Reach Out and Read and Health Literacy

1. Reach Out and Readand Health Literacy The Critical Link Denise Ogden, PA-C ROR Medical Coordinator for ROR – Swedish Family Medicine Residency

2. An integral part of life . . .

4. Imagine a Very Different Day . . .

6. Health Promotion and Disease Prevention

7. What is Health Literacy?

8. 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 decisions” --Institute of Medicine report “Health Literacy: A Prescription to End Confusion”

9. Health Literacy The ability to read, understand and act on health information.

10. Skills Required for Health Literacy • Ability to read • Listening skills • Analytical skills • Decision –making skills

11. Integrate these skills and apply them to health situations: • Following instructions on prescription drug bottles • Understand appointment slips • Read medical education brochures • Understood spoken and written doctor instructions • Navigate complex health care systems • Complete consent forms

12. Why is health literacy important? Poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level and race.” (Report on Council of Scientific Affairs, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, AMA, JAMA, Feb. 10, 1999)

13. New Diagnosis of Congestive Heart Failure • May be started on a variety of medications including loop diuretics, beta-blockers, ACE-inhibitors, spironolactone and digoxin • They may also received medications for hyperlipidemia • They may need to weigh themselves frequently and report any weight gain • Begin low sodium and low fat diets • Participate in structured exercise regimens

14. Impact of Low Health Literacy • Decreased personal health • Poor compliance and medical errors • Economic

15. Define the Scope of the Problem

16. Scope of the Problem • 90 million people in the United States have difficulty understanding and using health information • Institute of Medicine

17. Which of these individuals have poor health literacy?

18. Who is Affected? • Health literacy affects all age, race and income levels.

19. Fortune magazine Fortune Magazine Cover Story:Overcoming Dyslexia May 13, 2002

20. Who are the most vulnerable? • Ethnic minority groups • 50% of Hispanic patients • 40% of Black patients • 33% of Asian patients • Older patients • 66% of US adults > 60 years have marginal to inadequate literacy skills. • Others • Recent immigrants, patients with chronic disease or those of low SES

21. What Can Be Done about Inadequate Health Literacy?

22. What can be done to address each of these factors? • Screen for general literacy • Patient’s amount of experience in the health care system • Cultural factors • The complexity of the information presented • How the material is communicated

23. Identify those at risk.

24. Health Literacy Myths • You can tell by looking • People will tell you if they can’t read • Years of schooling is a good measure of literacy.

25. Identifying those at risk: • Many with low health literacy skills use well-practiced coping mechanisms that effectively mask their problem

26. Red Flags • Embarrassment, intimidation or confusion during medical encounters • Watching the behavior of others in the same situation and copying their actions • Always bring a family member or friend who assists with reading • Registration and other forms are filled out incompletely or incorrectly • Missed appointments, including appointments for specialty consultations or diagnostic tests • Frequent errors in self-care instructions • Unable to name medications, explain what medications are for or when they should be taken • “I forgot my glasses. I’ll read this when I get home”, “Let me take this home so I can discuss it with my family.”

27. Screening Questions 1. “How often do you need to have someone help you when you read instructions, pamphlets or other written materials from your doctor or pharmacy? 2. “How confident are you in filling out medical forms by yourself?” 3. “How would you rate your ability to read.”

28. Blame-Free Environment • “A lot of people have trouble reading and remembering these kinds of materials or instructions. Is this ever difficult for you? • “What questions do you have?” • “Who helps you interpret health information in your home or family?”

29. Communicators of health information must know how to reach the intended users.

30. Literacy and the Law • Our legal system recognizes the patient-physician relationship as a fiduciary relationship • Informed consent

31. Strategies • Make the office patient-friendly • Routinely offer all patients assistance in completing forms • Collect information and provide assistance in the patient’s preferred language • 15% of American residents speak a primary language other than English • Be sure that forms are designed to be reader-friendly • Offer assistance in scheduling ancillary tests and appointments with specialists

32. Strategies • Rethink Spoken Communication • Slow down • Use plain, nonmedical language • Show or draw pictures • Limit the amount of information provided and repeat it • Use “teach-back” techniques • Create a shame-free environment: encourage questions.

33. Talk Plainly Use communication that users can understand the first time that they hear it. • Organize information so that the most important points come first • Break down complex information into understandable chunks • Use simple language

34. Plain Language is not “dumbing down” • Plain language has to do with clear and effective communication – nothing more or less • “Plain words are eternally fresh and fit. . . capable of great power and dignity” • Bryan Garner, linguist

35. Plain Language • Lesion . . . . . . . . Wound, sore • Oral . . . . . . . . . . By mouth • Benign . . . . . . . . Will not cause harm, is not cancer • Intermittent . . . . On and off • Avoid . . . . . . . . .Stay away from • Intake . . . . . . . . What you eat and drink • Option . . . . . . . . Choice • Referral . . . . . . . Ask you to see another doctor • Adverse . . . . . . . Bad

36. Plain Language • Excessive . . . . . . . Too much • Support . . . . . . . . Help with your needs • Adequate . . . . . . . Enough • Routinely . . . . . . . Often (every week) • Significantly . . . . . Enough to make a difference

37. As stated by an adult with limited literacy skills: • A good doctor is not too busy to help, doesn’t use big words, sits down and listens, asks how you are doing today and what your problem is. The doctor asks how you want to be addressed, and doesn’t read the chart in front of you. Good doctors tell you things in plain English and break them down into what’s really important. If you don’t understand what the doctor says, you are comfortable asking him to repeat the explanation. When the doctor repeats and you still don’t understand, the doctor goes out of his way to make sure you do.

38. How can we prevent poor health literacy? • Reach Out and Read • Early literacy skills. • Transformation of the patient/provider relationship.