Health Literacy Its importance to you

1. Health Literacy Its importance to you Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region Michelle Burda, MLS mburda@pitt.edu (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.

2. 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

3. 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

4. Literacy skills are a stronger predictor of health status than: Age Income Employment status Education level Race or Ethnic group Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region Weiss, BD. Health Literacy: A Manual for Clinicians. AMA 2003 p.7.

5. What is Health Literacy? “The degree to which individuals have the capacity to obtain, process, and understandbasic 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

6. The Literacy Problem Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

7. 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

8. 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

9. What this means • Below basic • Basic • Intermediate • Proficient Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

10. Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

12. Three Types of LiteracyProse Document Quantitative Requires ability to search, comprehend, and use continuous text • Non-continuous text • Requires 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

13. Prose LiteracyExample of a surgical consent form Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

14. Document Literacy - NALS Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

15. 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

16. Differences between good and poor readers Teaching Patients with Low Literacy Skills 2nd ed. by Doak, Doak, & Root, 1996

17. Factors affecting learning ability • Stress • Illness • Age • Cultural Barriers • Language Barriers Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

18. 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

19. Testing for Readability Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

20. Overview • Method • Word count • Syllables • Sentence length • Readability of Materials • Fry • SMOG • Patient Literacy (REALM, TOFHLA, Newest Vital Sign) • Computer software (HeaLth Literacy Advisor)

21. SMOG Simple Measure Of Gobbledygook • Count off 10 sentences near the beginning, 10 in the middle and 10 at the end of text. • Circle every word containing 3 or more syllables and total the number of words circled • Estimate the square root of the total number of words counted • 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

22. REALM Rapid 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 – Form http://www.lsuhscshreveport.edu/HealthLiteracy/HealthLiteracyInfoFAQ.aspx Terry C. Davis, Ph.D. Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

23. 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 & Spanish Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

24. Newest Vital Sign Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

25. 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

26. 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”* Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region *AMA Council of Scientific Affairs

27. 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

28. 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.

29. What’s “plenty” of water? “Take twice a day “Don’t take medicine if you’ve been in the sun too long.” Medication Safety and Health LiteracyOnly about 50% of patients take meds as directed Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

30. Dosage using a spoon • Kitchen spoons • Medication dispensing spoons Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

31. Reading a thermometer Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

32. 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

33. 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, MLS, National Network Libraries of Medicine, Middle Atlantic Region

34. 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

35. Invite questions We 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 understanding If 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” technique http://www.youtube.com/watch?v=_Vo9Q_EfBX8 Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

36. 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 understanding http://healthliteracymn.org/sites/default/files/images/files/Teach-Back%20Program%20Guide.pdf

37. Tools and Resources Internet Resources Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

38. Tools & Resources • Health Literacy Universal Precautions Toolkit • Plain Language • Teach Back NLM Resources • MedlinePlus • SeniorHealth • DailyMed Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

39. http://medlineplus.gov • Easy-to-Read materials • Medical Dictionary • Understanding 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

40. HIV/AIDS Informationhttp://aids.nlm.nih.gov/index.php Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

41. http://nihseniorhealth.gov/ • Developed with the National Institute on Aging • Senior-friendly features: • Text Size • Contrast • Short segments of information Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

42. NLM Mobile http://www.nlm.nih.gov/mobile/ • MyMedList Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

43. Plain English/Plain Language http://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, MLS, National Network Libraries of Medicine, Middle Atlantic Region

44. 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

45. 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, MLS, National Network Libraries of Medicine, Middle Atlantic Region

46. 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 Consulting http://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, MLS, National Network Libraries of Medicine, Middle Atlantic Region

47. http://nnlm.gov/bhic/ Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region

48. Future of Healthcare

49. 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

50. From: Health Coverage Under the Affordable Care Act JAMA. 2012;308(24):2556-2556. doi:10.1001/jama.2012.128713 Created by Michelle Burda, MLS, National Network Libraries of Medicine, Middle Atlantic Region