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Literacy and Health: The Patient's Point of View

Literacy and Health: The Patient's Point of View. Paul D. Smith, MD, Associate Professor UW Department of Family Medicine Paul.Smith@fammed.wisc.edu. Welcome. Health Care Organizations Community-Based Literacy Organizations Technical Colleges Public Health. Thanks. Sponsors

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Literacy and Health: The Patient's Point of View

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  1. Literacy and Health:The Patient's Point of View Paul D. Smith, MD, Associate Professor UW Department of Family Medicine Paul.Smith@fammed.wisc.edu

  2. Welcome • Health Care Organizations • Community-Based Literacy Organizations • Technical Colleges • Public Health

  3. Thanks • Sponsors • Michele Erikson • Georgia Weier • Many others

  4. Topics today • Research about literacy and health • Focus group results • What can we do?

  5. Literacy skills

  6. 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.”

  7. 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

  8. Reading Levels • 20% of American adults read at or below the 5th grade level. • Most health care materials are written above the 10th grade level.

  9. 2004 Comprehensive Reports • Agency for Healthcare Research and Quality (AHRQ) • Literacy and Health Outcomes • The Institute of Medicine • The IOM report Health Literacy: A Prescription to End Confusion

  10. 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.”

  11. 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.”

  12. 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.”

  13. In Their Own Words • Insert video clip here

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

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

  16. 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

  17. 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

  18. Poorer Health Status • 2923 new Medicare enrollees • Inadequate literacy had increased frequency of: • Diabetes • Hypertension • Heart failure • Arthritis

  19. Poorer Health Status • Medical Outcomes Study (SF-36) • Inadequate literacy had • Decreased: • Physical function • Mental health • Increased • Limitations in activity due to physical health • Pain that interferes with normal work activities

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

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

  22. Increased Mortality Risk of Death Hazard ratio: 1.75

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

  24. Increased Health Care Costs Based on 1992 National Adult Literacy Survey data Majority from increased hospitalizations 1998 - $73 Billion Other private, 3.2 Other public, 7.6 Medicare, 28.3 Medicaid, 10.3 Patients, 11.5 Employers, 12.1 Friedland R. New Estimates of the high cost of inadequate health literacy. In Pfizer Inc. Proceedings Report from Promoting Health Literacy: A Call to Action. New York City, October 7-8, 1998:6-10.

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

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

  27. Non-Compliance has a New Cause • Medications • Testing • Consultations

  28. In Their Own Words • Six focus groups • Racine • Madison • Osh Kosh

  29. In Their Own Words • Adult basic education (ABE) • English language learners (ELL) • English as a second language (ESL)

  30. Main Themes • Translators • Understanding • Emotional cost

  31. Translators • Generally OK at hospitals. • Only Spanish, if at all, at doctors’ offices. • Should be available for all languages.

  32. Translators • Pride in not needing a translator. • Females reluctant to discuss personal problems with male translator. • Confidentiality not mentioned.

  33. Understanding • Length • Short questions • Short answers • Short words

  34. Understanding • Speed • Speaking too fast • Takes time to formulate answers

  35. Understanding • Easier written materials • Shorter sentences 10-15 words • Shorter words • Explain big words • Consents

  36. Emotional Cost • Shame common with ABE • Significant anxiety • Asking for help • Uncertainty about understanding

  37. Focus Group Summary • No single solution to address all issues. • ABE and ELL have some similar and some different issues. • There is a significant emotional impact.

  38. How do we fix this problem? Education

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

  40. Where do we start? Be a catalyst for change

  41. Where do we start? Raise Awareness • Your organization • Leadership • Staff • Statewide organizations • Legislators

  42. Where do we start? • Regional breakout groups • Regional follow up meetings • Steering Committee volunteers needed • Sponsors needed

  43. Where do we start? • Local collaborative projects • Walking Interview • Test written materials • Funding

  44. Where do we start? • Health Literacy Curriculum • Redesign and share documents • Medical consent forms

  45. Where do we start? • Universal Design • Health Literacy Definition • The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed tomake appropriate decisions regarding their health.

  46. Summary Low literacy affects health Most of our documents are written at a reading level that is too high.

  47. Summary Raising awareness is the first step What’s next is up to YOU.

  48. “Action expresses priorities.” ---Mohandas Gandhi

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