The document discusses various stakeholders involved in the healthcare improvement process, including primary care physicians, nurses, dietitians, social support workers, volunteers, and patients themselves. It emphasizes the importance of effective health communication and education programs in empowering patients, improving health outcomes, and reducing healthcare costs through better disease management and prevention of complications. Ongoing evaluation of programs is needed to continuously improve quality of care.

1. RIGHT
PATIENT
PROCEDURE
TIME

2. Coordination of Care

3. Importance Of Health
Communication
Pr Dr Mohamed BADR

4. Outline
• Health communication
• Adult literacy
• Health literacy
• What do we know about health literacy?
• What can we do about health literacy?

5. Health Communication
"Study and use of communication strategies to
inform and influence individual and community
decisions that enhance health"
CDC- http://www.cdc.gov/od/oc/hcomm/rolehcomm.html

6. Health Communication
Can Influence Audiences
at Different Levels
• Individual
• Social network
• Organizations
• Community
• Society

7. Individual
• Most fundamental target for health-related
change- since it is individual behaviors that
affect health status
• Communication can affect the individual's
awareness
– Knowledge
– Attitudes
– Self-efficacy
– Skills for behavior change

8. Organizations
• Organizations include formal groups with a
defined structure.
– Associations, clubs, and civic groups.
– Worksites.
– Schools.
– Primary health care settings.
• Organizations can carry health messages to
their membership, provide support for
individual efforts, and make policy changes
that enable individual change.

9. Outline
• Health communication
• Adult literacy
• Health literacy
• What do we know about health literacy?
• What can we do about health literacy?

10. LITERACY MAP

11. Literacy
The United Nations Educational, Scientific
and Cultural Organization (UNESCO) defines
literacy as the
"ability to identify, understand, interpret,
create, communicate, compute and use
printed and written materials associated with
varying contexts.
Literacy involves a continuum of learning in
enabling individuals to achieve their goals,
to develop their knowledge and potential,
and to participate fully in their community
and wider society

12. Outline
• Health communication
• Adult literacy
• Health literacy
• What do we know about health literacy?
• What can we do about health literacy?

13. Definition of 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.”

14. Relationship of Literacy to
Health Literacy
• Health literacy refers to all modes of
communication
• Written
• Oral
• Video
• Internet
• Literacy is a stronger correlate of health status than
education level and other socio-demographic
variables

15. Outline
• Health communication
• Adult literacy
• Health literacy
• What do we know about health
literacy- the research?
• What can we do about health literacy?

16. Health Literacy
• Pill bottles
• Appointment slips
• Informed consents
• Discharge instructions
• Health education
materials
• Insurance applications
Medication
Take as directed
Dr. Literate

18. • Uses actual materials from hospital setting.
• LOW or INADEQUATE (< 60)
– often misread dosing instructions and
appointment slips.
• MARGINAL (60-74)
– struggle with prescription instructions.
• ADEQUATE ( 75)≥
– handle most health care tasks.
– struggle with informed consents.
LOW
LITERATE
MARGINALLY
LITERATE
LITERATE
TOFHLA
Test Of Functional Health Literacy in
Adults
Pre-Education assessment

19. Low Health Literacy
Affects All
• More than 66% of the elderly have inadequate or
marginal literacy skills
• 40% of chronically ill patients are functionally
illiterate
• 45% of all functionally illiterate adults live in poverty
Health Literacy Fact Sheets. Center for Health Care Strategies, Inc.

20. Compliance with
medication
Knowledge of basic
self-care
Follow-up visits
Comprehension of
informed consent,
medical forms,
insurance benefits
Problems Associated
with Low Health Literacy
Reported poor health
status
Hospitalizations
Physician visits
Costs
Health Literacy Fact Sheets. Center for Health Care Strategies, Inc.
Health Literacy

21. Inadequate Health Literacy
Increases with Age
Atlanta LA- English LA-Spanish
0
20
40
60
80
100
Atlanta LA- English LA-Spanish
18-30 31-45 46-60 > 60
%
84%
51%
73%

22. Less Educated have
Poorer Health Literacy
0
10
20
30
40
50
60
0 to 8 9 to 11 12 > 12
Inadequate
Marginal
%

23. READING ERRORS for Medicare
Enrollees with Inadequate Literacy
• Take medicine every 6 hours
48%
• Interpret blood sugar value 68%
• Identify next appointment
27%
• Take medicine on empty stomach
54%

24. LOW
LITERATE
MARGINALLY
LITERATE
LITERATE

25. Low Literate Patients
Less Likely to Know Diagnosis
0
20
40
60
80
100
English Spanish
Literate Marginal Low
% Know
Diagnosis

26. Low Literate Patients Less Likely to Know
Name and Purpose of Medications
0
20
40
60
80
100
Name Purpose
Literate Marginal Low
%
Correct

27. Low Literate Diabetic Patients have
Less Knowledge of Their Illness
0 20 40 60 80 100
Low Literate
Marginally Literate
Literate
Know normal
sugar is 70 - 140
Percent
Know uncontrolled
diabetes damages
kidneys / nerves

28. Low Literate Diabetic Patients Less Likely
to Know Correct Management
0 20 40 60 80 100Low Literate
Marginally Literate
Literate
Know correct action
for hypoglycemic
symptoms
Percent
Know symptoms
of low blood sugar
(hypoglycemia)

29. Patients with Hypertension Less Likely
to Know Correct Health Behaviors
0 20 40 60 80 100Low Literate
Marginally Literate
Literate
Know exercise
↓ blood pressure
Know weight loss
↓ blood pressure
Percent

30. Patients with Low Literacy
More Likely to Report Poor Health
20
34
43
0
10
20
30
40
50
Literate Marginal Low Literate
% Poor
Health

31. Patients with Low Literacy
More Likely to be Hospitalized
0
5
10
15
20
25
30
35
Literate Marginal Low Literate
2 or more
1 admission
p < .001 for comparison of one or more admissions and
p < .001 for comparison of two or more admissions.
%

32. Communication Tools
• Verbal
• Demonstration
• Print

33. Components of the Diabetes TeamComponents of the Diabetes Team
The Ideal ScenarioThe Ideal Scenario
DietitianDietitian
EndocrinologisEndocrinologis tt
Health EducatorHealth Educator
Exercise TherapistExercise Therapist Case ManagerCase Manager
PCPPCP

34. BASIS OF PATIENT
EDUCATION

35. Patient Education
Change of the Attitude
and Behavior towards
common health
problems for better
control or reduce its
complications
Structure, Process and Outcome

36. Goal of Health Education
1. Knowledge
2. Improvement , development and corrects skills
3. Change attitudes and believes
Mission and Vision

37. STAGES OF PATIENT
HEATH EDUCATION
1.Explanation of details
2.Convinced by the knowledge given
3.Change believe
4.Application attitude
5.Transformation of recipient to donor
health educator

38. WHO PERFORM THE HEATH EDUCATION
1.Physicians
2.Nurses
3.Dieteticien
4.Social support
5.Volunteers
6.Patients themselves

39. Characteristics of Health educator
•Good Knowledge & experience
•Good listener
•Good observer
•Simplicity
•Repetition & Concentration
•Speech tone and expression
•Verbal & visual communication
•Avoid scientific terms
•Respect
•Accepting errors

40. Factors in The recipient
1.Interest
2.Concentration
3.The capability to change the attitude

41. Factors Affecting the Process of Learning
1.Time
2.Place
3.Intellectual ability
4.Motive

42. The Subject must be :
short
Clear
Complete

43. Plan For health education program
What are the goal
Who will do it
Content of knowledge & skills
When & to who
Duration &cost
Structure, Process, Outcome

44. THE WAY USED
• Person to person
• Small groups
• Large group lecture
• Media:
Newspaper
Radio
T V
Pamphlets

45. EU Elderly Are Very Positive About e-Health
and Its Potentials
• One of the strengths
highlighted in the
aforementioned SWOT analysis
is the general open
mindedness of the older
population towards e-Health.
• And by 2030/2050, even more
elderly will be computer savvy
(these will be today’s youth
and middle aged who are
already extensively using
computers and the Internet in
their daily lives).

46. Evaluation of educational program
Degree of disease control
Bld sugar, Wt,Glycated Hb, Lipids, Bld pressure
Prevalence of acute and chronic complication
Evaluation of the degree of retention
Pre and post program questionnaire
Skills direct observation
Continuous health education ,repetition
OUTCOME, CONTINOUS IMPROVEMENT

47. health managementhealth management

48. start
action
disruption
Divergence =
Quality fault
correction
goal
yes
no
Quality management cycle
Planning &
implementation Assessment &
observation
Removing
obstacles
analysis

50. FADE Model in Action
You Evaluate the impact of your change
You Focus down further
You Analyze the problem to find the root cause(s)
Then Develop methods for further improvement
And Execute and Evaluate again!
Repeat the process until the goal
is achieved.

51. PDSA

52. Lifetime Benefits and Costs of DCCT
Intensive Therapy
DCCT
References:
Diabetes Care, 1995 18:1468-78.
JAMA, 1996 276: 1409-15.

53. Type of Health Care Costs by Treatment
Group
Intensive Conventional
Treatment Side Effects Complications
DCCT

54. Cumulative Incidence of Proliferative
Retinopathy by Treatment Group
Age
Percent
19 29 39 49 59 69 79 89 99
0
20
40
60
80
100
Conventional
Intensive

55. Cumulative Incidence of Clinical Nephropathy
(Albuminuria) by Treatment Group
0
20
40
60
80
100
19 29 39 49 59 69
Age (years)
Percent
Intensive
Conventional
DCCT

56. Average Number of Years Living Without ...
Conventional Intensive Difference
Proliferative Retin. 39.1 53.9 14.8
Macular Edema 44.7 52.9 8.2
Visual Acuity Loss 49.1 56.8 7.7
Overt Nephrop. 49.7 59.5 9.8
ESRD 55.6 61.3 5.8
LE Amputation 55.2 60.9 5.7
1st major comp. 37.0 52.2 15.2
DCCT

57. Interventions to
Improve Quality of Care
Luigi Meneghini, MD, MBA
Diabetes Research Institute (DRI)
University of Miami School of Medicine
II PAHO-DOTA Workshop on Quality of Diabetes Care
DRI, 14–16 May 2003

58. Mastering Your Diabetes
Metabolic & Psychosocial Outcomes
Diabetes Empowerment Scale (DES)Diabetes Empowerment Scale (DES)
The DES is a valid and reliable survey of patient empowermentThe DES is a valid and reliable survey of patient empowerment
which yields an overall empowerment score based on all 28which yields an overall empowerment score based on all 28
items and three subscale scores (range for all scales: 1.0-5.0).items and three subscale scores (range for all scales: 1.0-5.0).
Improvement was evident on all DES scales for participants inImprovement was evident on all DES scales for participants in
the MYD pilot study, despite high baseline values.the MYD pilot study, despite high baseline values.
Diabetes Empowerment ScaleDiabetes Empowerment Scale PretestPretest PosttestPosttest 3mF/U3mF/U
Overall empowermentOverall empowerment 4.1 4.24.1 4.2 4.3*4.3*
Managing psychosocial aspectsManaging psychosocial aspects 3.9 4.23.9 4.2 4.24.2
Dissatisfaction/readiness to changeDissatisfaction/readiness to change 4.3 4.54.3 4.5 4.6*4.6*
Setting/ achieving diabetes goalsSetting/ achieving diabetes goals 4.0 4.04.0 4.0 4.14.1
(*P<0.05 v. baseline)(*P<0.05 v. baseline)
Quality of Life & Self-EfficacyQuality of Life & Self-Efficacy
Measures of both Quality of Life (QOL) and Self-EfficacyMeasures of both Quality of Life (QOL) and Self-Efficacy
showed statistically significant improvement following theshowed statistically significant improvement following the
intervention. At the three month follow-up the most significantintervention. At the three month follow-up the most significant
improvement in QOL sub-scales was for Satisfactionimprovement in QOL sub-scales was for Satisfaction
(p=0.0113).(p=0.0113).
8.848.84
8.018.01
7.657.65
8.108.10
7.507.50
6.806.80
7.007.00
7.207.20
7.407.40
7.607.60
7.807.80
8.008.00
8.208.20
8.408.40
8.608.60
8.808.80
MeanHbA1c%MeanHbA1c%
Mo 1-3Mo 1-3Pre-MYDPre-MYD
* p<0.05 v. pre-MYD* p<0.05 v. pre-MYD
Mo 4-6Mo 4-6 Mo 7-9Mo 7-9 Mo 10-12Mo 10-12
**
**
**

59. Impact of ComprehensiveImpact of Comprehensive
Diabetes Management ProgramDiabetes Management Program
Source: Rubin RJ, et al.
J Clin Endocrinol Metab 1998; 83: 2635.
$406
$362
$182
$135
$84 $76
$44 $45
$66 $76
$29 $30
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
AverageCostpermember/month
Total Inpatient Outpatient MD Drugs Other
Baseline (54,186 member months) Follow-up (55,879 member months)
* Total costs decreased by $44 per member/month (10.9%) which would translate into savings of
$528,000 in the first year for a plan with 1000 members with diabetes.
Break-even at 1,265 members with diabetes as per DTCA.

60. Success of Program Depends on
• Getting primary-care physicians (PCPs) FP to
attend the program.
• Inviting key diabetes educators.
– May need to set up additional training to certify
competency in basal/bolus therapy.
• Facilitating network opportunities between PCP
(FP )and educators.
• Evaluate impact of program.
– Pre- & post-program questionnaires.
– Importance of FP(Family Physician)

61. Health Communication Alone Can…
• Increase knowledge and awareness of a health issue,
problem, or solution
• Influence perceptions, beliefs, attitudes, and social
norms
• Prompt action
• Demonstrate or illustrate skills
• Show benefit of behavior change
• Increase demand for health services
• Reinforce knowledge, attitudes, or behavior
• Refute myths and misconceptions
• Help coalesce organizational relationships
• Advocate for a health issue or a population group

62. ARE INVOLVED IN THE PROCESS
OF HEALTHCARE
IMPROVEMENT