The Health Information Literacy Curriculum

1. The Health Information Literacy Curriculum Sponsored by the Medical Library Association Funded bythe National Library of Medicine Contract Number HHSN276200663511/NO1-LM-6-3511 2008

2. Learning Objectives • Recognize the impact low health literacy has on patient care • Name five strategies and resources to improve health literacy • Describe the health literacy services offered by the library

3. What is 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.” Healthy People 2010

4. What factors affect Health Literacy? • Health literacy is dependent on individual and system factors • Communication skills • Information and knowledge • Culture and language • Demands of the system

5. Why is Health Literacy Important? • Low health literacy is linked to… • Under-utilization of services • Increased medication errors • Poor knowledge about health • Increased hospitalizations • Poor health outcomes • Increased healthcare costs

6. Health Literacy and Cancer Screening Women with low health literacy are less likely to have had a mammogram or Pap test than women with higher health literacy skills Source: Davis, et al (1996). Caner. Lindau, et al (2002). Am J Obstet Gynecol.

7. Health Literacy and Diabetes Management Low Need to Know: symptoms of low blood sugar (hypoglycemia) Need to Do: correct action for hypoglycemic symptoms Moderate High Low Moderate High Percent of patients with diabetes correctly answering questions according to literacy level (low, moderate, high) Source: Williams, et al (1998). Arch Int Med.

8. Health Literacy and Healthcare Costs Annual Healthcare Costs of Medicaid Enrollees $10,688 $2,891 (<3rd-grade reading level) (>4th-grade reading level) Source: Weiss, et al (2004). J Am Board Fam Pract.

9. How is Information Critical to Health Literacy? • Health information is key to: • Patient and provider communication • Shared health care decision making • Understanding and following directions • Recognizing when to seek care • Learning and adopting healthy behaviors

10. What are the Challenges? • Health literacy in the U.S. • Readability of health materials • Health information and the Internet

11. Health Literacy in the U.S. 77 million adults have basic or below health literacy skills 12% Proficient 53% 13% Below Basic Intermediate Basic 22% 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

12. Readability of Health Information • Over 300 studies show health-related materials far exceed the reading ability of U.S. adults • Increasing number of studies show similar results when looking at the readability of online health information Source: NLM Bibliography—Understanding Health Literacy and Its Barriers (2004). www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html

13. Health Information and the Internet • 80% of Internet users search for health information • 75% rarely or never check the source and date • 72% express trust in most or all information found online 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

14. Health Literacy From the Patient’s Perspective Mr. Bell Mrs. Cordell Source: Help Your Patients Understand. AMA Foundation Health Literacy. www.ama-assn.org/ama/pub/ category/9913.html

15. Strategies to Improve Health Literacy • Use “living room” language • Limit information (3-5 key points) • Use easy-to-read print materials • Practice teach-back • Use Information Rx • Address culture and language needs

16. “Living Room” Language Name common terms for… • Hypertension • Insomnia • Benign • Hazardous • Disorder • Option • Poultry • Routinely

17. Ask Me 3 – National Patient Safety Foundation www.npsf.org/askme3

18. Teach-Back Method Source: Help Your Patients Understand. AMA Foundation Health Literacy. www.ama-assn.org/ama/pub/category/9913.html

19. Information Rx

20. www.MedlinePlus.gov

21. Interactive Health Tutorials

22. www.NIHSeniorHealth.gov

23. www.library.tufts.edu/hsl/spiral/

24. “Top 10” Most Useful Consumer Health Websites • Cancer.gov * • CDC.gov * • Familydoctor.org * • Healthfinder.gov * • HIVInsite.ucsf.edu * • KidsHealth.org * • Mayoclinic.com • Medem.com • MedlinePlus.gov * • Noah-health.org * *Available in Spanish Source: Medical Library Association. www.mlanet.org

25. How Can Librarians Help? • Free access to the Internet • Information Rx Program • Patient information packets • Consumer health collection • Native language resources • Teaching and training • Virtual chat / email assistance • Health literacy workgroup

26. Why Now? Why Hospitals? “The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care.” The Joint Commission Source: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety. The Joint Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm

27. Take Home Points • Accurate and reliable health information is critical to health literacy • Use Information Rx to refer patients to reliable health information and to the library for help • Librarians are available to address the health literacy needs of patients and providers

28. Thank You! Questions? Comments?

29. References • AHRQ Report—Literacy and Health Outcomes (2004)www.ahrq.gov/clinic/epcsums/litsum.htm • AMA Foundation Health Literacywww.ama-assn.org/ama/pub/about-ama/our-people/affiliated-groups/ama-foundation/our-programs/public-health/health-literacy-program.shtml • Fox, S. & Fallows, D. (2003) Internet Health Resources. Washington, DC:Pew Internet & American Life Project www.pewinternet.org/Reports/2003/Internet-Health-Resources.aspx • Healthy People 2010, Health Communication, Objective 11-2 www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm • IOM Report—Health Literacy: A Prescription To End Confusion (2004) www.iom.edu/CMS/3775/3827/19723.aspx

30. References • NLM Bibliography—Understanding Health Literacy and Its Barriers (2004) www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html • 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 • The Joint Commission Report: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety (2007)www.jointcommission.org/PublicPolicy/health_literacy.htm • Medical Library Association “Top 10” Most Useful Consumer Health Websiteswww.mlanet.org/resources/medspeak/topten.html

31. Acknowledgements • Pilot Site Librarians • Martha Prescott, Berkshire Medical Center Health Sciences Library • Tori Koch and Kim Hart, Billings Clinic Medical Library • Andrea Harrow, Good Samaritan Hospital Health Sciences Library • Holly Kimborowicz, Lake Hospital System Medical Library • Jeff Mason and Mary Chipanshi, Regina General Hospital Health Sciences Library • Julie Smith, St. Joseph Hospital Burlew Library • Denise Rumschlag and Carolyn Martin, St. Vincent Hospital Library • Lenora Kinzie, Stormont-Vail Healthcare Stauffer Health Sciences Library, and Scarlett Fisher-Herreman, Topeka & Shawnee County Public Library • Geneva Bush Staggs and Beverly Rossini, University of South Alabama Biomedical Library

32. Acknowledgements • Health Information Literacy Research Project • Sabrina Kurtz-Rossi, Project Coordinator • Jean P. Shipman, Co-Principal Investigator • Carla J. Funk, Co-Principal Investigator • Project Advisors • Elliot Siegel, Robert Logan, Angela Ruffin, Lisa Boyd, Susan Barns, Cindy Olney, Kathy Schilling, Marge Kars, Terry Jankowski, Barbara Bibel, and Cathy Boss