Health Literacy: A New Field with New Opportunities

1. Health Literacy: A New Field with New Opportunities Sabrina Kurtz-Rossi, M.Ed. 2007 Florida Literacy Conference

2. What is 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. Definition of Health Literacy Healthy People 2010 Source: U.S. Department of Health and Human Services, Offices of Disease Prevention and Health Promotion, Healthy People 2010. Washington, DC: U.S. Department of Health and Human Services, 2000.

3. ... a fairly recent movement, gaining momentum • Healthy People 2010 (DHHS 2000) • Prescription to End Confusion (IOM 2004) • Evidence Report/Literacy and Health (AHRQ 2004) • Improving Health Literacy to Protect Patient Safety (Joint Commission 2007)

4. … the coming together of the public health and adult basic education fields. “A new partnership between health and adult education researchers and practitioners can contribute to improved teaching and learning in both fields.” February 2002:Literacy and Health Quote from “A Maturing Partnership” by Rima Rudd in Focus on Basics: Literacy and Health, Volume, 5, Issue C: NCSALL, 2002.

5. Education and Health • Education and income traditional markers of socioeconomic status (SES) • Increase in SES measured by education and/or income improves health status • Increase access to health care • More likely to be insured • Better health outcomes Source: E. Pamuk, et al. Socioeconomic Status and Health Chartbook. Health United States, 1998. Hyattsville, MD: National Center for Health Statistics, 1998.

6. What is Education? More than a ‘marker’ for SES • Last grade completed • Knowledge • Skills – reading, writing, mathematics • Experience • Literacy Learning to read  Reading to Learn  Reading to Act

7. 1992 National Adult Literacy Survey • 40 million adults scored in the lowest of 5 literacy skill levels (most at risk) • 90 million adults scored in the lowest two skill levels Level 4 & 5 18-21% Level 1 21-23% Level 3 33% Level 2 25-28% Source: Kirsch I.S., et al. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey (NALS). U.S. Department of Education, 1993.

8. Readability Studies • Health materials written at reading levels exceeding patient skills(Doak 1980, Meade 1989, Davis 1990, Jackson 1991.) • Readability and usability of Web-based health information(Berland 2001, D’Allesandro 2001.) http://www.nlm.nih.gov/medlineplus/

9. Measuring Health Literacy • Wide Range Achievement Test (WRAT) • Test of Functional Health Literacy in Adults (TOFHLA) • Rapid Estimate of Adult Literacy in Medicine (REALM)

10. Health Literacy Research • Use screening and prevention services(Davis 1996, Bennett 1998, Scott 2002) • Misunderstand how to take medication(Kalickman 1991) • Chronic diseases management(Williams 1998, Schillinger 2002) • Hospitalization rates (Baker 1998, 2002) Source: Berkman ND et al. Literacy and Health Outcomes. Summary, Evidence Report/Technology Assessment: Number 87. January 2004. Agency for Healthcare Research and Quality, Rockville, MD.

11. NAAL 2003 Health Literacy Assessment • The majority of adults have Intermediate heath literacy. • Over 75 million adults combined have Basic and Below Basic health literacy. Number & Percentage of Adults in Each Health Literacy Level Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, 2003 National Assessment of Adult Literacy.

12. Educational Attainment & Health Literacy A higher percentage of adults who had not attended or completed high school had Below Basic health literacy than adults with higher levels of education. Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, 2003 National Assessment of Adult Literacy.

13. Health Literacy Initiatives • Developing easy-to-read materials • Training doctors and other providers • Helping patients navigate the system • Increasing cultural competence • Creating shame free environments

14. AMA Foundation Health Literacy Health Literacy Tool Kits and Training Videoshttp://www.ama-assn.org/ama/pub/category/8115.html

15. Signs That Work Hablamos Juntos Universal Symbols for Health Care http://www.hablamosjuntos.org/signage/default.index.asp

16. Ask Me 3 • Partnership for Clear Health Communication http://www.askme3.org/PFCHC/ • Promotes three simple questions • What is my main problem? • What do I need to do? • Why is it important for me to do this?

17. Literacy and Health Initiatives • Develop and teach health literacy curricula • Form a student health team and take action • Support teacher training and development • Partner with local health agencies Literacy class in Hillsborough County Florida working on a breast and cervical cancer health literacy project http://healthliteracy.worlded.org/heal/

18. Health Education and Adult Literacy: Breast and Cervical Cancer (HEAL:BCC) Curriculum and Teacher Support Developed by World Education with support from the Centers for Disease Control and Prevention (CDC)

19. Health & Literacy Special Collection www.healthliteracy.worlded.org

20. Easy-to-Read Health Information www.nlm.nih.gov/medlineplus/tutorial.html

21. Health Information in languages other than English http://medlineplus.gov/spanish/

22. Family Health and Literacy www.healthliteracy.worlded.org/docs/family/index.htm

23. Lessons Learned • Support for teachers is critical to successful implementation of a health literacy program • ESOL classes are particularly drawn to health content • Health literacy curriculum must draw upon learner experiences and be easily adapted to different class levels and needs

24. Lessons Learned • Health provides real-life content positively impacts learner persistence • Partnering with local health agencies facilitates needed access to health information and services • Engaging in health literacy brings new opportunities for teacher development and funding