Health Literacy: What is it, What to do about it, Why is it Important?
HEALTH LITERACY: What is it, What to do about it, Why is it Important? KAREN KOMONDOR, RN DIRECTOR, EDUCATION HEALTH LITERACY INSTITUTE ST VINCENT CHARITY MEDICAL CENTER RICHARD PETERSON PRESIDENT AND CEO, PROJECT LEARN
OBJECTIVES • Describe the scope and implications of the health literacy problem • Discuss the evolution of health literacy • Apply strategies and techniques to increase clear communication and patient understanding
DEFINITIONS • Literacy: The ability to read, write, compute, think critically to achieve one’s potential.
U.S. Department of Education. 1993
Characteristics Adults who can not read • Rely on oral sources for information; TV, radio, friends, family • Reluctance to ask questions of those they do not know. • They do not self-identify. • They carry significant shame. • They cannot be identified by appearance.
Lack of Basic Skills • Cuyahoga County: 1.3 million 1.1 million adults over 18
• One out of four read below grade level five. (U.S. Department of Education, 2003) • Over 200,000 lack a high school diploma or a GED. (U.S. Census, 2000) • Only 2-3% are enrolled in a basic education program.
The NAAL and Health Literacy 28 health items on the assessment •12 prose, 12 document, 4 quantitative •Three domains: •Clinical (3 items) •Prevention (14 items) •Navigating the health care system (11 items)
Health Literacy Findings The 2003 NAAL
Only 12% of adults are proficient
percentage of population at each level
Health Literacy results from the National Assessment of Adult Literacy, US Dept of Education, 2003
Why Project Learn? 1. Advocate for the undereducated
2. Help Healthcare providers understand the issue 3. Provide practical strategies for addressing the issue
DEFINITIONS • 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.” U.S. Department of Health and Human Services. Healthy People 2010
DEFINITIONS Health Literacy: In other words: • Patient’s ability to understand and act on health information • Health care provider’s ability to communicate so patients can act on the information to take better care of their health
Health literacy and patient safety: Help patients understand http://snbconsultants.com/2012/amahealth-literacy-video/
WHY IS HEALTH LITERACY IMPORTANT? • Up to 80 percent of medical information provided by healthcare providers is forgotten immediately by patients. • Almost half of the information that is remembered is incorrect. • Approximately 20 percent of American adults read at or below the fifth grade level. However, most health information materials are written at the tenth grade level or above.
SCOPE OF THE PROBLEM Healthcare is more complex now • 40 Years Ago Today 1 Doctor Multiple specialists 1 Pharmacist Chain Drug Stores No Forms Numerous Forms In-Patient Out-Patient 650 Medicines 24,000 Medicines
SCOPE OF THE PROBLEM • Persons with limited health literacy skills have: – Higher utilization of treatment services • Hospitalization • Emergency services – Lower utilization of preventive services
SCOPE OF THE PROBLEM • $106-$238 billion is lost every year on health care costs due to a disconnect in the delivery of health information
Vernon, J.(2oo7). Low Health Literacy: Implications for National Health Policy.
• Health Literacy Affects Everyone!
Word exercise Expected Option Strike Value Net Spot Time
Return Exercise Probability Present Negative Below Today
Calculate Equal Underlying Price Price Zero Using
When Does Exercising Give You An Advantage? “If you’re using expected return to calculate the option’s probability-weighted net present value, if you set the expected return below zero, the time value will go negative. If you set the strike price equal to zero, the option value will equal the exercise-today value, which will be equal to the spot price of the underlying.” Source: Black-Sholes Made Easy by Jerry Marlow, p. 193
SCOPE OF THE PROBLEM • "Mr. Smith, let's review the results of your blood tests. Your CBC, BMP, and LFTs were basically negative. You have prediabetes and a slightly elevated LDL, and since your BMI is 28, you should watch your diet and exercise more to prevent metabolic syndrome. Oh, and it's OK to keep taking an occasional NSAID with food for your idiopathic knee pain."
COMMON LOW HEALTH LITERACY PROBLEMS • Not understanding Consent Forms • Not understanding written education information • Having trouble filling out forms
COMMON LOW HEALTH LITERACY PROBLEMS • Not understanding how and when to take your medicine • Not understanding your main health problem
COMMON LOW HEALTH LITERACY PROBLEMS • Not knowing the words that the healthcare provider is saying • Having trouble finding your way
STRATEGIES TO IMPROVE HEALTH LITERACY 1. Conduct patient-centered visits – Engage in a dialogue with the patient – Listen more and speak less – Encourage questions (ASK Me 3)
Strategy: Empower patients
Ask Me 3 What Is My Main Problem?
What Do I Need to Do?
Why Is It Important for Me to Do This?
STRATEGIES TO IMPROVE HEALTH LITERACY 2. Explain things clearly using plain language. 3. Focus on key messages and repeat. 4. Use “teach back” or “show me” techniques
STRATEGIES TO IMPROVE HEALTH LITERACY • Ask patient to demonstrate understanding – “What will you tell your spouse about your condition?” – “I want to be sure I explained everything clearly, so can you please explain it back to me so I can be sure I did.” • Do not ask, – “Do you understand?”
POTENT CASE FOR TEACH-BACK • Video clip
STRATEGIES TO IMPROVE HEALTH LITERACY 5. Use Patient –friendly educational materials to enhance interaction • Focus only on key points • Emphasize what the patient should do
National Efforts Tipping Point 2010 • Plain Writing ACT • The Joint Commission – Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Road Map for Hospitals • National Action Plan – U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion
National Efforts AHRQ– Universal Precautions Toolkit • • • •
Tools to start on the path to improvement Tools to improve spoken communication Tools to improve written communication Tools to improve self-management and empowerment
Universal Precautions • Many patients are at risk of misunderstanding, but it is hard to identify them. • Testing general reading levels does not ensure patient understanding in the clinical setting. • Everyone benefits from clear information.