Promoting Health LiteracythroughEasy-to-Read Materials Cheryl Rowan, MSLS National Network of Libraries of Medicine, South Central Region
Agenda • Introduction • The Problem of Health Literacy • Internet Resources • Writing/Examining Easy-to-Read Materials • Assessment Exercise • Testing for Readability
Can you read this? Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc. Your physician has recommended that you have a colonoscopy. Colonoscopy is a test for colon cancer. It involves inserting a flexible viewing scope into your rectum. You must drink a special liquid the night before the examination to clean out your colon. Weiss, Barry: Health Literacy and Patient Safety: Help Patients Understand; AMA Foundation
National Assessment of Adult Literacy (NAAL) • Conducted in 2003 • More than 19,000 adults • One-on-one administration • GOAL: assess literacy in English • http://nces.ed.gov/NAAL
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
Three Types of Literacy • Prose • Document • Quantitative
Prose Literacy • Requires ability to search, comprehend, and use continuous text
Document Literacy • Non-continuous text • Requires ability to search, comprehend, and use information
Quantitative Literacy • Requires ability to identify and perform computations, using numbers within printed materials.
Readability Studies • Numerous studies document mismatch between patient reading skills and the readability level of health materials. ReadabilityPatient Skills (mean grade level) • Wilson (2003) 11th 6th • Davis (1994) 10th 7th • Jackson (1991) 12th 5th • Meade (1989) 10th 6th
Determinants of Health • Age • Income • Literacy Skills • Employment Status • Education Level • Race or Ethnic Group
Factors Affecting Learning Ability • Stress • Illness • Age • Cultural Barriers • Language Barriers
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
Calgary Charter on Health Literacy “…the skills and competencies that all people develop to seek out, comprehend, evaluate, communicate and use health information and concepts to make informed choices, reduce health risks and increase quality of life.”* *2009 Calgary Charter on Health Literacy *2009 Calgary Charter on Health Literacy
FunctionalHealth 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”*
Task: Appointment Slip • Locate information in a simple document. • When is your next appointment? Where?
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.
Why is Health Literacy Important? • To fill out a patient information form • To understand health-related instructions • To follow discharge instructions • To identify signs • To keep appointments • To understand insurance • To sign consent forms
Medical studies indicate most people suffer a 68% hearing loss when naked.
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!
Improving Oral Communication • Communication is two-way • Use “teach back” instructions • Avoid medical jargon • Use commonly understood words • Limit information • Videos
MedlinePlus 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
NIHSeniorHealth http://nihseniorhealth.gov/ • Developed with the National Institute on Aging • Recent redesign • Senior-friendly features: • Text Size • Contrast • Short segments of information
Healthy Roads Media http://www.healthyroadsmedia.org • Materials in 20+ languages • Various formats: • Written • Audio • Multimedia • Web video • iPod video
NN/LM SCR • Consumer Health Manual • Websites • Research information • Bibliography • http://nnlm.gov/outreach/consumer/hlthlit.html
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
Basic Tips for Message Content • Simple message • Lots of white space • Font type and size • Present tense and active verbs • No unnecessary words • Use “living room” language • Who is the audience?
Text is Important • 12 point or larger font size • Avoid ALL CAPITAL LETTERS; they are hard to read • Use common fonts such as Arial or Tahoma; avoid script Eat fruits and vegetables Eat fruits and vegetables • Use boldface type and underlining to cue readers to important text
Present Tense & Action Verbs • Wrap the cut in a clean cloth. • Keep it dry. Avoid: Give consideration to Make payment Is concerned with Use: Consider Pay Concerns
Active Voice • Roll to the left • Put your feet on the floor • Sit up • Grab the railing Avoid: It shall be signed You shall be notified Use: You must sign We will notify you
General Terms Avoid Use • Accordingly • Afford an opportunity • At a later date • Close proximity • In the event that • Incumbent upon • Utilize • So • Allow • Later • Near • If • Must • Use
Medical Terms Physician Cardiac
Medical Terms - 2 Tablets Nasal Congestion
Medical Terms -3 Hazardous Radiology
Logical Sequence of Instructions • Wash your hands with soap and water. • Place the fresh bandage on a clean towel. • Take off the old bandage gently. • Wash the burned area gently. • Apply a thin layer of antibiotic cream. • Cover with the clean bandage.
Use Short Words & Sentences • Return in one week. • Bring your insurance card with you. • Please sign in. • Brush along the gum line. • Drink plenty of orange juice.
Cultural Competency • Tailor messages to intended audience • Avoid stereotypes • Relevant photos/artwork • Appropriate symbols • Realistic recommended behaviors • Back-translate and field test translated material • “…more than a patients’ rights issue…critical to safety and quality of care”*