amrita mukhopadhyay*, hila calev*, jill huded, md** · 2017. 9. 5. · amrita mukhopadhyay*, hila...

Amrita Mukhopadhyay*, Hila Calev*, Jill Huded, MD**

Background+ Results+

Conclusions+

What+is+health+literacy?++It#is#de(ined#as#the#ability#to#understand#and#navigate#one’s#

healthcare#environment.##Literacy#is#one#of#the#strongest#predictors#of#health#status.##

Low#health#literacy#is#associated#with#poorer#health#outcomes,#higher#health#service#

utilization,#and#dif(iculty#understanding#written#medical#instructions.1,2#

+

How+prevalent+is+low+health+literacy?++More#than#33%#of#American#adults#do#not#have#

adequate#health#literacy#to#navigate#preventive#care#or#treatment3,#with#a#higher#risk#in#

limited#English#pro(iciency#populations.##

#

Our+population+at+high+risk:++The#largest#volunteerHbased#free#clinic#in#IL#serving#those#

under#250%#of#the#poverty#level,#many#with#limited#English#pro(iciency:#

•  50%#Latino,#15%#Polish#immigrants.#•  30%#with#less#than#8th#grade#readingHlevel,#30%#with#a#9H12th#grade#readingHlevel.#

#

#

An+interdisciplinary+team:++physician,#

nurse#practitioner,#medical#students,#

health#education#coordinators,#intern,#

dietician,#nurses,#and#social#worker.#

#

Our+process:++See#diagram.#

+

Assuring+quality+using+the+Suitability+

Assessment+of+Materials+(SAM):++a#

validated,#21Hitem#tool#requiring#a#score#

of#greater#than#70%#to#be#“superior”.4#

#

Patient+feedback:#a#verballyH

administered,#8Hquestion#survey#

assessing#readability,#vocabulary,#

graphics,#layout,#learning,#motivation,#

and#cultural#appropriateness#on#threeH

point#scales,#as#well#as#an#overall#

preference#for#the#old#handout#versus#

the#new#handout.#

Barriers+Methods+

Patients#

1.+Needs+assessment+surveys+

Allied#Health#

Professionals#

Topic#of#

Greatest#

Interest#

2.+Online+search+

for+materials+Only#accept#if#

“superior”#SAM#Score#

3.+Adapting+materials+

to+our+patient+

population+

Staff#

Providers#

Nurse#

Patients#

Social#Worker#

Dietician#

4.+Translation+

Two#trained#

native#speakers#

per#handout#

High#quality#

translation#

Tailored#

Handouts#

Demographics#

• There#is#a#scarcity#of#publicallyHavailable#patient#education#handouts#to#meet#the#needs#of#our#lowH

income,#lowHhealth#literacy#patient#population.#

• The#SAM#tool#can#be#used#to#assess#document#quality#of#such#materials.#

• We#used#a#replicable,#interdisciplinary#method#to#create#handouts#in#3#languages#with#strongly#

positive#patient#feedback.###

ACKNOWLEDGEMENTS:##Anna+Ruman,+Nicole+Potempa,+Audrey+Schield,+Adelle+White,+Stacy+Smrz,+Miguel+Barajas,+Ewa+Wojciechowska,+Bozena+Tybor,+Ornella+Razetta#REFERENCES:+

1.+Weiss+BD+et+al.+Health+status+of+illiterate+adults:+relation+between+literacy+and+health+

status+among+persons+with+low+literacy+skills.++J+Am+Board+Fam+Pract.1992.+

2. +Baker+D+et+al.+The+relationship+of+patient+reading+ability+to+selfYreported+health+and+use+of+health+services.+Am+J+Public+Health.1997.+

3. +Weiss,+B.,+2007.+Removing+Barriers+to+Better,+Safer+Care:+Health+Literacy+and+Patient+Safety.+Help+Patients+Understand.+Manual+for+Clinicians,+2nd+ed.+Chicago,+AMA+Found.+

4. +Doak+CC,+Doak+LG,+Root+JH.+Philadelphia,+Pa:+JB+Lippincott+Company;+1996.+Teaching+Patients+with+Low+Literacy+Skills.+2nd+ed.+

94.6%

5.2% 0.2% 0%

20% 40% 60% 80%

100%

Positive Neutral Negative

Per

cent

of

Res

pons

es

120/80& 140/90&

Have%your%blood%pressure%checked%often%%(at%the%doctor’s%of7ice%or%local%pharmacy).%

NORMAL'

PRE*HYPERTENSION'You%are%more%likely%to%end%up%with%high%blood%pressure.% HIGH'

Source:(Translated(from("Keep(the(Beat:(Control(Your(High(Blood(Pressure"(at(h=p://www.nhlbi.nih.gov/health/public/heart/other/laCno/hbp/bloodpressure.pdf((Accessed(03/3/2014).(NaConal(Heart,(Lung,(and(Blood(InsCtute;(NaConal(InsCtutes(of(Health;(U.S.(Department(of(Health(and(Human(Services.(((Note:(The(NHLBI(is(not(responsible(for(this(document(or(any(error(it(may(contain.(("Keep(the(Beat"(was(modified(in(

format(but(not(in(content(or(conclusions.((The(pictorial(presentaCon(of("What(Do(Your(Blood(Pressure(Numbers(Mean"(was(created(based(on(informaCon(in(the(above(document.)(

High%blood%pressure—also%called%hypertension—is%known%as%the%“silent%killer”%because%it%often%has%no%symptoms.%If%not%treated,%high%blood%pressure%raises%your%chances%of%%

•  Stroke.%•  Heart%attack.%•  Kidney%problems.%•  Eye%problems.%•  Death.%

Content#in##

serif#font.##

#

Shorter#words#

and#sentences. Punctuation#after##

listed#terms.#

#

Smaller#chunks#

of#information.#

#

Cartoons#>##

photographs.#

#

Pictures#closely##

linked#to#text.#

#

More#pictures.#

#

Color#>#

grayscale.#

• Lack#of#appropriate#publicallyHavailable#materials.#• Copyright#challenges#in#adapting#existing#materials#and#translating#into#other#languages.#

• Lack#continuity#due#clinic#staff#turnover.#• Native#speakers#to#translate#materials.#

Patients+ N+(%)+

Total#Participants# 30#

Female# 19#(63%)#

SpanishHspeaking# 20#(67%)#

EnglishHspeaking# 10#(33%)#

Health+Professionals+

Total#Participants# 11#

Female# 11#(100%)#

Patient+Feedback;#

•  New#handouts#universally#preferred#to#old#ones,#except#“High#Cholesterol”#(3#of#7#preferred#old),#which#was#

reworked#on#the#basis#of#patient#feedback.#

•  Free#response#feedback#centered#on#clarity#of#graphics#(7#comments)#and#wording#(8#comments).#

Figure+1:++Needs+Assessment.##Percent#of#participants#interested#in#each#health#

topic,#with#each#group#equally#weighted.##New#handouts#were#created#for#the#

eight#most#popular#topics#(red#boxes),#with#four#topics#combined#into#a#

“Women’s#Health”#handout.###

Figure+2:+Feedback.#Responses#to#8Hquestion#

feedback#surveys#(22#patients,#60#surveys).#

Designing+Education+Materials+Example+

0 10 20 30 40 50 60 70 80 90

Per

cent

of i

nter

este

d pa

rtic

ipan

ts (w

eigh

ted)

English-speaking Patients (N=10) Spanish-speaking patients (N=20) Allied Health Professionals (N=11) Women’s#Health#Handout#

Project+Aim+

+We#aimed#to#improve#health#education#materials#used#in#providerHpatient#encounters#

in#8#topics,#focusing#on#appropriateness#for#patients#with#low#health#literacy.#

#

Provide#translations#of#these#materials#in#English,#Spanish#and#Polish#while#

incorporating#aspects#of#culture#and#community#into#the#documents.#

#

Provide#team#education#on#health#literacy.#

#

#

Table+1.++Demographics#

of#patients#and#allied#

health#participants#in#

initial#needs#assessment.#

Final+Handout+