Low Health Literacy in the Older Adult: Identification & Intervention power point 2.1.15

Communication Strategies for the
Home Health Care Medical
Professionals
Low Health Literacy in the Older
Adult: Identification & Intervention
Jeanne M. Baus, RN, BSN, MS, RCFE, Alumnus CCRN
February 2015

What is Health Literacy?
Definition, “The degree to
which individuals have the
capacity to obtain, process,
and understand basic
health information and
services needed to make
appropriate health
decisions” (HSS:Healthy
People, 2010, p.1).

What is Health Literacy?
The National Health Education
Standard (NHES) states, “The
capacity of an individual to
obtain, interpret, and
understand basic health
information and servicers and
the competence to use such
information and services in
ways which are health-
enhancing”(1997, p.5).

What Does Health Literacy Include?
• Health Literacy includes being able to read and
understand instructions on a prescription bottle,
read medical brochures, understand medical
instructions and consent forms (ICE, A-06-04).
• Health Literacy encompasses (HSS, 2012):
– The ability to listen.
– The ability to follow directions.
– The ability to fill out forms.
– The ability to calculate using basic math.
– The ability to interact with health professionals.
– Locating health information.

Low Health Literacy
Factors That Directly Impact Health Literacy
Factors That Reduce Cognition:
• Hearing Impairments: One in three older adults over the age of 65 have
hearing deficits, by 85 years old it is 50%. Leads to misunderstanding &
information being repeated (ACN, 2009 & HHS, 2012).
• Visual Impairments: Do they have glasses?, Is the prescription current?
Always have magnifier on hand during a visit. Tape recording the
instructions in additional to written material may be needed (ACN, 2009
& HHS, 2012).
• Medication: Pain, antipsychotics, cardiac, antianxiety meds all can impair
mental clarity (ACN, 2009).
• Stress: Illness and self-care may result in being tired (ACN, 2009).
• Fatigue: Fatigue is related to an increased error rates and poor
judgment (ACN, 2009) .
• Inadequate Sleep: Poor sleep quality is related to decreased levels of
concentration and learning abilities.
• Lack of Nutrition: Poor nutritional status is linked to decreased
performance in abilities to comprehend and learn new skills.

Low Health Literacy
Factors That Directly Impact Healthy Literacy
• Cultural Differences: Different cultures do not always share
the same knowledge, education or expectations of
healthcare services. Culture impact communication styles
and response to health education (ACN, 2009 & HSS, 2012).
• Educational Levels: Low educational levels directly correlate
to low literacy (ACN, 2009).
• Language Barrier: Non-English speaking or English as a
second language directly impact learning barriers (ACN, 2009
& HSS, 2012).
• Behavioral Barriers: Stress, ADD, ADHC, psychiatric
conditions, dementia, autism, medications directly impact
ability to concentrate and learn (ACN, 2009).

Low Health Literacy
Chronic Conditions Impact Health Literacy
• 80% of older Americans 65 and older have a minimum of
one chronic condition (CDC, 2010).
• 50% of older adults have multiple chronic conditions.
• Almost 7% of older adults have 5 or more chronic
conditions (CDC, 2010).
• 50% of men over the age of 65 are more likely to have four
or more multiple chronic conditions (CDC, 2010).
• CDC reports, “The risk of having five or more chronic
conditions almost triples, from 8% for those ages 50-64 to
21% for those ages 85+” (National Health Survey, 2010,
p.2).

Low Literacy
Each chronic condition forces the older adult to navigate the
medical system on a more frequent basis. Increased chronic
conditions is related to higher rates of misunderstanding, error
and noncompliance (CDC, 2010).
Comparison between Sex, Number of Conditions between 2001 and 2010.
Note the rise in chronic conditions over the ten year period. CDC (2010).
National Health Interview Survey.

Low Literacy
Chronic Conditions among older Americans. Retrieved from
http://assets.aarp.org/rgcenter/health/beyond_50_hcr_conditions.pdf
Graph source: Medicare Beneficiaries 65+. John Hopkins Bloomberg School of Public Health analysis
of Medical Expenditure Panel Survey, 2005
The most common medical conditions older adults must learn how
to navigate safely and consistently include high blood pressure, high
cholesterol, diabetes, cancer, mental illness and back problems.
Note the increases of chronic conditions between 1997 and 2006.

Health Literacy Statistics
The Institute of Medicine
reports…
“Nearly half of all adult
Americans – over 90
million people- have
difficulty understanding
and acting upon
healthcare information.”
(2004, p. 1)

National Literacy Statistics
• Nation wide, the National Assessment
of Adult Literacy (NAAL)
(2004)reports, “More than 77 million
U.S. adults have basic or below basic
health literacy skills” (p. 1).
• The National Assessment of Adult
Literacy (NAAL) found that older
adults over the age of 65 had the
lowest literacy scores compared to all
other age groups surveyed (2004).

Health Literacy Scores by Age
National Centers for Education Statistic (NCES) (2003). The health literacy of America’s adults: Results from the 2003 National
assessment of adult literacy. Retrieved from http://nces.ed.gov/pubs2006/2006483_1.pdf
Note: Adults are defined as people 16 years of age and older living in households
or prisons. Adults who could not be interviewed because of language or
cognitive or mental disabilities are excluded from this figure.

The National Network of Libraries of Medicine
(NNLM) reports…
• 36% of adults in the U.S. have limited health
literacy.
• 22% have ‘Basic’ health literacy.
• 12% have ‘Below Basic’ health literacy.
• 53% have ‘Intermediate’, health literacy.
• 14% of the total population has a ‘Proficient’
health literacy level(2012, p. 1) .

Distribution of Health Literacy Performance
Levels from 2003 NAAL Literacy Levels
Low health literacy: Implications for National health policy (2011). Health literacy by race and ethnicity, U.S. Population.
Retrieved from http://www.npsf.org/wp-content/uploads/2011/12/AskMe3_UConnReport_LowLiteracy.pdf
Health Literacy is separated into four levels:
“proficient”, “intermediate”, “basic”, and “below basic” (NAAL, 2004).

NAAL below basic and basic literacy skills

Literacy Statistics: Los Angeles County
• Adults in Los Angeles have the lowest literacy
rate when compared to other major U.S.
metropolitan areas.
• Low literacy rates are 65% on the Eastside and
84% in South Los Angeles (In our own
backyard, San Fernando Valley).
• The city of Los Angeles ranks highest for low-
literacy numbers: 1,670,000.
Literacy Network of Greater Los Angeles & United Way (2004). Low literacy in Los Angeles. Retrieved from
http://unitedwayla.org/wp-content/uploads/2011/11/LiteracyatWorkSum_Sep2004.pd

Literacy Statistics: Los Angels County
Literacy Network of Greater Los Angeles & United Way (2004). Low literacy in Los Angeles. Retrieved from
http://unitedwayla.org/wp-content/uploads/2011/11/LiteracyatWorkSum_Sep2004.pd

Low health literacy: Implications for National health policy (2011). Health literacy by race and ethnicity, U.S. population.
Retrieved from http://www.npsf.org/wp-content/uploads/2011/12/AskMe3_UConnReport_LowLiteracy.pdf

The Cost of Health Literacy
• Vernon, Trujillo, Rosenbaum & DeBuono report…
“Low health literacy is a major source of
economic inefficiency in the U.S. health care
system” (2012, p.1).
• Vernon, Trujillo, Rosenbaum & DeBuono report,
“Future costs of low health literacy that result
from current actions (or lack of action), the real
present day cost ranges from $1.6 trillion to $3.6
trillion”(2012, p.5).

Low Health Literacy is Expensive
• Low literacy reduces patients to seek
preventative care.
• Low literacy levels result in a higher
frequency to the emergency room.
• This group is twice as likely to be
hospitalized and stay longer periods.
• Average one or more outpatients visits
annually.
• Are hospitalized for more day for each
admission (Vernon, Trujillo, Rosenbaum &
DeBuono, 2012).

Health Literacy & Hospitalization
American Public Health Association (2002, August). Health literacy. Am J Public Health, 92(8): 1278-1283.
Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447230/figure/f1/
Percentage of study participants hospitalized once (black)
or 2 or more times (white), by functional health literacy.

Low Health Literacy & Medical Costs
One Medicare study followed 3,260
enrollees around the country. People
with limited health literacy levels
were found to have higher costs for
emergency room visits, and inpatient
care (Howard, Gazmararian, & Parker,
2005).

Algorithm for Use of Health Care Services
Agency for Healthcare Research and Quality (2011, March). Health literacy interventions and outcomes: An updated
systematic review. Figure A. Logic model for analyzing studies of health literacy. Retrieved from
http://www.ahrq.gov/research/findings/evidence-based-reports/literacyup-evidence-report.pdf

Low Health Literacy
The Impact on Home Health Care Services

Who Do We Serve?
Home Health Care Patient Demographics
The HSS: National Health Statistics Report (HSS)(2011)
published the following home health statistics…
• 68.7% are older than 65 years.
• 64.0% are women.
• For the older adult who is 65+, the average length of
service is 242 days.
• For the oldest-old, 85+, the average length of service is 270
days.
• Average number of admitting diagnose is 4.2
• 68% of older adults live with family or nonfamily members.

Most Common Admitting Diagnoses
Home Health Care Patient
The most frequent admitting diagnosis for the home health care patient during the
initial interview. HSS: National Health Statistics Report (2007).

Low Health Literacy
Home Health Care Providers Need Family Support
Health literacy is
connected to being able
to advocate for
themselves or include an
individual or family
caregiver on a consistent
basis (IOM, 2012).

Home Health Care Patients
Difficulty With Understanding
• 71% of older adult have challenges
understanding printed health
education materials (AMA, 2007).
• 68% older adults have difficulties
understanding numbers and
completing calculations (AMA, 2007).
• 80% of older adults have difficulty
completing medical forms or
understanding charts (AMA, 2007).

Low Health Literacy & Medication
The AMA reports, “People over 65 and older
make nearly twice as many physician office visits
per year than 45 to 65. However, estimated two-
thirds of older people are ‘unable’ to understand
the information given to them about their
prescription medications” (2007, p. 4).
Low health literacy leads to medication and
treatment errors, under dosing and over dosing,
missed doses and noncompliance.
These errors directly relate to increased medical
costs, emergency room visits and hospitalization.

Health Literacy
Is Health Literacy Related to Education?
• Older adults who have completed high school may still
have challenges navigating health care instructions.
• Adequate functioning older adults who live at home or
still work may have inadequate health literacy (ICE, A-
06-04).
• Health literacy is also connected to the older adults
ability to listen, speak, and have an adequate
background of their health condition(s) regardless of
educational backgrounds (HSS, 2012).

Risky Behaviors
Low Health Literacy: Impact on the Home Health Care Patient
• More likely to not use their inhalers
correctly and at prescribed times.
• More confused about symptoms and
medical/dietary interventions for low or
high blood glucose levels.
• Less likely to understand correlation
between obesity, salt, diet & lack of
exercise in relationship to hypertension.
• Less likely to remember physical
symptoms of high or low blood pressure
(Weiss, 2007, p. 13).
Weiss, B.D. (2007). Health literacy and patient safety. Retrieved from http://www.ama-
assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

Home Health Care Provider
General Communication Tips: Initial Greetings
• Initial greetings set the tone –
Always address the older adult by
their last name. Ask “How they
would like to be addressed?” (ICE,
A-03-04).
• Begin conversation with general
questions (i.e. the weather, what
was their last meal?).
• Pay attention to the patient’s
speech patterns. Match your
volume and speed to that of the
patient (ICE, A-02-04).

• Eye contact is interpreted differently
by many cultures, do your homework
before the appointment.
• Pay attention to the patient’s level of
comfort with direct eye gazing. Never
force the patient’s to maintain direct
eye contact if they appear
uncomfortable (ICE, A-02-04).
• Physical gestures mean different
things to different cultures. Follow
the lead of the patient.

• Be conservative in your body
gestures.
• Always ask permission prior
to touching the patient (i.e.
taking vital signs, listening to
heart and breath
sounds)(ICE, A-02-04).

• Ask open ended questions.
Avoid “yes” or “no” type
questions.
• Reduce background noise (turn
off TV or radio).
• Stick to one topic at a time
(avoid switching from topic to
topic quickly).
• Keep sentences short, questions
short (American Speech-
Language-Hearing Association,
2012).

• Avoid hurrying their
answer, all extra time for
them to respond.
• Tolerate pauses or gaps
between questions and
answers.
• Engage in ‘active listening’
techniques (American
Speech-Language-Hearing
Association, 2012).

Teaching Patients with Low Health Literacy Skills
• Avoid medical terminology.
• Avoid technical words.
• Use simple words.
• Use short simple sentences.
• Speak slowly, repeat when needed.
• Avoid shouting.
• Use pictures, videos, brochures in their
language to improve comprehension.
• Give information is small segments,
assess comprehension prior to
proceeding (ICE, B-02-04).

• Avoid teaching for longer than 30 minutes at
a time. Observe for fatigue and pain (ACN,
2009) .
• Present one ‘key’ idea at each visit.
• Observe for facial and body language
indicating confusion or frustration. Repeat
with new strategy when necessary (ACN,
2009).
• With each visit, review information
presented on last visit, prior to proceeding
with a new skill or topic. Review…assess…
teach…review…assess…teach…etc.

• All essential information will be taught first.
• Present material in a step-by-step format (HSS,
2012).
• Avoid mixing ‘positive & negative’ information
(HSS, 2012).
• Repeat ‘key’ information, use visual aides
whenever available.
• Be consistent with choice of word. Avoid
interchanging words (ACN, 2009 & HSS, 2012).
• Confirm understanding by asking for a repeat
demonstration (ICE, B-2-04 & Parkland Patient
Education, n.d.).

Make Reading Material Easy To Read
• Provide written material in large print (16 or
18-point) (HHS, 2012).
• Always choose easy to read font (Serif).
• Organize the logical flow of information.
• Provide clear headings with subheadings.
• Allow a lot of space between each idea or
topic, at least ½ inch between each line (HSS,
2012).
• Sentences should remain simple and short
(Parkland Patient Education, 2013).

Women 65+ Men 65+
Arthritis/Hypertension 63.0% Arthritis/Hypertension 49.3%
Diabetes/Hypertension 25.4% Diabetes/Hypertension 29.5%
Arthritis/Diabetes 20.4% Cancer/Hypertension 27.6%
Cancer/Hypertension 21.8% CHD/Hypertension 24.8%
Arthritis/Cancer 21.0% Arthritis/Diabetes 21.2%
Five Most Prevalent Chronic Condition Dyads for US Adults With 2 or More Chronic
Conditions, by Sex and Age. CDC (2010). National Health Interview Survey
Most Common Teaching Topics For Field Staff

Challenges of Literacy, Culture & Language
The United States Department
of Health and Human Services
(HHS) acknowledge, “Culture
affects how people
communicate, understand and
respond to health information”
(Health Literacy Basics, 2012).

Challenges of Literacy, Culture & Language
Dr. Regina Benjamin from the 2010
Surgeon General’s Perspective
reported, “HHS reports that the
cultural and linguistic differences
among patients directly impact their
health literacy levels, which in turn
contribute to an increased
prevalence of health
disparities…more so in vulnerable
populations” (2010, p. 784)

Challenging Language Barriers
• Identify patient’s under agency service with Limited English
Proficient (LEP). Any patient’s with language barriers or
patient’s that have difficulty processing (understanding)
health information should be provided in their native
language (ICE, B-02-04).
• Utilize color coded stickers on office charts indicating when
interpreter services are needed (ICE, B-02-04).
• Ask the patient’s/family preference in the spoken language.
• If no staff or family are available for interpreting service, a
telephone interpreter service should be utilized to acquire
accurate information or to give vital medical instructions.
• Provide brochures or educational material in the language
the patient speaks.

Interpreter Services
When and How to Utilize the Interpreter:
• When agency staff is unable to communicate with the patient.
• When family/caregivers are unavailable.
• The interpreter should meet the patient’s needs. Some patient’s may
prefer a specific sex due to personal information being shared.
• Allow extra time when working with an interpreter.
• Avoid speaking loudly or too fast. Allow time for the interpreter to
communicate all your questions and instructions.
• Avoid technical terms, medical terminology.
• Face the patient, not the interpreter.
• Avoid interrupting the interpreter.
• Observe the patient’s body language, look for signs of confusion,
comprehension, disagreement or agreement (Industry Collaboration Effort
(ICE), 2004, B-03-04).

Interpreter Services
Telephonic Companies
• All companies provide training materials,
including specific reports and equipment.
• There is a start-up cost and some charge a low
monthly service fee.
• Rates depend on language requested.
Medical Interpreter Services (ICE, B-05-04):
• CyraCom International 800-713-4950
• Interpreting Services International, Inc. 818-753-9584
• Pacific Interpreters 800-311-1232
• Tele-Interpreters 877-835-3468

Home Health Care Providers
Alternative Patient Teaching Tools
• Use of Graphic Illustrations:
Pictures, Pictographs, Models
• Audiotapes and compact discs: Focus on one
topic at a time. Use plain/simple language.
• Videotapes: The Internet has thousands of
commercial and noncommercial sources.
• Information-only computer modalities
• CD-ROM, Downloadable Internet sites
American Medical Association, Health Literacy Resources (2013). Health literacy. Retrieved from http://www.ama-
assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/health-literacy-program.page

Paying Attention to Non-Verbal Behaviors
Low Health Literacy ‘Behaviors’ :
• Not completing forms, always having an
excuse (avoiding needed paperwork).
• Not taking medications as prescribed.
• Consistently arriving to appointments late.
• Calling for instruction clarification.
• Not filling prescriptions as directed (Joint
Committee on National Health Education, 1995).
Industry Collaboration Effort (ICE) (2004). Tips for identifying and addressing health literacy issues (A-06-04). Retrieved from
http://www.iceforhealth.org/library/documents/ICE_C&L_Provider_Tool_Kit.10-06.pdf

Pay Attention to What is Not Being Stated
Low Health Literacy ‘Verbal’ Comments:
• A) “What does this say?”
• B) “I don’t understand this?”
• C) “I will have my family explain it to me.”
• D) “I will have my neighbor explain it to me.”
• E) “I don’t know where my glasses are.”
• F) “My eyes are tired now, I will read it later.”
Industry Collaboration Effort (ICE) (2004). Tips for identifying and addressing health literacy issues (A-06-04). Retrieved
from http://www.iceforhealth.org/library/documents/ICE_C&L_Provider_Tool_Kit.10-06.pdf

Words that Avoid Confusion
Weiss, B.D. (2007). Health literacy and patient safety: Help patients understand. Manual for clinicians
(2nd ed.) Retrieved from http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

Free
Health Literacy Government Resources
• National Institute of Health (2013). MedlinePlus: How to Write Easy-to-
Read Health Materials. Available for download at
http://www.nlm.nih.gov/medlineplus/etr.html
* (A 5-page paper on education techniques considering reading level,
cultural background and English as a second language).
• The Council of State Governments (2002). State Official’s Guide to Health
Literacy. Available for download at
http://adph.org/ALPHTN/assets/060110literacyguide.pdf
* (This is a 136-page document discusses Medicare costs, impact on each
state an is full of excellent statistics and graphs).
• U.S. Department of Health and Human Services: Center for Disease
Control and Prevention (2009). Improving Health Literacy for Older Adults:
Expert Panel Report. Available for download at
http://www.cdc.gov/healthliteracy/pdf/olderadults.pdf
* (A 47-page brochure aimed at improving health literacy for older adults).

Free
• U.S. Department of Health and Human Services. Office of Disease Prevention and
Health Promotion (2010). National Action Plan to Improve Health Literacy.
Available for download at
http://www.health.gov/communication/HLActionPlan/pdf/Health_Literacy_Action
_Plan.pdf
* (This is a 73-page document that provides examples for restructuring the
way medical professional provide health care information of patient to
sustain a health literate Nation).
• U.S. Department of Health & Human Services. Agency for Healthcare Research and
Quality (AHRQ). Health Literacy Universal Precautions Toolkit. Available for
download at http://www.ahrq.gov/professionals/quality-patient-safety/quality-
resources/tools/literacy-toolkit/index.html
* (This is a 227-page document that provides step-by-step guidance and
tools for assessing patients for all literacy levels).
• U.S. Department of Health and Human Services: Centers of Disease Control.
Simply Put: A guide for creating easy-to-understand materials. Available for
download at http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf
* (This is 43-page brochure for strategic and proactive community
outreach).

Free
• Health Industry Collaboration (ICE) (2004). Better communication, better care:
Provider tools to care for diverse populations. Retrieved from
http://www.iceforhealth.org/library/documents/ICE_C&L_Provider_Tool_Kit.10-
06.pdf
(This is a 56-page tool kit for healthcare professionals. The packet addresses
communication with diverse patient populations, language barriers and the impact
of cultural background).
• The Gerontology Society of America (2012). Communicating with older adults: An
evidence-based review of what really works. Retrieved from
http://www.agingresources.com/cms/wp-
content/uploads/2012/10/GSA_Communicating-with-Older-Adults-low-Final.pdf
(This is a 40-page document that covers all aspects of improving communication
between the caregiver or medical professional. The material is all evidence-based
and has a long list of references and more reading material that is very helpful).

Staff Educational Training Resources
• American Medical Association, Health Literacy Resources.
Content: This Health Literacy kit includes DVD, CD-ROM
or VHS, online material, hand-outs and an in-depth
teaching manual.
Cost: Varies depending on course and materials chosen.
Available at http://www.ama-assn.org//ama/pub/about-
ama/ama-foundation/our-programs/public-
health/health-literacy-program/health-literacy-kit.page
• Health Literacy Missouri
Content: Online Training, workshops and diagnosing
health literacy weaknesses in staff.
Cost: Varies depending on course and materials chosen.
Available at https://www.healthliteracymissouri.org/our-
services

Free
• Centers for Disease Control and Prevention (CDC).
Health Literacy for Public Health Professions. This
offers 1 free CEU upon completion. Course ID WB185.
Available at:
http://www.cdc.gov/healthliteracy/gettrainingce.html.
• U.S. Department of Health and Human Services
(2011). Effective Communication Tools for Healthcare
Professionals. Course ID 101508. This course is free. It
does not offer CEU’s. Takes 5 hours to complete.
Available at:
http://www.cdc.gov/healthliteracy/gettraining.html

Free
• University of Minnesota. School of Public Health (2013).
Culture and Health Literacy Modules. This course is free.
Offers no CEU’s.
Available at: http://cpheo1.sph.umn.edu/healthlit/#a
* (This is a two-course offers case studies in culture and
health literacy).
• Public Health Training Center (2013). Health Literacy &
Public Health: Introduction. This course is free. This
course offers 1.5 CEU’s credit. Course ID 7WDQEL-PRV-10-
219.
Available at
http://www.empirestatephtc.org/learning/pages/catalog/
phlit01/credits.cfm
* (This course provides excellent examples of health
literacy in the field. All references are evidence-based).

Field Staff Communication Resources
• “On The Spot Communication Tool Kit”
is a valuable tool for home health care
providers who require simple-to-use
tools that assist in communication
difficulties related to low reading &
reading skills, language difficulties or
hearing challenges.
• The tool kit provides products that can
enhance provider/patient
communication.
Augmentative Communication News (ACN) (2009, August). Communication “On the Spot”. ACN, 21(2):1-15. Retrieved from
http://www.augcominc.com/newsletters/index.cfm/newsletter_129.pdf

Field Staff Communication Tools
• Dry erase board: For writing and drawing
messages.
• Picture communication board: Allows the
patient to point to specific areas of the
body, pain scale numbers and simple
messages.
• Pocket talker: This device increases hearing
in when a hearing aid is unavailable.
• English/Spanish: Flash cards for the most
common phrases and words.
Pressman, H. & Newman E. (2009). Communication access within healthcare environments: A call for action. Patient Provider
Communications. Retrieved from http://www.patientprovidercommunication.org/article_3.htm

Field Staff Communication Tools
• Vidatak E-Z Communication Boards (Multiple
Languages and Picture Boards). Vidatak,LLC
(877) 392-6273
• Critical Communicators/Pocket
Communicator/Picture Communicator
(Multiple Languages)
Interactive Therapeutics. (800) 382-8622
• PockeTalker (for hearing impaired). Williams
Sound products from ‘A Bridge Between
Nations’. (888) 432-0874 or (982)526-1596
• Chattervox (voice amplifier)
Asyst Communications Co., Inc. (847) 816-8580
Patient Provider Communications (2012). Communication access within healthcare environments. Retrieved from
http://www.patientprovidercommunication.org/article_3.htm

A Review of Points…
• Health care literacy can be improved.
• As a health care provider, have all staff become aware of this
critical issue with the older adult patients in your agency.
• Begin with general staff education focusing on communication
with the older adult.
• Schedule all staff to complete all free on-line tutorials about
developing plain language materials and messages.
• Print-out free governmental agency support training manuals
and use them as reference guides for future health literacy in-
services.
• Provide written support materials for all staff.
• Purchase and create patient educational materials that have
visual content. communication skills, techniques and support
materials for the low health literate patient.

A Review of Points…
• Review the various cultures in your agency, develop a
culturally competent staff.
• Create common health related topics in a number of
languages.
• Awareness of health literacy and implementing
proactive steps will improve patient communication.
These steps will result in improved patient outcomes
and reduced ER visits and hospitalizations.
• Remember: Creating effective health literacy
communication is a human right. It should remain
accessible and achievable for all patients regardless of
age, gender, language or culture.

Bibliography
• American Medical Association, Health Literacy Resources (2013). Health
literacy. Retrieved from http://www.ama-assn.org/ama/pub/about-ama/ama-
foundation/our-programs/public-health/health-literacy-program.page
• American Speech-Language-Hearing Association (2012). Health literacy.
Retrieved from http://www.asha.org/SLP/healthliteracy/
• Augmentative Communication News (ACN) (2009, August). Clinical News,
21(2):1-16. Retrieved from
http://www.augcominc.com/newsletters/index.cfm/newsletter_129.pdf
• Benjamin R.M. (2010, Nov.-Dec.). Improving health by improving health
literacy. Public Health Rep, 125(6):784-785.
• Centers for Disease Control and Prevention (CDC) (2010). Prevalence of
multiple chronic conditions among US adults: Estimates from the National
Health Interview Survey, 2010. Retrieved from
http://www.cdc.gov/pcd/issues/2013/12_0203.htm

Bibliography
• Eldercare Workforce Alliance (2012). Care coordination. Retrieved from
http://www.eldercareworkforce.org/research/issue-briefs/research:care-
coordination-brief/
• Howard, D.H., Gazmararian, J., & Parker, R.M. (2005). The impact of low health
literacy on the medical costs of Medicare managed care enrollees. Am J
Med.,118:371-377.
• Joint Committee on National Health Education (1995). Barriers to literacy.
Retrieved from http://www.cdc.gov/HealthyYouth/SHER/standards/
• Industry Collaboration Effort (ICE) (2004). Partnering with diverse patients:
Tips for office staff to enhance communication (A-03-04). Retrieved from
http://www.geneticcounselingtoolkit.com/pdf_files/ICE_Booklet.pdf
• Industry Collaboration Effort (ICE) (2004). Telephonic interpreting companies
(B-05-04). Retrieved from

Bibliography
• Industry Collaboration Effort (ICE) (2004). Ten Tips for working with
interpreters (B-03-04). Retrieved from
• Industry Collaboration Effort (ICE) (2004). Tips for communicating across
language barriers (B-02-04). Retrieved from
• Industry Collaboration Effort (ICE) (2004). Tips for identifying and addressing
health literacy issues (A-06-04). Retrieved from
• Industry Collaboration Effort (ICE) (2004). Working with diverse patients: Tips
for successful patient outcomes (A-02-04). Retrieved from
• Institute of Medicine (IOM) (2004, April). Health literacy: A prescription to end
confusion. Retrieved from http://www.iom.edu/Reports/2004/Health-
Literacy-A-Prescription-to-End-Confusion.aspx

Bibliography
• National Assessment of Adult Literacy (NAAL) (2003). The health literacy of
America’s adults: Results from the 2003 national assessment of adult literacy.
Retrieved from http://nces.ed.gov/pubs2006/2006483_1.pdf
• National Health Education Standard (NHES)(1997). Definition of health literacy.
Retrieved from http://opi.mt.gov/PDF/Health/NHES.PDF
• National Network of Libraries of Medicine (NNLM) (2012). Health literacy.
Retrieved from http://nnlm.gov/outreach/consumer/hlthlit.html
• National Women’s Health Report (2004, Oct.). Average health literacy skills
compared with poor health literacy skills. Retrieved from
http://nnlm.gov/outreach/consumer/hlthlit.html
• Joint Committee on National Health Education Standards (1977). National
health Education standards: Achieving Health literacy. Retrieved from
http://opi.mt.gov/PDF/Health/NHES.PDF

Bibliography
• Parkland Patient Education (2013). Guidelines for teaching patients with low health literacy.
Retrieved from
http://www.parklandhospital.com/patients_visitors/health_information/pdf/gdl%20teaching
%20ll.pdf
• Rhode Island Health Literacy Project (2013). Introduction to health literacy. Retrieved from
www.RIHLP.org
• United States Department of Health and Human Services (HHS) (2012). Health literacy and
older adults. Retrieved from
http://www.health.gov/communication/literacy/olderadults/literacy.htm
• United States Department of Health and Human Services (HHS) (2010) . Healthy People:
Health Literacy. Washington, DC: U.S. Government Printing Office. Retrieved from
http://nnlm.gov/outreach/consumer/hlthlit.html
• U.S. Department of Health and Human Services: National Health Statistics Report (HSS)(2011,
April 27). Home health care and discharge hospice care patients: United States, 2007 and
2007. Retrieved from http://www.cdc.gov/nchs/data/nhsr/nhsr038.pdf
• United States Department of Health and Human Services (HHS) (2012). Quick quick to health
literacy fact sheet: Health literacy basics. Office of Disease Prevention and Health Promotion.
Retrieved from http://www.health.gov/communication/literacy/quickguide/factsbasic.htm

Bibliography
literacy and older adults: Cognitive Challenges. Office of Disease Prevention and Health
Promotion. Retrieved from
http://www.health.gov/communication/literacy/olderadults/cognitive.htm
literacy and older adults: Hearing impairment. Office of Disease Prevention and Health
http://www.health.gov/communication/literacy/olderadults/hearing.htm
literacy and older adults: Visual Impairment. Office of Disease Prevention and Health
http://www.health.gov/communication/literacy/olderadults/visual.htm
• Vernon, J., Trujillo, A., Rosenbaum, S. & DeBuono, B. (2012). Low health literacy: Implications
for national health policy. Retrieved from
http://www.pfizerhealthliteracy.com/asset/pdf/Low-Health-Literacy_Implications-for-
National-Health-Policy.pdf
• Weiss, B.D. (2007). Health literacy and patient safety: Help patients understand. Manual for
clinicians (2nd ed.) Retrieved from http://www.ama-
assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

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