Health Literacy for Librarians & Information Specialists

1. Health Literacy for Librarians & Information Specialists Facilitator's name & position

2. Acknowledgement This workshop was developed collaboratively by Tina and Janet Papadakos, Patient Education Leads at St. Michael’s and Princess Margaret Hospitals in Toronto, Canada to support staff skills competencies related to health literacy.

3. Objectives • Define health literacy and why it matters • Gain skills to support client involvement in their care when preparing information packages • Use active listening techniques to identify learning needs • Select resources that are written for adult learners • Select resources that match client’s learning styles • Ensure resources are in plain language

4. Communication barriers

5. What is health literacy? The ability to make sound health decisions in the context of everyday life – at home, in the community, at the workplace, and in the healthcare system Kickbusch, Wait and Maag, Navigating Health: The Role of Health Literacy, 2005.

6. Fundamental literacy Scientific literacy Civic literacy Cultural literacy Health literacy has 4 parts Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

7. Fundamental literacy Prose – written words Document – charts, graphs, forms etc Numeracy – basic math Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

8. Scientific literacy • Basic understanding of how science and medicine work and evolve What science must a patient know to comprehend and decide to act on a specific health message? Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

9. Civic literacy Can your patient judge: the validity and quality of sources of information? The ability to be involved in health decisions: • Does your patient know: • where and how to access information? • how to advocate for self and others? Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

10. Cultural literacy The shared and dynamic characteristics of a group of people whose collective beliefs, worldview, customs and social identity are a lens through which they interpret and act on health information Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

11. Health literacy involves the ability to: • to understand health instructions • to read and act upon written health information • to communicate needs to health professionals

12. Scientific literacy

13. Cultural literacy

14. Fundamental literacy

15. Civic literacy

17. 60% of Canadians have difficulty getting, understanding and acting on health information and services 88% of Seniors Canadian Council on Learning, 2007

18. Institute of Medicine Report on Health Literacy • 90 million American adults have trouble understanding and acting on health information • • Health information is unnecessarily complex • • Providers need health literacy training

19. AHRQ Report Evidence shows that patients often misinterpret or do not understand much of the information given to them by clinicians due to low health literacy. The Agency for Healthcare Research and Quality (AHRQ) Report 2010

20. Low health literacy has been linked to: • Less use of preventive services • Delayed diagnoses • Less adherence to medical instructions • Poorer self-management skills • Higher health care costs • Poorer Health • Wolf MS, Gazmararian JA, Baker DW. Health Literacy and Functional Health Status Among Older Adults. 2005. Archives of Internal Medicine.

21. Health literacy is important for 2 reasons: Changes in medical practice with patients involved in complex self-care regimens Transition from ‘patient’ to ‘health consumer’ (expectations of involvement) The Agency for Healthcare Research and Quality (AHRQ) Report 2010

22. Health literacy can improve with better communication. You can help by providing custom information packages that adhere to health literacy standards for patients and families.

23. Skills you can use to support patient and family understanding and involvement in their care • Use active listening techniques to identify learning needs • Select resources that are written for adult learners • Select resources that match client’s learning styles • Ensure resources are in plain language • Use active listening techniques to identify learning needs

24. Active Listening Techniques: Prompt Question Paraphrase Empathize Summarize

25. Prompts indicate you are listening with minimal verbal or non-verbal cues to encourage patient to verbalize Nod your head Make eye contact Say “uh huh” Expressions of interest or approval Prompt

26. Questions are key to gathering information about your client 2 kinds of questions: Questions

27. Restate the factual content of the patient’s message in your own words Paraphrase “So it sounds like you are clear on your appointment time for your CT Scan but unsure how to get there. Is that right?”

28. Recognize the facts (intellectual) of the patient’s message and how the patient feels (emotional) Empathize “It sounds like you are overwhelmed with all of the information you have just been given.”

29. Recap the key points of the discussion Agreement of the problem Summarize “So, you have agreed to undergo radiation treatment and you would like to have the procedure reviewed with you and your family so you know what to expect.”

30. Skills you can use to support patient and family understanding and involvement in their care • Use active listening techniques to identify learning needs • Select resources that are written for adult learners • Select resources that match client’s learning styles • Ensure resources are in plain language Select resources that are written for adult learners

31. Favourite teacher

32. 1. Adults often see learning as a way to solve their real-life problems – especially their urgent ones. True False Principles of adult learning

33. 2. Adults tend to take errors personally and are more likely to let them affect self-esteem. Thus, they tend to apply tried-and-true solutions and take fewer risks. True False Principles of adult learning

34. 3. Adults relate new knowledge and information to previously learned information and experiences. True False Principles of adult learning

35. 4. Adults want to be treated as equals, not as children, (and so want to engage in a learning relationship with the healthcare professional). TrueFalse Principles of adult learning

36. 5. Adults need to know WHY they should learn, WHAT they will learn, and HOW the learning will take place. True False Principles of adult learning

37. Adult learning summary • Respect • Relevant • 2-Way Conversation • Specific and Focused • Allow time for learning to be applied to patient’s current knowledge, experience and beliefs • Safe environment (preserve dignity)

38. Skills you can use to support patient and family understanding and involvement in their care • Use active listening techniques to help client identify learning needs • Select resources that are written for adult learners • Select resources that match client’s learning styles • Ensure resources are in plain language Select resources that match clients learning styles

39. Learning styles Touch it/ Do it See it Hear it Think about it

40. Visual Learners How they learn: • They create diagrams of what they hear • Need to ‘picture it’ Clues that they are Visual Learners: • Doodling • Says “I can’t see it” What you can do: • Ask if they would like you to draw it

41. Auditory learners How they learn: • They pay attention to the speaker’s voice - the tone, energy, pitch, enthusiasm and modulation Clues that they are Auditory Learners: • Looking off in the distance • Put their hand by their ear What you can do: • Speak to them, pace yourself, sequence the information and ask if they would like you to repeat anything

42. Kinesthetic learners How they learn: • They prefer to put their hands on and touch • Like demonstrations that they can try after you show Clues that they are Kinesthetic Learners: • Gestures with their hands, puts their hands on things • Says “I feel…” What you can do: • Ask if they would like to try it after you show them

43. Reflective learners How they learn: • They like to have time to process information and make decisions • Want to analyze, categorize, review, reflect and ask questions Clues that they are Reflective Learners: • Pausing and looking in the distance (or down) • Asks broad questions for context What you can do: • Offer them more data, reading material

44. Learning retention is increased with more sensory involvement Think about it Hear it See it Touch it/ Do it 90% 20% 30% 40%

45. Visual Learners See it Auditory Learners Hear it Kinesthetic Learners Touch it Reflective Learners Think about it • Pamphlets • & Books • Statistics & • Facts • Demos & • Models • Analogies & • Stories • Group • Sessions

46. Skills you can use to support patient and family understanding and involvement in their care • Use active listening techniques to identify learning needs • Select resources that are written for adult learners • Select resources that match client’s learning styles • Ensure resources are in plain language Ensure resources are in plain language

47. Reading level 13 • The CVD outcomes can be influenced by a number of modifiable risk factors, including nutrition, weight, physical activity, smoking cessation, and alcohol consumption. For most people, appropriate treatments can control symptoms, allowing for return to functional status.

48. After plain language editing: Reading level 8 What you can do to improve your symptoms of heart disease : • Eat fruit, vegetables and whole grains • Avoid fatty foods like potato chips • Get to a healthy weight • Exercise once a day • Don’t smoke • Drink less than 1 -2 alcoholic drinks a day

49. Universal Precautions Taking specific actions that minimize the risk for everyone when it is unclear which patients may be affected. Research suggests that clear communication practices and removing literacy-related barriers will improve care for all patients, regardless of their level of health literacy. AHRQ Publication No. 10-0046-EF Current as of April 2010

50. Providers don’t always know which patients have limited health literacy Some patients with limited health literacy: Have completed high school or college Are well spoken Look over written materials and say they understand Hold white collar or health care jobs Function well when not under stress AHRQ Publication No. 10-0046-EF Current as of April 2010