a silent epidemic
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A Silent Epidemic. Georgia Health Sciences Library Association March 6, 2008. A Silent Epidemic. Learning Objectives 1. Discuss the importance of health literacy in relationship to consumer health information and education. - PowerPoint PPT PresentationTRANSCRIPT
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A Silent Epidemic
Georgia Health Sciences
Library Association
March 6, 2008
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A Silent Epidemic
Learning Objectives
1. Discuss the importance of health literacy in relationship to consumer health information and education.
2. Identify 3 interventions to promote health literacy in your library/facility.
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“There is no prescription more valuable than knowledge.”C. Everett Koop MD, Former Surgeon General of the United States
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What is health literacy?
Health literacy is the ability to
read, understand and act on
healthcare information.
Understanding health information is everyone’s right.
Improving health literacy is everyone’s responsibility.
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A Silent Epidemic
Question -
Which of the following is the strongest predictor of health status in America today?• A. Age• B. Income• C. Literacy skills• D. Employment status• E. Educational level• F. Racial or ethnic group
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Importance of Health Literacy
Literacy is a stronger predictor
of health status than age,
income, employment,
education or racial/ethnic group
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A Silent Epidemic
Scope: Occurs regardless of age, race, gender,
education or income level Affects over 90 million adults in the U.S. Costs billions of dollars per year
Diagnosis: Cannot be detected by appearance, a
physical exam, blood test or other diagnostic test.
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How silent is it?
Nondisclosure of limited literacy
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Co-workers - 85% HCP - 75% Spouses - 68% Friends - 62% Children - 52%
Pankh, Nrrss, Baker and Williams (1996) Shame and health literacy: The unspoken connection. Patient Education and Counseling. 27:33-39.
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Video
Help your patients understandAMA Foundation
2007
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Change in complexity in medicine
Medical topic 35 years ago Today
Drugs 650 > 10,000
Treatment for MI 4 weeks bedrest/admit
2-4 day admit
New onset diabetes
2-3 week admit Outpatient
Asthma Theophylline Inhalers, rescue meds, controller meds, peak flow meters, steroids, triggers
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U.S. Literacy Surveys
1993 National Adult Literacy Survey NALS – 26,000 people - English only Prose Document Quantitative
2003 National Assessment of Adult LiteracyNAALS – http://nces.ed.gov/naal 19,000 people – English and Spanish Added fluency and health literacy components
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2003 NAAL Survey
Sample literacy skills
Below basic - Tell how often a person should have a medical test based on an easy-to-read handout
Basic - Answer two questions based on a one-page article about a medical condition
Intermediate - Find the age-range a child should receive a vaccine from a chart listing all vaccines and ages
Proficient - Interpret a table about blood pressure, age and physical activity and understand the relationship between them
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http://nces.ed.gov/naal/
11 million adults are Non-literate in English
30 million adults have Below Basic Literacy skills
63 million adults have Basic Literacy skills
2003 NAAL Key Findings
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2003 NAAL survey
2003 NAAL Level
Total
population
Medicare Recipients
Medicaid
Recipients
Below Basic 14% 27% 30%
Basic 22% 30% 30%
Intermediate 52% 40% 38%
Proficient 12% 3% 2%
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Poor Health Literacy
Mean reading level for Medicaid recipients is 5.6 grade level
• 8.7% are illiterate
• 25% read below the 4th grade level
Mean reading level for Spanish speaking Medicaid recipients is 3.1 grade level
• 1 in 10 Americans is foreign-born (2002)
• 1990 – 2000 - the non-English speaking, adult
population increased from 117,000 to 261,000
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Poor Health Literacy
Last grade completed in school does not equate with reading level Poor readers may read about 2-4 grade
levels below last grade completed in school
Unfamiliar information and anxiety lower reading level by 1-2 grades
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Clear Health Communications
Verbal information
Written materials
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Clear Health Communications
“Words mean what I want
them to mean” Alice in
Wonderland
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Clear Health Communications - Verbal
Create a patient-centered environment(See through the eyes of the patient)
Involve and individualize: Be positive, respectful, caring and sensitive Sit rather than stand Listen rather than speak Make eye contact when culturally appropriate Encourage patients to ask questions
• “What questions do you have for me”?
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Clear Health Communications
Create a Shame- Free Environment
Observe for : Taking too long to fill out a form Filling out only parts of forms Filling out forms incorrectly Asking someone else to complete
forms or read materials Eyes wandering over the page Lack of interest in written materials
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Clear Health Communications
Create a Shame- Free Environment
Listen for: “I forgot my glasses.” “I left my glasses in the car.” “I’ll take this home and read it later.” “I don’t have time to read this - just tell
me the important things I need to know.” “Could you read this for me? I have a
headache.”
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Clear Health Communications
Create a “shame-free” environment
and offer help
“How happy are you with the way you read?”
“What is the easiest way for you to learn and remember?”
“These forms are quite complicated, can I help you complete them?”
“A lot of people have trouble reading and remembering this. Is this difficult for you?”
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Clear Health Communications
“What is clear to you is clear to you. Every patient should be a full partner in his or her medical decisions. This requires crystal-clear communication that is done with compassion and mutual respect.”
Toni Cordell, former adult literacy student and
health literacy advocate
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Clear Health Communications - Written
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“Half of the adult population needs easy-to-read materials; the other half who do not need them want them anyway.”
Sue Stapleford, Health Literacy Institute
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Can you read this?
For lamitpo doolb ragus tnemeganam of setebaid, it
is yrassecen to take the tcerroc nilusni dose.
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Health literacy in a word
KISS
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What’s a librarian to do?
Healthcare consumers
Healthcare providers
Community
Public libraries
Other health librarians
Policy makers
Your organization
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Your turn…
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For consumers
Offer plain language resources and patient education materials:
AV materials
Books
Patient education handouts - Krames, Pritchett and Hull, Channing-Bete
Computer-based resources - Micromedex, Krames, LexiComp
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Clear Health Communications
Slow down
Use plain, non-medical language
Limit information to 3-5 key points
(“need-to-know” information)• 7-digit phone number• Emergency phone number
Be specific and concrete
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Clear Health Communications
Demonstrate, draw pictures, use models
Use non-medical, living room, conversational language
Repeat, repeat, repeat (6x rule)
We remember 20% of what we hear
50% of what we hear and see
90% of what we do
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Patients first
Focus on the patient and family -
not on our teaching, but on what are
they are actually learning
Evaluate learning often Open ended questions Teach back Show me Scenarios
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Clear Health Communications
Ask Me 3
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do
this?
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Health literacy resources for consumers and providers
Partnership for Clear Health Communications
Ask Me 3
http://www.askme3.org/
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Health literacy resources for providers
AMA Foundation. Health literacy and patient safety: Help patients understand. (Kit containing DVD, CD-rom, manual) $35.00
http://www.ama-assn.org/ama/pub/category/9913.html
Institute of Medicine. A Prescription to End Confusion. $44.96 http://www.iom.edu/?id=19750
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Health literacy resources for providers
What did the doctor say? Improving health literacy to protect patient safety. 2007 White Paper. http://www.jointcommission.org/PublicPolicy/health_literacy.htm
Hospitals, Language, and Culture: A Snapshot of the Nation. 2007 White Paper.
http://www.jointcommission.org/PatientSafety/HLC/
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The community
Partner with:
Public health clinics and departments
Pharmacies
Non-profit organizations and social service agencies
Professional schools (physician, nursing, allied health)
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The community
Partner with:
Schools, churches and other religious institutions
Cultural groups Community events and health fairs Literacy groups (adult basic education,
ESL, etc) Senior citizen groups
Reach-out-and-read programs
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Community libraries
Partner to help:
Promote awareness
Provide health education books for children and adult
Health-related “story hours”
Coordinate community programs
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Community libraries
The Humana Foundation, Libraries of the Future and the Dekalb and Fulton county libraries
www.wellzone.org
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Other health libraries
Raise awareness through:
Networking opportunities
Shared resources, projects and presentations
Literacy inservices and train-the- trainer sessions
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Policy makers and media
Legislators
Advocacy
Community events
Medicare and Medicaid officials
Newspapers, radio, TV
Public service announcements
School curriculums/librarians
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Your organization
Work with:
Patient education committees
Interpreter/cultural groups
Physicians and educators
Marketing department:
• Publications
• Intranet and intranet sites
• Closed-circuit TV programming
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Your organization
Special events: MedlinePlus inservices Health Literacy Month Health Education Week Literacy inservices
Special displays: Library displays Bulletin boards Cafeteria
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MLA Involvement
Health Information Literacy “There is a huge need to bring sense to the information universe
if MLA's vision of "quality information for improved health" is to
be achieved. There is at the same time a significant gap in the
awareness by the public and by opinion-leaders and decision
makers of the contributions that health sciences librarians can
make (and are making) to bring order to the chaos.”
MLA website
MLA Health Information Literacy Research Project –http://www.mlanet.org/resources/healthlit/hil_project
overview.html• $250,000 two-year NLM contract - research into hospital-based health
care provider and administrators’ awareness and understanding of health information literacy and its value in support of patient care.
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Health Literacy Resources
www.askme3.org
www.healthliteracy.worlded.org/index
www.hsph.harvard.edu/healthliteracy/
www.jointcommission.org
www.rwjf.org
http://www.healthliteracy.com/
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Literacy Resources
www.nces.ed.gov/naal
www.proliteracy.org
www.wisconsinliteracy.org
www.unesco.org
www.national-coalition-literacy.org/naal
www.ncsall.net
www.nifl.gov/nifl/facts/health
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Final thoughts
Health Literacy is of concern to everyone involved in health promotion and protection, disease prevention and early screening, health care maintenance,and policy making.
Committee on Health Literacy of the Institute of Medicine, 2004
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Take home message
1. Raise awareness
2. Provide education
3. Provide resources
4. Partner with others
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The End!