Health Literacy & Health Disparities

1. Health Literacy & Health Disparities Jann Keenan, Ed.S. DC Convention Center, May 20, 2008

2. The travesty of health care disparities “It’s intolerable that a in nation as wealthy as ours, there are people who cannot get the right care at the right time” Richard Carmona, June 14, 2003 AMA House of Delegates Meeting)

3. Today’s Goals After today’s talk you will walk away with… • Part 1: An understanding of the impact of low health literacy on health outcomes • Part 2: Next steps you can take to get a health literacy initiative going in your area. To get providers on board.

4. Which is the biggest predictor of a person’s health status? • Age • Income • Literacy Skills • Job status • Education • Racial or ethnic group

5. Literacy skills— yep! How well you can read and understand!

6. Greater % of ethnic groups and seniors • The majority of those with low literacy skills in the United States are white, native-born Americans • Yet ethnic minority groups and seniors are disproportionately affected by low literacy.(the Center for Health Care Strategies)

7. The numbers = real people 50% of Hispanic Americans 40% of African Americans 33% of Asian Americans 66% of US adults age 60 plus

8. Here in the District • Literacy skills substantially lower than those in the US overall1 • 36% of DC adults have functional illiteracy versus 21% nationally. • Translation: 1 in 3 in DC versus 1 in 5 in the Nation) • (FI means trouble with bus schedules, reading maps, filling out job applications) 2 2 Phase 1 of the 2204 Study by State Education Agency 1 DC State of the Workforce Report, 2003

9. One contributor from report • Growing number of Hispanic and Ethiopian residents who are not proficient in English

10. Leap to Functional Health Literacy • The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. (IOM and Parker)

11. In plain English . . . • A person ability to understand and act on health information.

12. We’re All at Risk . . . • People of all ages, races, incomes and education levels are challenged by low health literacy. • The accountant who can’t fill out insurance forms • The provider who speaks “medicalese” • Anyone who doesn’t know “take on an empty stomach” or “light snack” means

13. Still . . . at most risk . . . • Economically disadvantaged • Older adults • Chronically ill most at risk (Prudential study) • Ethnic groups. African Americans and HPB, sleep problems, heart attack, stroke. Latinos and diabetes.

14. Widespread problem • Low health literacy is a threat to the health and well-being of Americans! • Many patients don’t understand the best way to take care of themselves and prevent disease.

15. When Patients Don’t Understand. . . • People with limited literacy skills: • Have poorer overall health • Use health services more often • Are less likely to go to screenings • Are more likely to be hospitalized • Seek treatment in later stages of disease

16. Have less understanding of their treatment and less adherence to medical regimes

17. Significant relationship between good health and literacy • Adults with lower-than-average reading skills are less likely to get • Screening tests such as mammograms and Pap smears • Flu shots and pneumonia vaccines • Their kids to well child visits and more . . .

18. Surprising Stats • 2,659 patients were surveyed • On an empty stomach--1,100 off base • Next appointment--691 perplexed • Upper GI tract XRay--886 in the dark • Informed consent form--1,582 didn’t get it

20. This?

21. Or this?

22. Lofty materials/not speaking to culture • When low-income Hispanic and African American women got culturally appropriate materials/easy-reads- smoking during and after pregnancy went down! (Lillington, 1995) • SNAP (Stanford Nutrition Action Program) worked for people with low-literacy. More diet changes!

23. 23 folks with low-literacy and heart failure had 100% weigh in compared to 32% without easy-to-read materials

24. When materials and information are not clear • 75 African American women being treated for HPB (CDC. 1990) • 54 said they had “pressure trouble” or “pressure” • 32 believed they had 2 diseases • “High-blood” a disease where the blood was too “hot” “rich” or “thick. • “High-pertension” a condition where blood would “shoot up “ toward their head when they were emotionally excited and “fall back” as they calmed

25. For the 32 women using folk meds • The treatment for the “high blood” • lemon juice, vinegar, or garlic water to “cool and thin” their blood so it would drop t o the lower level in the body • The treatment for the High-pertension • lower stress by not eating pork, hot, or spicy foods, or grease • Message to providers-listen about folk medicine. Have respect . . .

26. Low health literacy is a threat to the well-being on the medical system • REPORT: Low Health Literacy: Implications for National Health Policy • $106-$236 per year. U of CT in Oct 2007

27. Adequate health literacy • Essential to promoting good health—especially in preventing disease • Instead of helping folks stay healthy . . .

29. We treat them when they are sick . . . Well, sometimes

30. Review and take aways from Part 1 • Most materials are lofty and not culturally relevant. (Grade 10 or above. Nearly 1 out of 2 US adults read at grade 8 or lower) • Ineffective communication and low health literacy combine to affect patient safety and health outcomes. • Everyone is at risk- yet ethnic groups, chronically ill, poorer, and older adults at most risk!

31. On to Part 2-The Best Part Turning the tide! Some Solutions!

32. What providers can do • Slow down. • Use analogies • Use “living room” language • Benign = not cancer • Lateral = side • Anaphylactic reaction = shock, throat closing • Oral= by mouth • Monitor = watch • Hypertension = blood pressure

33. And there’s more . . . • Limit information given at one time. Repeat and rephrase • Show or draw pictures • Use “teach back” or “show me” • Be respectful, welcoming, and caring • Consider culture “saving my last nerve” “falling out” “evil” on the “down low. low ” • Ethno-medicine—herbs. Spirit moves me. • Encourage questions. The Outcome? A way to empower patients to participate in their own health care

34. What communities can do

35. Transformational change through “Community Youth Mapping”

36. In the selected cities, youth help determine: • How many people in the community have problems with health literacy • Where the average person can go to get help understanding their health paperwork • If doctors & hospitals have support in creating health literate materials

37. If pharmacies have programs to help people understand their medicines If written materials are tested in the community If adult literacy programs include health lit examples

38. Who can help make a change in the community? • Adult end classes can add health content to their adult literacy classes. • Elder organizations can help senior citizens understand their medicines & provide tools to remember when to take meds 

39. More ways! • Patient advocacy groups can provide tools to prepare for a doctor's visit • Local advertising & marketing agencies can volunteer their services to test print materials for readability & comprehension.

40. Health professionals collaborate in Detroit • Michigan Dept of Community Health (2003) • Employed cultural competency and health literacy techniques • 92% of docs are Caucasian and Asian/PI • Difficulty in effective cross cultural communication • Established a “shame-free” environment

41. AMA.ORG for Tool Kit- 35 bucks

42. Free, free, & low fee for Ask Me 3www.npsf.org

43. The “Ask me 3” questions

44. www.niapublications.org • Safe Use of Medicines—FREE! • Take your medicines the right way - each day! • An easy-to-read booklet from the National Institute on Aging. • This booklet offers practical tips to make sure you are taking all your medicines the right way: • Medicine safety • How to stay on track and get the best results from your medicines • Questions you should ask your doctor and pharmacist

45. More patient centered communications www.jointcommission.org • What did the doctor say? White paper 2/07 describes interventions to improve the ability of patients to understand complex medical info. • Hospitals, Language, and Culture.3/07 Report recommends strategies of 60 US hospitals providing health care to diverse populations. • Speak Up Program 3/02 with Brochures on surgical safety, infection, preventing med mistakes, patients rights.

46. Joint Commission & Iowa Health System • Grant proposal in review • At the NIH • To develop new evidence-based performance measure • To provide critical information about how well hospitals address the health literacy needs of patients.

47. To review next steps • Doctors can improve communication by looking to Ask Me 3 and AMA tool kit. • Communities can seek grants for community youth mapping. • Can get freebies from the Gov’t and the Joint Commission and Gov’t. • Can look at best practice & do it! • Can encourage more funding for literacy programs to include health teachings

48. Bottom line • Each one- Teach one • Spread the word!