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Health Literacy

Health Literacy. Why it’s important and what you can do about it. Paul D. Smith, MD, Associate Professor UW Department of Family Medicine Paul.Smith@fammed.wisc.edu. Topics today. General literacy and health literacy information Why it matters What you can do about health literacy.

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Health Literacy

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  1. Health Literacy Why it’s important and what you can do about it. Paul D. Smith, MD, Associate Professor UW Department of Family Medicine Paul.Smith@fammed.wisc.edu

  2. Topics today • General literacy and health literacy information • Why it matters • What you can do about health literacy

  3. Literacy skills

  4. What is Literacy? National Assessment of Adult Literacy (NAAL 2003) “Using printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential.”

  5. What is Literacy? • Literacy is a combination of skills: • Verbal • Listening • Writing • Reading

  6. More than just reading grade level • Prose Literacy • Written text like instructions or newspaper article • Document literacy • Short forms or graphically displayed information found in everyday life • Quantitative Literacy • Arithmetic using numbers imbedded in print

  7. What is Health Literacy? The Institute of Medicine 2004 “The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”

  8. What is Health Literacy? The Institute of Medicine 2004 “The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”

  9. What is Health Literacy? The Institute of Medicine 2004 “The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”

  10. Literacy VS Health Literacy • Almost everyone will have difficulty with health literacy at some point. • Much harder for those that do not: • Read very well. • Speak English as their primary language.

  11. Two Sides to the Equation • It’s all about effective communication • Verbal • Written • Multi-media • It has to be presented in a way that is understandable to most people.

  12. In Their Own Words • Insert video clip here

  13. 2003 National Assessment of Adult Literacy • Data released 12/05 • ~17,000 people participated • Over age 15 • Living in households and prisons

  14. 2003 National Assessment of Adult Literacy • 4 categories of literacy • Below basic • Basic • Intermediate • Proficient

  15. 2003 National Assessment of Adult Literacy • Below Basic literacy – one piece of information • Can: • Sign name on a document • Identify a country in a short article • Total a bank deposit slip

  16. 2003 National Assessment of Adult Literacy • Below Basic literacy – one piece of information • Cannot: • Enter information on a social security card application • Locate an intersection on street map • Calculate the total cost on an order form

  17. 2003 National Assessment of Adult Literacy • Basic literacy – two related pieces of information • Can: • Identify YTD gross pay on a paycheck • Determine price difference between tickets for 2 shows

  18. 2003 National Assessment of Adult Literacy • Basic literacy – two related pieces of information • Cannot: • Use a bus schedule • Balance a check book • Write a short letter explaining error on a credit card bill

  19. 2003 National Assessment of Adult Literacy 34-55% of adults are at below basic and basic literacy levels 55% 43% 34%

  20. 2003 National Assessment of Adult Literacy • NAAL health literacy assessment • 28 questions specifically related to health • 3 clinical • 14 prevention • 11 system navigation

  21. NAAL Health Literacy Assessment • Entire population • Proficient 12% • Intermediate 53% • Basic 22% • Below basic 14%

  22. NAAL Health Literacy Assessment • Basic and Below Basic Health Literacy • Entire population 36% • White 28% • Native Americans 48% • Blacks 58% • Hispanics 66%

  23. NAAL Health Literacy Assessment • Basic and Below Basic Health Literacy • Age16-64 28-34% • Age 65+ 59%

  24. NAAL Health Literacy Assessment • Basic and Below Basic by education level • In High School, GED or HS grad 34-37% • Less than/some High School 76%

  25. NAAL Health Literacy Assessment • Basic and Below Basic by Self-reported health status • Excellent 25% • Very Good 28% • Good 43% • Fair 63% • Poor 69%

  26. The Impact of Low Literacy on Health • Poorer health knowledge • Poorer health status • Higher mortality • More hospitalizations • Higher health care costs

  27. Poorer Health Knowledge • Understanding prescription labels • 395 patients • 19% low literacy (6th grade or less) • 29% marginal literacy (7-8th grade) • 52% adequate literacy (9th grade and over) • 5 prescription bottles Literacy and Misunderstanding Prescription Labels. Davis et al. Ann Intern Med 2006;145:887-894

  28. Poorer Health Knowledge • At least one incorrect • 63% low literacy • 51% marginal literacy • 38% adequate literacy Literacy and Misunderstanding Prescription Labels. Davis et al. Ann Intern Med 2006;145:887-894

  29. Poorer Health Knowledge “Take two tablets twice daily” Stated correctly Demonstrated correctly 71% low literacy 35% 84% marginal literacy 63% 89% adequate literacy 80% “Show me how many pills you would take in one day.” Counted out 4 tablets-correct

  30. Poorer Health Status Diabetics with retinopathy 36% 19%

  31. Increased Mortality • Age 70-79 • 2512 participants • Reading level 8th grade or less • Five Year Prospective Study Sudore R, et al. Limited Literacy and Mortality in the Elderly. J Gen Intern Med 2006; 21:806-812.

  32. Increased Mortality Risk of Death Hazard ratio: 1.75

  33. More Hospitalizations 2 year hospitalization rate for patients visiting ED 31% 14%

  34. Increased Health Care Costs • Data • 2003 Medical Expenditure Panel Survey • 2003 National Assessment of Adult Literacy Low Health Literacy: Implications for National Health Policy. Vernon, J, Trujillo, A, Rosenbaum, S, DeBuono, B. Oct. 2007

  35. Increased Health Care Costs • Annual cost today: • Future costs based on today’s actions (or lack of action): Low Health Literacy: Implications for National Health Policy. Vernon, J, Trujillo, A, Rosenbaum, S, DeBuono, B. Oct. 2007 $106-238 Billion $1.6-3.6 Trillion

  36. Low Literacy is Overlooked • Patients do not volunteer their literacy problem • Many are ashamed • Some do not recognize their inadequate literacy • Lack of trust

  37. The Big Secret • % of low literate adults that have not told their:

  38. More likely to have Low Literacy • Older • Less education • Non-white

  39. More likely to have Low Literacy • Immigrants • Immigrate after age 12 >50% • Below Basic literacy level

  40. More likely to have Low Literacy • Low-income • Medical Assistance • Incarceration

  41. You Can’t Tell by Looking • Many below basic people don’t fit the stereotypes • 75 % born in USA • 50% are white • 40% hold full or part time jobs

  42. A New Cause for Non-Compliance? • Medications • No-shows • Testing • Referral

  43. New Joint Commission Standards • Effective communication • Cultural competence • Patient centered care • http://www.jointcommission.org/NR/rdonlyres/B48B39E3-107D-495A-9032-24C3EBD96176/0/PDF32009HAPSupportingStds.pdf

  44. New Joint Commission Standards • Approved 12/2009 • Will start evaluating compliance January 2011 • Compliance included in accreditation decision no sooner than 1/2012

  45. How do we fix this problem? • Education • Universal Design • If it works for people with limited literacy or limited English skills, it will work for everyone.

  46. Re-Designing What We Do • Team effort • In-service and new employee training • Health literacy committee? • Infuse health literacy concepts in new programs and redesign of current processes

  47. Re-Designing What We Do • Improved discharge process • less re-hospitalizations • Find, develop and use plain language materials • MedlinePlus • http://www.nlm.nih.gov/medlineplus/

  48. Improve Verbal Communication • SLOW DOWN • Sit face to face • Plain language, no medical jargon • Simple diagrams

  49. Check Understanding • Teach back method “I imagine you’re really worried about this [diagnosis]. I’ve given you a lot of information. It would be helpful to me to hear your understanding about your [diagnosis] and its treatment.” Kemp E, et al. Patients Prefer the Method of “Tell Back-Collaborative Inquiry” to Assess Understanding of Medical Information. J Am Board Fam Med 2008;21:24 –30.

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