Promoting Health Literacy through Easy-to-Read Materials

1. Promoting Health LiteracythroughEasy-to-Read Materials Cheryl Rowan, MSLS National Network of Libraries of Medicine, South Central Region

2. Agenda • Introduction • The Problem of Health Literacy • Internet Resources • Writing/Examining Easy-to-Read Materials • Assessment Exercise • Testing for Readability

3. 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

4. The Literacy Problem

5. 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

6. 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

7. Numbers by Literacy Level

8. Three Types of Literacy • Prose • Document • Quantitative

9. Prose Literacy • Requires ability to search, comprehend, and use continuous text

10. Example – Prose Literacy NALS

11. Document Literacy • Non-continuous text • Requires ability to search, comprehend, and use information

12. Example – Document Literacy NALS

13. Quantitative Literacy • Requires ability to identify and perform computations, using numbers within printed materials.

14. 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

15. Example: Patient Education Page

16. Determinants of Health • Age • Income • Literacy Skills • Employment Status • Education Level • Race or Ethnic Group

17. Factors Affecting Learning Ability • Stress • Illness • Age • Cultural Barriers • Language Barriers

18. The “Face” of Health Literacy

19. 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

20. 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

21. 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”*

22. “The Silent Epidemic”– Case Studies

23. Health Literacy Levels

24. Task: Appointment Slip • Locate information in a simple document. • When is your next appointment? Where?

25. 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.

26. “Costs” of Low Health Literacy

27. 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

28. Medical studies indicate most people suffer a 68% hearing loss when naked.

29. 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!

30. Improving Oral Communication • Communication is two-way • Use “teach back” instructions • Avoid medical jargon • Use commonly understood words • Limit information • Videos

31. Internet Resources

32. 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

33. NIHSeniorHealth http://nihseniorhealth.gov/ • Developed with the National Institute on Aging • Recent redesign • Senior-friendly features: • Text Size • Contrast • Short segments of information

34. Healthy Roads Media http://www.healthyroadsmedia.org • Materials in 20+ languages • Various formats: • Written • Audio • Multimedia • Web video • iPod video

35. NN/LM SCR • Consumer Health Manual • Websites • Research information • Bibliography • http://nnlm.gov/outreach/consumer/hlthlit.html

36. 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

37. Key Players in Health Literacy

38. More Key Players

39. Writing/Examining/Selecting Easy-to-Read Materials

40. 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?

41. 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

42. 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

43. 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

44. 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

45. Medical Terms Physician Cardiac

46. Medical Terms - 2 Tablets Nasal Congestion

47. Medical Terms -3 Hazardous Radiology

48. 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.

49. 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.

50. 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”*