il cittadino su problemi inerenti la salute
53
affection trust
distrust respect
cari
ng
competence
high
highlow
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