Patient Education: Literacy, Barriers and Success

1. Patient Education: Literacy, Barriers and Success Robin Gasparini, RN, PCCN Cardiothoracic Nurse Clinician Robin.Gasparini@duke.edu Holly D’Addurno, MLS Director, Cancer Patient Education Holly.Daddurno@duke.edu

2. Objectives • Define Health Literacy and Patient Activation • Describe Barriers to Patient Education • Identify High Risk Populations

3. What We Know Already • 44 Million Americans are functionally illiterate (Hwang, Tram, & Knarr, 2005) • 50 Million Americans are marginally illiterate (Hwang, Tram, & Knarr, 2005) • 90 Million Americans have low levels health literacy that may lead to poor outcomes (Wilson, 2009)

5. Health Literacy The degree to which individuals have the capacity to (1) obtain, (2) process, and (3) understand basic health information and services needed to make appropriate health decisions.

6. Statistics Support… • 35% of U.S adults fall in the lowest health literacy categories of below basic health literacy* • 58% of the lowest health literacy categories are blacks and 66% Hispanics, respectively* • 59% are elders aged 65 and older* *(Hill-Briggs & Smith, 2008)

7. Example: 42% of Americans did not understand instructions for taking medicine on an empty stomach (Hwang, Tram, & Knarr, 2005)

8. Another Way of Looking at it Each year the average person is likely to spend: • -84 hours reading magazines • -165 hours reading newspapers • -480 hours accessing the internet • -1,248 hours watching TV • -less than 1 hour in a doctor's office (Kline, 2003)

9. Elderly Minorities Immigrants Poor Homeless Prisoners Persons with limited education High Risk Groups

10. So what are our barriers to patient education?

11. (Russell, 2006)

12. Patient Activation refers to the ability to manage one's own health and health care.

13. Four Stages of Patient Activation 1. The patient does not yet believe that they have an active and important role in their health. 2. The patient lacks the confidence and knowledge to take action. 3. The patient begins to take action. 4. The patient maintains behaviors over time. (Hibbard, et al, 2005)

14. Barriers to Education • Emotional Readiness • Anxiety, Support System, Motivation • Risk-Taking Behaviors • Frame of Mind, Maslow • Experimental Readiness • Level of Aspiration • Past Coping Mechanisms • Cultural Background • Locus of Control- assertiveness

15. Barriers to Education • Cognitive Ability • Extent to which information can be processed • Behavioral objectives + Cognitive Ability = Learning • Knowledge vs. Competence • Competency Validation • Health Literacy + Activation = Health Outcomes

16. What We Know… • 71% of Americans in 2007 accessed the internet for information regarding healthcare* • 48.6% of Americans consulted the internet prior to their trusted physicians* • Americans are looking for more information! *(Anderson & Klemm, 2008)

17. Perceptions • Roberts Study (1982) Significant differences found between the perception of needs identified by patients and problems identified by nurses Only a 20% congruency! • Include the learner as a source of information…

18. Keys…… …. to Successful Development of Patient Education Materials

19. Strategies • Effective design of an education tool should facilitate communication of content and promote audience understanding • Will use a multidisciplinary approach • Requires use of all steps in the Nursing Process

20. Planning • Identify available resources • Define the target audience • Define goals and objectives • Determine key concepts • Include content experts and members of targeted audience

21. Goals and Objectives • Is the purpose to • Disseminate Factual Content • Change behaviors: Contractual Agreement • It is recommended that 50% or greater of content be directed to step-by-step instructions to enable behavior modification of readers (Hill-Briggs & Smith, 2008)

22. Developing Content • Keep content congruent with identified goals/objectives • Limit the focus • Accurate and up-to-date information • Clear and easy to read (present information at a 5th grade reading level)

23. Evidence Supports: • Patient education is best understood when delivered at a 5th grade reading level or below* • Even learners with higher reading abilities prefer information written at lower levels* • Last grade level completed is a poor indicator of readability level

24. In Summary • Learner single most important person in the process • 90 Million Americans are health illiterate • Literacy may not equate to health literacy • Identify the barriers that impact patient learning • Assess the learner/population; is there a 20% deficit?

25. Questions? Thank You! Please email us if we can provide any clarity regarding the lecture content!

26. References Anderson, A.S. & Klemm, P. (2008) The internet: Friend or foe when providing patient education? Clinical Journal of Oncology Nursing, 12(1), 55-63 Hibbard, Judith H., et al. (2004). “Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers,” Health Services Research, Vol. 39, No. 4. Hwang, S.W., Tram, C.Q., & Knarr, N. (2005) The effect of illustrations on patient comprehension of medication instruction labels. BMC Family Practice, 6(26).

27. Kirsch, I., Jungeblut, A., Jenkins, L., Kolstad, A., (1993). Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC: National Center for Education Statistics, US Department of Education. Kline, K.N. (2003). Popular media and health: Images, effects, and institutions. In T.L. Thompson, A.M. Dorsey, K.L. Miller, & R. Parrott (Eds.), Handbook of health communication (pp.557-582). Mahwah, NJ: Lawrence Erlbaum Associates. Russell, S.S. (2006) An overview of adult-learning processes. Urologic Nursing, 26(5), 349-352

28. Wilson, E.A.H., & Wolf, M.S. (2008) Working memory and the design of health materials: A cognitive factors perspective. Patient Education and Counseling, Article in Press. Wilson, M. (2009) Readability and patient education materials used for low-income populations. Clinical Nurse Specialist, 23(1), 33-40.