Let’s start out with the definition of health literacy. The definition that has evolved over the years. The most recent change came from the Affordable Care Act passed in 2010; the word “communicate” was added. This makes it even clearer that a health literate individual is not a passive receiver of health information but is engaged in an exchange of information. It also underscores that health literacy is not limited to comprehending written information, but includes verbal communication as well.
Only 12 percent of adults had Proficient health literacy. In other words, nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease. Over half of Black Americans and two-thirds of Hispanic Americans did not reach the Intermediate level. An example of an intermediate task is understanding the correct dosage of a drug based on reading an over-the-counter drug label.
Limited health literacy contributes to the “cycle of crisis care,” illustrated here.
Published in April 2010, the National Action Plan is a product of public-private collaboration, through town hall meetings held in NYC, Sacramento, St. Louis, and Tampa. Develop and disseminate health and safety information that is accurate, accessible, and actionable Promote changes in the health care system that improve health information, communication, informed decisionmaking, and access to health services Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community Build partnerships, develop guidance, and change policies Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy Increase the dissemination and use of evidence-based health literacy practices and interventions
The term “health literate organization” was coined by the Institute of Medicine Roundtable on Health Literacy.
Inspired by the National Standards for Culturally and Linguistically Appropriate Services, we defined a set of 10 attributes of a health literate organization. These attributes are most relevant to organizations that provide direct care to patients, but also relevant to health care professionals, and to the broader range of organizations and institutions such as payors and health plans, vendors of health information technology and patient education products, accreditation and credentialing organizations, and benefits managers.
Makes clear and effective patient communication a priority across all levels of the organization and across all communication channels. Applies health literacy universal precautions, whereby communication is simplified to the greatest extent possible and comprehension must be demonstrated by all because no assumptions are made as to who understands or needs extra assistance. Include an explicit commitment to be health literate in the organization’s mission statement, policies, and programs. Assign responsibility for health literacy oversight (e.g., a health literacy officer or high-level health literacy task force) Set goals for health literacy improvement, provide incentives to achieve those goals, and establish accountability for sub-optimal outcomes at every level of the organization. Allocate fiscal and human resources necessary to effectively and efficiently meet health literacy improvement goals (e.g., funds for editing and testing materials with target audiences, extra time to support individuals who need additional reinforcement or assistance, funds and time for health literacy training). Cultivate health literacy champions throughout the organization. Redesign systems to maximize individuals’ capacities to learn how to maintain good health, manage illness or disease, communicate effectively, and make informed decisions. Contribute to local, state, and national efforts to improve organizational responses to health literacy.
Develop and routinely collect metrics to measure the success of their system in achieving the health literacy attributes and to identify areas for further improvement Design and conduct rigorous program evaluations of health literacy interventions and activities. Assesses the impact of policies and programs on individuals with limited health literacy Partner with researchers to build an evidence base for health literacy interventions. Use assessments, measurement, and evaluations to inform continuous quality improvement. Ensure that patient surveys are designed to be understandable and easy to complete, and offer and provide assistance in completing surveys. Conduct root cause analysis of patient safety events to uncover and address communication failures.
Use this slide to walk through the assessment format. The rating system. Importance column. Direction to tools to help.
AHRQ and RWJF Other tools include a training program on communication for pharmacy staff, and a script for telephone reminders to refill prescriptions.
HCAHPS Item Set for Addressing Health Literacy Did hospital staff tell you how to take care of yourself after you left the hospital? Were these instructions easy to understand? Did hospital staff ask you if you would have any problems taking care of yourself immediately after you left the hospital? Did you get instructions in writing about how to care for yourself immediately after you left the hospital? Were the written instructions easy to understand?
MEPS NHDR Healthy People 2020
Support staff in attending specialized health literacy training outside the organization. Bring in outside experts to augment in-house training resources. Develop ‘expert educators’ with cross-cutting educational skills who can serve as role models, mentors, and teach health literacy skills to others. Identify and implement appropriate new curricula. Collaborate with patients who can be effective speakers and trainers
The Unified Health Communication: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency Free online training from HRSA Go at your own pace Has helped +4,000 health care professionals and students improve patient-provider communication
Tell personal story about pap smear
Developed for AHRQ by the University of North Carolina
(e.g., using the Teach-Back, Show-Me, or Chunk-and-Check methods)
It’s not just clinicians that have to practice clear communication strategies. Receptionists should teach back appointment times, billing clerks should break down the steps patients have to take to be reimbursed by insurers.
Health Literacy Online outlines how to: Deliver online health information that is actionable and engaging. Create a health Web site that's easy to use, particularly for people with limited literacy skills and limited experience using the Web. Evaluate and improve your health Web site with user-centered design.
Toolkit for Making Written Material Clear and Effective 11-part health literacy resource Detailed guidelines on writing, design, and culturally appropriate translation from English into other languages Guide to testing written materials with readers
AHRQ and RWJF
Successful implementation of health literacy system adaptations can help break the cycle of crisis care and move health literacy into the mainstream of health care practices.
Kentucky is not alone. Over a dozen states have health literacy coalitions or activities, including some of Kentucky’s neighbors such as Ohio.
Priester conference brach 4 6-12 with hyperlinks
Becoming a Health Literate Organization:Tools You Can Use from DHHS & Beyond Cindy Brach Center for Delivery, Organization, and Markets
Overview Health Literacy Basics 10 Attributes of a Health Literate Organization Vision for the Future
Definition of Health Literacy“The degree to which individuals havethe capacity to obtain, communicate,process, and understand basic healthinformation and services needed tomake appropriate health decisions.” - Affordable Care Act
Prevalence & Disparities Percentage of adults in each health literacy level, by race/ethnicity, 2003100% 12 2 4 7 3 14 1880% 41 31 45 Proficient 53 5960% 58 52 Intermediate 2540% 34 23 Basic20% 22 41 18 28 Below Basic 19 24 25 14 9 13 9 0% l N I te k ta AP nic l cia ac /A hi Source: NAAL To a AI W Bl a sp tir Hi ul M
New Evidence Report Report found: More evidence of link between limited health literacy and poorer health outcomes Some evidence interventions can reduce disease severity, ER visits, and hospital admissions
Health Literacy Equation X =Skills/Abilities x Difficulty/Complexity = Health Literacy
National Action Plan to Improve Health Literacy Goal 1: Patient education materials Goal 2: Tools to implement system change Goal 3: Health education in school Goal 4: Adult Ed, ESOL Goal 5: Partnerships Goal 6: Fund research and build the field Goal 7: Dissemination
Health Literate OrganizationsA health literate organizationmakes it easier for people tonavigate, understand, anduse information and servicesto take care of their health. Brach et al. 2012
10 attributesof a healthliteratehealth careorganization
A Health Literate Organization1. Has leadership that makes health literacy integral to its mission, structure, and operations. Leadership: – Makes clear and effective communication a priority – Assigns responsibility for health literacy oversight – Sets goals for health literacy improvement – Allocates fiscal and human resources
Attribute 2 A Health Literate Organization1. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement. – Incorporates health literacy into all planning activities – Conducts ongoing organizational assessments – Measures the success in achieving the health literacy attributes and identifies areas for quality improvement
CDC Health Literacy Planning ToolTool available fromCDC’s health literacy site
Pharmacy Health Literacy Assessment Tool 3 Parts: Assessment tour by objective auditor Pharmacy staff survey Pharmacy patient focus group guide Available from the AHRQ Pharmacy Health Lite Lit
Measuring Patient Experiences: CAHPS® Health Literacy CAHPS® Item Set for Addressing Health Literacy - Supplement to Clinician/Group CAHPS® Hospital CAHPS® Supplement - coming soon Health Plan CAHPS® Supplement - pilot testing
National Benchmarking DataIn the last 12 months, how often did: This provider give you easy to understand instructions about what to do to take care of this illness or health condition? This provider ask you to describe how you were going to follow these instructions? Someone explain the purpose of a form before you signed it?
Attribute 3 A Health Literate Organization Prepares the workforce to be health literate and monitors progress – Hires diverse staff with health literacy expertise – Sets and meets goals for training all staff and members of governing bodies – Provides health literacy training and incorporates health literacy into orientations and other trainings – Arranges for staff to take advantage of on- line health literacy training resources
Attribute 4 A Health Literate Organization Includes populations served in the design, implementation, and evaluation of health information and services – Includes members of the population on governing bodies – Establish advisory groups that involve individuals with limited health literacy, adult educators, and experts in health literacy – Collaborate with community members in design and implementation of interventions and development and testing of materials.
Attribute 5 A Health Literate Organization Meets needs of populations with a range of health literacy skills while avoiding stigmatization – Adopts health literacy universal precautions, such as offering everyone help with literacy tasks – Allocates resources proportionate to the concentration of individuals with limited health literacy
Health Literacy Universal PrecautionsStructuring the delivery of care as ifeveryone may have limited healthliteracy– You can’t tell by looking– Higher literacy skills ≠ understanding– Health literacy is a state not a trait– Everyone benefits from clear communication
Health Literacy Universal Precautions Toolkit 20 Tools Quick Start Guide Path to Improvement Appendices – Over 25 resources such as sample forms, PowerPoint presentations, and worksheets http://ahrq.gov/qual/literacy
Attribute 6 A Health Literate Organization Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact – Refrains from using medical jargon – Confirms understanding (e.g. Teach-Back) – Secures language assistance for speakers of languages other than English – Limits to two to three messages at a time – Encourages questions
Attribute 7 A Health Literate Organization Provides easy access to health information and services and navigation assistance – Facilitates scheduling appointments with other services – Uses clear signage – Offers assistance with all literacy related tasks – Makes electronic patient portals user- centered and provides training on how to use them
Attribute 8 A Health Literate Organization Designs and distributes print, audio/visual materials, and social media content that is easy to understand and act on – Involves diverse audiences, including those with limited health literacy, in development and rigorous user testing – Uses a quality translation process to produce materials in languages other than English
Pill Cards www.ahrq.gov/pharmhealthlit/Name: Sarah Smith Date Created:12/15/07Pharmacy phone number: 123-456-7890Name Used For Instructions Morning Afternoon Evening NightSimvastati Cholester Take 1 pill at n ol night 20mgFurosemid Fluid Take 2 pills e in the 20mg morning and 2 pills in the evening Insulin Inject 24 24 units 12 units 70/30 Diabetes units before (Sugar) breakfast and 12 units before dinner
Attribute 9 A Health Literate Organization Addresses health literacy in high risk situations, including care transitions and communications about medicines – Prioritizes high-risk situations (e.g., informed consent for surgery and other invasive procedures) – Emphasizes high-risk topics (e.g., conditions that require extensive self- management)
A Practical Guide to Informed Consent No more Toni Cordells Hospital Culture Change Improving the process Improving forms – Style guide – Samples Guide available on the Web
Attribute 10 A Health Literate Organization Communicates clearly what health plans cover and what individuals will have to pay for services – Provides easy-to-understand descriptions of health insurance policies – Communicates the out-of-pocket costs for health care services before they are delivered
Benefit and Coverage Information Template for Summary of Benefits and Coverage that all private insurers will use Coverage examplesinsurance of health Glossary terms insurance terms
Vision of National Action Plan to Improve Health LiteracyThe vision informing theNational Action Plan is of asociety that: Provides everyone access to accurate, actionable health information Delivers person-centered health information and services Supports life-long learning and skills to promote good health
Find Other State Health Literacy ActivityCDC State Health Literacy Activity Map
Federal Health Literacy Information AHRQ Health Literacy and Cultural Competence Browse Page 30,000+ subscribers to AHRQ Email Updates HHS Resources
“If [patients’] understandingis incorrect or incomplete,we did not find the rightway to reach them. Beinghealth literate is just asimportant for clinicians as itis for patients.” Dr. Regina Benjamin Surgeon General