1. RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
Health
Literacy
and
PaAent-­‐Centered
Care
(IOM)
Audiology
and
Health
Literacy:
ImplicaAons
v Patient-centered care is the provision of care “that is respectful of
and responsive to individual patient preferences, needs, and values,”
and ensures “that patient values guide all clinical decisions.”
v Health Literacy is “the degree to which individuals have the
capacity to obtain, process, and understand basic health information
and services needed to make appropriate health decisions.”
Health Literacy Demographics
At-­‐risk
populaAons
Methods:
3 experienced audiologists from the university clinic (2 with graduate level counseling
courses)
12 adult hearing impaired participants
8 male, 4 female; mean PTA 36.1 dB HL; mean age 70.6 (57-75)
5 first-time hearing aid users, 7 experienced hearing aid users
§ Each participated in a hearing aid orientation appointment. Dialogs were videotaped
and transcribed. Some were given printed educational materials (Hearing aid guides)
§ Transcribed dialog and print materials were analyzed using the Flesch-Kincaid grade
level formula (FKGL) which assigns a US educational grade equivalent to the text.
Results
“What is the impact of health literacy on
patient understanding of counseling and
education materials?”
Important
Resources
QuanAtaAve
Health
Literacy
Screening
Measures
References
Ask Me 3 | National Patient Safety Foundation (2013). Retrieved from http:// www.npsf.org/for-healthcare-professionals/
programs/ask-me-3/
Caposecco A., Hickson L. & Meyer C. (2013). Hearing aid user guides: Suitability for older adults. Int J Audiol, 53: S43–S51
Dewalt, D. A., Callahan, L. F., Hawk, V. H., Broucksou , K. A., Hink, A., Rudd, R., & Brach, C. (2010). Health literacy
universal precautions toolkit (10-0046-EF). Retrieved from Agency for Healthcare Research & Quality (AHRQ) website: http://
www.ahrq.gov/qual/literacy/‎
Eadie, C. (2014). Health Literacy: A Conceptual Review. MEDSURG Nursing, 23(1), 1-13.
Health Literacy: A Prescription to End Confusion - Institute of Medicine. (2004). Retrieved from http://www.iom.edu/
Reports/2004/Health-Literacy-A-Prescription-to-End-Confusion.aspx
Health Literacy. (n.d.). Retrieved from http://www.asha.org/slp/healthliteracy/#SLP%20role
Institute of Medicine (2004). Health literacy: a prescription to end confusion. Retrieved from National Academies Press
website: http://www.iom.edu/Reports/2004/Health-Literacy-A-Prescription-to-End-Confusion.aspx
Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America’s Adults: Results from the 2003
National Assessment of Adult Literacy (NCES 2006483). Retrieved from National Center for Education Statistics website:
http://nces.ed.gov/naal/health.asp
Morris, N., MacLean, C, Chew, L, & Littenberg, B. (2006). Single item literacy screener: Evaluation of a brief instrument to
identify limited reading ability. Biomed Central Family Practice, 7(21), 1-7.
Nair, E. L., & Cienkowski, K. M. (2010). The impact of health literacy on patient understanding of counseling and education
materials. International Journal of Audiology, 49(2), 71-75.
National Assessment of Adult Literacy (NAAL) - Health Literacy (2003). Retrieved from http://nces.ed.gov/naal/health.asp
Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American
Geriatrics Society: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity
(2012). J Am Geriatr Soc, 60 (2012), pp. 1957–1968.
U.S. Department of Health and Human Services (2000). Healthy People 2010. Washington, DC: U.S. Government Printing
Office
Audiologists encounter health literacy challenges, because most
patients/clients already have an existing or underlying communication
disorder such as hearing loss, and may also belong to one or more of
the other at-risk categories:
1. How is information communicated?
2. How are materials formatted in terms of language, font size, & grade
level.
3. Recall of patients – 40 -80% of information is forgotten immediately
and 50% of what is retained is incorrect!!
“Hearing
Aid
InstrucAonal
Brochures-­‐
Suitable
for
Older
Adults?”
Barbara
E.
Weinstein,
Ph.D,
FAAA*;
Jennifer
Gilligan,
BA*
*The
Graduate
Center,
City
University
of
New
York,
Au.D
Program,
Speech-­‐Language-­‐Hearing
Sciences
Program
The
Importance
of
PaAent-­‐Centered
Care
and
Health
Literacy
in
Audiology
An
integral
part
of
clinical
prac/ce
Facilitate
understanding
of
hearing
loss
Help
with
acceptance
of
circumstances
Empowering
towards
self-­‐
efficacy
Facilitate
compliance
with
recommenda/on
(e.g.
hearing
aid
use)
Must
be
culturally
and
linguis/cally
appropriate.
Source:
U.S.
Department
of
Educa/on,
Ins/tute
of
Educa/on
Sciences,
Na/onal
Center
for
Educa/on
Sta/s/cs,
2003
Na/onal
Assessment
of
Adult
Literacy
(NAAL)
•
Individuals
with
hearing
loss,
speech,
language,
and
vision
disorders
•
Individuals
with
cogni/ve
or
mental
disorders
including
demen/a
•
Non-­‐English
speaking
&
immigrant
popula/ons
•
Elderly
popula/ons
•
Ethnic
minority
popula/ons
&
those
with
cultural
differences
•
Persons
living
on
or
below
the
poverty
line
•
Homeless
persons
Ins/tute
of
Medicine
(2004)
Hearing
Loss
Depression
Hypertension
Diabetes
Cogni/ve
Impairment
Vision
Loss
What
is
my
main
problem?
What
do
I
need
to
do?
Why
is
it
important
for
me
to
do
this?
Ask
Me
3
is
a
registered
trademark
licensed
to
the
Na/onal
Pa/ent
Safety
Founda/on
² About 33 % of patients have limited health literacy
² Only 12 % have proficient health literacy
National Assessment of Adult Literacy (2003)
Poor
Compliance
With
Treatment
Poor
Mo/va/on
Poor
Health-­‐related
Decision
Making
Poorer
Overall
Health
Outcomes
LIMITED
HEALTH
LITERACY
.
u All of the patients in this study had a predicted health literacy that was
below a fourth grade reading level. The audiologists’ language was
significantly different from predicted patient health literacy.
IMPLICATIONS
Erika L. Nair & Kathleen M. Cienkowski (2010)
Department of Communication Sciences,
University of Connecticut, Storrs, USA
Research Questions:
§ What is the predicted health literacy of patients receiving audiological services?
§ Are there significant differences present in the level of language used by patients
and the average level of reading among U.S. adults?
§ Are there significant differences present between the level of language used by
audiologists and patients?
§ Are there significant differences present in the level of patient education materials
(i.e. hearing aid instruction guide) and the level of language used by audiologists?
The
Agency
for
Healthcare
Research
and
Quality
(AHRQ)
commissioned
The
University
of
North
Carolina
at
Chapel
Hill
to
develop
and
test
a
Health
Literacy
Universal
PrecauAons
Toolkit.
It
provides
step-­‐by-­‐step
guidance
and
tools
for
assessing
clinical
prac/ce
and
making
changes
in
order
to
connect
with
pa/ents
of
all
literacy
levels.
It
is
a
comprehensive
guide
to:
u
Improve
spoken
communica/on
u
Improve
wriden
communica/on
u
Improve
self-­‐management
&
empowerment
u
Improve
suppor/ve
systems
PaAent-­‐Centered
Counseling:
ConsideraAons
Several
specific
health
and
behavioral
domains
could
be
related
to
older
adults
being
less
educated
and
having
poor
reading
skills:
there
is
a
higher
prevalence
of
demen/a
or
cogni/ve
impairment
in
older
adults;
there
is
also
a
higher
prevalence
of
chronic
diseases
like
hypertension
that
can
result
in
reduced
cogni/ve
func/on
and
poor
physical
and
mental
health;
older
adults
tend
to
have
higher
rates
of
hearing
and
visual
impairments
that
can
impede
reading
and
other
communica/on
skills
that
are
necessary
for
everyday
literacy
as
well
as
health.
American Geriatric Society (AGS) goals for optimizing health of
older Americans:
§ Ensure every older adult gets high quality patient-centered care.
§ Increase number of healthcare professionals who employ
principles critical to caring for older adults.
§ Collaborate to influence public policy to improve health of older
adults.
Physical
Impairment
Counseling is a professional
relationship that empowers
diverse individuals, families,
and groups to accomplish
wellness goals.
Ø Poor
understanding
of
informaAon
costs
Ame,
money
and
frustraAon:
Ø E.g.
needing
to
make
addi/onal
appointments
for
clarifica/on
of
hearing
aid
func/on.
Ø Poor
understanding
can
lead
to
reduced
saAsfacAon
Ø E.g.
a
pa/ent
might
reject
the
hearing
aids
altogether.
Ø Poor
understanding
can
affect
self
esteem
Ø Psychological
consequences
can
be
far-­‐reaching.
Ø Poor
understanding
can
negaAvely
impact
overall
health
Ø A
hearing
impaired
person
without
amplifica/on
will
be
at
a
great
disadvantage
in
naviga/ng
the
health
system
as
a
whole.
“Access
to
informa.on
starts
with
being
able
to
hear
it,
ask
ques.ons,
and
understand
the
responses.
In
this
regard,
hearing-­‐impaired
pa.ents
are
at
a
disadvantage”
Nair
&
Cienkowski (2010)
v
Empirically
analyzed
the
content,
literacy
demand,
design,
readability,
graphic
content,
layout,
interac/vity
and
cultural
appropriateness
of
36
printed
hearing
aid
user
guides
from
9
manufactures
to
determine
their
suitability
for
older
adults.
Uncommon
vocabulary
Small
text
size
Excessive
technical
info
Poor
layout
Mean
grade
level
of
9.6
USER
GUIDES
NOT
OPTIMAL
69%
of
guides
unsuitable
PCC
&
Health
Literacy
in
Older
Adults
(ASHA)
TIPS
FOR
PROMOTING
UNDERSTANDING
OF
IMPORTANT
INFORMATION
1.
Teach-­‐back
can
confirm
that
you
have
explained
to
the
paAent
what
they
need
to
know
in
a
manner
that
the
paAent
understands.
DO
NOT
USE
JARGON
• LIMIT
INFORMATION
TO
3-­‐5
KEY
POINTS
BE
SPECIFIC
&
CONCRETE
• DEMONSTRATE,
USE
MODELS
&
SIMPLE
GRAPHICS
REPEAT
&
SUMMARIZE
• BE
POSITIVE,
HOPEFUL
&
EMPOWERING
Health
Literacy
Universal
Precau/ons
Toolkit
2.
Use
plain,
non-­‐technical
language
in
wri[en
materials
and
when
speaking.
3.
Chunk
related
informaAon.
4.
Use
large,
clear
fonts,
leave
white
spaces,
use
contrasAng
colors.
5.
Encourage
quesAons,
speak
clearly
at
a
moderate
pace.
6.
PrioriAze
informaAon.
S-­‐TOFHLA
(Oldfield,
2005)
• Shortened
version
of
the
Test
Of
Func/onal
Health
Literacy
in
Adults
• Takes
only
7minutes
to
complete
• Considered
the
gold
standard
in
measuring
health
literacy
Single
Item
Literacy
Screener
(SILS)
(Morris
et
al.,
2006)
• Iden/fies
pa/ents
who
need
help
with
reading
health-­‐related
informa/on
• Clinicians
ask
“How
open
do
you
need
to
have
someone
help
you
read
instruc/ons,
pamphlets
or
other
wriden
material
from
your
doctor
or
pharmacy?”
Rapid
EsAmate
of
Adult
Literacy
in
Medicine
(REALM)
(Safeer,
2005)
• 3-­‐minute
reading
test
that
measures
the
ability
to
interpret
health
care
terms
and
health-­‐related
materials.
• A
score
of
18
or
below
indicates
a
third
grade
reading
level.
Health literacy impacts overall health status and the health care
encounter. Poorer outcomes are more common in patients with low
health literacy (DHHS, 2010).
Addressing low health literacy and employing strategies to increase it
will reduce disparities in overall health outcomes, leading to a
healthier and more empowered aging population.
Audiologists should strive to increase patients’ health literacy, as this
is integral to delivery of patient-centered care.
CONSEQUENCES
Caposecco, Hickson & Meyer (2014)
HEARing Cooperative Research Centre, Melbourne
School of Health & Rehabilitation Sciences,University of Queensland, Australia
It
is
neither
just,
nor
fair,
to
expect
a
pa.ent
to
make
appropriate
health
decisions
and
safely
manage
his/her
care
without
first
understanding
the
informa.on
needed
to
do
so.
Reducing
the
Risk
by
Designing
a
Safer,
Shame-­‐Free
Health
Care
Environment
(AMA,
2007).
Understanding is a two-
way street.
—Eleanor Roosevelt