The National Action Plan to Improve Health Literacy

1. The National Action Plan to Improve Health Literacy Cynthia Baur, Ph.D. Senior Advisor, Health Literacy August 23, 2011 Office of the Director Office of the Associate Director for Communication

2. Key Messages Government agencies, foundations, and research universities should prioritize funding for qualitative and quantitative studies related to health literacy improvement. Goal 6, National Action Plan Funders play a critical role in the dissemination and use of research findings. Goal 7, National Action Plan

3. What is the Gap?

4. Health Literacy: Hearing the voices of people on the receiving end of our communication

5. What is a 2 times greater risk for pneumonia if I don’t get a flu shot? Greater than what?

6. What do these survival rates mean for me? 80% 8 of 10 women? 80 of 100? .8? Is one better than the other?

7. What is Health Literacy? • Obtain • Process • Understand • Decide Health Information and Services Sources: National Library of Medicine, Healthy People

8. How is Health Literacy Different from General Literacy? • Builds on literacy skills BUT ALSO Cultural and contextual factors • Beliefs, experience and preferences • Topic area and conceptual knowledge, such as • knowledge of the body and how it works • terms for specific health conditions • scientific results and risk

9. Institute of Medicine Report on Health Literacy • Limited health literacy is a major public health issue • Interaction of individual skills and social complexity creates health literacy problems • Professionals need health literacy training

10. Health Literacy Health Literacy Dynamic

11. Literacy in AmericaNational Assessment of Adult Literacy (NAAL) • National sample survey conducted in 1992 and 2003 • Performed by U.S. Department of Education,National Center for Health Statistics • In-person interviews with Americans age 16 and older (N~19,000) • Tested in English or alternate short test in Spanish • Over sampling of Blacks and Hispanics http://nces.ed.gov/naal/

12. Quantitative Document Prose NAAL Domains • Emphasized the use of printed everyday materials (newspapers, prescriptions, bills) needed to function • 153 items that assessed prose, document, or quantitative literacy • Most items required searching text for specific information, short written responses http://nces.ed.gov/naal/

13. Categories and Sample Health Tasks • Proficient – Calculate employee’s share of health insurance costs for a year • Intermediate– Determine healthy weight range; medication timing • Basic– Explain why it is difficult to know if they have a specific chronic condition • Below Basic– Identify what is permissible to drink before a medical test http://nces.ed.gov/naal/

14. Results from the NAAL 12% Proficient 13% Below Basic 53% Intermediate Basic 22% 77 Million Adults have Basic or Below Basic Health Literacy Kutner et al. National Assessment of Adult Literacy, 2006

15. Health Literacy by Age 59% Kutner et al. National Assessment of Adult Literacy, 2006

16. 28% 58% 66% Health Literacy by Race/Ethnicity Kutner et al. National Assessment of Adult Literacy, 2006

17. 76% 44% 13% 11% Health Literacy by Education Kutner et al. National Assessment of Adult Literacy, 2006

18. Outcomes Associated with Limited Health Literacy • Health outcomes • Taking medications appropriately • Interpreting labels and health messages • Seniors’ health status and quality of life • Mortality • Health services • Hospitalization • Emergency care visit • Flu immunization • Knowledge and comprehension Berkman et al 2011 Health Literacy Interventions and Outcomes :An Updated Systematic Review

19. Why A National Action Plan?

20. What is the Plan?

21. Seven Goal Areas • Health information creation and dissemination • Healthcare services • Early childhood-university education • Community-based services • Partnership and collaboration • Research and evaluation • Dissemination of evidence-based practice

22. HHS Health Literacy Research • NIH/AHRQ Understanding and Promoting Health Literacy Program Announcement (PAR-10-133) • R01, R03 and R21 • NIH: 85 grants totaling $67 million (2004-2011) • http://obssr.od.nih.gov/scientific_areas/social_culture_factors_in_health/health_literacy/index.aspx • Additional research under other Funding Opportunity Announcements and contracts • NIH/AHRQ support of annual research conference • http://www.bumc.bu.edu/healthliteracyconference/

23. Ideas for research and intervention topics • NIH/AHRQ Program Announcement • National Action Plan Goals • Research presented at annual conference • AHRQ systematic review • http://www.ahrq.gov/clinic/tp/lituptp.htm • Evaluation of tools • Organizational audits • Universal precautions in clear communication • Clear communication training • Standards

24. Call to Action The National Action Plan to Improve Health Literacy challenges individuals, organizations and communities to fulfill their responsibility to make health information and services ACCURATE, ACCESSIBLE AND ACTIONABLE

25. A Challenge Is your foundation using its resources to improve health literacy OR perpetuate and create health literacy barriers?

26. What questions do you have? www.cdc.gov/healthliteracy http://blogs.cdc.gov/healthliteracy/ Office of the Director Office of the Associate Director for Communication