Health Literacy

1. Health Literacy Asilomar 2009 September 13 – 16, 2009 Mary Annese, M.P.A. Adapted in part from: Advancing Clear HealthCommunicationto Positively Impact Health Outcomes (www.npsf.org/askme3/PCHC/professional_presentation.ppt)

2. Learning Goals • Define health literacy • Discuss impact of low literacy on health outcomes • Identify health literacy needs in own setting • Develop a plan to address health literacy needs in own setting

3. Presentation Sections • Definition of Health Literacy • Low Health Literacy • Finding a Solution • Clear Communication and Clinical Practice

4. What Critical Public Health Issue • Impacts 1:3 people living in the U.S.? • Does not discriminate? • Costs $58 billion a year? • Can’t be diagnosed or observed?

5. The Answer! Low Health Literacy

6. Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Preamble to the Constitution of the World Health Organization (1948)

7. Literacy Literacy is the ability to read, speak, write, and use math skills that enable one to successfully function at certain levels of society.

8. Functional Illiteracy Functional illiteracy is the inability of an individual to use reading, speaking, writing, and math skills to effectively perform fundamental tasks in everyday life situations - even in his own cultural and linguistic environment.

9. Effects of Functional Illiteracy • People who are functionally illiterate are subjected to: • Social intimidation • Health risks • Stress • Low income

10. How Big is the Problem?

11. This Big! • 40 – 44 million adults are functionally illiterate • 50 million adults are marginally illiterate • Average reading skills of adults are between 8th and 9th grade levels

12. National Adult Literacy Survey

13. National Adult Literacy Survey

14. National Adult Literacy Survey

15. The Problem:Low Health Literacy Scope and Impact

16. 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.

17. And So Much More ….

18. Nac Stneitap Dnatsrednu? Can patients understand the materials and information needed for their health? 90 Million U.S. Adults Have Problems

20. High Risk for Low Health Literacy • Elderly • Racial/ethnic minority populations • Arriving in the United States after Age 12 • Unemployed and Underemployed • Less than a high school education

21. Largest Study to Date Found: 33% Were unable to read basic health care materials 42% Could not comprehend directions for taking medication on an empty stomach 26% Were unable to understand information on an appointment slip 43% Did not understand the rights and responsibilities section of a Medicaid application 60% Did not understand a standard informed consent

22. Low Health Literacy Results In: • Less compliance • Lowered adherence • Increased medication errors • More and longer hospitalizations • Less preventive care • Inability to negotiate the healthcare system

23. Effects of Low Health Literacy • Poor health outcomes • Underutilization of prevention services • Overutilization of emergency services • Unnecessary healthcare expenditures • Limited treatment effectiveness • Needless patient suffering

24. The Practical Solution: Clear Health Communication

25. Literacy and Provider Communication Health providers sometimes or never listen carefully, explain things, show respect, or spend enough time if: • You are • Asian • American Indian • Hispanic (regardless of race) • Have a family income less than 400% FPL • Have a chronic disease 2005 National Healthcare Disparities Report, Agency for Healthcare Research and Quality

26. Promoting Clear Communication

27. For Patients • Health information can be confusing at times • Everyone wants help with health information • Asking questions helps patients understand how to prevent or manage illness Patients Should Not Be Anxious About Asking Their Health Care Provider Questions!

28. For Providers Health Care Providers Want Patients to Know: • All they can about their condition/medication • Why this advice/treatment is important for good health • Steps to take to prevent a condition or keep it under control Patient Provider

29. Provides a consistent approach to patient-provider dialogue • Allows patients to get information they need to manage their health • Time-efficient for providers to reinforce healthcare instructions Ask Me 3 – Creates Shared Responsibility for Clear Health Communication Patient Provider De-stigmatize andReduce Embarrassmentof Low Health Literacy RecognizePatient Coping Mechanisms

30. Promotes three simple, but essential, questions and answers for every healthcare interaction: What Is My Main Problem? • Why Is It Important for Me to Do This? What Do I Need to Do? Diagnosis Treatment Context What Is Ask Me 3

31. Even if you are not in a position to directly answer the three questions, keep clear health communicationin mind and in your dialogue when communicating with patients Many people have trouble understanding medical terms. Often, these terms are better understood when explained with common words, an example or visual interpretation Clear Health Communication– We Can All Be a Part of the Solution

32. Six steps to improving patient understanding Limit the amount of information provided at each visit Slow down Avoid medical jargon Use pictures or models to explain important concepts Assure understanding with the “show-me” technique Encourage patients to ask questions What Can Providers Do?

33. What Else Can Providers Do? People Have Difficulty Making Appointments Appointment InstructionsAlso see: Urgent Care (if you are too sick to wait for an appointment)Making a medical appointment for the first time, it is straightforward: You call 555-2222 and make a appointment at XYZ Health Services just like you would at any doctor's office. You can request a specific clinician if you have someone in mind, or you can explain your need or problem to the appointment counselor, and he or she will schedule you with an appropriate clinician at the earliest possible date. At your first appointment you will receive a medical record card -- often referred to as your "gold card" -- which you will keep and use as your XYZ Health Services identification.  If you are unsure about whether you should make an appointment, you may call the Advice Nurse at 666-7777. Also, in advance of your first appointment, be sure to read "How to Make the Most of Your XYZ Visit." Please call 643-7177 to make an appointment in the Specialty Clinics, including Allergy & Travel. Specialty appointments require a referral. You may also drop by the Appointment Office to make a medical appointment. The Appointment Office is located on the first floor in Room 1111. You may also make an appointment in the Specialty Clinics by going to the Specialty Clinic reception desk, located behind the elevators on the first floor. If you need to cancel an appointment, please call our 24-hour cancellation line at 643-7033. Please note that you will be billed for a broken appointment fee if you do not show up for your appointment and have not called to cancel it. • When making an appointment, provide people with simple options and clear facts Your Name Your Appointment Date Time Place Our Telephone Number: Do not eat or drink for 6 hours before the day and time on this card.

34. What Else Can Providers Do? People Have Trouble Understanding Phone Recordings • Phone answered by a tape recording. Speaking quickly, the caller is offered numerous options and alternatives • Speak slowly and clearly • Provide an easy way to connect with a live person • Provide options in other languages

35. Ambulatory Entrance Ambulatory Entrance Hospital XYZ What Else Can You Do? People Have Trouble Reading Signs • Some people become confused about whether this entry was intended for ambulances or for patients • The use of visuals clarify the message • Contrast in color makes it easy to read • Try to be consistent when hanging signs

36. What Can Providers Do? People Have Trouble Understanding Maps Maps are usually hard to follow: • Too complicated • Codes are hard to understand • Names and directions not always match • Small fonts To make maps easier to follow: • Match the color in the map with the paint color on walls or floors • Match the names in the map to the names on the signs • Use 14 point font size or larger

37. Patients who understand health care information may: Be more compliant with instructions and medications Call back less often Visit less often Have fewer hospitalizations Have better health outcomes Have increased patient satisfaction How Can Enhanced Communication With Patients Benefit Provider Practice? Greater Provider Satisfaction

38. National Assessment of Adult Literacy http://nces.ed.gov/pubs2009/2009481.pdf Agency for Healthcare Research and Quality http://www.ahrq.gov/clinic/epcsums/litsum.pdf American Medical Association Health Literacy Program http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/health-literacy-program/health-literacy-news.shtml HP2010 – Health Communication Objective (Goal 11.0, Objectives 11.1 – 11.6) Resources

39. Resources (continued) U.S. DHHS/Office of Disease Prevention and Health Promotion: Health Literacy Improvement http://www.health.gov:80/communication/literacy/default.htm AMA/Health Literacy Resources Health Literacy Kit $35.00 AMA Bookstore On-line http://www.ama-assn.org/ama/no-index/about-ama/9913.shtml Join the Partnership for Clear Health Communication. Sign up as a member at www.AskMe3.org Adopt the Action Agenda within your own work