The document discusses health literacy, including how it is defined as skills needed to function in the healthcare system, why it is important as low health literacy is associated with poor health outcomes, and how it should be measured using tools that assess word recognition, reading comprehension, and numeracy. It also reviews research that has identified limitations in current health literacy measures and calls for more comprehensive measures to be developed.
Department of Clinical Epidemiology, Monash University
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.
School of Health and Social Development, Deakin University
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.
Low Health Literacy in the Older Adult: Identification & Intervention power p...Jeanne Baus
Low Health Literacy in Older Adults is a common challenge for home health care nurses. This powerpoint addresses how to identify low health literacy levels and how to effectively meet the patient needs to improve health education goals and outcomes.
Department of Clinical Epidemiology, Monash University
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.
School of Health and Social Development, Deakin University
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.
Low Health Literacy in the Older Adult: Identification & Intervention power p...Jeanne Baus
Low Health Literacy in Older Adults is a common challenge for home health care nurses. This powerpoint addresses how to identify low health literacy levels and how to effectively meet the patient needs to improve health education goals and outcomes.
An informatics perspective on health literacyLibrary_Connect
Professor Prudence Dalrymple, a leading health information professional, presented "An Informatics Perspective on Health Literacy: Challenges and Obstacles" at the Elsevier Luncheon for Medical Librarians concurrent with the 2017 Medical Library Association Annual Meeting and Exhibition in Seattle.
Don Nutbeam | The evolving concept of health literacySax Institute
Professor Don Nutbeam, Vice Chancellor of the University of Southampton in the UK, spoke to the HARC network in April 2010 to help us consider how to improve healthcare delivery for people with low health literacy.
HARC stands for the Hospital Alliance for Research Collaboration. HARC is a collaborative network of researchers, health managers, clinicians and policy makers based in NSW, Australia managed by the Sax Institute.
HARC Forums bring members of the HARC network together to discuss the latest research and analysis about important issues facing our hospitals.
For more information visit saxinstitute.org.au.
Health literacy is the most important factor in getting the proper health information and health services. Health literacy significantly affects healthcare accessibility, availability, affordability and eventually cost. Health literacy makes it possible for the people to actively participate in the healthcare decision making process.
Cooperative Extension's National Focus on Health literacySUAREC
Please presentation, that was presented as a webinar focuses on the National Land-grant's role on Health Literacy. The presenters of this webinar were Dr. Sonja Koukel, New Mexico State University Extension and Dr. Fatemeh Malekian, Southern University Agricultural Research and Extension Center.
Va Health Literacy Research Presentationguest169e62f
What is the Impact of Low VA Patient Literacy on VA Diabetes Patient Educational Initiatives?
Department of Veterans Affairs Medical Center, North Chicago, IL USA
A very important aspect in determining and studying disease is the knowledge of surveys. Its designs, methods etc. This elaborative presentation gives a detailed insight to the survey procedures used in dentistry. Special section on the WHO oral assessment proforma.
The Undergraduate Research Opportunity Program’s Annual Spring Research Symposium is the culminating event for all students participating in UROP for the 2016-2017 academic year. The symposium will take place Wednesday, April 19th, 2017 from 9am - 5pm, at the Michigan Union
An informatics perspective on health literacyLibrary_Connect
Professor Prudence Dalrymple, a leading health information professional, presented "An Informatics Perspective on Health Literacy: Challenges and Obstacles" at the Elsevier Luncheon for Medical Librarians concurrent with the 2017 Medical Library Association Annual Meeting and Exhibition in Seattle.
Don Nutbeam | The evolving concept of health literacySax Institute
Professor Don Nutbeam, Vice Chancellor of the University of Southampton in the UK, spoke to the HARC network in April 2010 to help us consider how to improve healthcare delivery for people with low health literacy.
HARC stands for the Hospital Alliance for Research Collaboration. HARC is a collaborative network of researchers, health managers, clinicians and policy makers based in NSW, Australia managed by the Sax Institute.
HARC Forums bring members of the HARC network together to discuss the latest research and analysis about important issues facing our hospitals.
For more information visit saxinstitute.org.au.
Health literacy is the most important factor in getting the proper health information and health services. Health literacy significantly affects healthcare accessibility, availability, affordability and eventually cost. Health literacy makes it possible for the people to actively participate in the healthcare decision making process.
Cooperative Extension's National Focus on Health literacySUAREC
Please presentation, that was presented as a webinar focuses on the National Land-grant's role on Health Literacy. The presenters of this webinar were Dr. Sonja Koukel, New Mexico State University Extension and Dr. Fatemeh Malekian, Southern University Agricultural Research and Extension Center.
Va Health Literacy Research Presentationguest169e62f
What is the Impact of Low VA Patient Literacy on VA Diabetes Patient Educational Initiatives?
Department of Veterans Affairs Medical Center, North Chicago, IL USA
A very important aspect in determining and studying disease is the knowledge of surveys. Its designs, methods etc. This elaborative presentation gives a detailed insight to the survey procedures used in dentistry. Special section on the WHO oral assessment proforma.
The Undergraduate Research Opportunity Program’s Annual Spring Research Symposium is the culminating event for all students participating in UROP for the 2016-2017 academic year. The symposium will take place Wednesday, April 19th, 2017 from 9am - 5pm, at the Michigan Union
Descriptive EpidemiologyHIVAIDS was first recognized as aemersonpearline
Descriptive Epidemiology
HIV/AIDS was first recognized as an epidemic in the United States in 1981. At the beginning of the AIDS epidemic, the life expectancy for infected persons was less than 7 years. Today, because of research and new treatment options, people who begin treatment soon after diagnosis can expect to live a nearly normal life span (Cairns, 2010). The HIV/AIDS epidemic was identified through descriptive epidemiology.
Descriptive epidemiologic studies are often conducted as precursors to analytic studies. Epidemiologic concepts are used to gather data to better understand and evaluate health trends in populations. Data such as characteristics of the persons affected, place where an incident occurred, and time of occurrence are collected and analyzed to look for patterns in an effort to identify emerging health problems.
In this Discussion, you will apply the epidemiologic concepts of time, place, and person to a specific population health problem.
To prepare:
Consider a variety of population health problems, and then select one on which to focus for this Discussion.
Identify a specific population affected by your selected health problem.
Research the patterns of the disease in your selected population using the epidemiologic characteristics of person, place, and time.
Explore three to five data sources presented in the Learning Resources that could aid you in describing the population and magnitude of the problem. Analyze the strengths and limitations of each data source.
Consider methods for obtaining raw data to determine the variables of person, place, and time for your health problem. Ask yourself: How would the methods I select influence the accuracy of case identification, definition, and diagnosis?
By tomorrow Wednesday 03/07/18 by 4pm, write a minimum of 550 words in APA format with a minimum of THREE scholarly references from the list of required readings below. Include the level one headers as numbered below:
Post
a cohesive response that addresses the following:
1) Evaluate your selected health problem in the population you identified by describing
THREE
to
FIVE
characteristics related to person, place, and time.
2) Appraise the data sources you utilized by outlining the
strengths
and
limitations
of each.
3) Discuss
TWO
methods you could use to collect raw data to determine the descriptive epidemiology of your health problem, determine how these methods would influence the completeness of case identification as well as the case definition/diagnostic criteria used.
Required Readings
Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.
Chapter 3,
“Measures of Morbidity and Mortality Used in Epidemiology”
Chapter 4
, “Descriptive Epidemiology: Person, Place, Time”
Chapter 5
, “Sources of Data for Use in Epidemiology”
Chapter 3
examines several measu ...
Final Presentation of the Bergen Summer Research School 2010, course 4: Mobile Technologies for Global Health Research (presented on Friday, July 2 by Ali Habib, John Wesonga and Heather Zornetzer)
EMPIRICAL STUDYThe meaning of learning to live with medica.docxSALU18
EMPIRICAL STUDY
The meaning of learning to live with medically
unexplained symptoms as narrated by patients in primary
care: A phenomenological�hermeneutic study
EVA LIDÉN, PhD1, ELISABETH BJÖRK-BRÄMBERG, PhD2 &
STAFFAN SVENSSON, MD3
1Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, 2Institute
of Environmental Medicine, Karolinska Institutet, Solna, Sweden, and 3Angered Family Medicine Unit, Angered, Sweden
Abstract
Background: Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a
large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical
perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person
with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of
learning to live with MUS as narrated by patients in primary health-care settings.
Methods: A phenomenological�hermeneutic method was used. Narrative interviews were performed with ten patients
suffering from MUS aged 24�61 years. Data were analysed in three steps: naive reading, structural analysis, and
comprehensive understanding.
Findings: The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms
overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining
insights and moving on, was based on subthemes describing the patients’ search for explanations, learning to take care of
oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky’s theory of sense
of coherence and Kelly’s personal construct theory. Possibilities and obstacles, on an individual as well as a structural level,
for promoting patients’ capacity and learning were illuminated.
Conclusions: Patients suffering from MUS constantly engage in a reflective process involving reasoning about and
interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this
reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged
as a conventional and necessary care activity.
Key words: MUS, primary care, person centred care, phenomenological-hermeneutics
(Accepted: 19 March 2015; Published: 16 April 2015)
Medically unexplained symptoms (MUS) is a condi-
tion that affects a large but heterogeneous group
of people. The health services have so far been
unsuccessful in addressing the healthcare needs of
these people, partly because of outdated theories and
diagnostic systems that fail to encompass the com-
plexity of the patients’ health problems (Fink &
Rosendal, 2008). The lack of a medical explanation
and cure leaves patients and healthcare professionals
in a ...
Similar to Hahn Health Literacy, RIC Grand Rounds 11.09.11 (20)
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. Health Literacy
What is it?
Why is it important?
How should it be measured?
What do patients think?
Elizabeth A. Hahn
Associate Professor
Department of Medical Social Sciences
Feinberg School of Medicine, Northwestern University
e-hahn@northwestern.edu
RIC Grand Rounds
November 9, 2011
2. Learning Objectives
1. Understand how health literacy is defined and measured
2. Identify the relationships between low health literacy and
poor health outcomes
3. Evaluate strategies to overcome literacy barriers
4. Develop strategies for using health literacy measures in
research and clinical practice
3. Definition of Health Literacy
Health literacy is “the degree to which individuals can obtain,
process, and understand the basic health information and
services they need to make appropriate health decisions.”
It represents a constellation of skills necessary for people to
function effectively in the health care environment and act
appropriately on health care information. These skills
include the ability to interpret documents, read and write
prose (print literacy), use quantitative information
(numeracy), and speak and listen effectively (oral literacy).
Berkman et al. Health Literacy Interventions and Outcomes: An Updated
Systematic Review. AHRQ Publication Number 11-E006. March 2011.
4. Why is it important?
Results. Differences in health literacy were associated with increased
hospitalizations, greater emergency care use, lower use of mammography, lower
receipt of influenza vaccine, poorer ability to demonstrate taking medications
appropriately, poorer ability to interpret labels and health messages, and, among
seniors, poorer overall health status and higher mortality. Health literacy level
potentially mediates disparities between blacks and whites.
Conclusions. Future research priorities include justifying appropriate cutoffs for
health literacy levels; developing tools that measure additional related skills
(e.g., oral (spoken) health literacy); and examining mediators and moderators of
the effect of health literacy. Priorities in advancing the design features of
interventions include testing novel approaches to increase motivation, techniques
for delivering information orally or numerically, “work around” interventions such
as patient advocates; determining the effective components of already-tested
interventions; determining the cost-effectiveness of programs; and determining
the effect of policy and practice interventions
Berkman et al. Health Literacy Interventions and Outcomes: An Updated
Systematic Review. AHRQ Publication Number 11-E006. March 2011.
5. Measures of Health Literacy
1. Word recognition
2. Reading comprehension
3. Numeracy
6. Word Recognition:
Rapid Estimate of Adult Literacy in
Medicine (REALM) (Davis et al., 1993)
1 2 3
fat fatigue allergic
flu pelvic menstrual
pill jaundice testicle
dose infection colitis
… … …
bowel syphilis anemia
asthma hemorrhoids obesity
rectal nausea osteoporosis
incest directed impetigo
7. Reading Comprehension:
Test of Functional Health Literacy
in Adults (TOFHLA) (Parker et al., 1995)
Your doctor has sent you to have a _______________ x-ray.
a. stomach
b. diabetes
c. stitches
d. germs
8. Numeracy:
Test of Functional Health Literacy
in Adults (TOFHLA) (Parker et al., 1995)
GARFIELD IM 16 Apr 93
FF941862 Dr. LUBIN, MICHAEL
DOXYCYCLINE
100 mg 20/0
Take medication on empty
stomach one hour before or
two to three hours after a
meal unless otherwise
directed by your doctor.
02 11 (0 of 20)
Interviewer: If you eat lunch at 12:00 noon, and you want to
take this medicine before lunch, what time should you take it?
9. Numeracy:
Newest Vital Sign (NVS) (Weiss et al., 2005)
Interviewer: If you eat the entire container, how many calories
will you eat?
10. Jordan JE, Osborne RH, Buchbinder R. Critical appraisal of health
literacy indices revealed variable underlying constructs, narrow
content and psychometric weaknesses. J Clin Epidemiol
2011;64:366-379
reviewed development, content and properties of 19 indices
(originals and short-form derivatives; did not evaluate translated versions)
3 measurement approaches: direct testing of an individual’s abilities, self-
report of abilities, and population-based proxy measures
Findings:
underlying constructs and content varied widely
none appeared to fully measure a person’s ability to seek,
understand, and use health information
content focused primarily on reading comprehension and
numeracy
scoring categories were poorly defined
few indices had been assessed for reliability
11. Jordan JE, Osborne RH, Buchbinder R. Critical appraisal of health
literacy indices revealed variable underlying constructs, narrow
content and psychometric weaknesses. J Clin Epidemiol
2011;64:366-379
Conclusions:
health literacy is not consistently measured
this makes it difficult to interpret and compare health
literacy at individual and population levels
empirical evidence demonstrating validity and reliability of
existing indices is required
more comprehensive health literacy instruments need to
be developed
12. Health Disparities Research
Long-term goals: Develop interventions to prevent health
disparities related to literacy, language and culture
Short-term goals:
Develop literacy-, language- and culture-fair tools for patient-
reported outcomes and patient education
Develop better health literacy measures
Validate these tools and measures in research and clinical settings
1999-2002, Evaluate patient attitudes & preferences (Coleman Found.)
1999-2004, Develop TT/PP (R01-HS010333, TURSG-02-069-01-PBP)
2005-2009, Develop TT/PP health literacy measure (R01-HL081485)
2007- , Test TT intervention in cancer care (R18-HS017300)
2010- , Test TT/PP intervention in diabetes care (R18-HS019335)
13. Research on Health
Literacy Measurement
A New Approach to Measurement of
Health Literacy in English and Spanish
(Hahn; R01-HL081485)
Health Literacy Assessment Using
Talking Touchscreen Technology
(Health LiTT)
(Yost et al., Patient Educ Couns 2009;J Health Commun 2010;
Hahn et al., J Health Commun 2011)
14. Literacy and Technology Skills
Required to Function Optimally as a Patient1
Literacy Technology
Medical
Oral Writing Reading Computers Multimedia
Instruments
Prose3
Listening2 (Understand and use information
from texts)
Document3 3Three types of scales defined for the 1992 National
Speaking (Locate and use information from Adult Literacy Survey (NALS) and 2003 National
forms, tables, graphs, etc.) Assessment of Adult Literacy (NAAL)
Quantitative3
(Apply arithmetic operations using
Blue shading denotes areas of focus for R01-HL081485 numbers in printed materials)
2 1Adapted from: Speaking of Health: Assessing Health
Listening skills are needed to hear the recorded literacy
questions, but these skills will not be specifically measured Communication Strategies for Diverse Populations,
2002; and Health Literacy: A Prescription to End
Confusion, 2004.
15. The Talking Touchscreen
(Hahn, PI: AHRQ/NCI #R01-HS010333)
Hahn et al., Psycho-Oncology 2004; Qual Life Res 2007
La Pantalla Parlanchina
(Hahn, PI: ACS #TURSG-02-069-01-PBP)
Hahn et al., J Oncol Manag 2003; Med Care 2010
16. The sound is very helpful because I don’t read
too good and listening to the recording really
helps.
It was easy to understand; it was fun.
At the beginning, I thought I would not be able
to do the surveys, but it turned out to be very
easy.
Helpful; gives you more privacy.
It’s good that there’s a Spanish survey for
patients who don’t speak English.
Interesting; every clinic should have one.
It’s about time that someone thought about
doing something like this for us patients.
17. Health Literacy Study Rationale
unclear at what level low health literacy begins to adversely
affect health and health care utilization
this may be due to the lack of precision for categorizing individuals in
the marginal health literacy category
improving measurement in the “middle zone” will help:
estimate the size of the population at risk from low health literacy
identify vulnerable patients within a clinical setting
clinicians and researchers need precise, brief measures
that can be individually administered and scored in real-time
to enable tailoring for the patient’s health literacy level
to provide reliable & valid scores for use in testing interventions
need to distinguish between Literacy and Language Barriers
English and non-English measures must yield equivalent information
R01-HL081485
18. Definition of Health Literacy
for Measurement Purposes
Capacity Application
Theoretical Actual
Read and comprehend
health-related print Apply health-related
material information to a Implement an
health care situation appropriate decision
Identify and interpret and understand what and related behavior
information presented an appropriate in the management of
in graphical format decision or behavior one’s own health
SHOULD be
Perform arithmetic
operations
Capacity to obtain information (i.e., information-seeking)
is a navigation skill that will not be included at this time. R01-HL081485
23. Patient Evaluation of Health LiTT
(n=610 English-speaking primary care patients)
Any difficulty using Not at all 93%
the touchscreen? A little bit 6%
Somewhat or quite a bit 1%
Ever feel Not at all 86%
uncomfortable, A little bit 11%
anxious, nervous? Somewhat or quite a bit 3%
Overall rating of Poor or Fair 4%
screen design Good 24%
Very Good 33%
Excellent 39%
Burden of 30 health Too many 14%
literacy questions About right 58%
(avg. 18 minutes) Could have answered more 28%
Rating of study Worse than expected 2%
participation About the same as expected 23%
A little better than expected 28%
A lot better than expected 47%
26. Item Information and Reliability, and Distribution of Person
Scores Estimated by the Final 2-PL Calibration Model
(n=608 English-speaking primary care patients)
60
50
40
Information
Prose
30
rel.=.95
20
rel.=.90
Document
10 Quantitative
0
20 30 40 50 60 70 80
PI: Hahn; R01-HL081485
T-Score Hahn et al., J Health Commun 2011
27. Health Literacy Screening
in Clinical Practice?
Depends on how the data are used.
Screening can identify individual patient needs.
this may be especially valuable when comprehension of health
information is critical (e.g., when patients need to make decisions
regarding stem cell transplant or hospice care)
Health literacy data aggregated at the clinic level can help
identify what education materials and communication
strategies are appropriate and gauge the effectiveness of
practice changes after they are implemented.
Garcia, et al. J Support Oncol 8:64-69, 2010.
28. Health Literacy Screening
in Clinical Practice?
To justify screening, several conditions must be met:
1. screening tests need to accurately and reliably detect limited literacy
2. the benefit of early treatment options to reduce adverse health
outcomes must be proven and available
3. the benefits need to outweigh adverse effects of the program (U.S.
Preventive Services Task Force, AHRQ, 2006)
Risks: literacy screening programs could negatively impact
patient care by promulgating fear and labeling
Paasche-Orlow & Wolf. J Gen Intern Med 23:100-102, 2008.
30. Agree that it is important for doctors/nurses
to know about their patients’ reading abilities
p=0.469 p=0.334 p=1.000
PI: Hahn; Coleman Foundation
31. Willing to have results of literacy survey
given to my doctors and nurses
p=0.697 p=0.157 p=0.189
PI: Hahn; Coleman Foundation
32. Many Patients Reported That They
Learned Something by completing
Health LiTT
It was nice because it showed me and educated me on
drug addiction, mammograms, and how to read charts.
Very interesting; learned a lot.
It was very interesting. It showed me about my diabetes
and cancer and high blood pressure.
It's very informative about different illnesses. It educates
and teaches us how to take control of our health.
Very informative; learned a lot of things I didn’t know
about my health.
PI: Hahn; R01-HL081485
33. Health LiTT
Implications for
Policy, Practice or Delivery
A bilingual, computer-adaptive test of health literacy will
enable clinicians and researchers to more precisely determine
at what level low health literacy begins to adversely affect
health and health care utilization.
This tool will provide better opportunities to determine the
independent effects of limited English proficiency and limited
health literacy.
By using novel computer-based methods for health literacy
assessment, this tool will increase the access of underserved
populations to new technologies, and contribute information
about the experiences of diverse populations with new
technologies.
34. Health Literacy Universal
Precautions Toolkit
AHRQ Publication No. 10-0046-EF, April 2010. http://www.ahrq.gov/qual/literacy/index.html
What Are Health Literacy Universal Precautions?
taking specific actions that minimize risk for everyone when it is unclear which
patients may be affected
e.g., health care workers take universal precautions when they minimize the
risk of bloodborne disease by using gloves and proper disposal techniques
How Can This Toolkit Help?
Experts recommend assuming that everyone may have difficulty understanding
and creating an environment where all patients can thrive.
Research suggests that clear communication practices and removing literacy-
related barriers will improve care for all patients, regardless of their level of
health literacy.
This toolkit is designed to help adult and pediatric practices ensure that systems
are in place to promote better understanding by all patients, not just those you
think need extra assistance.
35. Research on Patient-Centered Care
Improving the delivery of patient-centered health information is especially
important for vulnerable populations, e.g., patients with limited economic
resources, low literacy skills or racial/ethnic minority status.
These patients experience greater disease burden, are less informed about
diagnosis and treatment, are less involved in disease management, are less likely
to ask questions of providers, and are less likely to be satisfied with
communication with their providers.
Traditional patient education relies heavily on written material. However, these
materials are often written at high reading levels with poor usability
characteristics for patients with lower literacy.
The use of new information technologies is a recommended strategy to improve
access to health information and to enhance the quality of communication.
We are conducting two research projects that are relevant to the overarching
goal of Healthy People 2010 and 2020 of Eliminating Health Disparities.
the focus area of Health Communication and Health IT endorses the strategic
use of communication and health information technology to improve health
36. Figure 1.1 Clinicians, patients, relationships (clinical and social), and health services are all integral to
patient-centered care. The interactions among these elements are complex(Epstein et al, 2005) and deficits in any
one area can significantly decrease the quality of patient care. [from 2007 NCI/NIH Pub. #07-6225 “Patient-
Centered Communication in Cancer Care”]
37. Strategies to Overcome Literacy Barriers
Cancer Patient Education Software for English-
speaking cancer patients: Cancer Care
Communication (C3) (Hahn; R18-HS017300)
Diabetes Patient Education Software for English-
and Spanish-speaking patients with Type 2
Diabetes: Innovative Adaptation and
Dissemination of AHRQ Comparative
Effectiveness Research Products (iADAPT)
(Hahn; R18-HS019335)
48. Patient Evaluation of CancerHelp-TT in Field Test
(n=13 English-speaking cancer patients)
Any difficulty using Not at all n=11
TT for questions? A little bit n= 2
Any difficulty using Not at all n=12
CancerHelp-TT? A little bit n= 1
Ever feel Not at all n=12
uncomfortable, A little bit n= 1
anxious, nervous?
Overall rating of Very good n=12
screen design Excellent n= 1
Poor, Fair, Good ---
Overall, how easy Very easy n=10
or hard to use? Easy n= 3
Hard, Very hard ---
49. Characteristics of Cancer Patients
Enrolled in C3 (n=127) (thru 10/15/11)
Female 83%
Age, years
mean (SD) 52 (10)
range 26 - 70
Race, ethnicity Hispanic 22%
Black, non-Hispanic 58%
White, non-Hispanic 14%
Other, non-Hispanic 6%
50. How much have you looked at booklets
or on the Internet for information about
health or cancer? (C3 Baseline, n=30)
Booklets or Internet
Pamphlets
Not at all 13% (n=4) 45% (n=13)
A little bit 23% (n=7) 17% (n=5)
Somewhat 23% (n=7) 7% (n=2)
A lot 40% (n=12) 31% (n=9)
53. C3 Discussion and Implications
Talking Touchscreen (TT) is a practical, user-friendly
method for assessment of patient-reported outcomes
CancerHelp® patient education program has been a valued
resource since 1994
Purpose of integrating these two HIT applications:
• to improve access to health information
• to enhance the quality of health care communication
CancerHelp®–TT:
• meets security requirements in DHHS Automated
Information Systems Security Handbook
• programmed as a flexible, web-based research
application that could be linked to an EMR system
54. Thanks to the agencies that funded this
research: AHRQ, NCI, NHLBI, ACS, Coleman!
Thanks to the dozens of co-investigators,
collaborators, consultants and research staff who
contributed to these projects!
Thanks to all the patients and community members
who participated in our research projects!
What questions do you have?
Editor's Notes
Newest Vital Sign (NVS), is an ice cream nutrition label that is accompanied by 6 questions (4 quantitative & 1-2 regarding peanut allergies) and requires 3 minutes for administration. Each question is scored as correct or incorrect.Q.1 above: 1,000 is the only correct answer
12 original instruments & 7 derivatives (all interviewer-administered):REALM, TOFHLA, NVS, Medical Achievement Reading Test (MART), Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA; based on the REALM-S, but also includes a comprehension test), Note: REALM & MART were modeled on the Wide Range Achievement Test (WRAT)
Modern health care systems use audiovisual, graphical and electronic media to present health information, assist in decision-making and collect self-report data.The use of new health information technologies is a recommended strategy for improving access to health information and for enhancing the quality of communication in health care delivery (Kreps et al, 2003). Despite advances in health information technology, many computer and multimedia tools remain inaccessible to many patients, particularly those with low literacy skills.
another approach is to assume that all patients benefit from improved communication and to implement universal precautions based on best practices
Cancer health Information Sources will be assessed at baseline and end of treatment. Items address whether or not a patient has used an information source (e.g., booklets, family, the Internet), how much that source was used and how helpful the source was. This measure will be useful for assessing possible variability in the control group.
Patient Preference in Patient-Provider Interaction is being assessed with the Control Preferences Scale (Degner et al., 1998), an adapted measure of the degree of control patients want to assume in their healthcare decisions. This measure has been validated with cancer patients and consists of portrayals of 5 different collaborative roles in medical decision-making, ranging from the patient making medical decisions alone to allowing physicians to make decisions alone. Patients will choose the role with which they are most comfortable. Patient preference is expected to be related to more or less interest and effort in acquiring knowledge about treatment and medical information, and will be assessed at baseline and end of treatment.