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Health Literacy: From Discussion to Action May 2012

Health Literacy: From Discussion to Action May 2012. Rima E. Rudd, Sc.D. Harvard School of Public Health Boston, Massachusetts USA. Kia Ora. With gratitude. Down Under Explorations New Zealand Journey Partnership Developments. Literacy. Core components Reading Writing Speaking

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Health Literacy: From Discussion to Action May 2012

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  1. Health Literacy:From Discussion to ActionMay 2012 Rima E. Rudd, Sc.D. Harvard School of Public Health Boston, Massachusetts USA

  2. Kia Ora With gratitude • Down Under Explorations • New Zealand Journey • Partnership Developments

  3. Literacy Core components • Reading • Writing • Speaking • Listening • Calculating [math, math concepts] Social Meaning • Identity • Dignity • Inclusion & participation • Civic • Economic • Cultural • Intellectual Dr. Rima E. Rudd - May 2012 3

  4. Pedagogy: Paulo Freire Naming and Owning the World The word is not the privilege of some few men, but the right of every man Pedagogy of the Oppressed, 1967 Dr. Rima E. Rudd - May 2012 4

  5. Literacy in Industrialized Societies Literacy influences one’s ability to access information and to navigate the highly literate environments of modern society Dr. Rima E. Rudd - May 2012 5

  6. Literacy and Social Factors People with high literacy skills are more likely to • Be employed • Have access to resources/wealth • Have at least high school education • Hold majority status • Live in geographically accessible and developed areas • Use libraries, read newspapers, vote [Rudd, Kirsch, Yamamoto, 2004] Dr. Rima E. Rudd - May 2012 6

  7. Health Literacy • A new field of inquiry • Starting point • Publication and dissemination of findings in 1990s: Literacy skills of adults • Question: What are the implications for health? Dr. Rima E. Rudd - May 2012 7

  8. Literacy & Health:Research Findings Literacy is linked to: • Information / Knowledge • Health care navigation • Participation in health promotion • Participation in disease prevention • Management of chronic diseases • Morbidity & Mortality IOM, 2004 ETS, 2004 AHRQ 2004, 2011 Dr. Rima E. Rudd - May 2012 8

  9. Research Studies: Health Outcomes Key Finding: Patients with limited reading skills have poorer health outcomes • Less likely to engage in screening & preventive action • Less likely to have chronic disease under control • Less likely to advocate for themselves • More likely to be hospitalized • More likely to report poor health • More likely to die earlier Conclusion: Significant differences in health outcomes based on patients’ reading skills Dr. Rima E. Rudd - May 2012 9

  10. Analysis: Missing Perspective Health literacy studies has kept its eye on the patient BUT: Literacy is contextual For example: Reader & Text Speaker & Listener Dr. Rima E. Rudd - May 2012

  11. Health Literacy and the Focus of Attention Recommended Action for Individuals & Communities: Participate Find Comprehend Evaluate Use Determine Who carries the burden of change? Dr. Rima E. Rudd - May 2012 11

  12. Refocus Health Care Public Health Demands Expectations Processes Culture Professional skills: Roles Language Skills Processes Commercial Sector Civil Society Dr. Rima E. Rudd - May 2012 12

  13. Health Literacy: Application of skills in health contexts for health tasks Health Literacy is an interaction between skills of individuals and the demands of health systems IOM Committee on Health Literacy, April 2004 Dr. Rima E. Rudd - May 2012 13

  14. Consider the Demands of the Health Sector World wide, we see an increased demand from complex health care systems & increased responsibility for individuals interacting with health care systems Adult Literacy and Lifeskills Surveys 2003 Dr. Rima E. Rudd - May 2012 14

  15. Consider Literacy Demands in Health Settings Dr. Rima E. Rudd - May 2012

  16. Reading Consider the quality of health materials: • Explanations • Directions • Instructions 16

  17. Writing Consider expectations & materials provided • Questionnaires & survey instruments • Forms • Consent & other legal documents 17

  18. Oral Exchange • Listening: Consider the speech & language of a wide variety of health professionals • Speaking: Consider what people are asked to describe and present. • Question asking: Consider power & efficacy 18

  19. Math Consider: • Needed calculations • The variety of tools provided • The words/concepts often unexplained • Range • Normal • Probability & Likelihood • Risk 19

  20. Characteristics of Health Systems Culture of science & medicine Language of specialized professional groups Perspective based on science & medicine Hierarchies within and among professional groups Patterned behaviors reflecting bureaucratic needs Accepted processes for history taking, diagnosis, tests, procedures, care, consent… Complexity of procedures, processes, institutions Expectations related to knowledge and appropriate behaviors Dr. Rima E. Rudd - May 2012 20

  21. Interaction Individual Factors Literacy & numeracy skills Language skills Emotional state Health status Experience Background knowledge Health Sector Factors Communication skills of professionals Institutional characteristics Procedures & processes Materials in use Assumptions Dr. Rima E. Rudd - May 2012 21

  22. What Happens When Words Get in the Way? Lose your way Make errors Run out of words Retreat into silence Cover up Limit participation Miss opportunities Be assigned a passive role Lose dignity Lose entitlements Lose rights Endanger health Dr. Rima E. Rudd - May 2012 22

  23. Needed Emphasis:Balancing Act Dr. Rima E. Rudd - May 2012 23

  24. Change Practice “The definition of insanity is continuing to do the same thing over and over again and expecting a different result” Variously attributed to Benjamin Franklin / Albert Einstein Dr. Rima E. Rudd - May 2012 24

  25. How? A Public Health Lens Reciprocal relationship between persons & environment • Epidemiology • Health Education Dr. Rima E. Rudd - May 2012 25

  26. Strategy: Nothing so practical as a good theory • Consider facilitating factors and barriers • First: Identify and remove barriers • Then: Strengthen facilitating factors Lessons from Kurt Lewin’s Force Field Analysis Dr. Rima E. Rudd - May 2012 26

  27. Who? What can we do? • Journalists • Public Health Officers • Health Care Managers • Health Care Professionals • Academics & Researchers • Policy Makers • Public/Members of Communities Literacy teachers Dr. Rima E. Rudd - May 2012 27

  28. Journalists • Focus on the full picture [both sides of the coin] • Improve access to information • Be attentive to existing skills • Draw lessons from health literacy studies [scientific and medical cultural assumptions, jargon, complexity] • Help the diffusion process • Enhance communication skills of health researchers & professionals Dr. Rima E. Rudd - May 2012 28

  29. Public Health Officials and Practitioners • Improve access to information • Examine and modify tools & materials • Examine and modify health environments • Insist on rigor [regulate production of critical texts] • Engage in participatory processes • Work in and with communities • Engage intended audiences in development and reviews • Build and enhance community resources • Share expertise and information • Promote opportunities for analyses • Engage in community based problem solving Dr. Rima E. Rudd - May 2012 29

  30. Dr. Rima E. Rudd - May 2012 30

  31. Research Studies: Health Materials Key Finding: Most health materials are written at a level that far exceeds the reading skills of the average high school graduate Conclusion: A majority of adults in most industrialized nations do not have the literacy skills needed to use health related print materials and tools with accuracy and consistency. Health materials & tools are poorly written & poorly designed Dr. Rima E. Rudd - May 2012 31

  32. Change Materials:Consider the Task and Tools Finding: Over 1,500 studies demonstrate a mismatch between health resources and the skills of the intended audience Suggestion: Assess information in print, on-line, in oral presentations Apply rigorous research Pilot, modify, pretest with members of the intended audience Dr. Rima E. Rudd - May 2012 32

  33. Model Good Practice Protocols for Development Requirements for ease of use Rigor for user reviews Regulations Dissemination Materials as models of communication Critical Texts Reports Brochures Response to complaints Informed consent Test results Instructions [e.g. discharge documents] Dr. Rima E. Rudd - May 2012 33

  34. Health Care Managers • Link health literacy to patient safety • Address emerging legal responsibilities: Failure to provide patients with information about their care in ways that they can understand, will continue to undermine other efforts to improve patient safety. Joint Commission Public Policy White Paper, 2007 Dr. Rima E. Rudd - May 2012 34

  35. Identify and Eliminate Literacy Barriers How literacy friendly are your healthcare settings? Are navigation tools/aides readily available? Is technology put to good use? Do words serve as barriers to access, navigation, care, consent, dignity? Dr. Rima E. Rudd - May 2012 35

  36. Develop Accessible Organizations Physical environment: remove barriers to entry, navigation, services Social context: change expectations, norms, language, rituals, & encourage dialogue Dr. Rima E. Rudd - May 2012 36

  37. Orient and Train Health Care Workers • Normative change • Staff as ambassadors • Questions welcomed • Integration of HL into orientation and training for all • Scripts & tool boxes for common interactions Dr. Rima E. Rudd - May 2012

  38. Create Shame Free Environments Offer help to all Encourage questions & sharing concerns Let patients know that others have difficulties Define medical and scientific words Explain procedures [what is next] Literacy and Patient Safety: Help Patients Understand. Manual for clinicians. AMA Foundation, 2007 Dr. Rima E. Rudd - May 2012 38

  39. Institute Protocols and Policies Institute rigor for critical texts • Protocols for materials development • Requirements for review • Scientific • Lay public • Standards for assessments Dr. Rima E. Rudd - May 2012

  40. Health Professionals • Enhance Professional Education • Diffusion of information: Mismatch between demands/skills • Communication skills • Require and support dual language skills[professional language and everyday language] • Encourage question asking • Apply teach back Dr. Rima E. Rudd - May 2012

  41. Researchers Expand Scope of Inquiry • 5 Aspects of literacy • Both sides of the coin • Implementation studies Consider the Data • Interview protocols • Questions • Inclusion/Exclusion • Validity Dr. Rima E. Rudd - May 2012

  42. Policy Makers • Articulate expectations for professional rigor related to critical health materials • Consider health systems • Social and Physical Environment • Processes • Work Force Development • Consider Regulations Dr. Rima E. Rudd - May 2012 42

  43. Regulations • Standards for critical texts • Processes for all vendors • Review boards & articulated processes • Environmental standards • Accreditation requirements for institutions • Professional training & licensing requirements • Staff orientations Dr. Rima E. Rudd - May 2012 43

  44. Policy – US Example Potential for change: Public Law 111–274 111th Congress An Act To enhance citizen access to Government information and services by establishing that Government documents issued to the public must be written clearly… 111TH CONGRESS 2d Session COMPILATION OF PATIENT PROTECTION AND AFFORDABLE CARE ACT Dr. Rima E. Rudd - May 2012

  45. Members of Communities • Identify trustworthy sources of information • Ask questions • Offer feedback • Expect and ask for translations [from jargon to plain words] • Advocate for change Dr. Rima E. Rudd - May 2012 45

  46. All: Reorientation • Share wisdom & experience • Make information accessible • Ease entry and access • Develop partnerships for action Dr. Rima E. Rudd - May 2012

  47. Urgency Health Disparities • Morbidity • Mortality Equity Literacy skills have implications for social justice Dr. Rima E. Rudd - May 2012 47

  48. Attention to Disparities • Distribution of literacy skills is linked to social factors • Literacy is a social determinate • Match/Mismatch between demands and skills has implications for justice & dignity • Access to information • Participation & Agency • In prevention and early detection • For chronic disease management • For informed choice [personal and policy] Dr. Rima E. Rudd - May 2012 48

  49. Time for Outrage Stephane Hessel Time for Outrage: Indignez-vous! New York, NY: Twelve. 2011. We must rely on our belief in human rights, the violation of which must provoke our indignation Dr. Rima E. Rudd - May 2012 49

  50. Time for Action Documented: Literacy skills of adults in industrialized nations Documented: Links between literacy and health outcomes Documented: Mismatch between demands and skills Business as usual is unethical Dr. Rima E. Rudd - May 2012 50

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