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Patient Advocacy for Healthcare Quality Earp, French, Gilkey

Patient Advocacy for Healthcare Quality Earp, French, Gilkey. Chapter 8 Advocacy and Patient Literacy. What is literacy?.

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Patient Advocacy for Healthcare Quality Earp, French, Gilkey

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  1. Patient Advocacy for Healthcare QualityEarp, French, Gilkey Chapter 8 Advocacy and Patient Literacy

  2. What is literacy? “An individual’s ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential” -- National Literacy Act, 1991

  3. The 2003 National Assessment of Adult Literacy (NAAL) Based on a national sample of over 19,000 adults, the NAAL groups individuals’ literacy into four levels of literacy • Below basic • Basic • Intermediate • Proficient

  4. NAAL Level 1: Below Basic This category describes those with only the “most simple and concrete” abilities. At the very most, adults at this level can pick out information from written text and perform simple addition, such as adding numbers on a bank deposit slip. They may have trouble finding pieces of information or numbers in a lengthy text or finding two or more numbers in a chart and performing a calculation.

  5. NAAL Level 2: Basic Adults at this level can comprehend simple written passages and use numeric information to solve arithmetic problems requiring one step. Skills at this level include using a television guide to find what shows are playing at a particular time or comparing the list price of two products.

  6. NAAL Level 3: Intermediate This level describes adults who can read and understand more complex written passages, pick out numeric information from dense graphs or charts, and draw conclusions about an author’s reason for writing. Those at the intermediate level can, for example, find a point on a map, use reference materials, and total the costs of a catalog order.

  7. NAAL Level 4: Proficient These adults can comprehend more demanding written passages and can think abstractly about the author’s purpose in writing. Skills at this level include the ability to compare two editorial columns and to perform more complex arithmetic such as calculating the price per pound of a certain food.

  8. Prevalence of Low Literacy According to NAAL • 63 million American adults have only basic literacy skills. • Another 30 million have skills below basic literacy. • Low literacy is particularly prevalent among certain populations. Those: • without a high school degree • from certain ethnic and racial minorities • with multiple disabilities • age 65 and over.

  9. What is health literacy? “Health Literacy is a constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment. Patients with adequate health literacy can read, understand, and act on health care information.” --Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, 1999

  10. Low literacy is associated with: • Lower health-related knowledge • Less preventive care • Poorer control of chronic illnesses • Lower adherence to medical regimens • Increased rates of hospitalization • Worse overall health status

  11. The intersection of Literacy in Healthcare • Access to care • Illness management • General information processing

  12. 1. Literacy and Healthcare: Access • Obtaining health insurance • Finding a provider • Knowing when to seek care

  13. 2. Literacy and Healthcare: Illness Management • Acute care management • Chronic care management • Health care transitions

  14. 3. Literacy and Healthcare: General Information Processing • Informed consent • Medical bills

  15. Advocacy Strategies and Tools • Recognize the problem • Assess patients’ literacy levels using tests • Rapid Estimate of Adult Literacy in Medicine (REALM) • Test of Functional Health Literacy in Adults (TOFHLA) • Newest Vital Sign • Distill information and tailor to patients’ needs • Improve readability of documents using literacy formulae • SMOG • Fry • Flesch-Kincaid • Lexile • Employ different media (e.g., audio, video)

  16. Action Steps for Communicating with Patients with Limited Health Literacy • Write the way people talk • Use plain language • Define unfamiliar words • Use simple, specific, and direct sentences • Stay in the active voice • Follow a clear and logical structure when expressing ideas

  17. Action Steps for Communicating with Patients with Limited Health Literacy • Consider the implicit and explicit messages being sent • Be aware of diverse cultural backgrounds • Adapt policies and procedures to accommodate individuals with low literacy • Provide training in health literacy to all health care personnel • Invite people with low literacy to pilot test new programs and educational interventions (adapted from Rudd, 2002)

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