Health Literacy Internal MedicinePresentation Transcript
An Introduction to Ycaretil Htlaeh Mary J. Markland MA, AHIP UND SE Clinical Campus Librarian February 15, 2008
"Not knowing how to read feels like being blind, ignorant, not able to understand or ask people. I feel embarrassed to tell the doctor I cannot understand."
AMA Video Health Literacy: Help Your Patients Understand
Do you know?
Which of the following is the strongest predictors of an individual’s health status?
C) Literacy skills
D) Education level
E) Racial or ethnic group
True or False?
Most people with limited literacy are poor, immigrants or minorities.
Most people with limited literacy have low IQs.
People will tell you if they have trouble reading.
The number of years of schooling is a good general guide to determine literacy level
What is Health Literacy
Healthy People 2010 defines health literacy as the ability to obtain, process and understand health information and services to make appropriate health decisions.
Health literacy is the degree to which people can understand basic health information and services they need to make appropriate health decisions, including:
Reading an appointment slip
Interpreting prescription information
Understanding recommendations for health care
Completing health insurance applications
Understanding informed consent
Health Literacy is Math too
Cholesterol and blood sugar levels
Understanding nutrition labels
Choosing between health plans or comparing prescription drug coverage requires calculating premiums, copays, and deductibles.
The Literacy Problem
Nearly half of the U.S. adult population (90 million people) have low functional health literacy (National Adult Literacy Survey (NALS) data)
11 million adults are non-literate in English (2003 National Assessment of Adult Literacy (NAAL) data)
7.8 million seniors can only perform the most simple and concrete literacy skills (Below Basic) (2003 National Assessment of Adult Literacy (NAAL) data)
Literacy Levels of Adults in America 2003 National Assessment of Adult Literacy (NAAL) *Estimates Reading Ability NAAL Level *Approx Grade Level % of Pop. Below Basic Basic 1 2 0-5 6-8 14 (30 mil) 29 (47 mil) Intermediate 3 9-12 44 (114 mil) Proficient 4 College 15 (12 mil)
Literacy Levels of Adults in America: Sample of Tasks Typical of Level (NAAL)
Searching a short, simple text to find out what a patient is allowed to drink before a medical test
Signing a form
Adding amounts on a deposit slip
Can’t use bus schedule, find intersection on map
Can’t fill out social security application
Using a television guide to find out what programs are on
Comparing the ticket prices for two events
Can’t use bus schedule
Can’t read a bar graph
Can’t write a letter of complaint
Consulting reference materials to find out which foods contain a certain vitamin
Identifying a specific location on a map
Calculating the total cost of ordering office supplies from a catalog
Comparing viewpoints in two editorials
Interpreting a table about blood pressure, age and physical activity
Computing and comparing the cost per ounce of food items
The average reading level in the U.S. is 8th grade, and 20 percent read at the 5th grade level or below. (NALS data)
40 percent of seniors read at or below the 5th grade level (Doak, Doak, and Root)
50 percent of African Americans and Hispanics read at or below the 5th grade reading level (Center for Health Care Strategies)
Chronic physical and/or mental health conditions
Most health-related material is written at the 10th grade reading level or higher (Institute of Medicine)
Literacy skills are a stronger predictor of health status than age, income, employment status, education level or racial/ethnic group (Partnership for Clear Health Communication)
People with low functional health literacy have:
Poorer health status
Less treatment adherence and a greater number of medication/treatment errors
Higher rates of health services utilization, including 29 - 69 percent higher hospitalization rates
Higher health care costs:
$50 - $73 billion in additional health expenditures annually
$7,500 more in annual health care costs for a person with limited health literacy, versus a person with higher health literacy skills
Partnership for Clear Communication http://askmethree.com/health-literacy.aspx
Implications for HealthCare
Misread prescriptions and OTC instructions
Can’t read or understand appointment slips, letters or informed consent
Can’t read or understand directions for procedures like colonoscopies
Patients are noncompliant
Risk management issues
Diagnoses are made at later stages
Literacy in North Dakota
Level 1 15%
Level 1 or 2 39%
Level 1 or 2 27%
Grand Forks County
Level 1 or 2 30%
Level 1 or 2 32%
Level 1 or 2 45%
Level 1 or 2 44%
Data based on 1992 National Adult Literacy Survey and the 1990 Census Data from Synthetic Estimates of Literacy/National Institute for Literacy http://www.nifl.gov/reders/reder.htm
How to Identify a Patient
I can’t read this now. I forgot/broke my glasses.
I’m in a hurry. Can I read this at home?
My eyes are tired. Could you read this for me?
I’m not feeling very good. Could you read this for me?
Do you have a videotape on this?
How to Identify a Patient
Clarification – individual asks a lot of questions about written information
Visual clues – individual may be holding paper upside down while trying to read it
Inability to please – none of the materials are “right” or “fit their needs” or “it’s just not what I was looking for”
Indifference – individual hands written materials to an accompanying family member
Can’t read directions on their prescription bottles
REALM Rapid Estimate of Adult Literacy in Medicine Davis TC, Crouch MA, Long SW, Jackson RH, Bates P, George RB, Bairnsfather LE. Rapid assessment of literacy levels of adult primary care patients. Fam Med. 1991 Aug;23(6):433-5.
Abbreviated REALM Directions
The survey only takes 2 to 3 minutes to do
I want to hear you read as many words as you can from this list. Begin with the first word on List 1 and read aloud. When you come to a word you cannot read, do the best you can or say “blank” and go on to the next word
If the patient takes more than five seconds on a word say “blank” and point to the next word, if necessary, to move the patient along. If the patient begins to miss every word; have him/her pronounce only known words.
Count as an error any word not attempted or mispronounced. Count the number of correct words for each list and record the numbers in the “SCORE box.
Total the numbers and match the total score with its grade equivalent in the table below:
Newest Vital Sign
Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005 Nov-Dec;3(6):514-22. Erratum in: Ann Fam Med. 2006 Jan-Feb;4(1):83.
Assesses general literacy and numeracy skills
Quick to administer (three minutes)
Available in both English and Spanish.
Ice Cream Label
Quick Screening Questions
1. How often do you have problems learning about your medical condition because of difficulty understanding written information?
2. How often do you have someone help you read hospital materials?
3. How confident are you filling out medical forms by yourself?
Possible answers are: always, often, sometimes, occasionally, never
Most effective question was the “filling out medical forms.” An answer of “sometimes” was indicative of literacy issues.
Wallace LS, Rogers ES, Roskos SE, Holiday DB, Weiss BD. Brief report: screening items to identify patients with limited health literacy skills. J Gen Intern Med. 2006 Aug;21(8):874-7.
What to do about handouts
Basic information about a colonoscopy, as perceived by a patient with limited literacy skills
What Makes a Handout Easy-to-Read
Limit major points to 3-5 “need-to-know”
Sections are short, distinct, labeled with subheadings
Key messages are action-focused, up front and repeated
Conversational, active voice, friendly tone
Lots of white space, make sure there is good contrast between the print and the paper.
Only use capital letters when grammatically needed
Watch Your Words and Numbers
Words that have multiple meanings
Stool, dressing, gait
HDL, CAT, MRI, PCI, CBT
Put Health Measurements in a context
Give a healthy cholesterol number and then their number
Idioms don’t always work
Are you feeling blue? Try using sad instead.
Once means 11 in Spanish
Where Can You Find Easy-To-Read Handouts?
AAFP Family Doctor
Health and Literacy Compendium – an annotated bibliography of print and web-based health materials for use with limited-literacy adults