Literacy and Health Literacy: Prerequisites to Effective Health Care Decision Making

1. Literacy and Health Literacy: Prerequisites to Effective Health Care Decision Making National Coalition for Literacy December 5, 2007 Washington, DC Presented by Joyce Dubow, AARP

2. Presentation Overview • Profile of the Medicare population • Information burden and the importance of patient engagement • Implications of poor health literacy skills on ability to navigate Medicare • Strategies to meet needs • Policy implications

4. People on Medicare: Age, 2005 Source:http://www.cms.hhs.gov/DataCompendium/018_2006_Data_Compendium.asp

8. People on Medicare: Education Source: MedPAC analysis of the Medicare Current Beneficiary Survey, Cost and Use file, 2004

9. Today’s Medicare Program

10. What is expected of Medicare beneficiaries • Recognize differences among Medicare coverage options • Decide whether to buy Rx coverage • Identify differences among similar plans • Choose “best” doctors and hospitals • Navigate within a plan • Choose most appropriate treatment options • Understandrights and responsibilities

14. Numeracy

15. Source: Kripalani and Jacobson, www/ahrq.gov/qual/pharmlit/pharmtrain2.htm

16. 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.” IOM, Health Literacy: a Prescription to End Confusion

17. Source: Kripalani and Jacobson www.ahrq.gov/qual/pharmlit/pharmtrain2.htm

18. Average Health Literacy Scores of Adults by Age, 2003 Average Score Source: Results from the 2003 NAAL Age

19. Source: Literacy in Everyday Life: Results from the 2003 NAAL

20. Source Kripalani and Jacobson, www.ahrq.gov/qual/pharmlit/pharmtrain

22. Consequences of Inadequate Health Literacy • Poor health outcomes • Low health literacy is an independent risk factor for hospital admission among Medicare managed care enrollees. • Risk of non-compliance • Errors • Poor decisions • Anxiety • Inertia

23. People with Chronic Conditions Report Getting Conflicting Advice Source: Jane Horvath, Partnership for Solutions (Chronic Illness and Caregiving, a survey conducted by Harris Interactive, Inc., 2000.)

24. Engagement Fosters Desirable Patient Behaviors (Hibbard) • Informed choice role —using performance information to validate choice of provider • Co-producer role —having skills and confidence to partner with providers and to be vigilant in ensuring that one’s own care is safe • Evaluator role —understanding and acting on information on performance and understanding how such information affects one’s life.

25. Health Literacy Level and Decision Making • Health literacy influences decision making • confidence to make decisions • ability to use comparative information • (Patient activation influences engagement in self-management behaviors )

26. Challenges • Cognitive overload • Need to help people take into account multiple variables in making decisions • Statistical concepts not well understood (e.g., absolute vs. relative performance; average/percentage; benchmarks; statistical uncertainty. • Lack of Interest? • Adequacy and timeliness of relevant and meaningful information

27. What Works? • Symbols vs. numbers • Simplifying • Focus on key messages • Present recommended actions steps clearly • Rank ordering by performance vs. alphabetical ordering • Summarizing • “Teach Back”

28. What Works? • “Evaluable” formats (can be as important as content) • Framing makes a difference. • Use of alternative media (e.g., interactive data bases)

29. Other Strategies • Test materials • with diverse groups • for comprehension and appeal • Use simple language, (e.g., “plain English”) white space, large fonts culturally sensitive; “age-appropriate” colors; avoid fancy graphics

30. Policy Challenges • Medicare must address needs of a very diverse beneficiary population: • diverse skills • diverse preferences • diverse needs • diverse SES • Advance health literacy as a policy issue

31. Summary: Help Beneficiaries Use Information • Lower cognitive effort required to use information • Reduce amount of information • Computer-aided decision tools • Evaluable displays • Highlight meaning and significance • Framing; Provide information that helps consumers understand the implications of their choices • Give a better idea of what the actual experience of a choice might be like. • Narratives • Design information displays to highlight the meaning of important information that might otherwise be overlooked

32. Conclusions • Emphasis on private plans/market competition and consumerism in Medicare requires an “informed consumer” • Adequate funding for information and education programs, including counseling programs, is required to address diverse beneficiary needs