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Health Literacy

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Health Literacy

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  1. Health Literacy Paul D. Smith, MD, Associate Professor University of Wisconsin Department of Family Medicine Paul.Smith@fammed.wisc.edu

  2. Topics today • General health literacy information • Results of WAFP Health Literacy Survey • Communication Issues • What can you do?

  3. Literacy skills

  4. What is Literacy? National Adult Literacy Survey 1992 “Using printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential.”

  5. More than just reading grade level • Prose Literacy • Written text like instructions or newspaper article • Document literacy • Short forms or graphically displayed information found in everyday life • Quantitative Literacy • Arithmetic using numbers imbedded in print

  6. What is Health Literacy? The Institute of Medicine 2004 “The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”

  7. What is Health Literacy? The Institute of Medicine 2004 “The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”

  8. What is Health Literacy? The Institute of Medicine 2004 “The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”

  9. Real People with Real Problems • Insert video clip here

  10. National Adult Literacy Survey • Federal survey conducted in 1992 • 26,000 people over age 15 • Living in households and prisons • Divided into 5 levels

  11. National Adult Literacy Survey • Level 1 – find one piece of information • Level 2 – find two related pieces of information • Level 3 – integrate multiple pieces of information • Level 4 – respond • Level 5 – analyze, formulate

  12. National Adult Literacy Survey • Level 1 – find one piece of information • Can: • Sign name on a document • Identify a country in a short article • Total a bank deposit slip

  13. National Adult Literacy Survey • Level 1 – find one piece of information • Cannot: • Enter information on a social security card application • Locate an intersection on street map • Calculate the total cost on an order form

  14. National Adult Literacy Survey • Level 2 – Find two related pieces of information • Can: • Identify YTD gross pay on a paycheck • Determine price difference between tickets for 2 shows

  15. National Adult Literacy Survey • Level 2 – Find two related pieces of information • Cannot: • Use a bus schedule • Balance a check book • Write a short letter explaining error on a credit card bill

  16. National Adult Literacy Survey 47-51% of Americans in Levels 1 and 2

  17. National Adult Literacy Survey 39% of Wisconsin adults in Levels 1 and 2

  18. How Age Effects NALS Data • Adults age 60 and over • Living in households or prisons • 68-80% are in Level 1 and 2 • More in Level 1 and 2 with advancing age • 89-99% Level 1 and 2 age 80 and over

  19. Literacy Levels Change with Age Document Literacy

  20. Literacy Levels Change with Age 80 and over Level 1 + 2 89% Document Literacy

  21. Literacy Levels Change with Age BUT, they do not recognize their problem Age 60 and older • 91% Read well or very well • 88% Write well or very well • 83% Do arithmetic well or very well

  22. 2003 National Assessment of Adult Literacy • Data released 12/05 • ~17,000 people participated • Changed reporting methodology

  23. New Reporting Method • 80% correct responses moved down to 67% • 4 categories • Below basic • Basic • Intermediate • Proficient

  24. 2003 National Assessment of Adult Literacy

  25. 2003 National Assessment of Adult Literacy The Bottom Line • Not much change • Prose a bit worse • Document a bit better • Quantitative a bit better

  26. Clinician Survey • 16 question email survey • Sent to 411 Wisconsin family physicians • 28% response rate

  27. Impact on Quality and Outcomes >87% Number of Respondents Impact Health Outcomes Impact Quality of Care

  28. Results : Prevalence Mean = 17.4% NALS= 47-51% Number of Responses

  29. Results Does your clinic screen patients?

  30. The Bottom Line • Physicians are aware of literacy impacting on health and health care • They underestimate the extent of the problem

  31. The Impact of Low Literacy on Health • Poorer health knowledge • Poorer health status • More hospitalizations • Higher health care costs

  32. Poorer Health Knowledge Diabetics that know low glucose symptoms 94% 50%

  33. Poorer Health Knowledge Hypertensives that know exercise lowers BP 68% 40%

  34. Poorer Health Status Diabetics with retinopathy 36% 19%

  35. Poorer Health Status • 2923 new Medicare enrollees • Inadequate literacy had increased frequency of: • Diabetes • Hypertension • Heart failure • Arthritis

  36. Poorer Health Status • Medical Outcomes Study (SF-36) • Inadequate literacy had • Decreased: • Physical function • Mental health • Increased • Limitations in activity due to physical health • Pain that interferes with normal work activities

  37. More Hospitalizations 2 year hospitalization rate for patients visiting ED 31% 14%

  38. Increased Health Care Costs Total annual Medicaid charges $10,688 $2,890

  39. Increased Health Care Costs Based on NALS data Majority from increased hospitalizations

  40. Reading Levels • 20% of American adults read at or below the 5th grade level • Most health care materials are written above the 10th grade level.

  41. Low Literacy is Overlooked • Clinicians don’t ask about literacy • Some are not aware of the problem • Not sure how to ask • Not sure how to respond • Do not want to open the can of worms

  42. Low Literacy is Overlooked • Patients do not volunteer their literacy problem • Many are ashamed • Some do not recognize their inadequate literacy • Lack of trust

  43. The Big Secret • % of low literate adults that have not told their:

  44. More likely to have Low Literacy • Older • Immigrants • Less education • Incarceration

  45. More likely to have Low Literacy • Non-white • Low-income • Medical Assistance

  46. Low Literacy is Overlooked • Many Level 1 people don’t fit the stereotypes • 75 % born in USA • 50% are white • 40% hold full or part-time jobs

  47. Common Clues of Low Literacy • Patients say things like: • “I lost my glasses” • “I’d like to discuss this with my family” • “I have a headache now and can’t focus”

  48. Common Clues of Low Literacy • Medication review • Looking vs reading • Unable to name med • Do not know why taking med • Do not know medication timing

  49. Common Clues of Low Literacy • Non-compliance • Medications • Testing • Consultations