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A Silent Epidemic

A Silent Epidemic. Georgia Health Sciences Library Association March 6, 2008. A Silent Epidemic. Learning Objectives 1. Discuss the importance of health literacy in relationship to consumer health information and education.

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A Silent Epidemic

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  1. A Silent Epidemic Georgia Health Sciences Library Association March 6, 2008

  2. A Silent Epidemic Learning Objectives 1.Discuss the importance of health literacy in relationship to consumer health information and education. 2. Identify 3 interventions to promote health literacy in your library/facility.

  3. “There is no prescription more valuable than knowledge.” C. Everett Koop MD, Former Surgeon General of the United States

  4. What is health literacy? Health literacy is the ability to read, understand and act on healthcare information. Understanding health information is everyone’s right. Improving health literacy is everyone’s responsibility.

  5. A Silent Epidemic Question - Which of the following is the strongest predictor of health status in America today? • A. Age • B. Income • C. Literacy skills • D. Employment status • E. Educational level • F. Racial or ethnic group

  6. Importance of Health Literacy Literacy is a stronger predictor of health status than age, income, employment, education or racial/ethnic group

  7. A Silent Epidemic Scope: • Occurs regardless of age, race, gender, education or income level • Affects over 90 million adults in the U.S. • Costs billions of dollars per year Diagnosis: • Cannot be detected by appearance, a physical exam, blood test or other diagnostic test.

  8. How silent is it? Nondisclosure of limited literacy Pankh, Nrrss, Baker and Williams (1996) Shame and health literacy: The unspoken connection. Patient Education and Counseling. 27:33-39.

  9. Video Help your patients understand AMA Foundation 2007

  10. Change in complexity in medicine

  11. U.S. Literacy Surveys 1993 National Adult Literacy Survey NALS – • 26,000 people - English only • Prose • Document • Quantitative 2003 National Assessment of Adult Literacy NAALS – http://nces.ed.gov/naal • 19,000 people – English and Spanish • Added fluency and health literacy components

  12. 2003 NAAL Survey • Sample literacy skills • Below basic - Tell how often a person should have a medical test based on an easy-to-read handout • Basic - Answer two questions based on a one-page article about a medical condition • Intermediate - Find the age-range a child should receive a vaccine from a chart listing all vaccines and ages • Proficient - Interpret a table about blood pressure, age and physical activity and understand the relationship between them

  13. 2003 NAAL Key Findings http://nces.ed.gov/naal/ • 11 million adults are Non-literate in English • 30 million adults have Below BasicLiteracy skills • 63 million adults have Basic Literacy skills

  14. 2003 NAAL survey

  15. Poor Health Literacy • Mean reading level for Medicaid recipients is 5.6 grade level • 8.7% are illiterate • 25% read below the 4th grade level • Mean reading level for Spanish speaking Medicaid recipients is 3.1 grade level • 1 in 10 Americans is foreign-born (2002) • 1990 – 2000 - the non-English speaking, adult population increased from 117,000 to 261,000

  16. Poor Health Literacy Last grade completed in school does not equate with reading level • Poor readers may read about 2-4 grade levels below last grade completed in school • Unfamiliar information and anxiety lower reading level by 1-2 grades

  17. Clear Health Communications Verbal information Written materials

  18. Clear Health Communications “Words mean what I want them to mean” Alice in Wonderland

  19. Clear Health Communications - Verbal Create a patient-centered environment (See through the eyes of the patient) Involve and individualize: • Be positive, respectful, caring and sensitive • Sit rather than stand • Listen rather than speak • Make eye contact when culturally appropriate • Encourage patients to ask questions • “What questions do you have for me”?

  20. Clear Health Communications Create a Shame- Free Environment Observe for : • Taking too long to fill out a form • Filling out only parts of forms • Filling out forms incorrectly • Asking someone else to complete forms or read materials • Eyes wandering over the page • Lack of interest in written materials

  21. Clear Health Communications Create a Shame- Free Environment • Listen for: • “I forgot my glasses.” • “I left my glasses in the car.” • “I’ll take this home and read it later.” • “I don’t have time to read this - just tell me the important things I need to know.” • “Could you read this for me? I have a headache.”

  22. Clear Health Communications Create a “shame-free” environment and offer help • “How happy are you with the way you read?” • “What is the easiest way for you to learn and remember?” • “These forms are quite complicated, can I help you complete them?” • “A lot of people have trouble reading and remembering this. Is this difficult for you?”

  23. Clear Health Communications “What is clear to you is clear to you. Every patient should be a full partner in his or her medical decisions. This requires crystal-clear communication that is done with compassion and mutual respect.” Toni Cordell, former adult literacy student and health literacy advocate

  24. Clear Health Communications - Written

  25. “Half of the adult population needs easy-to-read materials; the other half who do not need them want them anyway.” Sue Stapleford, Health Literacy Institute

  26. Can you read this? For lamitpo doolb ragus tnemeganam of setebaid, it is yrassecen to take the tcerroc nilusni dose.

  27. Health literacy in a word KISS

  28. What’s a librarian to do? • Healthcare consumers • Healthcare providers • Community • Public libraries • Other health librarians • Policy makers • Your organization

  29. Your turn…

  30. For consumers • Offer plain language resources and patient education materials: • AV materials • Books • Patient education handouts - Krames, Pritchett and Hull, Channing-Bete • Computer-based resources - Micromedex, Krames, LexiComp

  31. Clear Health Communications • Slow down • Use plain, non-medical language • Limit information to 3-5 key points (“need-to-know” information) • 7-digit phone number • Emergency phone number • Be specific and concrete

  32. Clear Health Communications • Demonstrate, draw pictures, use models • Use non-medical, living room, conversational language • Repeat, repeat, repeat (6x rule) • We remember 20% of what we hear 50% of what we hear and see 90% of what we do

  33. Patients first Focus on the patient and family - not on our teaching, but on what are they are actually learning Evaluate learning often • Open ended questions • Teach back • Show me • Scenarios

  34. Clear Health Communications Ask Me 3 1.What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

  35. Health literacy resources for consumers and providers Partnership for Clear Health Communications Ask Me 3 http://www.askme3.org/

  36. Health literacy resources for providers AMA Foundation. Health literacy and patient safety: Help patients understand. (Kit containing DVD, CD-rom, manual) $35.00 http://www.ama-assn.org/ama/pub/category/9913.html Institute of Medicine. A Prescription to End Confusion. $44.96 http://www.iom.edu/?id=19750

  37. Health literacy resources for providers What did the doctor say? Improving health literacy to protect patient safety.2007 White Paper. http://www.jointcommission.org/PublicPolicy/health_literacy.htm Hospitals, Language, and Culture: A Snapshot of the Nation. 2007 White Paper. http://www.jointcommission.org/PatientSafety/HLC/

  38. The community Partner with: • Public health clinics and departments • Pharmacies • Non-profit organizations and social service agencies • Professional schools (physician, nursing, allied health)

  39. The community Partner with: • Schools, churches and other religious institutions • Cultural groups • Community events and health fairs • Literacy groups (adult basic education, ESL, etc) • Senior citizen groups • Reach-out-and-read programs

  40. Community libraries Partner to help: • Promote awareness • Provide health education books for children and adult • Health-related “story hours” • Coordinate community programs

  41. Community libraries The Humana Foundation, Libraries of the Future and the Dekalb and Fulton county libraries www.wellzone.org

  42. Other health libraries Raise awareness through: • Networking opportunities • Shared resources, projects and presentations • Literacy inservices and train-the- trainer sessions

  43. Policy makers and media • Legislators • Advocacy • Community events • Medicare and Medicaid officials • Newspapers, radio, TV • Public service announcements • School curriculums/librarians

  44. Your organization • Work with: • Patient education committees • Interpreter/cultural groups • Physicians and educators • Marketing department: • Publications • Intranet and intranet sites • Closed-circuit TV programming

  45. Your organization • Special events: • MedlinePlus inservices • Health Literacy Month • Health Education Week • Literacy inservices Special displays: • Library displays • Bulletin boards • Cafeteria

  46. MLA Involvement Health Information Literacy “There is a huge need to bring sense to the information universe if MLA's vision of "quality information for improved health" is to be achieved. There is at the same time a significant gap in the awareness by the public and by opinion-leaders and decision makers of the contributions that health sciences librarians can make (and are making) to bring order to the chaos.” MLA website MLA Health Information Literacy Research Project – http://www.mlanet.org/resources/healthlit/hil_project overview.html • $250,000 two-year NLM contract - research into hospital-based health care provider and administrators’ awareness and understanding of health information literacy and its value in support of patient care.

  47. Health Literacy Resources • www.askme3.org • www.healthliteracy.worlded.org/index • www.hsph.harvard.edu/healthliteracy/ • www.jointcommission.org • www.rwjf.org • http://www.healthliteracy.com/

  48. Literacy Resources • www.nces.ed.gov/naal • www.proliteracy.org • www.wisconsinliteracy.org • www.unesco.org • www.national-coalition-literacy.org/naal • www.ncsall.net • www.nifl.gov/nifl/facts/health

  49. Final thoughts Health Literacy is of concern to everyone involved in health promotion and protection, disease prevention and early screening, health care maintenance,and policy making. Committee on Health Literacy of the Institute of Medicine, 2004

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