Health Information Literacy

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Presentation by Jean Shipman at the Health Sciences Libraries 'Health Literacy Forum' October 23, 2009

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  • Script: This curriculum was developed as a core component of the Health Information Literacy Research Project sponsored by the Medical Library Association with funding from the National Library of Medicine. The curriculum was piloted by hospital-based librarians with over 900 health care providers in the US and Canada. We hope you find the content of the session useful to your practice. Please complete the pre-survey on page one now. Please wait until after the session is complete the post-survey which begins on page. Notes: To evaluate participant knowledge gain and intention to act as a result of the curriculum distribute a pre- and post-session evaluation. For a copy of a pre- and post-session evaluation designed for use with this curriculum visit www.mlanet.org/resources/healthlit/ For a list of suggested materials for a health information literacy toolkit to distribute to session participants go to www.mlanet.org/resources/healthlit/ Reading: To read more about the Health Information Literacy Research Project, including results from the pilot, go to www.mlanet.org/resources/healthlit/ Tips: “ If at all possible a champion in your organization would be a huge advantage to anyone trying to start a health literacy program, someone high up that has authority to validate the program and encourage participation.” Martha Prescott, Medical Librarian
  • Script: By the end of this session participants will be able to: define health literacy and the challenges patients face; recognize the impact low health literacy has on quality patient care; name five health information resources and strategies to improve health literacy, including MedlinePlus and the information referral tool known as Information Rx; and describe the health literacy services and support provided by the library. Notes: If you want to offer continuing education (CE) credits be sure to contact the CE department within your institute in advance of offering the session in order to clarify requirements and submit your application. For a sample CE application for this session which you may adapt to fulfill your institution’s CE requirements go to www.mlanet.org/resources/healthlit/ TIPS: “ Plan classes in advance. It takes time to partner with your education department and CME department. Many times their calendars are set a year in advance.” Julie Smith, Medical Librarian “ It’s good to reach out to those within your institution who may have health literacy on their radar before putting your session out to the general staff.” Andrea Harrow, Medical Librarian
  • Script: What is health literacy? Healthy People 2010 defines health literacy as the ability to read, understand and act on health information. This includes: reading consent forms, medicine labels, and other written health information; understanding written and oral information and instructions from health care providers; and acting on that information to make health care decisions for one’s self and one’s family. Reading: For more on the definition of health literacy go to the IOM Report (2004) – Health Literacy: A Prescription To End Confusion, pages 31 - 58 at www.iom.edu/report.asp?id=19723 To read about health literacy in Healthy People 2010, go to Health Communication, Objective 11-2, Improve the health literacy of persons with inadequate or marginal literacy skills at www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm TIPS: “ Test out the AV equipment you will be using in the area where you are going to present before doing your program.” Denise Rumschlog and Carolyn Martin, Medical Librarians
  • Script: The Institute of Medicine (IOM) emphasizes that health literacy is dependent on a variety of individual and system factors. For example: Health literacy is dependent on the communication skills of both patients and health care providers. Do you what your patient’s reading, numeracy, and oral communication skills are like? Think about the jargon and medical language we use (COPD, metastasize, etc). Health literacy is dependent on patient and health care provider knowledge about health. This includes the knowing the cause of the disease and how it is best treated. And then there is the amount of health information which can overwhelm even those with the most proficient health literacy skills. Health literacy is dependent on culture and language as it affects how and what people communicate about their health. Health literacy is also dependent on the demands of the health care system. People need to read, understand, and complete all kinds of forms, they need to understand where to go for health care, and how health insurance works. Think about how we send people home with medications and equipment (inhalers, glucometers, etc) and expect them to use these correctly to care for themselves and others. Today’s healthcare places great demands on patients. Reading: For more information on the shared influences affecting health literacy see the IOM Report (2004) – Health Literacy: A Prescription To End Confusion at www.iom.edu/report.asp?id=19723 For more information on the relationship between culture, language and literacy go to Andruilis, DP, Brach, C (2007). Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations. Am J Health Behav. 31(Suppl 1):S122-133 at www.ahrq.gov/research/oct07/1007RA6.htm or www.ajhb.org/2007/s1/Suppl1607Andrulis.pdf
  • Script: Low health literacy is increasingly recognized as a barrier to quality patient care and is linked to under utilization of preventive services, little knowledge and poor management of chronic diseases, medication error, and increased hospitalization and costs. Reading: For a review of the literature linking literacy to health outcomes see the Agency for Healthcare Research and Quality (AHRQ) Evidence Report – Literacy and Health Outcomes (2004) at www.ahrq.gov/clinic/epcsums/litsum.htm Tips: “ Participating in the pilot gave us the opportunity to increase exposure of the library and present the topic of health literacy to over 150 health care providers.” Tori Koch and Kim Hart, Medical Librarians “ The greatest benefits of participating in the project were raising awareness in the hospital about health literacy and being able to offer librarian support to help assist with health literacy challenges.” Denise Rumschlog and Carolyn Martin, Medical Librarians
  • Script: In a study by Davis in 1996 women with low health literacy were less likely to have had a Pap test or mammogram than women with higher health literacy. These same findings were reconfirmed by Lindau in 2002. Reading: To read the articles go to Davis, et al (1996). Knowledge and Attitude on Screening Mammography Among Low-literacy, Low-income Women. Cancer. 78(9):1912-20; and Lindau, et al (2002). The Association of Health Literacy with Cervical Cancer Prevention Knowledge and Health Behavior in a Multiethnic Cohort of Women. Am J Obstet Gynecol. 186(5):938-43. Tips: “ Nearly every session we conducted faced a time constraint. Often when we asked for 45 minutes to an hour of time we were limited to 30 minutes, and in actuality that often become 20-25 minutes.” Tori Koch and Kim Hart, Medical Librarians “ Having access to a very presentable program is a great benefit, but librarians need to adapt the session depending on their audience and the available time, space, and equipment.” Geneva Staggs and Beverly Rossini, Medical Librarians
  • Script: Low health literacy is associated with less knowledge and understanding of one’s own health status. This graph comes from a study by Kalichman in 2000 and shows that those with lower health literacy demonstrated poorer knowledge and understanding of their HIV / AIDS status than those with higher health literacy, regardless of education level. Reading: For a copy of this article go to Kalichman, et al (2000). Health Literacy and Health-Related Knowledge Among Persons Living with HIV / AIDS. Am J Prev Med. 18(4):325-331.
  • Script: Among patients with diabetes, low health literacy is associated with poor disease management and outcome (Schillinger 2002). In a study by Williams in 1998 (n=114), 94% of diabetic patients with high health literacy knew what to do if they experienced hypoglycemic symptoms while only 50% of those with low health literacy knew what to do. Reading: To read these articles go to Schillinger, et al (2002). Association of Health Literacy with Diabetes Outcomes. J Am Med Assoc. 288(4);475-82; and Williams, et al (1998). Relationship of Functional Health Literacy to Patient Knowledge of Their Chronic Disease: A Study of Patients with Hypertension and Diabetes. Arch Intern Med. 158:166-172.
  • Script: In 2004 a small study in a hospital in Arizona found that very limited literacy skills ( < 3 rd grade) was independently associated with higher healthcare costs. Charges among subjects with very low literacy skills were $10,688/year as compared to only $2,891/year for those with higher literacy skills. This difference remained even after adjusting for age, ethnic group and health status. In the most recent health literacy cost analysis, low health literacy was estimated to cost the health care system between $106 to $238 billion dollars a year, or between 7% and 17% of the all personal healthcare expenditures (Vernon 2007). Reading: For a copy of the Weiss article go to Weiss, et al (2004): Relationship Between Health Care Cost and Very Low Literacy Skills in a Medically Needy and Indigent Medicaid Population. J Am Board Fam Pract. 17: 44-47. For the recent health literacy cost analysis go to www.gwumc.edu/sphhs/departments/healthpolicy/chsrp/downloads/LowHealthLiteracyReport10_4_07.pdf
  • Script: Having accurate and up-to-date health information is absolutely imperative. It is key to health literacy and to effective health communication in a number ways. It’s key to being able to communicate an accurate health history or even describing symptoms; it’s key to engaging in a shared decision making process; it’s key to understanding and following a treatment plan; it’s key to knowing when to seek care; and it’s key to learning about and adopting healthy behaviors. Reading: For more information on how information in critical to health literacy go to the Department of Health and Human Services (DHHS) Office of Disease Prevention and Health Promotion (ODPHP) Health Communication Activities webpage at www.health.gov/communication/home.asp Tips: “ Many people were unaware that patients and family members were welcome in the library.” Lenora Kinzie, Medical Librarian, and Scarlett Fisher-Herreman, Public Librarian “ The program helped raise awareness about the library in the organization and that it is available to both patients and community members.” Martha Prescott, Medical Librarian
  • Script: And there are a number of very specific challenges patients face when it comes to finding and using health information. Namely that: low health literacy in the U.S. is more common than you think, as demonstrated in earlier slides; health materials are written at reading grade levels far exceeded patients’ skills; and the increasing quantity of questionable health information on the Internet. Tips: “ Everyone I spoke with was surprised and interested in using the library as a resource to refer patients and families or to call themselves for patient information. Many people were not aware that we could provide information and computers.” Martha Prescott, Medical Librarian
  • Script: Current population data on literacy in the U.S. comes from the 2003 National Assessment of Adult Literacy conducted by the National Center for Education and Statistics. Based on a representative sample of 19,000 adults age 16 years or older, this study found that nearly half the adults in the U.S. have basic or below basic literacy skills and that 77 million have basic or below health literacy skills. Most adults having below basic health literacy skills (30 million adults) would not be able to circle the date of their next appointment on a medical appointment slip, or identify what is permissible to drink before a medical test based on a set of short instructions. Those scoring at a basic level would find it difficult to give two reasons why a person with no symptoms of a specific disease should be tested for the disease based on information in a clearly written pamphlet. Even among the 1 in 9 adults who have proficient health literacy skills, the demands of the health care system and the sheer amount of information there is to process can be challenging and overwhelming. Notes: To make the session most relevant to your audience, add a slide with literacy data from their own state, county or town. To find these data go to Adult Literacy Estimates at www.casas.org/lit/litcode/Search.cfm or your state department of education, adult literacy center, or adult literacy coalition website for local statistics. Reading: For more information on health literacy in the U.S. go to the National Center for Education Statistics (NCES) Health Literacy of American Adults, Results from the 2003 National Assessment of Adult Literacy (2006) at http://nces.ed.gov/naal/health.asp
  • Script: A growing body of literature, beginning in the early 1980s and continuing through today documents the mismatch between patient’s reading ability and the reading grade level at which health education materials are written. Over 300 studies documenting the mismatch between the reading grade level at which patient education materials are written and the grade level at which patients read while a growing body of literature shows similar results related to online health information. Mead’s (1989) seminal study looked at 49 tobacco education materials using the SMOG readability formula and found the materials to be written at the 10 th grade level while the reading ability of her 258 smoking patients was 6 th grade. Paasche-Orlow (2003) found the average readability score for informed consent forms (n=114) was 10.6 using the Flesch-Kincaid scale. Stevens (2007) found the readability of instruction on over-the-counter (OTC) nicotine replacement therapy (n=6) using the SMOG formula to be grade level 10.5. Berland (2001), looking at the readability and usability of web-based health information, found all the English websites and 86% of the Spanish websites required a high school reading level or above. Reading: For more studies on the readability of health materials see NLM Bibliography—Understanding Health Literacy and Its Barriers (2004) at www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html
  • Script: The number of online health information seekers continues to increase. According to the Internet Health Resources Report, Pew Internet & American Life Project [Online Health Search 2006], 80% of Internet users have searched for health information; and 75% said they rarely check the source or date. In another study by the Pew Internet & American Life Project [Vital Signs 2003], researchers found that 86% of users did not seek advice about which website to use, and 2% said they trusted all or most of the information they found without checking the sources. Reading: For more information on health information and the Internet go to the Pew Internet & American Life Project, Health Reports at www.pewinternet.org/PPF/c/5/topics.asp Tips: “ The concern was raised that if you are working with patients with low literacy levels would they have a computer or be able to use one. This was a good opener to discuss the resources available in the library for consumers.” Martha Prescott, Medical Librarian
  • Script: In this this video clip from the AMA Foundation Health Literacy Initiative video entitled “Help Your Patients Understand” patients with low literacy skills talk about their experiences interacting with the health care system. Notes: To order a copy of the CD go to www.ama-assn.org/ama/pub/category/9913.html . Be sure to set up the CD before your session. Start the CD using a media player and move forward to time marker 6:01. Minimize the window. When you get the this slide, maximize the medial player window and push play. Play to time marker 9:21 then stop the CD. Minimize the window and continue your presentation. Ask participants for their impressions. The AMA Foundation Health Literacy Initiative suggests the following questions to stimulate discussion: Mrs. Cordell talks about her experience signing a surgical consent form without reading and understanding it. Is it reasonable to assume that when patients sign consent forms, they have read and understood them? Why or why not? Mr. Bell talks about his fear of having others find out he has trouble reading and walking out of a doctor’s office. If you had not heard Mr. Bell’s story would you consider literacy challenges as a possible reason for his response? Reading: For a more information on the AMA Foundation Health Literacy Initiative go to http://www.ama-assn.org/ama/pub/about-ama/our-people/affiliated-groups/ama-foundation/our-programs/public-health/health-literacy-program.shtml Tips: “ Try to encourage the sharing of personal experiences. The more discussion the better.” Mary Chipanshi and Jeff Mason, Medical Librarians
  • Script: What can you do? There are a number of simple strategies health care providers are putting into practice to ensure that their patients understand critical information. These health literacy strategies are recommended by the AMA Foundation, Patients Safety Foundation, American College of Physicians, Medical Library Association, and other national organizations. Use “living room” language. For example, what is another word for abdomen – stomach. Limit the amount of information you try to get across in one session. Patients generally remember no more than 3-5 key pieces of information per session. Use easy-to-read handouts to support your teaching and highlight or circle key information. Use examples and demonstrate what you want your patient to do. Check for understanding by using the teach-back method. And acknowledge culture and language needs, learn to work with interpreters and use multilingual materials when available. Reading: For more information on health literacy strategies for clinicians see AMA Foundation(2007) Manual for Clinicians, 2 nd Edition at www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf For more on culture and language needs see HRSA (2007) Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency at www.hrsa.gov/healthliteracy/training.htm and click on “Go to www.train.org”
  • Script: Here is a list of commonly used health-related terms often used without regard to patient understanding. Acronyms are also often used without regard to patient understanding. Can you come up with “living room” language alternatives for each? Notes: With the large group have participants “shout out” there responses. Hypertension… high blood pressure Insomnia… can’t sleep Benign… not cancer Hazardous… dangerous Disorder… problem Option… choice Poultry… chicken Routinely… often If there is time have participants work individually or in pairs to come up with five additional terms used in their field and the “living-room” alternatives which they can then share with the group. Reading: For a list of words used in the healthcare and suggested “living room” language alternatives see Pfizer Principles for Clear Health Communication, 2 nd Edition, pages 49 - 51 at www.pfizerhealthliteracy.com/physicians-providers/chc-principles.htm l or www.pfizerhealthliteracy.com/pdf/PfizerPrinciples.pdf
  • Script: A AskMe3 campaign of the National Patient Safety Foundation encourages patients to ask their health care providers three questions and encourages health care providers to ensure that the three questions are answered and understood. The questions are: 1) What is my main problem? 2) What do I need to do? 3) Why is it important for me to do this? Notes: For more information and to order campaign materials to include in a health literacy information packet or toolkit visit www.npsf.org/askme3 Reading: For more information and to order campaign materials visit www.npsf.org/askme3
  • Script: Teach-back is a method health care providers use to check patient understanding. You do not simply ask, “Do you understand?” To use teach-back correctly, clinicians ask their patients to demonstrate understanding using questions such as: What will you tell your spouse or friends about your condition? I want to be sure I explained everything clearly, so can you please explain it back to me so I can be sure I did? According to the Agency for Healthcare Research and Quality (AHRQ), asking patients to recall and restate what they have been told is one of the top patient safety practices based on scientific evidence (AHRQ, 2001 Report on Making Health Care Safer). In this video clip from the AMA Foundation Health Literacy video entitled “Help Your Patients Understand” the clinician demonstrates how to use teach-back. Notes: To order a copy of the CD go to http://www.ama-assn.org/ama/pub/about-ama/our-people/affiliated-groups/ama-foundation/our-programs/public-health/health-literacy-program/help-patients-understand.shtml . If you have time show the portion of the CD that demonstrates teach-back. Be sure to set up the CD before your session. Start the CD using a media player and move forward to time marker 18:08. Minimize the window. When you get the this slide, maximize the medial player window and push play. Play to time marker 19:55 then stop the CD. Minimize the window and continue your presentation. Ask participants for their impressions. If you do not have time to show the video clip watch it your self and describe it to your audience and suggest they see the video clip or the entire video at another time. Reading: For a more information on the AMA Foundation Health Literacy Initiative go to http://www.ama-assn.org/ama/pub/about-ama/our-people/affiliated-groups/ama-foundation/our-programs/public-health/health-literacy-program.shtml
  • Script: You can also use easy-to-read materials to reinforce learning. The Deciphering Medspeak brochures developed by the Medical Library Association (MLA) can help patients understand the complicated language of health care, and are available in Spanish and low literacy versions. Note: To order copies of the Deciphering Medspeak brochures go to www.mlanet.org/resources/medspeak/index.html Reading: To more information about the Deciphering Medspeak brochures and to order copies go to www.mlanet.org/resources/medspeak/index.html
  • Script: Information Rx in a health literacy intervention created by the American College of Physicians and National Library of Medicine (ACP/NLM). Health care providers use Information Rx prescription pads to refer patients to reliable online health information resources. The goal is to reduce the number of poor quality Internet searches patient sometimes do. It can save valuable time, empower patients, and ultimately enhance the quality and outcome of your interactions with patients. For those who do not have access to a computer or need help searching the Internet, the library offers patients and their families free access to the Internet and help finding the health information the need. I strongly encourage you to use the Information Rx pads to refer patients to reliable health information resources and to the library for assistance. Notes: For more information about Information Rx and to order prescription pads and other Information Rx promotional materials go to www.informationrx.or g. Order your Information Rx materials ahead of time and tailor them to include your library’s contact information. Replace this slide with a slide showing an Information Rx pad with your contact information. For examples of how librarians have tailored their Info Rx pads go to www.mlanet.org/resources/healthlit/hil_project.html . Be sure to have more than enough pads on hand so that each participant leaves the session with at least one pad. Encourage participants to use the Information Rx pad to refer patients to the library for help and remind them that they can get additional pads from you at anytime. Reading: For more information about Information Rx and to order prescription pads and other Information Rx promotional materials go to http://foundation.acponline.org/hl/inforx.htm
  • Script: MedlinePlus is a highly reliable, user friendly health information website by the National Library of Medicine. It provides drug and supplement information, an illustrated medical encyclopedia, a medical dictionary, health topic pages, and interactive health tutorials with audio and visual. MedlinePlus recently added links to health information in over 40 languages. MedlinePlus in Español is also available. MedlinePlus links to thousands of clinical trials and their health topic pages covering over 750 diseases and conditions. When easy-to-read pages are available, they are marked as such. The quality guidelines and selection criteria are clear and consistent. Medlineplus one of the most reliable, consumer health information resources. It is updated daily and contains no advertising. Notes: Explore the site ahead of time at medlineplus.gov . If you have time and live Internet access demonstrate one of the interactive tutorial and other aspects of the site as part of your session. Be sure to check your Internet connection just prior to the session. Reading: For more information on MedlinePlus explore the site at medlineplus.gov . For a tutorial on how to use the site, take the MedlinePlus Tour at www.nlm.nih.gov/medlineplus/tour/tour.html Tips: “ Most participants stated they were likely or very likely to use the Information Rx pads to refer patients to online health information on the post-session evaluations, and were enthusiastic about the concept when I presented it.” Holly Kimborowitz, Medical Librarian
  • Script: The MedlinePlus interactive health tutorials are particularly useful for patients with limited literacy skills. The tutorials use animated graphics, audio, and text to facilitate learning about over 165 diseases and conditions, tests and procedures, prevention and wellness. Tutorials include question and answer sections to increase interaction. Stop, start, forward, and back buttons, and a volume control allow users go at their own pace and tailor each tutorial to their own needs. Tutorial are very well received by patients. Notes: Be sure to check your flash plug in and audio if you plan on demonstrating the interactive tutorials during your session. Reading: Explore the MedlinePlus Interactive Tutorials at www.nlm.nih.gov/medlineplus/tutorial.html Tips: “ We found adding live demonstration of the resources at the end of the presentation to be well accepted and appreciated by the participants. Very few left before I finished. The websites were the most “likely to use” response on the post-session evaluations” Geneva Staggs and Beverly Rossini, Medical Librarians
  • Script: NIHSeniorHealth is designed for older adults. The site's senior-friendly features include large print, short, easy-to-read segments of information, and simple navigation. A "talking" function reads the text aloud and special buttons can enlarge the text or turn on high contrast to make the text more readable. NIHSeniorHealth was tested with adults age 60 to 88. The American Geriatrics Society provides expert review of materials found on this site. Each health topic includes general background information, open-captioned videos, quizzes, and frequently asked questions. New topics are always being added. This is a very reliable site in terms of content accuracy. Another key feature is the new toolkit for trainers on how to help older adults search for health information online. Notes: Explore the site ahead of time at nihseniorhealth.gov . If you have time and live Internet access demonstrate various aspects of the site as part of your session. Be sure to check your Internet connection just prior to the session. Reading: For more information on NIHSeniorHealth explore the site at nihseniorhealth.gov . For guidance on how to teacher seniors to use the site go to Helping Older Adults Search for Health Information Online: A Toolkit for Trainers at http://nihseniorhealth.gov/toolkit/toolkit.html
  • Script: SPIRAL stands for Selected Patient Information Resources in Asian Languages and links to health information created by a variety of non-profit health agencies and organizations. The website was created by the Tufts University School of Medicine Health Sciences Library and covers most of the main disease categories as well as health and wellness, nutrition, and health issues for children, teens, and seniors. Notes: Explore the site ahead of time a: www.library.tufts.edu/hsl/spiral / . If you have time and live Internet access demonstrate various aspects of the site as part of your session. Be sure to check your Internet connection just prior to the session. Reading: To learn more about Spiral explore the site at www.library.tufts.edu/hsl/spiral/ Tips: “ Participating in the pilot helped me realize an existing need expressed by the nurses for patient education materials in native languages, especially Korean. This lead me to provide bilingual patient education materials in Korean and English to all the nursing stations which has been enthusiastically received.” Andrea Harrow, Medical Librarian
  • Script: There are a number of other very reliable, easy-to-read and use websites available for patients and consumers. The consumer health information websites listed here are recommended by the Medical Library Association (MLA). Reading: For more information on the MLA “Top 10” Most Useful Consumer Health Websites go to www.mlanet.org/resources/userguide.html Tips: “ Participating in the pilot has provided the public library with a connection to the medical community and the hospital library a partnership with the public library.” Lenora Kinzie, Medical Librarian, and Scarlett Fisher-Herreman, Public Librarian
  • Script: How can librarians help? When you write an Information Rx a librarian will fill it. Whether you write down a website for your patient, or note their disease, condition, or treatment, a librarian will use your referral to help the patient find the health information they need. Librarians can print out information from the Internet and prepare an information pack for patients to take home. If coming to the library is a problem, a patient may call or send an email and information can be sent to patients through the mail. Medical libraries and public libraries often liaise to find and provide books, DVDs, and other published materials, including information in other languages. Librarians will work with patients and family members that come into the library one-on-one to teach them search strategies and quality assessment skills. Notes: This is where you describe and promote your library services. Describe where the library is located and the hours of operation. Give participants information about your library to take with them. Be sure to emphasize that your library serves patients and their families as well as health care providers. Remind participants about Information Rx and that you have additional Information Rx pads and other promotional materials if they need them. For stories of how library supported Information Rx programs have helped health care providers and their patients go to www.mlanet.org/resources/healthlit/ Reading: For more information on the role of librarians in health literacy see the Medical Library Association Guide to Health Literacy Edited by Marge Kars, Lynda Baker, and Feleta Wilson, Neal-Shuman Publishers at www.neal-schuman.com/bdetail.php?isbn=9781555706258
  • Script: In a recent report by the Joint Commission (2007) “What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety,” health literacy issues are described as undermining the ability of hospitals and other health care delivery systems to comply with accreditation standards and safety goals. The report included the following recommendations for hospitals and health care organizations: raise awareness on the impact of health literacy and English proficiency on patient safety; address health literacy across the continuum of care; and pursue policy changes that promote patient-provider communication. In a number of studies, low health literacy has been linked to patient misunderstanding of the instructions on medication labels (Davis 2006). With medication errors resulting in the injury of more than 1 million people each year in U.S. hospitals, we must look to address health literacy barriers in order to improve the quality of patient care and protect patient safety. Reading: For more information on health literacy and medication labels see Davis, et al (2006). Literacy and Misunderstanding of Prescription Drug Labels. Ann Intern Med . 145(12):887-894. For more information and a copy of the Joint Commission Report: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety (2007) go to www.jointcommission.org/PublicPolicy/health_literacy.htm
  • Script: In conclusion, if you are to remember but three key points from this session, let them be these: Health information is critical to health literacy; Use Information Rx to refer patients to the library for assistance; and Librarians are available to meet the health information needs of both you and your patients. Tips: “ By far the greatest benefit of participating in the pilot was giving me the tools and resources to implement Information Rx.” Julie Smith, Medical Librarian “ Give your consumer health program time. Many departments in the hospital are overwhelmed with all the things they are dealing with. You’ll need to approach them in a manner that shows how the library can help.” Martha Prescott, Medical Librarian
  • Script: Thank you for participating in the health information literacy curriculum. Please complete the post-survey before leaving.
  • Notes: For more information and additional resources see the Health Information Literacy Research Project Inventory of Health Literacy Curricula and Resources at www.mlanet.org/resources/healthlit/
  • Notes: For more information and additional resources see the Health Information Literacy Research Project Inventory of Health Literacy Curricula and Resources at www.mlanet.org/resources/healthlit/
  • The Health Information Literacy Curriculum is a product of the Health Information Literacy (HIL) Research Project, supported by the Medical Library Association and funded by the National Library of Medicine. This curriculum was developed by Sabrina Kurtz-Rossi, M.Ed., Project Coordinator, and piloted by librarians in nine hospital-based library sites in the in the U.S. and Canada. Over 900 health care providers participated in the curriculum between April - July 2008. Participants completed pre- and post-session evaluations. Those who agreed to be contacted also received a follow-up survey. Pilot sites librarians provided extensive feedback to inform the curriculum development process. A heart felt thank you goes to each of the pilot site librarians for engaging in this project and exceeding all expectations. For more information on the experiences of the pilot site librarian who participated in the HIL Research Project via the project Webinar at www.mlanet.org/resources/healthlit/
  • The following people were instrumental to the success of the HIL Research Project. Sincere appreciation is extended to all. Jean Shipman , Co-Principle Investigator, for her leadership and guidance. Carla Funk , Co-Principle Investigator, for her guidance and supervision. Sabrina Kurtz-Rossi , Project Coordinator, for developing the curriculum and supporting the pilot sites. Elliot Siegel , National Library of Medicine, for his vision and support. Robert Logan , National Library of Medicine, his health literacy content expertise. Angela Ruffin, Lisa Boyd , National Network of Libraries of Medicine (NLM) and the NNLM Regional Medical Libraries for their connection to the field. Susan Barns and Cindy Olney , NNLM Outreach Evaluation Resource Center, for their evaluation expertise. Kathy Schilling , Indiana University School of Library and Information Science, for hosting the curriculum working conference. Marge Kars , Bronson Methodist Hospital Health Sciences Library, for sharing lessons learned from her health literacy work in a hospital setting. Terry Jankowski , University of Washington Health Sciences Libraries, for her curriculum development and continuing education guidance. Barbara Bibel , City of Oakland, for her commitment to public librarian involvement in health literacy. Cathy Boss , Jersey Shore University Medical Center, for her guidance regarding hospital-based libraries.
  • Health Information Literacy

    1. 1. The Health Information Literacy Curriculum Sponsored by the Medical Library Association Funded by the National Library of Medicine Contract Number HHSN276200663511/NO1-LM-6-3511 2008
    2. 2. Learning Objectives <ul><li>Recognize the impact low health literacy has on patient care </li></ul><ul><li>Name five strategies and resources to improve health literacy </li></ul><ul><li>Describe the health literacy services offered by the library </li></ul>
    3. 3. What is Health Literacy? <ul><li>“ The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” </li></ul><ul><li>Healthy People 2010 </li></ul>
    4. 4. What factors affect Health Literacy? <ul><li>Health literacy is dependent on individual and system factors </li></ul><ul><ul><li>Communication skills </li></ul></ul><ul><ul><li>Information and knowledge </li></ul></ul><ul><ul><li>Culture and language </li></ul></ul><ul><ul><li>Demands of the system </li></ul></ul>
    5. 5. Why is Health Literacy Important? <ul><li>Low health literacy is linked to… </li></ul><ul><ul><li>Under-utilization of services </li></ul></ul><ul><ul><li>Increased medication errors </li></ul></ul><ul><ul><li>Poor knowledge about health </li></ul></ul><ul><ul><li>Increased hospitalizations </li></ul></ul><ul><ul><li>Poor health outcomes </li></ul></ul><ul><ul><li>Increased healthcare costs </li></ul></ul>
    6. 6. Health Literacy and Cancer Screening <ul><li>Women with low health literacy are less likely to have had a mammogram or Pap test than women with higher health literacy skills </li></ul>Source: Davis, et al (1996). Caner . Lindau, et al (2002). Am J Obstet Gynecol .
    7. 7. Health Literacy and HIV / AIDS Knowledge Source: Kalichman, et al (2000). Am J Prev Med .
    8. 8. Health Literacy and Diabetes Management Percent of patients with diabetes correctly answering questions according to literacy level (low, moderate, high) Need to Know : symptoms of low blood sugar (hypoglycemia) Need to Do : correct action for hypoglycemic symptoms Low Moderate High Low Moderate High Source: Williams, et al (1998). Arch Int Med .
    9. 9. Health Literacy and Healthcare Costs $2,891 $10,688 Annual Healthcare Costs of Medicaid Enrollees Source: Weiss, et al (2004). J Am Board Fam Pract. ( < 3 rd -grade reading level) ( > 4 th -grade reading level)
    10. 10. How is Information Critical to Health Literacy? <ul><li>Health information is key to: </li></ul><ul><ul><li>Patient and provider communication </li></ul></ul><ul><ul><li>Shared health care decision making </li></ul></ul><ul><ul><li>Understanding and following directions </li></ul></ul><ul><ul><li>Recognizing when to seek care </li></ul></ul><ul><ul><li>Learning and adopting healthy behaviors </li></ul></ul>
    11. 11. What are the Challenges? <ul><li>Health literacy in the U.S. </li></ul><ul><li>Readability of health materials </li></ul><ul><li>Health information and the Internet </li></ul>
    12. 12. Health Literacy in the U.S. Intermediate Basic Below Basic Proficient 13% 12% 53% 22% 77 million adults have basic or below health literacy skills Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics (2006). http://nces.ed.gov/naal/health.asp
    13. 13. Readability of Health Information <ul><li>Over 300 studies show health-related materials far exceed the reading ability of U.S. adults </li></ul><ul><li>Increasing number of studies show similar results when looking at the readability of online health information </li></ul>Source: NLM Bibliography—Understanding Health Literacy and Its Barriers (2004). www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html
    14. 14. Health Information and the Internet <ul><li>80% of Internet users search for health information </li></ul><ul><li>75% rarely or never check the source and date </li></ul><ul><li>72% express trust in most or all information found online </li></ul>Source: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC: Pew Internet & American Life Project. www.pewinternet.org/PPF/c/5/topics.asp
    15. 15. Health Literacy From the Patient’s Perspective Source: Help Your Patients Understand . AMA Foundation Health Literacy. www.ama-assn.org/ama/pub / category/9913.html Mrs. Cordell Mr. Bell
    16. 16. Strategies to Improve Health Literacy <ul><li>Use “living room” language </li></ul><ul><li>Limit information (3-5 key points) </li></ul><ul><li>Use easy-to-read print materials </li></ul><ul><li>Practice teach-back </li></ul><ul><li>Use Information Rx </li></ul><ul><li>Address culture and language needs </li></ul>
    17. 17. “ Living Room” Language <ul><li>Name common terms for… </li></ul><ul><ul><ul><li>Hypertension </li></ul></ul></ul><ul><ul><ul><li>Insomnia </li></ul></ul></ul><ul><ul><ul><li>Benign </li></ul></ul></ul><ul><ul><ul><li>Hazardous </li></ul></ul></ul><ul><ul><ul><li>Disorder </li></ul></ul></ul><ul><ul><ul><li>Option </li></ul></ul></ul><ul><ul><ul><li>Poultry </li></ul></ul></ul><ul><ul><ul><li>Routinely </li></ul></ul></ul>
    18. 18. Ask Me 3 – National Patient Safety Foundation www.npsf.org/askme3
    19. 19. Teach-Back Method Source: Help Your Patients Understand . AMA Foundation Health Literacy. www.ama-assn.org/ama/pub/category/9913.html
    20. 20. Easy-to-Read Materials <ul><li>Deciphering Medspeak Brochures </li></ul><ul><ul><li>HIV </li></ul></ul><ul><ul><li>Cancer </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Other </li></ul></ul>www.mlanet.org/resources/medspeak/index.html
    21. 21. Information Rx
    22. 22. www.MedlinePlus.gov
    23. 23. Interactive Health Tutorials
    24. 24. www.NIHSeniorHealth.gov
    25. 25. www.library.tufts.edu/hsl/spiral/
    26. 26. “ Top 10” Most Useful Consumer Health Websites <ul><li>Cancer.gov * </li></ul><ul><li>CDC.gov * </li></ul><ul><li>Familydoctor.org * </li></ul><ul><li>Healthfinder.gov * </li></ul><ul><li>HIVInsite.ucsf.edu * </li></ul>* Available in Spanish <ul><li>KidsHealth.org * </li></ul><ul><li>Mayoclinic.com </li></ul><ul><li>Medem.com </li></ul><ul><li>MedlinePlus.gov * </li></ul><ul><li>Noah-health.org * </li></ul>Source: Medical Library Association. www.mlanet.org
    27. 27. How Can Librarians Help? <ul><li>Free access to the Internet </li></ul><ul><li>Information Rx Program </li></ul><ul><li>Patient information packets </li></ul><ul><li>Consumer health collection </li></ul><ul><li>Native language resources </li></ul><ul><li>Teaching and training </li></ul><ul><li>Virtual chat / email assistance </li></ul><ul><li>Health literacy workgroup </li></ul>
    28. 28. Why Now? Why Hospitals? <ul><li>“ The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care.” </li></ul><ul><li>The Joint Commission </li></ul>Source: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety. The Joint Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm
    29. 29. Take Home Points <ul><li>Accurate and reliable health information is critical to health literacy </li></ul><ul><li>Use Information Rx to refer patients to reliable health information and to the library for help </li></ul><ul><li>Librarians are available to address the health literacy needs of patients and providers </li></ul>
    30. 30. Thank You! <ul><li>Questions? Comments? </li></ul>
    31. 31. References <ul><li>AHRQ Report— Literacy and Health Outcomes (2004) www.ahrq.gov/clinic/epcsums/litsum.htm </li></ul><ul><li>AMA Foundation Health Literacy www.ama-assn.org/ama/pub/about-ama/our-people/affiliated-groups/ama-foundation/our-programs/public-health/health-literacy-program.shtml </li></ul><ul><li>Fox, S. & Fallows, D. (2003) Internet Health Resources. Washington, DC: Pew Internet & American Life Project www.pewinternet.org/Reports/2003/Internet-Health-Resources.aspx </li></ul><ul><li>Healthy People 2010, Health Communication, Objective 11-2 www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm </li></ul><ul><li>IOM Report— Health Literacy: A Prescription To End Confusion (2004) www.iom.edu/CMS/3775/3827/19723.aspx </li></ul>
    32. 32. References <ul><li>NLM Bibliography—Understanding Health Literacy and Its Barriers (2004) www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html </li></ul><ul><li>The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy (2007) http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483 </li></ul><ul><li>The Joint Commission Report: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety (2007) www.jointcommission.org/PublicPolicy/health_literacy.htm </li></ul><ul><li>Medical Library Association “Top 10” Most Useful Consumer Health Websites www.mlanet.org/resources/medspeak/topten.html </li></ul>
    33. 33. <ul><li>Pilot Site Librarians </li></ul><ul><ul><li>Martha Prescott , Berkshire Medical Center Health Sciences Library </li></ul></ul><ul><ul><li>Tori Koch and Kim Hart , Billings Clinic Medical Library </li></ul></ul><ul><ul><li>Andrea Harrow , Good Samaritan Hospital Health Sciences Library </li></ul></ul><ul><ul><li>Holly Kimborowicz , Lake Hospital System Medical Library </li></ul></ul><ul><ul><li>Jeff Mason and Mary Chipanshi , Regina General Hospital Health Sciences Library </li></ul></ul><ul><ul><li>Julie Smith , St. Joseph Hospital Burlew Library </li></ul></ul><ul><ul><li>Denise Rumschlag and Carolyn Martin , St. Vincent Hospital Library </li></ul></ul><ul><ul><li>Lenora Kinzie , Stormont-Vail Healthcare Stauffer Health Sciences Library, and Scarlett Fisher-Herreman, Topeka & Shawnee County Public Library </li></ul></ul><ul><ul><li>Geneva Bush Staggs and Beverly Rossini , University of South Alabama Biomedical Library </li></ul></ul>Acknowledgements
    34. 34. <ul><li>Project Advisors </li></ul><ul><ul><li>Elliot Siegel, Robert Logan, Angela Ruffin, Lisa Boyd, Susan Barns, Cindy Olney, Kathy Schilling, Marge Kars, Terry Jankowski, Barbara Bibel, and Cathy Boss </li></ul></ul>Acknowledgements <ul><li>Health Information Literacy Research Project </li></ul><ul><ul><li>Sabrina Kurtz-Rossi, Project Coordinator </li></ul></ul><ul><ul><li>Jean P. Shipman, Co-Principal Investigator </li></ul></ul><ul><ul><li>Carla J. Funk, Co-Principal Investigator </li></ul></ul>

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