This document discusses health literacy from an informatics perspective and identifies challenges and opportunities. It provides an overview of key topics, including definitions of health literacy, models of health literacy, the impact of low health literacy, and efforts to address it. Examples are given of digital health literacy interventions using patient portals, mobile apps, and text messaging. Collaboration across disciplines and co-locating health and library services can improve health literacy. Lessons from initiatives in Philadelphia highlight the benefits of needs assessments, small and flexible programs, and evaluating outcomes.

1. HEALTH LITERACY
An Informatics Perspective
Challenges and Opportunities
Prudence Dalrymple, M.S., Ph.D., M.S., FMLA

2. Acknowledgements ■ Dr. Alla Keselman and Dr. Catherine
Arnott Smith, editors of Meeting
Health Information Needs Outside of
Health Care for their foresight and
mentorship
■ Catherine Gold and Elsevier for
their invitation and hospitality here
today
■ The many librarians, clinicians and
public health professionals who will
help bend the curve of health
illiteracy in the U.S. today
 Renee Pokorny, Will Torrence,
Katie Dangerfield-Fries, Tony
Luberti, Autumn McClintock,
Barbara Cavanaugh
2

3. 3

4. Overview
■ What are the best ways to help individuals become more literate
and more responsible for their health?
■ What lessons can we learn from the information and informatics
communities that can be applied to health literacy research and
practice?
■ What values and beliefs must we examine as we attempt to
achieve a more health literate society?
■ What unique contributions are librarians making to improve
health literacy?
4

5. Obstacle: Many Definitions
■ Clinical medicine
■ Public Health
■ eHealth
■ Library &
information science
6

6. What Is Health Literacy?
It Depends…..
■ The degree to which individuals have the capacity to obtain,
process and understand basic health information and services
needed to make appropriate health decisions [Institute of
Medicine, 2004]
■ E-Literacy – the ability to seek, find, understand and appraise
health information from electronic sources, and apply the
knowledge gained to addressing or solving a health problem.
Norman CD, Skinner HA. (2006) eHealth literacy: essential
skills for consumer health in a networked world. JMIR 8: e9.
■ [Health] literacy is the product of individuals’ capacities AND the
health literacy related demands and complexities of the
healthcare system. Baker DW. The Meaning and the Measure of
Health Literacy. J Gen Intern Med 2006; 21(8):878-883. 7

7. Obstacle: Multiple
Research Communities
8
■ Clinical medicine, nursing
■ Public Health
■ Communications, Education and
Information Science

8. Nutbeam’s Model
:
Functional literacy which consists of reading, writing, and understanding
Communicative/interactive health literacy which consists of
communication and social skills to derive meaning and
to apply new information as situations change; and
Critical literacy, which consists of
higher level skills needed to analyze and use information
to exert control, over life events and situations, and make decisions
Ideally, health literacy supports patient autonomy and empowerment
10
Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and
communication strategies into the 21st century. Health Promot Internation. 2000;15(3):259-67.

9. HL as a Social Determinant of Health
11
Sorensen K, et al. (2012) Health literacy and public health: a systematic review and integration fo defnitions and
models,. BMC Public Health, 12(80)

10. 12

11. Impact of Low Health Literacy
Patients with low HL have more …
 medical non-adherence,
 serious medication errors,
 difficulty navigating the health system,
 communicating with providers,
 chronic disease and mortality for themselves & their families,
 problems during transitions of care
 Which results in ….
 lower patient engagement
 and costs as much as $236 billion annually
13

12. U.S. Health Literacy
36% of Americans are at or
below basic HL
*
Source: U.S. Department of Education,
Institute of Education Sciences, 2003
National Assessment of Adult Literacy.
14

13. What Has Been Done to Help?
■Assessment
■Curated information
■Public Health campaigns
15

14. HL Assessment Tools
Help for clinicians Handy tool for quick
assessment
16

15. MedlinePlus
17

16. Questions Are the Answer
18

17. 19
Data
Introducing Informatics

18. Data, Data, Data
■ Health data is ubiquitous
■ Health data is digital
■ Health data can be organized, managed, analyzed,
visualized … and USED
■ Data [usually] don’t lie
■ Data can drive decisions
20

19. Make a Decision, Take an Action
■ Harder, more important in today’s complex healthcare system
■ Harness technology to support and guide decisions
■ For clinicians AND consumers
■ Health decisions happen anywhere, any time
– Not limited to clinical encounter
■ Patients may want to make decisions outside the clinical
context
– Time is needed outside the moment to think through,
review information, and decide
21

20. Digital Health Literacy:
Actionable Interventions
Embedding Information in Patient Portals
– Medline Connect
■ Embedding HL Assessment in the Electronic Health Record
– Should be standard part of EHR (Healthy People 2020)
– Self assessment of HL comparable to performance based
assessment ( Kiechle ES, JGIM 2015)
■ Mobile apps
– iPrescribe
– Text messaging at 11th Street
22

21. Linking Information to Patient Portal
23

22. iPrescribe apps
24
iPrescdibeapps will enable
providers to “prescribe “ an
app to their patients. An
email wil be sent enableing
the patient to access the
site. May nto always be free
(drugs aren’t either) but
apps will be vetted by
phsycians from iMedical
Appsl
Currenlty in Beta test.

23. Apps to Help Patients
25
http://www.imedicalapps.com/

24. Informatics: A Team Sport
■ Interdisciplinary
■ Iterative
■ Collaborative
26

25. Health Literacy and Informatics
■11th Street text messaging project
■Needs assessment for patient portal
■Decision Counseling for Cancer
Clinical Trial
27

26. TAKING A CLOSER
LOOK…
Philadelphia
28

27. Highest poverty rate of 10 largest U.S. cities
22% of adults lack basic literacy
Health literacy is even lower
29
City of Contrasts

28. -Children’s Hospital of
Philadelphia (CHOP)
-Philadelphia Free Library
-City of Philadelphia
-Philadelphia Department of
Public Health
-Philadelphia Parks & Recreation
30
South Philly Community Health and
Literacy Center

29. Free
Library
150,000 “customers”
Nurse on-site weekly
Healthy story time
31

30. 32
Health Center 2
City of Philadelphia
FQHC
Full service adult
healthcare
Dental services, family
planning
Nutrition classes

31. CHOP Primary Care Center
Easy referral from M.D. to librarian
35,000 year--a book each time!
Stories, games, puppets, oh my!
33

32. Adjacent Park & Rec Center
34
Basketball courts, playground,
garden, indoor programs, too

33. Collaborative Model
35
 Established early
 Public private partnership
 Monthly inter-disciplinary
meetings
 Location, location, location
 Opportunistic
 Clinician proximity for easy
referral
 Shared goals

34. University of Pennsylvania Libraries
Community Outreach
36

35. UPenn Libraries
Community Outreach
37
Biomedical Library,
Philadelphia Free Library (3
branches)
UPenn School of Nursing
Sayre Health Clinic (FQHC)
City of Philadelphia Health Clinic
Netter Center for Community
Partnerships
Mid-Atlantic Region NN/LM

36. UPenn Community Outreach
Locations
Cobbs Creek Library Free Library Branch
38

37. 39

38. Lessons Learned
■ Anonymity & flexibility—reluctant to “enter the room” for a class or
deeper discussion
■ Needs assessment
■ Usability, HL in small bits and bytes
■ Citizenship classes very successful
■ Flexible space, jazz concerts, health fairs, active events
■ 1/3 of library users ask health questions
■ Integrate health into other library activities
■ http://www.webjunction.org/explore-topics/ehealth/news.html
40

39. Ideas & Opportunities
■ Collaboration across disciplines, across agencies, across time and space?
■ Lend stuff, too—BP cuffs, pedometers…
■ Locations & linkages
– Telehealth sessions from the library
– Health librarian on call from clinic, information and referral from library
– BP, flu vaccine, nurse in library
■ Digital information hub
– How to use your patient portal, collect and add data, personal data management
■ Understanding and improving health
– Exercise classes, yoga, books and puppets, games and exercise in the clinic
– Kitchens for nutrition, numeracy & literacy
■ New skills
– Safety net skills training for librarians
– Information literacy skills for health professionals
41

40. Tips for Success
■ Many hands make light work—team science, many
disciplines working together, talking together, and
collaborating.
■ Having separate communities of practice that don’t talk to
each other is not a good use of resources.
■ Knowing what each of us is good at, and iterate until it’s
right
■ Evaluate!
■ Understanding quality information, understanding your
own health
42

41. Improving Health Literacy Is
 Affordable
 Pragmatic
 Enhances social welfare
 Has a moderate influence on health outcomes
 Contested intellectual territory
43

42. Staking a Claim
■ Accessibility experts
■ Connectors
■ Subject specialists
■ Collaborators
■ Imaginative
44

43. As Promised--
■ What are the best ways to help individuals become more
literate and more responsible for their health?
■ What lessons can we learn from the information and
informatics communities that can be applied to health literacy
research and practice?
■ What values and beliefs must we examine as we attempt to
achieve a more health literate society?
■ What unique contributions are librarians making to improve
health literacy?
45

44. 46
Let’s begin the
conversation…..
For additional information or to make comments,
please feel free to contact me at
pdalrymple@drexel.edu