Health Literacy for Clinicians

1. Health Literacy for Clinicians Facilitator's name & position

2. Acknowledgement This workshop was developed collaboratively by Tina and Janet Papadakos, Patient Education Leads at St. Michael’s and Princess Margaret Hospitals in Toronto, Canada to support staff skills competencies related to health literacy.

3. Objectives Define health literacy and why it is important Identify signs that a patient may have low health literacy Know how to address the health literacy needs of patients and families

4. Agenda • Define health literacy • Gain skills to address barriers to health literacy: • Apply the principles of adult learning • Use active listening techniques & teach-back • Teach to patient/families' learning styles • Use plain language

5. Communication barriers

6. What is health literacy? The ability to make sound health decisions in the context of everyday life – at home, in the community, at the workplace, and in the healthcare system Kickbusch, Wait and Maag, Navigating Health: The Role of Health Literacy, 2005.

7. Fundamental literacy Scientific literacy Civic literacy Cultural literacy Health literacy has 4 parts Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

8. Fundamental literacy Prose – written words Document – charts, graphs, forms etc Numeracy – basic math Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

9. Scientific literacy • Basic understanding of how science and medicine work and evolve What science must a patient know to comprehend and decide to act on a specific health message? Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

10. Civic literacy Can your patient judge: the validity and quality of sources of information? The ability to be involved in health decisions: • Does your patient know: • where and how to access information? • how to advocate for self and others? Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

11. Cultural literacy The shared and dynamic characteristics of a group of people whose collective beliefs, worldview, customs and social identity are a lens through which they interpret and act on health information Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

12. Health literacy involves the ability to: • to understand health instructions • to read and act upon written health information • to communicate needs to health professionals

13. Scientific literacy

14. Cultural literacy

15. Fundamental literacy

16. Civic literacy

18. 60% of Canadians have difficulty getting, understanding and acting on health information and services 88% of Seniors Canadian Council on Learning, 2007

19. Institute of Medicine Report on Health Literacy • 90 million American adults have trouble understanding and acting on health information • • Health information is unnecessarily complex • • Providers need health literacy training

20. AHRQ Report Evidence shows that patients often misinterpret or do not understand much of the information given to them by clinicians due to low health literacy. The Agency for Healthcare Research and Quality (AHRQ) Report 2010

21. Low health literacy has been linked to: • Less use of preventive services • Delayed diagnoses • Less adherence to medical instructions • Poorer self-management skills • Higher health care costs • Poorer Health • Wolf MS, Gazmararian JA, Baker DW. Health Literacy and Functional Health Status Among Older Adults. 2005. Archives of Internal Medicine.

22. Health literacy is important for 2 reasons: Changes in medical practice with patients involved in complex self-care regimens Transition from ‘patient’ to ‘health consumer’ (expectations of involvement) The Agency for Healthcare Research and Quality (AHRQ) Report 2010

23. Know your role in promoting health literacy for: • Patient safety • Patient self-management • Patient satisfaction • Efficient use of your time

24. Fundamental literacy is one of strongest predictors of health status. 1. Weiss BD, Hart G, McGee D, D’Estelle S. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills' Am Board Fam Pract. 1992;5:257-264. 2. Baker D, Parker R, Williams MV, Clark WS, Nurses J. The relationship of patient reading ability to self reported health and use of health services. Am J Public Health. 1997;87:1027-1030. 3. Sudore RL, Yaffe K, Satterfield S, Harris TB, et al. Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med. 2006;21:806-812.

25. Red Flags for Low Literacy Frequently missed appointments Incomplete registration forms Non-compliance with medication Unable to name medications or explain purpose or dosing Identifies pills by looking at them, not reading label Unable to give coherent, sequential history Ask fewer questions Lack of follow-through on tests or referrals

26. Agenda • Define health literacy • Gain skills to address barriers to health literacy: • Apply the principles of adult learning • Use active listening techniques & teach-back • Teach to patient/families' learning styles • Use plain language • Apply the principles of adult learning

27. Favourite teacher

28. 1. Adults often see learning as a way to solve their real-life problems – especially their urgent ones. True False Principles of adult learning

29. 2. Adults tend to take errors personally and are more likely to let them affect self-esteem. Thus, they tend to apply tried-and-true solutions and take fewer risks. True False Principles of adult learning

30. 3. Adults relate new knowledge and information to previously learned information and experiences. True False Principles of adult learning

31. 4. Adults want to be treated as equals, not as children, (and so want to engage in a learning relationship with the healthcare professional). TrueFalse Principles of adult learning

32. 5. Adults need to know WHY they should learn, WHAT they will learn, and HOW the learning will take place. True False Principles of adult learning

33. Adult learning summary • Respect • Relevant • 2-Way Conversation • Specific and Focused • Allow time for learning to be applied to patient’s current knowledge, experience and beliefs • Safe environment (preserve dignity)

34. Agenda • Define health literacy • Gain skills to address barriers to health literacy: • Apply the principles of adult learning • Use active listening techniques & teach-back • Teach to patient/families' learning styles • Use plain language • Use active listening techniques & teach-back

35. Active Listening Techniques: Prompt Question Paraphrase Empathize Summarize

36. Prompts indicate you are listening with minimal verbal or non-verbal cues to encourage patient to verbalize Nod your head Make eye contact Say “uh huh” Expressions of interest or approval Prompt

37. Questions are key to gathering information about your client 2 kinds of questions: Questions

38. Restate the factual content of the patient’s message in your own words Paraphrase “So it sounds like you are clear on your appointment time for your CT Scan but unsure how to get there. Is that right?”

39. Recognize the facts (intellectual) of the patient’s message and how the patient feels (emotional) Empathize “It sounds like you are overwhelmed with all of the information you have just been given.”

40. Recap the key points of the discussion Agreement of the problem Summarize “So, you have agreed to undergo radiation treatment and you would like to have the procedure reviewed with you and your family so you know what to expect.”

41. Teach-back To check if your patient truly understands, ask them to explain what you just told them in their own words

42. Agenda • Define health literacy • Gain skills to address barriers to health literacy: • Apply the principles of adult learning • Use active listening techniques & teach-back • Teach to patient/families' learning styles • Use plain language • Teach to patient/families’ learning styles

43. Learning styles Touch it/ Do it See it Hear it Think about it

44. Visual Learners How they learn: • They create diagrams of what they hear • Need to ‘picture it’ Clues that they are Visual Learners: • Doodling • Says “I can’t see it” What you can do: • Ask if they would like you to draw it

45. Auditory learners How they learn: • They pay attention to the speaker’s voice - the tone, energy, pitch, enthusiasm and modulation Clues that they are Auditory Learners: • Looking off in the distance • Put their hand by their ear What you can do: • Speak to them, pace yourself, sequence the information and ask if they would like you to repeat anything

46. Kinesthetic learners How they learn: • They prefer to put their hands on and touch • Like demonstrations that they can try after you show Clues that they are Kinesthetic Learners: • Gestures with their hands, puts their hands on things • Says “I feel…” What you can do: • Ask if they would like to try it after you show them

47. Reflective learners How they learn: • They like to have time to process information and make decisions • Want to analyze, categorize, review, reflect and ask questions Clues that they are Reflective Learners: • Pausing and looking in the distance (or down) • Asks broad questions for context What you can do: • Offer them more data, reading material

48. Learning retention is increased with more sensory involvement Think about it Hear it See it Touch it/ Do it 90% 20% 30% 40%

49. Visual Learners See it Auditory Learners Hear it Kinesthetic Learners Touch it Reflective Learners Think about it • Pamphlets • & Books • Statistics & • Facts • Demos & • Models • Analogies & • Stories • Group • Sessions

50. Agenda • Define health literacy • Gain skills to address barriers to health literacy: • Apply the principles of adult learning • Use active listening techniques & teach-back • Teach to patient/families' learning styles • Use plain language • Use plain language