1. Health Literacy: What It Is &
Why It MattersToYour Practice
Professor ChristopherTrudeau,
Western MichiganUniversity – Cooley Law School

2. Have you ever had a colonoscopy?
Had a baby?
Had surgery?
Taken medication?
Shopped for health insurance?
Had your blood drawn?
Gone to the hospital?
THENYOUR HEALTH LITERACY HAS BEEN TESTED

3. What is health literacy?
A person’s ability “to obtain,
process, and understand basic
health information . . . .”
Source: Institute of Medicine, Health literacy: A prescription to end confusion (2004)

4. Which of the following is the best
predictor of an individual’s health status?
a. Age
b. Income
c. Race/ethnicity
d. Education Level
e. Literacy Skills
75% of patients who reported being in poor
health also tested in the below-basic HL
category
Source:Weiss BD. Health Literacy: A Manual for Clinicians.American Medical Association /
American MedicalAssociation Foundation, 2003. p. 7.

7. Source: U.S. Department of Education, Institute of Education Sciences
2003 National Assessment of Adult Literacy

8. Let’s hear from some patients…
Source: AMA Health LiteracyVideo (ShortVersion)

9. HHS, CDC, and FDA also care about
improving health literacy:
“Engage individuals and families as
partners in their care by incorporating
patient and caregiver preferences;
using clear and productive
communication strategies; improving
the experience of care for patients,
caregivers, and families; integrating
health literacy principles; and
promoting patient self-
management.”
Strategic Goal #1 from HHS’s
2011-2015 Strategic Plan:

10. Okay. I see why this is important
in life, but how does this impact
me – as a health lawyer?

11. Health literacy impacts all sorts of
health lawyers:
Do you represent plaintiffs?
You can use HL research as a sword in your malpractice
litigation. HL research creates new territory for attacking the
way a HCO communicates with patients.
Do you represent hospitals, provider practices,
medical device companies, drug companies,
medical researchers, or health insurers?
You can use HL as a shield to better protect your clients.
HL should be factored in to almost everything you do.

12. Your clients care about health literacy?
“Patient-Centered Care is More than a Goal - it's a Reality
You and your well-being are the reasons we exist.Your needs
are our priority, and your uniqueness will be recognized,
respected, and appreciated in all that we do.”
From McLaren Northern Michigan’s website:
http://www.mclaren.org/northernmichigan/McLaren-Patient-Centered.aspx
“Spectrum Health hospitals have developed Implementation Plans
dedicated to ‘improving health care access and improving health
literacy, awareness and education’ as identified in the ‘Community
Health Needs Assessments’ conducted in each county throughout
the Spectrum Health service area.”
From Spectrum Health website: http://www.spectrumhealth.org/community-health-needs-
assessment

13. But our role as counsel is to legally protect
our clients. How does health literacy fit in?
We can help our clients meet their business
objectives AND legally protect them. We can
create win-wins for patients and HCOs.
Creating clear, patient-centered institutional
processes and materials will help better shield
your clients from marginal lawsuits over
misunderstandings.
The law & health literacy are NOT mutually exclusive!

14. Scary data for health lawyers
In one of the largest studies conducted on health literacy,
researchers using patients from two public hospitals found
that:
Source: http://www.ncbi.nlm.nih.gov/pubmed/7474271

15. Speaking of informed consent…
The typical informed consent document has an
average 10th – 12th grade reading level.
But the average reading
level of adults in the U.S.
Falls between the 6th & 7th
grade, depending on the
study.

16. Guess the reading level needed to
understand this…
I consent to the performance of operations and procedures in
addition to or different from those now contemplated, whether
or not arising from presently unforeseen conditions, which the
above-named doctor or his associates or assistants may
consider necessary or advisable in the course of the operation.

18. Tips for your toolbox

19. First, consider patients – what do
we know about users of health docs?
1. People decide for themselves how much
attention to pay to a document
We cannot assume people will work their way
through a document because we think it is
important!
2. These documents are tools that are meant to be
used for a purpose.
They are not novels meant to be read from
cover to cover.

20. 3. People actively interpret as they read – they
don’t wait until the end and then assess the big
picture.
 So what we put up front matters greatly.
 And so does the way we draw a user’s attention –
e.g. text walls won’t work.
4. Users interpret documents based on their own
knowledge and expectations.
User-testing high-stakes documents can help to
ensure the document’s message is reaching the
intended audience.
For more, read – Redish, J.C. (1993). Understanding Readers, Chapter 1. In Barnum, C.M and
Carliner, S. (Eds.)Techniques forTechnical Communicators. NewYork: Macmillan.

21. Structure all health communications as if everyone
has limited health literacy
 You cannot tell by looking at someone
 Higher literacy skills ≠ understanding
 Anxiety can reduce ability to manage health
information
 Everyone benefits from clear communications
Second, universal precautions are key

22. Third, written communication is no
substitute for in-person conversations
 Ensure your clients are
trained – teach-back
training is very useful.
 Help your clients design
health-literate institutional
processes – not just forms.

23. Fourth, document design is as important
as the document’s wording
Clear
Content
User-
Focused
Design
Clarity

24. Fifth, pay attention to how you
communicate risk (including statistics)
The U.S. ranks at
the bottom in
numeracy skills.

25. Pop Quiz on Numeracy
1. A person taking Drug A has a 1% chance of having an allergic
reaction. If 1,000 people take DrugA, how many would you
expect to have an allergic reaction?
Answer: ___ persons out of 1000
1. A person taking Drug B has a 1 in 1,000 chance of an allergic
reaction.What percent of people taking Drug B will have an
allergic reaction?
Answer: ___%
3. Imagine that I flip a coin 1,000 times. What is your best guess
about how many times the coin would come up heads in
1,000 flips?
Answer: ___ times of 1000

26. Pop Quiz on Numeracy - Answers
1. A person taking Drug A has a 1% chance of having an allergic
reaction. If 1,000 people take DrugA, how many would you
expect to have an allergic reaction?
Answer: 10 persons/1000 (46% missed this)
1. A person taking Drug B has a 1 in 1,000 chance of an allergic
reaction.What percent of people taking Drug B will have an
allergic reaction?
Answer: 0.1% (80% missed this)
3. Imagine that I flip a coin 1,000 times. What is your best guess
about how many times the coin would come up heads in
1,000 flips?
Answer: 500/1000 (46% missed this)
Source: Schwartz,Woloshin, Black, andWelch (1997)

27. Example: Creating a health-literate
consent process for colonoscopies

29. First, Design the consent process – including all
interactions and materials patients will receive.
1. Patient & provider discuss the need for
procedure including risks, benefits, alternatives;
2. Patient then receives educational info and the
consent form;
3. Patient preps for procedure; (no small task)
4. Patient goes to appointment;
5. Patient & provider further discuss consent form,
using teach back. (Before anesthetics)

30. Next, create the consent form (and any other
educational materials you are producing in house).
Consider your design strategy
 multi-column format?
 visuals?
 font size & type
 monochrome or color?
 white space
 limited to 2 pages for
content?
 space for office admin needs?
 signature lines
Consider your content
 procedure description
 risks (numeracy?)
 alternatives
 recovery issues
 other disclosures
 in plain language?
 high-frequency words?
 no text walls
 short sentences
 teachback?
 Test for reading level?
User test?

31. And now for a completely
redesigned consent form…
(See the handout. Also available in
the conference materials booklet)

32. THANKYOU!