This document provides an overview of health literacy and tools for organizations to become more health literate. It defines health literacy and discusses the prevalence of limited health literacy. It outlines 10 attributes of a health literate organization, such as having leadership prioritize clear communication, training staff to be health literate, and designing easy-to-understand materials. The document presents tools and resources organizations can use to improve health literacy, including assessment tools, universal precautions, and a vision for greater access to health information.
4. Definition of Health Literacy
“The degree to which individuals have
the capacity to obtain, communicate,
process, and understand basic health
information and services needed to
make appropriate health decisions.”
- Affordable Care Act
5. Prevalence & Disparities
Percentage of adults in each health literacy
level, by race/ethnicity, 2003
100% 12 2 4 7 3
14 18
80% 41 31
45 Proficient
53 59
60% 58 52 Intermediate
25
40% 34 23 Basic
20% 22 41 18 28 Below Basic
19
24 25
14 9 13 9
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6. 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
9. 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
10. Health Literate Organizations
A health literate organization
makes it easier for people to
navigate, understand, and
use information and services
to take care of their health.
Brach et al. 2012
13. A Health Literate Organization
1. 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
14. Attribute 2
A Health Literate Organization
1. 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
15. CDC Health Literacy
Planning Tool
Tool available from
CDC’s health literacy site
16.
17. 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
18. 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
19. National Benchmarking Data
In 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?
20. 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
23. 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.
24. 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
25. Health Literacy
Universal Precautions
Structuring the delivery of care as if
everyone may have limited health
literacy
– You can’t tell by looking
– Higher literacy skills ≠ understanding
– Health literacy is a state not a trait
– Everyone benefits from clear
communication
26. 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
27. 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
29. 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
31. 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
33. Pill Cards
www.ahrq.gov/pharmhealthlit/
Name: Sarah Smith Date Created:
12/15/07
Pharmacy phone number: 123-456-7890
Name Used For Instructions Morning Afternoon Evening Night
Simvastati Cholester Take 1 pill at
n ol night
20mg
Furosemid 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
34. 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)
35. 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
36. 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
37. Benefit and
Coverage Information
Template for Summary of Benefits
and Coverage that all private insurers
will use
Coverage examples
insurance of health
Glossary
terms
insurance terms
39. Vision of National Action
Plan to Improve Health Literacy
The vision informing the
National Action Plan is of a
society 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
41. Find Other State Health
Literacy Activity
CDC State Health Literacy Activity Map
42. Federal Health
Literacy Information
AHRQ Health Literacy and Cultural
Competence Browse Page
30,000+ subscribers to AHRQ
Email Updates
HHS Resources
43. “If [patients’] understanding
is incorrect or incomplete,
we did not find the right
way to reach them. Being
health literate is just as
important for clinicians as it
is for patients.”
Dr. Regina Benjamin
Surgeon General
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.