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Health Literacy June 10
 

Health Literacy June 10

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    Health Literacy June 10 Health Literacy June 10 Presentation Transcript

    • Health Literacy:
      Costs, Consequences,
      and Clinical Implications
      Peggy Sissel-Phelan, Ed.D.
      Community Health Centers of Arkansas
      Annual Conference
      June 14 – 15, 2010
    • Defining Literacy
      An individual’s ability to read, write, and speak English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.
      Workforce Investment Act (1998)
       
      The ability to use printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential.
      National Assessment of Adult Literacy (2003)
    • Literacy Needs in Context
      Historic Perspectives
      Multiple meanings
      Changing measures
      20th Century Changes
      1900 – 1950’s . . . . . . . . Industrialization
      1960’s . . . . . . . . . . . . . . Space race
      1970’s . . . . . . . . . . . . . . International development
      1980’s . . . . . . . . . . . . . . Technological advancement
      1990’s . . . . . . . . . . . . . . Globalization
    • Assessing Literacy
      2003
      National Assessment of Adult Literacy
      (NAAL)
      19,000 adults ages 16+
      107 incarcerated
      1992
      National Adult Literacy Survey
      (NALS)
      16,000 adults ages 16+
      1,000 incarcerated
    • Methodology
      NAAL
      Tested literacy tasks
      Prose, Document, and Quantitative
      5 reading skill levels
      Below Basic
      Basic
      Intermediate
      Proficient
      Not literate in English
      Health Literacy Component
      NALS
      Tested literacy tasks
      Prose, Document, and Quantitative
      5 reading skill levels
      Level 1 – approx. 1st grade
      Level 2 – approx. 4th grade
      Level 3 – approx. 8th grade
      Level 4 – approx 12th grade
      Level 5 - College
    • Results
      2003 NAAL
      14% Below Basic
      29% Basic
      43% at Basic or Below
      plus
      5% not literate in English
      =
      97 million U.S. adults
      1992 NALS
      23% Level 1
      28% Level 2
      51% at Level 1 or 2
      =
      90 million U.S. adults
    • NALS and Communities
      State by State Extrapolation
      1992 NALS results synthesized with 1990 census data
      Late 90’s Findings Released
      State
      Congressional District
      County
      City
      Arkansas
    • Note:
      Level 1 equates to about 1st grade reading skills
    • Estimated Adults at Level 2 Literacy Skills or Below
      Number of Counties
      Note:
      Level 2 equates to about 4th grade reading skills
      n = 3
      n = 8
      n = 19
      n = 29
      n = 12
      n = 3
       
       
      43-45% 46-51% 52-59% 60-69% 70-79% 80-89%
    • Percentage of Adults in Arkansas Towns at Level 2 or Below
      Fayetteville
      Sherwood
      Arkadelphia
      Bentonville
      Conway
      Fort Smith
      Jacksonville
      Jonesboro
       
      Benton
      Magnolia
      N. Little Rock
      Paragould
      Van Buren
       
      Blytheville
      Camden
      El Dorado
      Hot Springs
       
      Forrest City
      Pine Bluff
      30-39%
      40-49%
      50-59%
      60-69%
      70-79%
      Little Rock
      Rogers Russellville
      Searcy
      Springdale
       
       
      Stuttgart
      Texarkana
      W. Memphis
       
    • Literacy Across Generations: Arkansas
      Below or Below Basic Literacy Skills
      Percent
      100
      90
      80
      70
      60
      50
      40
      30
      20
      10
      0
      Children
      Parents/Adults
      Children whose parents have low literacy skills are more likely to become adults with low literacy skills than children whose parents are good readers. Thomas Sticht, 2002
    • Literacy Across Generations: Arkansas
      Basic or Below Basic
      Parents/Adults 8th Graders City
      32% 34% Fayetteville
      44% 37% Bentonville
      48% 40% Springdale
      42% 46% Conway
      44% 50% Jonesboro
      42% 57% Rogers
      46 % 55% Searcy
      50 % 58% Benton
      49 % 61% Arkadelphia
      Note: Parents data derived from National Adult Literacy Survey, 1992
      Students data derived from National Assessment of Educational Progress, 2002
    • Basic or Below Basic
      Parents/Adults 8th Graders City
      46 % 70% Little Rock
      59% 58% Magnolia
      58% 68% Paragould
      54% 77% North Little Rock
      63% 69% El Dorado
      64% 70% Blytheville
      62% 83% Texarkana
      71% 92% Pine Bluff
      78% 90% Forrest City
      Literacy Across Generations: Arkansas
    • Almost half of U.S. adults lack the basic skills needed to function successfully in society.
      These Adults Can Not:
      • Find which foods contain a specific vitamin
      • Identify a specific location on a map
      • Use fractions
      • Interpret a growth chart or table
      Functional illiteracy impedes health and
      economic well-being.
      Practical Implications
    • Perspectives ofHealth Literacy
      Levels of Literacy Skills & Health?
      Levels of Understanding & Health?
      Chronic
      Acute
      • Systemic
      • Preventative
    • Perspectives ofHealth Literacy
      Levels of Literacy Skills & Health?
      Chronic – persistent in daily living
      Systemic – resistance and culture of medical settings
      Levels of Understanding & Health?
      Acute – situational
      Preventative - cultural
    • Defining Health Literacy
      ROLE
      LEVEL
      ACTION
      EXPECTATION
      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 Affairs, 2000)
      The degree to which individualshave the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
      (Ratzan and Parker, 2000)
    • Defining Health Literacy
      ROLE
      LEVEL
      ACTION
      EXPECTATION
      The ability to read, understand, and act on health care information.
      (Healthy People 2010, US Department of Health and Human Services,
      Office of Disease Prevention and Health Promotion, 2000, )
      The ability to use printed and written information associated
      with a broad range of health-related tasks to accomplishone’s
      goals at home, in the workplace, and in the community (including
      health care settings).
      (NAAL, 2003)
    • Defining Health Literacy
      ROLE ROLE
      LEVEL
      ACTION
      EXPECTATION
      Health literacy allows the public andpersonnel working in all health-related contextsto find, understand, evaluate, communicate, and use information. Health literacy is the use of a wide range of skills that improvethe ability of people to act on informationin order tolive healthier lives. These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills.
      (Calgary Charter on Health Literacy, 2008)
    • Defining Health Literacy
      ROLE ROLE
      LEVEL
      ACTION
      EXPECTATION
      Health literacy allows the public andpersonnel working in all health-related contextsto find, understand, evaluate, communicate, and use information. Health literacy is the use of a wide range of skills that improvethe ability of peopleto act on informationin order to live healthier lives. These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills.
      (Calgary Charter on Health Literacy, 2008)
      * The interconnected expectation of improving ability to act as a result of being health literate does not address key resource and access issues (distance, price, cultural norms, living conditions, personal constraints)
    • Defining Health Literacy
      ROLE ROLE
      LEVEL
      ACTION
      EXPECTATION
      Health literacy allows the public andpersonnel working in all health-related contextsto find, understand, evaluate, communicate, and use information. Health literacy is the use of a wide range of skills that improvethe ability of peopleto act on information in order to live healthier lives. These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills.
      (Calgary Charter on Health Literacy, 2008)
      * Not simply being acted upon as the subject of care, but empowering individuals to address their own, and others’ health as a “partner” with health care providers and systems.
    • Health Literacy Needs
      in Context
      Changes in Care35 yrs. ago Today
      Treatment of Acute 4 - 6 weeks bed 2-4days Myocardial Infarction rest in hospital in hospital
      # Prescription Drugs 650 10,000 +
      on the market
      Treatment of new 3 weeks +/- outpatient
      onset Diabetes in hospital classes 0-3 hrs.
      2 hours a day of
      diabetic classes
      Source: Balydon, Glusman, and Sharkey-Asner, 2009
      For Reach Out and Read Illinois
    • NAAL Health Literacy Component
      Health literacy and relationship to prose, document, and quantitative skill.
      Address deficiencies in health literacy skills
      Policies
      Programs
      Development of appropriate health information
      Health Literacy Component
    • Health Literacy Component
      NAAL
      Data on target audiences 
      Relationship between health literacy and
      educational attainment
      age
      race/ethnicity
      where adults get information about health issues, and
      health insurance coverage
    • Health Literacy Component
      Question types
      Clinical
      Navigation
      Preventive
      Assessment Methods
      Perform a task (circle word)
      Decode words (read instructions)
      Locate words or section (review and respond)
      Interpret (infer applicability)
    • Elements of Health Literacy
      Accessing health care system
      Levels of existing health information
      Locating information
      Understanding rights/responsibilities
      Decoding information
      Making inferences about care needs
      Carrying out directives
      Formulating questions
      Interpreting Oral information
    • NAAL Results
      Low Health Literacy: Social Characteristics
      Reports poor health
      1 or more disabilities
      No health insurance or Medicaid
      Fewer preventive health measures
      Lower Educational Achievement
      Gets no health information from the Internet
    • NAAL Results
      Low Health Literacy: Social Characteristics
      Poverty
      Racial and ethnic minorities
      English as a Second Language
      Single Parent Families
      Older adults
      Prison inmates
    • Consequences of Low Literacy
      Access
      Misunderstanding Diagnosis
      Unable to Read Patient Education Materials
      Understanding and Following Health Related Instructions, compliance issues
    • Low Literacy Affects Access
      Locating, obtaining, navigating
      ie: 84% of Medicaid patients do not understand rules and regulations of the application form
      Adhering to and accepting care
      While still in the clinic 26% did not understand when return appointment was scheduled
      Cultural and beliefs stress no need for care
      Feelings of rejection, abuse, by health care staff
    • Consequences of Low Literacy
      Medication Errors
      Poor Outcomes
      2 x more likely to be hospitalized
      Higher rates of medication and treatment errors
      Link: Low literacy, poor health, and early death
      Related factors: housing, diet, addiction, violence
    • Costs
      $38 -53 billion in unnecessary costs annually (Center for Health Care Strategies, Inc, 2001)
      $73 billion (Friedland, Georgetown University, 2003)
      $106-$236 billion (Vernon, University of Connecticut, 2007)
      Medical costs for adults with low literacy skills are four times the national average - $21,760.
    • You Can’t Always Tell
      In the Below Basic Literacy Group
      37% have a HS or some college education
      52% speak only English
      54% have no physical or mental disabilities
      Kutner M et al, Nat Center for Educ Statistics 2005
    • The Stigma
      Patients who have never told:
      %
      Supervisor 91%
      Spouse 68%
      Children 53%
      Anyone 19%
      Parikh N, et al., Patient EducCouns, 1996.
    • How Does It Feel?
      The following passage simulates what a reader with below basic general literacy sees on the printed page.
      Read the entire passage out loud.
      You have 1 minute to read.
      Hint: The words are written backwards and the first word is “cleaning”
    • How Does It Feel?
      GNINAELC – Oterussahgihecnamrofrep, yllacidoirepnaelcehtepatsdaehdnanatspacrevenehwuoyecitonnanoitalumuccafotsuddnanworb-red edixoselcitrap. Esu a nottocbawsdenetsiomhtiwlyporposilohocla. Eberus on lohoclasehcuotehtrebbur strap, satisdnetotyrddnayllautnevekcarcehtrebbur. Esu a pmadtholcroegnopsotnaelcehttenibac. A dlimpaos, ekilgnihsawhsidtnegreted, lliwplehevomeresaergrolio.
    • How Does It Feel?
      How do you clean the capstan?
    • Red Flags: What to Look for
      Unable to name medications, or explain purpose or timing of administration
      Difficulty explaining medical concerns
      Detour, letting doctor miss the concern
      Have no questions
      Incomplete registration forms
      Frequently missed appointments
      Skipped tests and referrals
      Non-compliant with meds
    • Red Flags: What to Look for
      Seeking help only when illness is advanced
      Walking out of the waiting room
      Becoming angry, demanding
      Clowning around, using humor
      Being quiet, passive
      Making excuses
      Pretending they can read
    • Or . .
      “I forgot my glasses. I’ll read this when I get home.”
      “Let me bring this home so I can discuss it with my husband.”
    • Strategies: Make Changes
      Lessen stigma: Approach all patients the same way
      Be non-judgmental.
      There is no one correct way to ask
      There are natural times in the history during which you can bring this up
      Never ask “do you have questions”
      Use, what kind of questions do you have?
    • Strategies: Enhance Communication
      Attitude of helpfulness, caring and respect by all staff
      Conduct patient-centered visits
      Explain things clearly in plain language
      Focus on key messages and repeat
      Use a “teach back” or “show me” technique to check for understanding
      Use patient-friendly educational
      materials to enhance interaction
    • Strategies: Use Plain Language:
      Examples
      Stops Swelling
      Not Cancer
      Birth Control
      High BP
      By Mouth
      Picture of the heart
      Anti-inflammatory
      Benign
      Contraception
      Hypertension
      Oral
      Echocardiogram
    • Plain Language: It’s not just medical terms!
      We are disseminating information about….
      We are giving outinformation about…
      How do you administer the medication?
      How do you givethe medicine?
      Have you ever purchased generic medications?
      Do you ever buystore brand medicine?
      This product has an extensive list of symptoms that it treats…
      Thismedicinecan help with many thingslike fever, or pain, etc….
    • Strategies: Use Patients’ Social History
      How far did you go in school?
      Did you ever have any difficulty in school?
      Has reading ever been a problem for you?
      Other possible ways to ask:
      Have you ever had difficulty reading materials the doctor gave you?
      Has a doctor ever been unclear when they explained things to you?
    • D.I.R.E.C.T.
      D- Do you have any Difficulty reading
      I- Are you interested in Improving
      R-We have Referrals/resources available
      E- Ask Everyone
      C- This is a Common problem
      T- Take down the barriers to obtaining the resources and take down current barriers to providing effective care
      Source: Balydon, Glusman, and Sharkey-Asner, 2009
      For Reach Out and Read Illinois
    • Strategies: Written materials
      Simple words (1-2 syllables)
      Short sentences (4-6 words)
      Short paragraphs (2-3 sentences)
      No medical jargon
      Headings and bullets
      Lots of white space
    • Strategies: Teach Back
      Ask patient to demonstrate understanding
      “What will you tell your spouse about your child’s condition?”
      “I want to be sure I explained everything clearly, so can you please explain it back to me so I can be sure I did.”
      Academic settings can use the resident or student/attending interaction to do this
      Do not ask,
      “Do you understand?”
    • Strategies: Use Visuals
      Show or draw simple pictures
      Focus only on key points
      Emphasize what the patient should do
      Minimize information about anatomy and physiology
      Be sensitive to cultural preferences
      Visual aids can include handouts, pictures, models etc.
    • System Change
      Identify patients
      Identify the barriers faced by both patients and clinicians
      Identify and implement strategies to enhance health literacy
      Advocate for system change
    • Resources
      Pfizer Clear Health Communication Initiative http://www.pfizerhealthliteracy.com
      NYU Patient and Family
      Resource Center
      http://www.nyupatientlibrary.org/medcenter/build-skills
      Center for Health Care Strategies
      Health Literacy Fact Sheets
      http://www.chcs.org/publications3960/publications_show.htm?doc_id=291711
    • Resources
      Institute for Healthcare Advancement
      www.iha4health.org
      Michael Villaire, MSLM
      Director, Programs and Operations
      mvillaire@iha4health.org
      (800) 434-4633 x202
      American Medical Association
      Health Literacy Program and Kit
      www. ama-assn.org
    • Resources
      Communicating Health Information. Editorial.
      Critical Care Nurse. 2004;24: 8-13
      http://ccn.aacnjournals.org/cgi/content/full/24/4/8
      Assessing the Nation’s Health Literacy:
      Key Concepts and Findings of the National Assessment of Adult Literacy (NAAL)
      Sheida White, PhD
      National Center for Education Statistics
      A Publication of the American Medical Association Foundation
      “Help Your Patients Understand.”
      Video Available from AMA Foundation
      http://www.ama-assn.org/ama/pub/category/8035.html