When Words Get in the Way:

A Collaborative Plan to Address Health Literacy in San Diego

County

Community Health Improvement Partners

The San Diego Council on Literacy

The Community Health Improvement Partners (CHIP) is a collaboration of San Diego health care systems, hospitals, community clinics, insurers, physicians, universities, community based organizations and the County of San Diego who are dedicated to a common vision.

• Vision

The leading countywide health partnership advancing the wellbeing of all San Diegans

• Mission

Improving the health of all San Diegans through needs assessment, advocacy, education, and programs best accomplished collectively

As a public-private collaborative dedicated to community health improvement, CHIP values:

• COLLABORATION: Where we can make a difference

• RESPECT: Recognition of each member’s perspective

• NEUTRALITY: A safe place to collaborate

• INNOVATION: A forum for critical thought

• EFFICIENCY: Wise use of resources

• CREDIBILITY: A reliable source

*Formed in 1995, CHIP is organized under the auspices of the Hospital Association of San Diego and Imperial Counties

Project Background

GOAL: Develop a collaborative health literacy plan for San Diego County.

Report findings and recommendations are based on an in-depth review of published literacy and health literacy research and focus groups with low literate adults, promotoras, medical front office staff and physicians.

Report Available At: http://www.sdchip.org/publications/pub_pdfs/HealthLiteracyReport_FINAL.pdf

Pioneering

Community Health Improvement Partners and the San Diego Council on Literacy successfully merged the health care and literacy fields in ways that will result in improved health for those in San Diego County whom are affected by low health literacy.

This is a one of kind partnership among two fields, that based on our research, does not exist anywhere else in the U.S.

What is health literacy?

From the Institute of Medicine’s book, “Health Literacy: A Prescription to End Confusion:”

A two-year-old is diagnosed with an inner ear infection and prescribed an antibiotic. Her mother understands that her daughter should take the prescribed medication twice a day. After carefully studying the label on the bottle and deciding that it doesn’t tell how to take the medicine, she fills a teaspoon and pours the antibiotic into her daughter’s painful ear (Parker et al., 2003).

What is health literacy?

US Department of Health and Human Services Defines Health Literacy as:

The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.

What is health literacy?

The Institute of Medicine (IOM) adds:

In addition to reading skills, health literacy also includes writing, listening, speaking, arithmetic, and conceptual knowledge.

The IOM also presents a different conceptual framework that shares the responsibility for health literacy on both the individual and healthcare systems.

What are the consequences of low health literacy?

Patients with low health literacy often fail to seek preventive care.

Average longer hospital days.

Are less likely to comply with prescribed treatment and self-care regimens.

“The nurses told me to take the elevator and go to where it says ‘x-rays.’ I took the elevator and I just went home because I couldn’t read the signs. It’s a scary thing when you don’t know the words.”

--Enrique

Who is at Risk?

Native-born English speaking adults who read below the eighth grade level.

Non-English speaking and limited-English speaking adults.

Seniors, typically persons age 65 and over.

There are three specific groups of patients who are at significant risk for health-related problems due to low health literacy:

Health Literacy in the U.S.

Others impacted by low health literacy include:

Health Literacy LevelThose most impacted by low health literacy

Source: 2003 National Assessment of Adult Literacy (NAAL)

Chart 7

Percent of adult population in each demographic category below basic health literacy

Recommendations

Are the outcome of the literature review, asset mapping, focus groups and input from the advisory committee.

Address the multifaceted nature of health literacy and of the literacy and healthcare fields.

Recommendation One

Taskforce

Establish a joint taskforce of literacy and healthcare professionals to champion the awareness of health literacy in the San Diego community.

The taskforce will oversee the implementation of this plan and monitor its progress.

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Recommendation Two

Curricula

Identify and/or create health literacy curricula for inclusion in adult literacy courses and healthcare settings.

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Recommendation Three

Website

Create a SDCOL and CHIP sponsored website that would include resources and

referrals for adult literacy and healthcare professionals.

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Recommendation Four

Training

Develop methods, tools, and policies to help medical organizations train front and back office staff to deal more effectively with low literacy and low health literacy adults.

This would be a collaborative effort between literacy professionals and medical office and front-line hospital staff.

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Recommendation Five Awareness/Education

Increase awareness of low literacy and low health literacy issues within the healthcare community through development of articles for organization publications, continuing medical education courses and more.

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Recommendation Six

Volunteers Develop and implement a pilot program

utilizing trained volunteers on-site in the healthcare setting to work as advocates for low literate patients.

This would also be a collaborative effort between the literacy and healthcare fields.

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Recommendation Seven

Marketing

Create a marketing campaign

a. Create a campaign logo and slogan

b. Create an implementation plan

c. Define the audience

d. Promote programs such as Ask Me 3, the

Teach Back Method, Health Literacy Month…

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Recommendation Eight

Sharing Forums

Implement health literacy sharing forums. These sharing forums will include the following:

a. Healthcare professionals (i.e. physicians, nurses, administrators, office staff, paraprofessionals)

b. Adult learners

c. Adult literacy practitioners (program coordinators, classroom teachers, administrators, volunteer tutors)

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Recommendation Nine

Multimedia

Investigate the inclusion of multimedia formats to improve the health literacy of San Diego County adults.

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Opportunities

Health Literacy Curriculum Develop health literacy curricula to teach low

literate adults in literacy programs, senior centers, community clinics, and other organizations how to navigate the healthcare system, learn health-related vocabulary, fill out forms, ask questions of healthcare providers, and advocate for themselves.

www.healthliteracynetwork.org/curriculum

Opportunities

Health Literacy Website Post patient materials in various languages; Provide resources for professionals;

Opportunities

B-4: Boo-Boos, Belly Aches and Bumps BEFORE You Go to the Doctor

CHIP developed train the trainer program

http://www.sdchip.org/B-4/index.html

Resources http://rhin.org/ http://hrsa.gov/healthliteracy/training.htm http://www.211sandiego.org If you need help with your reading/writing/math skills, or

are interested in becoming a volunteer tutor, please call our hotline at 1-888-850-READ (7323)

Contact InformationCommunity Health Improvement Partners (CHIP)Shreya Sasaki, M.P.H.Senior Manager, Policy & Programs5575 Ruffin Road, Suite 225San Diego, CA 92123Tel: 858-614-1554 Fax: 858-614-0230www.sdchip.orgssaski@hasdic.org

The San Diego Council on LiteracyChris McFadden Manager of Program Services2515 Camino del Rio South, Suite 125San Diego, CA 92108Tel: 619-574-1641Fax: 619-491-9242www.literacysandiego.orgcmcfadden@literacysandiego.org