Addressing Health Literacy at State Health Departments

1. Addressing Health Literacy at State Health Departments September 25, 2013 Presented by: Genelle Lamont, MPH DHPE Fellow

2. Objectives • Describe health literacy within a public health context. • Relay the importance of addressing health literacy in public health. • List strategies for starting a health literacy initiative at a state department of health.

3. Health Literacy… “is 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.” -National Academies of Sciences, Institute of Medicine (2004)

4. The Calgary Charter Find Understand Evaluate Communicate USE Health Literacy Domains (Zarcadoolas, 2005) Fundamental: reading, writing & numeracy Scientific: science and technology Cultural: customs and cultural beliefs Civic: enabling citizens to become involved

5. Medicaid Letter The law cited below [not included here] requires that all conditions of eligibility must be verified at each redetermination of eligibility unless the verification is pending from a third party and the recipient has cooperated in obtaining the verification. Since you have not provided the necessary verification or you have failed to cooperate in obtaining verification from a third party, your cash and/or medical assistance must be stopped.

6. Antibiotic Resistance Print Ad Source: United Health Foundation (2003) as seen on page 47 of Zarcadoolas C; Pleasant AF; and Greer DS (Eds). Advancing Health Literacy: A Framework for Understanding and Action. Jossey-Boss Publications; San Francisco, CA: 2006.

7. …But what about examples that ARE health literate? Contact: Don McCormick, Public Information Officer, Iowa Department of Public Health www.idph.state.ia.us/PlainAndSimple/Default.aspx

8. Barriers to Health Literacy Complexity of written health information in print/web. Lack of health information in languages other than English and inadequate translations. Lack of cultural appropriateness of health information. Inaccuracy or incompleteness of information in mass media. Low-level reading abilities, especially among undereducated, elderly and some segments of ethnic minority populations. Lack of empowering content that targets behavior change as well as direct information (social marketing strategies). Source: Zarcadoolas, Pleasant and Greer (2006)

9. U.S. Adult Health Literacy 88% of American adults do not have proficient health literacy skills needed to make important individual and family health choices. Source: National Center for Education Statistics (2006). The Health Literacy of America’s Adults: Results from the 2003 National Assessment Of Adult Literacy. Washington, DC: U.S. Department of Education.

10. Risk Factors for Low Health Literacy • Older adults (65+ years) • Limited English Proficiency (LEP) • Socioeconomically disadvantaged • Lower educational attainment • Lower income level • Higher percent minorities • Medicare/Medicaid recipients or uninsured • Chronic and severe health conditions

11. Health Literacy: A Social Determinant of Health • “Adults with limited health literacy have less knowledge of disease management, report poorer health status, and are less likely to seek preventative care.” (IOM, 2004) • “Low health literacy costs the U.S. healthcare industry $73 billion per year in misdirected or misunderstood healthcare services (Vernon, 2009; Friedland, 1998; Howard, 2005) • Public health has ethical and legal obligation to promote health literacy (Gazmararian et al. 2005)

12. 2013 CHP Health Literacy Workshop Purpose: Create a public health workforce at MDH fluent in health literacy principles and best practices.

13. Methodology • Conducted comprehensive literature review • Developed workshop learning objectives and content • Arranged guest speakers, facilitators and panelists • Arranged workshop venue and catering service • Advertisements and invitations sent via MDH Intranet and MS Outlook Calendars • Assessed participant learning needs for break-out group activity: CDC Training Module and Simply Put Checklist • Created Participant Workshop and Resources Packet

14. Resources Participants received • Welcome letter • Agenda • Learning objectives • Speaker bios • Presentation slides • Directory of resources • MDH Communication policies/resources • Panel questions • Copies of pre-workshop assignment

15. Agenda • Health literacy overview • Using health behavior theory to target, design, and evaluate health messages • Implementing health literacy in a state public health department • Video Screening: Say It Visually! • Break-out group activity • Panel Discussion: communicating with a diverse audience • Wrap-up

16. Evaluation Results (51 of 85 attendees)

17. Lessons Learned • Health literacy curriculum for health departments needs to include application of health literacy and numeracy principles and best practices. • Curriculum should also include related topics such as health equity and SDH, health behavior and marketing models, risk communication, and cultural competency. • Emphasize data collection on target audience, including demographic data, focus groups and work on previous programs.

18. Lessons Learned (Contin…) 4. Utilizing internal and external resources (e.g. graphic designer, marketing consultants, website developer, communications department and community partners. 5. Use of education design specialists, to apply adult learning theory to the curriculum. 6. Evaluate curriculum.

19. What State Health Departments Can Do • Identify leadership and staff with interest • Become local experts in health literacy • Build and strengthen relationships with internal and external partners • Conduct an agency health literacy assessment • Create an agency health literacy plan • Identify health literacy resources and guides for staff • Provide opportunities for staff to be trained in health literacy principals and best practices • Build health literacy into staff competencies and performance measures • Evaluation

20. Acknowledgements Directors of Health Promotion & Education • Steve Owens, Director of Health Equity • Karen Thompkins, Internship & Fellowship Manager • Liz Traore, Evaluation & Epidemiology Manager • Cheryl Welbeck, Executive Assistant Minnesota Department of Health • Mary Manning, Promotion & Chronic Disease (HPCD) Director • Jose Gonzalez, Office of Minority & Multicultural Health (OMMH) Director • Jim Peacock, Epidemiologist Senior Heart Disease & Stroke Prevention Center for Health Promotion Leadership • Don Bishop, Director • Charity Kreider, Oral Health Program Coordinator • Mark Kinde, Injury & Violence Prevention Supervisor • Stan Shanedling, Heart Disease & Stroke Prevention Supervisor • Gretchen Taylor, Diabetes Program Supervisor • Merry Jo Thoele, Oral Health Program Supervisor

21. Questions

22. Genelle Lamont genelle.lamont@state.mn.us glamont1@umn.edu Don Bishop don.bishop@state.mn.us Charity Kreider charity.kreider@state.mn.uswww.health.state.mn.us/divs/hpcd/chp/