Good morning. I am so glad to be here today to share some wonderful multi-language resources. I am the Health Information Literacy Coordinator for the National Network of Libraries of Medicine based at the University of Colorado’s Anschutz Medical Campus in Denver. I also oversee the HCEA listservs – you might have seen a posting or two from me. I read your questions and posts every day, and doing so has increased my understanding of the complexity of your jobs and how resourceful you are and how willingly you share resources.
I hope that after our time together today that you will:Please feel free to ask questions, share resources that you use.
Let’s talk for a moment about health literacy in general. Research shows that most consumers need help understanding health care information; and regardless of reading level, patients prefer medical information that is easy to read and understandWe can see from the first two statistics that there are many barriers for English speakers, let alone someone who’s first language is not English.
Low health literacy impacts both the patient and the health care systems.
Let’s add language to the mix. Numerous studies over the past 25 years have demonstrated a strong connection between language and health. Language can affect:And a recent study showed that patients are less likely to receive counseling in diet, exercise and smoking cessation.
The National Network of Libraries of Medicine, funded by the National Library of Medicine, maintains a site of free and authoritative patient education resources. I will be showing you some of the resources, but there are many, many more available on the Many Languages page. One great feature is the “search” the web sites on this page feature using the Customized Search Engine. It will search your terms in all the sites contained here – except the dictionaries. It’s a great way to locate relevant resources if you are not sure where to begin.
Culture also plays a significant role in health, healing and wellness belief systems – impacting how illness, disease, and their causes are perceived by the patient and the care provider.Cultural competence is a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices, and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups. But we also need to avoid stereotyping an individual who affiliates with a particular cultural group.http://erc.msh.org/mainpage.cfm?file=2.1.htm&module=provider&language=English
Cultural competence is a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices, and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups. Provider’s Guide is a great resource and could be used for CE activities at your institution. It was developed by Management Sciences for Health, a global health nonprofit organization, in partnership with the Department of Health and Human Services.
By 2050, it is projected that minorities will comprise about half of the US population, with a similar increase in individuals speaking a language other than English at home.The problems with Census Data - While the Census Bureau codes 381 detailed languages, data tabulations are not generally available for all of these detailed groups. Instead, the Census Bureau collapses languages into smaller sets of “language groups.” The most detail used in standard data products separates out 39 languages and languagegroups (Table 1). The simplest uses four major groups: Spanish, Other Indo-European languages, Asian and Pacific Island languages, and All Other languages. These four groups are explained further in the text box.http://www.census.gov/prod/2013pubs/acs-22.pdfhttp://www.ethnologue.com/
Constant shifts in populations throughout the United States can make it difficult to know exactly what language are being spoken in your community of practice. The first step to providing culturally and linguistically appropriate patient education is to find out what is going on in your community. The Modern Language Association has created the Language Map Data Center to help you understand the number, age, and percentage of speakers of each language in a particular geographic region. MLA Language Map Data Center - Data marked 2010 are aggregated by the American Community Survey (ACS) from information collected between 2006 and 2010.County Health Rankings – provides glimpse of possible other language and health issues at a county level based on 2010 census dataThe National Center for Education Statistics has data from 2003 – you can search county level data on low literacy.
Many providers rely on linguistic services, here are a few resources if you are exploring this option for your institution. There have been mixed outcomes in the research literature regarding the benefit of such a service. Overall, studies have concluded that:Patient’s reported interpreter did not serve as a substitute for shared languageMost satisfied when able to speak directly to clinician
HCEA 2013 the language game connecting patients and providers to health information d. abbey
The Language Game: Connecting Patients
and Providers to Health Information
HCEA 2013 Conference
Dana Abbey, MLS
Health Information Literacy Coordinator
National Network of Libraries of Medicine, MidContinental Region
Identify and evaluate online resources which
provide quality health information in multiple
Understand the importance of culture in
Compare resources for pinpointing language
trends in the communities you serve.
Low Health Information Literacy in Our Communities
• More than 66% of U.S. adults age 60 and over have
either inadequate or marginal literacy skills.
• One out of five American adults reads at the 5th grade
level or below, and the average American reads at the
8th to 9th grade level, yet most health care materials are
written above the 10th grade level.
• Literacy skills are a stronger predictor of an individual’s
health status than age, income, employment status,
education level, or racial/ethnic group.
• For people who don’t have strong reading skills, easyto-read health care materials are essential.
Impact of Low Health Literacy
• Annual health care costs for individuals with low literacy
skills are 4 times higher than those with higher literacy
• Only about 50% of all patients take medications as directed.
• Patients with low literacy skills were observed to have a
50% increased risk of hospitalization, compared with
patients who had adequate literacy skills.
• Patients with low health literacy and chronic diseases, such
as diabetes, asthma, or hypertension, have less knowledge
of their disease and its treatment and fewer correct selfmanagement skills than literate patients.
Language and Patient Health
Accuracy of health history and ability to describe
Patient trust level with provider.
Ability to engage in treatment decision-making.
Understanding a medical diagnosis or treatment.
Lower use or misuse of medications.
Underuse of primary care and preventative care.
Less likely to receive counseling in diet, exercise
and smoking cessation.
Consumer Health Information in Many Languages – start here for a wealth of
multi-language patient education resources @
DeafMD – disease and illnesses information from the CDC and NIH translated into
American Sign Language @ http://www.deafmd.org/.
Health Information Translations – 19 languages, including American Sign Language.
Formats include print, audio and video @
Health Translations Online Directory -92 languages, customize the popular “I
Speak” poster @ http://www.healthtranslations.vic.gov.au/.
Healthy Roads Media – 21 languages. Formats include handouts, audio,
multimedia, web-video, iPod video @ http://www.healthyroadsmedia.org/.
“I Speak” Language Identification Card - short phrases written in over 30 languages
that a user can check to indicate the language they speak @
Lab Tests Online – Peer-reviewed site for understanding clinical lab tests in 17
languages @ http://labtestsonline.org.
LeLeche League – Breastfeeding information in 12 languages @
MedlinePlus – Spanish and 48 additional languages. Formats include video,
tutorials, patient handouts, current news @ www.medlineplus.gov.
New Americans Health Information Portal – 20 languages. Formats include audio,
multimedia, podcast, video @ http://palantir.lib.uic.edu/nahip/.
New South Wales Multicultural Health Communications Service – 50 languages.
Audio, video, print, signage @ http://www.mhcs.health.nsw.gov.au/
RHIN (Refugee Health Information Network) – 89 languages. Formats include print,
audio and video @ http://rhin.org/.
Refugee Health Technical Assistance Center – provides tools, resources and
support for health providers @ http://www.refugeehealthta.org/.
SPIRAL: Selected Patient Information Resources in Asian Languages - 7 languages
Cultural and Patient Health
Health-related beliefs and cultural values(the
Disease prevalence (the epidemiological
Treatment efficacy (the outcome perspective).
EthnoMed – 10 languages. Strong in Southeast Asian and East
African languages. Primarily print @
– Medical and cultural information about immigrant and refugee
– Designed as a quick reference tool and resource for patient education
– Contains calendar with significant religious holidays
Provider’s Guide to Quality and Culture - http://erc.msh.org/.
– Great resource for possible CE activity
– Helps providers put culture in context to health care
– Discusses in depth the health disparities we touched on earlier
regarding language and health outcomes
The Language Game
There are 7,105 know spoken languages in the
world – 420 determined to be first language in
50 million U.S. adults have limited English
Minorities comprise 26% of the population, and
nearly 20% of Americans speak a language other
than English at home.
Only 23% of U.S. teaching hospitals provide any
language training, and those that do make it
MLA Language Map Data Center - number,
ages, and percentage of speakers of each
language in a particular geographic region @
County Health Rankings – select “Additional
Measures” tab for LEP information @
National Center for Education Statistics –
percentage of adults with low literacy by state
and county @
Language Services Resource Guide for Health Care Providers interpreter and translator associations and agencies, training
programs, assessment tools @
American Translators Association @ http://www.atanet.org/.
National Council on Interpreting in Health Care @
International Medical Interpreters Association @
Registry of Interpreters for the Deaf @ www.rid.org.
Video Interpreting @
Dana Abbey, MLS
Health Information Literacy Coordinator
National Network of Libraries of Medicine, MidContinental
University of Colorado – Health Sciences Library
Anschutz Medical Campus
12950 E. Montview Blvd., A003
Aurora, CO 80045