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Stfm 2006 Presentation

Stfm 2006 Presentation






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    Stfm 2006 Presentation Stfm 2006 Presentation Presentation Transcript

    • Let’s Create Materials Patient’s Can Read And Understand Betty J. Westmoreland, MBEd, CPA President Pritchett & Hull Associates, Inc.
    • Objectives
      • Understand the role low-literacy plays in healthcare and the need to assess each patient
      • Understand the principles of creating patient education materials for the low-literate
      • Judge the appropriateness of the patient education materials you use
      Upon completion of this presentation, you should be able to:
    • Answers Needed
      • How do we assess our patients’ ability to read and understand our teaching?
      • How do we go about developing patient teaching materials that are suitable for our patients?
      • How do we know whether the teaching materials we are using are what we need?
    • How do we assess our patients’ ability to read and understand our teaching?
    • Literacy
      • An individual’s ability to read, write and speak English, compute and solve problems sufficient to function in society, develop one’s knowledge and potential, and to achieve one’s goals.
    • Scope of the Problem
      • 21% of adult Americans (40 – 44 million) are functionally illiterate and read at or below a 5 th grade level
      • An additional 25% (50 million) are marginally illiterate
    • National Adult Literacy Survey (1992)
      • 90 million adults (47%) read at the lowest levels
      • 75% of Welfare recipients read at the lowest levels
    • Low-literacy is Prevalent Among All Ages and Ethnic Groups
      • More than 66% of adults > 60 years of age have inadequate or marginal skills
      • Greatest number of low-literate Americans are native born whites
      • Other groups with literacy problems:
        • 52% of Hispanics
        • 41% of African Americans
        • 35% of Asians
      • Kirsch, et al., Adult Literacy in America, 1993
    • 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 decisions
    • Significance
      • Groups with highest prevalence of chronic disease and greatest need demonstrate the least ability to read and comprehend information
      • It is worse among the most vulnerable
    • Literacy and Health
      • People with Lowest Literacy Levels
      • Report poorer health
      • Incur higher expenses for health care
      • More outpatient and ED visits
      • Greater likelihood of hospitalizations
      Weiss, et al., Illiteracy among Medicaid recipients (1991) Baker, et al., Functional health literacy, self reported health status (1997)
    • Health Literacy Research
      • 42% are able to understand directions for taking medicine on an empty stomach
      • 26% do not understand information regarding when a next appointment is scheduled
      • 60% cannot understand an informed consent form
      • 33% do not understand instructions for an upper GI tract x-ray written at a 4th grade level
      Williams MV, Parker RM, Baker DW, et al. Inadequate Functional Health Literacy Among Patients at Two Public Hospitals. JAMA. 1995; 274:1677-1682.
    • Source: IMS America, 1997
    • Patients at Risk
      • Older age
      • Low income
      • Unemployed
      • Ethnic minorities (Hispanic, African American)
      • Fewer years of school completed
      • Recent immigrants to the U.S.
      • Born in U.S. with English as 2 nd language
    • Illiteracy means being unable to read or write Low-literacy does not mean illiterate
    • Comprehension
      • Grasping the meaning of the instruction
    • Logic Language Experience Comprehension
    • Patient Variables that Affect Comprehension
      • Illness-related stress
      • Perceived threat
      • Motivation
      • Physical and mental energy
      • Visual acuity
      • Length of formal education
    • Low Literacy Learner’s Behaviors
      • Perspective limited to direct personal experience
      • Insensitive to the need to give information
      • Does not think in terms of categories of information
      • Gives information in bits and pieces without an identifiable pattern
    • Good Readers
      • Use prior knowledge
      • Associate randomly
      • Are fluent
      • Hesitant
      • Get help
      • Skip over words
      • Interested
      • Not focused
      • Continuous
      • Skip around
      Poor Readers
    • Elderly Learners
    • Barriers to Learning
      • Functional limitations
      • Fatigue
      • Motivation
      • Experience with learning
      • Depression
      • Medications
      • Pain
      • Disabilities
    • To Facilitate Comprehension
      • Adapt teaching to sensory changes
        • Presbyopia
        • Presbyacusis
      • Pace the delivery
      • Enhance readability of teaching materials
      • Use concrete, familiar examples
    • Cultural Considerations
    • Reaching Patients of Different Cultural Backgrounds
      • Do a culturally sensitive assessment
      • Teach within cultural context
      • Translate oral and written instructions using member of cultural community
      • Build on culturally compatible experiences
      • Must make sense within cultural context
    • Recognizing Signs of Low-literacy
    • Signs of Low-literacy
      • Ask you to fill out forms for them, or make mistakes when they fill them out
      • Bring a friend to help
      • Take forms home to complete
      • Miss appointments, imaging tests, lab tests, etc.
      • Noncompliant with medication regimens
      • Use excuses for not reading – “Left glasses,” “Didn’t have time”
      • Ask you to explain what they have just read
      • Eyes fail to move right while “reading”
      • Fail to respond to mailed notices, bills
      • Ask you to call rather than mail information
      • Turn down opportunities that require reading and/or writing
      Foulk, D., Carroll, P., Wood, S. Addressing Health Literacy (2001)
    • Assessing Health Literacy
      • REALM (Rapid Estimate of Adult Literacy in Medicine)
        • LSU Medical Center
      • TOFHLA (Test of Functional Health Literacy in Adults)
        • Center for Study of Adult Literacy
        • Georgia State University
    • Patient and Family Education Assessment
      • What problems have your illness caused for you?
      • What concerns you most about this illness?
      • What bothers you most about this illness?
      • What do you fear most about your illness?
      • What do you think caused the problem?
      • Why do you think it happened when it did?
      • What do you think this illness does to you?
      • How does it work?
      • How severe is your illness?
      • How long do you think it will last?
      • What kind of treatment do you think you should get?
      • What are the most important results you hope to get from this treatment?
      • What do you need to know to take care of yourself at home?
      • The last time you wanted to learn something, how did you go about it?
      • What do you want to learn more about?
      • Provided by © (2005) Fran London, MS, RN, Phoenix Children’s Hospital
    • How do we go about developing patient teaching materials that are suitable for our patients?
    • What to look for in teaching materials
      • Legibility
      • Organization and flow of content
      • Effective use of visuals
      • Relevance and personalization to the reader
      • Interactivity
    • Basics
      • Poor readers read one word at a time
      • Short sentences are better
      • First sentence in a paragraph should contain the most important information- “how to do it”
      • Avoid big (multi-syllabic) and technical words
      • Only tell what the patient needs to know
      • Use bold rather than ALL CAPS to emphasize importance
      • Do not use italics —hard to read
      • Use a lot of white space so it’s not cluttered
      • Use at least 13 point type
      • Use black ink on white or cream colored paper for good contrast
      • Use visuals that teach—good visuals can lower the readability of material by two grade levels
      • Write text as you would talk to the reader
      • Interactive materials are more personal to the reader because they involve him
      • Summarize and repeat, clearly and simply, the most important points you want the reader to remember
    • Plain Language Initiative from the NIH An important tool for improving health literacy
    • Plain Language
      • Writing that effectively communicates with the specific audience being addressed.
      • Insures that your patient can understand the information you provide
      • It is critical to:
        • Know your patient
        • Have patients test materials being used
          • Before they are developed
          • During the development
          • After they are developed
      • Speaking plainly is just as important as writing plainly
    • Plain Language is Not
      • Unprofessional writing
      • Talking down to the reader
    • Plain Language is
      • Grammatically correct
      • Tells the reader only what he/she needs to know
      • Uses common everyday words
      • Uses the active voice
      • Uses pronouns (you, your, your child, etc.)
      • Uses design features that are easy to understand (bullets, lists, etc.)
    • The Visual Message
    • The Visual Message…
      • Can improve visual learning by directing the eye to the message
      • Uses lots of white space
      • Uses visuals that communicate the content
    • The visuals should reinforce the text
    • Use visuals that readers can identify with (within their cultural framework)
    • Use the Subjective Point of View 200 METERED INHALATIONS
    • Edit Out Extraneous Details
    • Identify Steps Clearly 1 2 3
    • Show the Proper Point of Reference
    • Avoid Stereotypes and Exaggerations in Caricatures
    • Use of exaggerations can help to reinforce negative concepts at times ?
    • How do we know whether the teaching materials we are using are what we need?
    • Readability Tests
      • SMOG
      • Fry
      • Flesch
      • Fog
    • Cautions About Using Readability Tests
      • Reading level is only one element in assessing the appropriateness of printed materials
      • Just because it is written at a low reading level does not mean that it is clear and well-written
      • Readability tests do not address the visual elements which are key in assessing reading ease and appeal
      • Readability formulas are only estimates-not precise fact
      • Readability formulas tell you nothing about your patient
          • Level of knowledge
          • Experience
          • Cultural background
          • Motivation and interest
    • Suitability Assessment of Materials (SAM)
      • Attributes that define easy-to-read materials
        • Content
        • Literacy
        • Graphics
        • Layout
        • Learning motivation
        • Cultural appropriateness
    • Recommendations
      • Know how to assess patients for their reading abilities
      • Don’t rely on “grade reported as completed” for reading ability
      • Use materials written at a 6th to 7th grade level
    • The ultimate test!
      • What do your patients think about it?
      • Test the material on them!
        • Do they like it?
        • Do they understand it?
        • Can they learn from it?
    • The End
    • References
      • National Institute for Literacy, FACT SHEET: Literacy & Health
      • Doak, Cecilia C., Leonard G. Doak and Jand H. Root, Teaching Patients with Low Literacy Skills, 2 nd Edition, Philadelphis, JB Lippincott Co., 1996
      • Redman, Barbara Klug, The Process of Patient Education, 7 th Edition, Chapter 7, St. Louis, Mosby-Year Book, Inc., 1993
      • Plain Language Action and Information Network. www.plainlanguage.gov
      • US Dept. of Health and Human Services, 2001, National Standards for Culturally and Linguistically Appropriate Services in Health Care. Washington, DC, Office of Minority Health
      • Institute of Medicine. 2004. Health Literacy” A Prescription to End Confusion . Washington, DC, The National Academies Press
      • National Center for Education Statistics, 2005, National Assessment of Adult Literacy (NAAL): A first Look at the Literacy of America’s Adults in the 21 st Century , US Dept. of Education