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Transcript of Health Literacy Its importance to you Michelle Burda, MLS [email protected] (412) 624-1589 Network and...
Health Literacy Its importance to you
Michelle Burda, MLS
[email protected] (412) 624-1589
Network and Advocacy Coordinator
National Network of Libraries of Medicine
Middle Atlantic Region
Developed by NN/LM staff.
This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N-276-2011-00003-C with the University of Pittsburgh-Health Sciences Library System.
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
Agenda
#1 Raise Awareness
Define the meaning of health literacy
Identify the various types of literacy
Recognize the impact health literacy plays in healthcare
Examples to raise awareness
Affordable Care Act
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Objectives:At the end of the presentation you will be able to:
Recognize the affects health literacy has on health outcomes
Identify the “red flags” that signal a patient may have low literacy
Identify techniques to improve patient-provider communication skills
Recognize why health literacy is important in managing chronic illness
List sources of where you can find additional literacy tools and materials
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Literacy skills are a stronger predictor of health status than: Age Income Employment status Education level Race or Ethnic group
Weiss, BD. Health Literacy: A Manual for Clinicians. AMA 2003 p.7.
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
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 care decisions.”*
*Ratzan, S., and R. Parker. (2000); Healthy People 2010 and Healthy People 2020
Health Literacy = finding, understanding, evaluating, communicating, and using information to make decisions.* Applies to both public and health professionals
*Calgary Charter on Health Literacy
It is an emerging public health issue that effects all ages, race and income levels*.*National Patient Safety Foundation
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Created by Michelle Burda, M
LS, National N
etwork Libr
aries of Medicine, M
iddle Atlantic Region
THE LITERACY PROBLEM
National Assessment of Adult Literacy (NAAL)http://nces.ed.gov/NAAL
Conducted in 2003
More than 19,000 adults >16yr. One-on-one administration
Goal: assess literacy in English
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Results of NAAL: Literacy Statistics
Functionally illiterate = 23% of adults
Marginal literacy skills = 28% of adults
Proficient = Only 13% of adults
66% of adults over age 60 have inadequate or marginal literacy skills
Average reading level in the U.S. is 8th grade; 20% read at 5th grade level or below
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
What this means
Below basic Basic Intermediate Proficient
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Three Types of Literacy
Prose Document Quantitative
Requires ability to search, comprehend, and use continuous text
Non-continuous textRequires ability to search, comprehend, & use information
Requires ability to identify & perform computations, using numbers within printed materials
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Prose LiteracyExample of a surgical consent form
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Document Literacy - NALS
Quantitative Literacy
Requires ability to identify and perform computations, using numbers within printed materials.
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Differences between good and poor readers
Skilled Readers Poor Readers Managing the Problem
Interpret meaning Take words literally Explain the meaning
Read with fluency Read slowly – miss meaning
Use common words give appropriate ex.
Get help for uncommon word
Skip over words Use examples, review
Grasp the content Miss the content Explain content, use visuals
Persistent Reader Tire quickly Short segments, easy clear layout
Teaching Patients with Low Literacy Skills 2nd ed. by Doak, Doak, & Root, 1996
Factors affecting learning ability Stress
Illness
Age
Cultural Barriers
Language Barriers
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
What it is like to be a patient who doesn’t understand*?
*AMA Foundation Health Literacy Help Patients Understand 2nd ed. 2007
(short version)www.amafoundation.org/go/healthliteracyt Version
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
TESTING FOR READABILITY
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
Overview
MethodWord countSyllables Sentence length
Readability of MaterialsFry SMOG
Patient Literacy (REALM, TOFHLA, Newest Vital Sign) Computer software (HeaLth Literacy Advisor)
SMOG
Simple Measure Of Gobbledygook
1. Count off 10 sentences near the beginning, 10 in the middle and 10 at the end of text.
2. Circle every word containing 3 or more syllables and total the number of words circled
3. Estimate the square root of the total number of words counted
4. Add three to the square root.
SMOG grade = 3 + Square Root of Polysyllable Count
http://www.readabilityformulas.com/smog-readability-formula.php
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
REALMRapid Estimate of Adult Literacy in Medicine
Asks patients to pronounce 66 words ranging from “fat” to “impetigo”
Test provides grade level scores for people who read below a ninth grade level
May be better suited for research
Realm SF – Formhttp://www.lsuhscshreveport.edu/HealthLiteracy/HealthLiteracyInfoFAQ.aspx Terry C. Davis, Ph.D.
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
What is the Newest Vital Sign? Also know as NVS
New tool for rapid assessment of health literacy skills
First published Dec. 2005 Annals of Family Medicine Quick Assessment of Literacy in Primary Care: The Newest Vital Sign by Barry D. Weiss, MD. Professor of family and community medicine at University of Arizona College of Medicine
3 minute assessment- Ice cream label
English & SpanishCreated by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Newest Vital Sign
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Interpretation of Scores Number of correct answers
Score : 0-1 suggest likelihood (50% or more ) of limited literacy
Score: 2-3 indicated the possibility of limited literacy
Score: 4-6 almost always indicates adequate literacy
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Functional Health Literacy
“The ability to read and comprehend prescription bottles, appointment slips, and the other essential health related materials required to successfully function as a patient”*
*AMA Council of Scientific AffairsCreated by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Task: Appointment Slip
Locate information in a simple document. When is your next appointment? Where?
CLINIC APPOINTMENT
CLINIC: Diabetic
DAY: Thursday DATE: April 2nd HOUR: 6:45
YOU MUST BRING YOUR PLASTIC CARD WITH YOU
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Task: Prescription Label
Applying information in a document If you were going to eat lunch at noon, what time
should you take your medicine?
Bouvier, Patricia
FF9418262 Dr. Hibbert, Julius
DOXYCYCLINE 100 MG
Take medication on empty stomach one hour before or two to three hours after a meal unless otherwise directed by your doctor.
Medication Safety and Health LiteracyOnly about 50% of patients take meds as directed
What’s “plenty” of water?
“Take twice a day
“Don’t take medicine if you’ve been in the sun too long.”
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Dosage using a spoon Kitchen spoons
Medication dispensing spoons
Reading a thermometer
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Medical studies indicate most people suffer a 68% hearing loss when naked.
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
And, furthermore…
Up to 80% of patients forget what a doctor told them as soon as they leave the office!
Nearly 50% of what they do remember is remembered incorrectly!
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
Improving Oral Communication
Communication is two-way
Use “teach back” instructions
Avoid medical jargon
Use commonly understood words
Limit information
Include visual aids- models, pictograms,
Videos
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Invite questionsWe usually say – Do you have any questions? Better to say: What questions do you have?Implies you are expecting questions. Or…. Let me answer any questions you may have.
Assess understandingIf we ask - Do you understand? Easy to say yes.We are implying the patient understands or should understand what we just said to them. Better to use “teach back” techniquehttp://www.youtube.com/watch?v=_Vo9Q_EfBX8
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Summary Assess patients’ needs
Focus on 1-3 key “need-to-know” items
Use “plain language”
Use visual aids
Ask ”what questions do you have”
Use “teach back” to validate understandinghttp://healthliteracymn.org/sites/default/files/images/files/Teach-Back%20Program%20Guide.pdf
INTERNET RESOURCES
Tools and Resources
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
TOOLS & RESOURCES Health Literacy Universal Precautions Toolkit Plain Language Teach Back
NLM Resources MedlinePlus SeniorHealth DailyMed
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
http://medlineplus.gov
Easy-to-Read materials
Medical DictionaryUnderstanding Medical Words tutorial
Interactive tutorials
How to write easy-to-read materials: http://www.nlm.nih.gov/medlineplus/etr.html
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
HIV/AIDS INFORMATIONHTTP://AIDS.NLM.NIH.GOV/INDEX.PHP
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
http://nihseniorhealth.gov/
Developed with the National Institute on Aging Senior-friendly features:
Text SizeContrastShort segments of information
Created by Michelle Burda, M
LS, N
ational Netw
ork Libraries of M
edicine, Middle Atlantic Region
NLM Mobile http://www.nlm.nih.gov/mobile/
MyMedList
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
PLAIN ENGLISH/PLAIN LANGUAGEhttp://www.plainlanguage.gov
Promote the use of plain language for all government communications
Examples, word suggestions, thesaurus
Separate section for health literacy
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
Health Literacy Universal Precautions Toolkithttp://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/ Experts recommend assuming everyone may have difficulty
understanding Systems are needed to be in place to promote better
understanding not only to those we think may need help Promoting health literacy improves health outcomes Areas that are important to address
Improve spoken communication Improve written communication Improve self-management & empowerment Improve supportive systems Tools to address these areas are included in the toolkit
KEY PLAYERS Partnership for Clear Health Communication/AskMe3
Initiative http://www.npsf.org/askme3/ Centers for Disease Control and Prevention – Simply Put
http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf
U.S. Department of Health & Human Services, Office of Disease Prevention and Health Promotion http://www.health.gov/communication/literacy
“Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites” (U.S. Dept. HHS)http://www.health.gov/healthliteracyonline/index.htm
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
MORE KEY PLAYERS Hablamos Juntos – “Universal Symbols in Health Care
Workbook”http://www.rwjf.org/pr/product.jsp?id=15864
Clear Health Communications (Pfizer) http://www.pfizerhealthliteracy.com/
Health Literacy Consultinghttp://www.healthliteracy.com
Agency for Healthcare Research and Quality (AHRQ)http://www.ahrq.gov/browse/hlitix.htm
National Center for the Study of Adult Learning & Literacy ( end federal funding 2007 but all resources are online-training, teaching materials etc. http://www.ncsall.net/index.html@id=1.html
Created by Michelle Burda, M
LS, National N
etwork
Libraries of Medicine, M
iddle Atlantic Region
HTTP://NNLM.GOV/BHIC/Created by M
ichelle Burda, MLS, N
ational N
etwork Libraries of M
edicine, Middle Atlantic
Region
Future of Healthcare
What does this mean to you? You will need to review the design of outreach
campaigns, eligibility documents and forms
People without PCs or the internet will need a private alternative for accessing their healthcare records
There will be a need for non-web-based access
There will be a need for educational and outreach in developing skills in the areas of computer research, choosing and comparing cost of services, insurance benefits
Culturally appropriate
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
From: Health Coverage Under the Affordable Care ActJAMA. 2012;308(24):2556-2556. doi:10.1001/jama.2012.128713
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Explaining deductible Complicated & technical If you can’t substitute a plain language word or phrase we must
explain what it means by example: What is a deductible?Your deductible is the amount of money you have to pay for your health care before your health insurance plan will start to pay for medical services. In other words, your health insurance plan “kicks in” only after you’ve paid the amount of your deductible out of your own pocket.
For example: Your health plan has a deductible of $1,000. That means that you need to spend $1,000 of your own money on health care before your health insurance plan will start to pay for things.
http://communicatehealth.com/ideas/we-heart-health-literacy/
10 120
10 Attributes of a Health Literate Organization
About the Middle Atlantic Region (MAR)http://nnlm.gov/mar/
The University of Pittsburgh Health Sciences Library System (HSLS) serves as the Regional Medical Library (RML) for the National Network of Libraries of Medicine, Middle Atlantic Region (NN/LM, MAR) under a 5-year contract with the National Library of Medicine. The MAR is one of eight regions in the National Network of Libraries of Medicine (NN/LM) and includes Delaware, New Jersey, New York and Pennsylvania.
Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region
Our outreach efforts are directed toward libraries, health professionals and consumers. Throughout the 2011-2016 contract, our role is to develop, fund and manage a variety of outreach awards that support programs to:
Promote the changing role of librarians within their institutions and communities
Provide access to biomedical information to unaffiliated health professionals, including behavioral and mental health professionals, the public health workforce, minority health workers and rural, underserved hospitals
Improve health through access to reliable information for consumer groups, including soldiers, veterans and their families, senior citizens, caregivers, K-12 schools, community-based and faith-based organizations