Health and Literacy Crouse Nurse Practice Council

1. Health and LiteracyCrouse Nurse Practice Council Marsha L. Tait, National Coalition for Literacy Donna Valerino, Literacy Volunteers of Greater Syracuse

2. PresentationHighlights • The Scope of Adult Literacy Globally and in the US • The 2003 National Assessment of Adult Literacy • The NAAL Health Literacy Report • Tips and Techniques for Health Care Providers • Resources

3. Global Adult Literacy • The UN defines illiteracy as: Having no reading and writing skills at all • UNESCO estimates more than 770 million adults are illiterate • Two-thirds of illiterate adults are women • UN Decade of Literacy: Cut illiteracy in half by 2015

4. The 2003 National Assessment of Adult Literacy (NAAL) was the first examination of the literacy skills of America’s adults in more than a decade • A nationally representative household survey of more than 19,000 adults, including adults in prison

5. NAAL: What is Adult Literacy in the US? Definition: using printed and written information to function in society, to achieve goals, and to develop knowledge and potential.

6. 2003 NAAL Key Findings • 11 million adults are Non-literate in English • 30 million adults have Below Basic Literacy skills • 63 million adults have Basic Literacy skills

7. Why Should You Care? Poor Health Outcomes: • Poor Health Knowledge • Less Frequent Screening and Preventive Care • Increased Use of Emergency Rooms • Increased Hospitalization • Higher Rates of Disease and Mortality Baker et al, 1997

8. Patient Interviews

9. Special NAAL Report: Health Literacy Definition: The degree to which individuals have the capacity to obtain, process, and understandbasic health literacy information and services needed to make appropriate health decisions. ?

10. AMA Definition of Health Literacy Definition: the ability to read and comprehend prescription bottles, appointment slips and other essential health-related materials required to successfullyfunction as a patient.

11. NAAL Estimate ofHealth Literacy Skills

12. Who needs help with health literacy? "We are your family-members; we are your neighbors; we are your co-workers. We are small-business owners; we are first-responders. We are among the working poor; we are millionaires. Few ever know our truth. Because of shame and stigma, we keep it hidden."

13. Characteristics of Population with Low Health Literacy

14. Gender • More men (16%) than women (12%) had Below Basic or Basic Literacy Skills • Less men (51%) than women (55%) had Intermediate literacy skills • Men had lower average health literacy scores (242) than women (248)

15. Older Americans • Adults aged 65+ had the lowest average health literacy scores • More Americans aged 65+ had Below Basic or Basic Skills than any other age group (29 + 30%) • Adults with Medicare and Medicaid or no health insurance had the lowest average health literacy scores

16. Health Condition Self-Assessment

17. Sources of Health Information

18. Information from Professionals

19. Information From Other People

20. Information From Print

21. Information From The Internet

22. Where are they getting it? A higher percent of adults with Below Basic or Basic literacy skills cited radio and television as their primary source of health information.

23. Factors Affecting Patient Provider Communication Additional factors that may hinder understanding: • Intimidation, fear, vulnerability • Shock upon hearing a diagnosis • Extenuating stress within the patient's family • Multiple health conditions to understand and treat

24. Make Effective Communications an Organizational Priority • Address Patients’ Communication Needs Across the Continuum of Care • Pursue Policy Changes that Promote Improved Provider-Patient Communications

25. Signage

26. 3 3 3 • What is my main problem? • What do I need to do? • Why is it important for me to do this?

27. What Can You Do? • Create a safe environment where patients feel comfortable talking openly with you • Use plain language instead of technical language or medical jargon • Sit down (instead of standing) to achieve eye level with your patient • Use visual models to illustrate a procedure or condition • Ask patients to "teach back" the care instructions you give to them From “Askme3.org

28. Avoid Jargon • “Hypertension” vs “High Blood Pressure” • “Fatigued” vs “Tired” • “Acetaminophen” vs “Tylenol” • “Febrile” vs “Feverish” • “Myopathy” vs “Muscle Aches”

29. NYS Patients’ Rights “Advance directives are verbal or written instructions made by you before an incapacitating illness or injury… Advance directives communicate that your wishes about your treatment be followed if you are too sick or unable to make decisions about your care. Advance directives include but are not limited to a health care proxy, a consent to a do-not-resuscitate (DNR) order recorded in your medical record, and a living will.”

30. Simplify, Simplify, Simplify! • Colonoscopy is the endoscopic examination of the large colon and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected lesions. Wikipedia

31. Is Consent Informed?

32. Advocacy Americans are anticipated to spend $45.5 Billion on their pets in 2009! American Pet Products Association

34. Health Literacy Resources • www.askme3.org • www.cdc.gov/az/a.html • www.healthliteracy.worlded.org/index • www.hsph.harvard.edu/healthliteracy/ • www.lvgs.org • www.jointcommission.org • www.national-coalition-literacy.org • www.proliteracy.org • www.rwjf.org

35. Clear Communication “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

36. And Remember… Marsha L. Tait mtait@twcny.rr.co Donna Valerino dvalerino@lvgs.org