health literacy and cultural competency...(naal, 2003) 88% of u.s. adults below proficient level...
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Health Literacy and
Cultural Competency
Sabrina Kurtz-Rossi, MEd, Assistant Professor, Tufts
University School of Medicine, Health Literacy Consultant
Julie McKinney, MS, Moderator of the Health Literacy
Discussion List, Health Literacy Consultant
CNYCC Webinar
February 27, 2015
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What We Will Talk About
•Link health literacy and cultural competency
•Define health literacy and who is at risk
•Consider evidence-based interventions
•Facilitate discussion
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What are the literacy and language
demands in health and healthcare?
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What is your role?
Clinician
Administrator
Public Health Professional
Educator
Care coordinator
Community Based Organization
Other
Poll: Please click on the choice that’s closest to what you do
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What kind of facility are you from?
Hospital or Medical Center
FQHC or other health center
Private or group practice
Public Health Department
Health Home/Nursing Home/Assisted Living Facility
Specialty Care Treatment Center (Behavioral health,
dental, substance abuse, etc.)
Other
Poll: Please click on the choice that’s closest
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How much does your workplace address…
Health Literacy
None
A little
A lot
Cultural Competency
None
A little
A lot
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“Culture and health literacy both influence the content and outcome of health care encounters.”
“This intersection between culture and health literacy is recognized in the DHHS OMH National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care.”
Source: Institute of Medicine Committee on Health Literacy. Health Literacy: A Prescription to End Confusion. Nielsen-Bohlman L,
Panzer AM, Kindig DA, eds. Washington, DC: The National Academies Press; 2004.
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Culturally and Linguistically Appropriate
Services (CLAS) Standards
• National standards developed by DHHS Office of Minority Health
• Provide common understanding of culturally and linguistically appropriate services
• Offer framework for services and structure to respond to cultural and linguistic differences
Source: U.S. DHHS OMH (2001). National Standards for Culturally and Linguistically Appropriate Services in Health care.
Federal Register 65(247):80865-79.
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Enhanced - Culturally and Linguistically
Appropriate Services (CLAS)
• Principle Standard (Standard 1)
Provide effective, equitable, understandable and
respectful quality care and services that are responsive
to diverse cultural health beliefs and practices,
preferred languages, health literacy and other
communication needs.
Source: U.S. Department of Health and Human Services Office of Minority Health. National Standards for Culturally and
Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and
Practice. U.S. DHHS. Washington, DC: 2013.
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Calgary Charter, 2008
“Health literacy allows the public and personnel working in all
health-related contexts to find, understand, evaluate, communicate,
and use information.”
http://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_
Charter_2011.pdf
What is Health Literacy?
http://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_Charter_2011.pdfhttp://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_Charter_2011.pdf
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Health Literacy Includes
• Finding health information
• Understanding it
• Evaluating it
• Communicating it
• Using it…acting on it…to live longer and better!
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Health Literacy: A Two-way Street
http://www.google.com/imgres?imgurl=http://www.sipmoc.com/images/w17ra25_img.jpg&imgrefurl=http://www.sipmoc.com/warning_signs.html&usg=__7ipshnvVEj8paW2ed5A5p1R7HRQ=&h=141&w=141&sz=28&hl=en&start=107&zoom=0&tbnid=I3PME0mnwbVmcM:&tbnh=94&tbnw=94&ei=w5t_Tfq3EcXJgQeLl7yTCA&prev=/images?q=double+arrow+two-way+street&hl=en&sa=G&biw=1088&bih=741&gbv=2&tbs=isch:1&itbs=1
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Health literacy of U.S. Adults
12% 14%
22%
52%
Below Basic
Basic
Intermediate
Proficient
(NAAL, 2003)
88% of U.S. Adults below Proficient level That is nearly 9 out of every 10 adults!
~ Andrew Pleasant, Canyon Ranch Institute
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Why Does Low Health Literacy Contribute to Health
Disparities?
Who has the lowest skills? (Basic and Below Basic )
• 58% of Blacks
• 66% of Hispanics
• 76% of high school dropouts
• 28% of whites
• 36% of total population
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Low Health Literacy is Linked to …
• Under-use of primary care services
• Overuse of EDs
• Increased hospitalizations
• Increased medication errors
• Poor health knowledge
• Poor health outcomes
• Increased healthcare costs
Source: Berkman N, Sheridan S, Donahue K, et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence Report/Technical Assessment No. 199. Prepared by RTI International-University of North Carolina Evidence-based Practice Center under
contract No. 290-2007-10056-1. AHRQ Publication Number 11-E006. Rockville, MD. Agency for Healthcare Research and Quality. 2011.
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What does health literacy have to do with it?
The People:
• Poor health literacy skills
The Health System:
• Poor health literacy skills
• Too complex
• Intimidating
People can’t meet their health
needs
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Build Health Literate Organizations
Source: Institute of Medicine Roundtable on Health Literacy. Attributes of a Health Literate Organization
http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf
http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf
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Attributes of Health Literate Organizations
Source: Institute of Medicine Roundtable on Health Literacy. Attributes of a Health Literate Organization
http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf
A Health Literate Organization 1. Has Leadership that makes health literacy integral to its mission structure and operation
2. Integrates health literacy into planning, evaluation, patient safety and quality improvement
3. Prepares the workforce to be health literate and monitors progress
4. Includes populations served in the design, implementation and evaluation of health information and services
5. Meets need of populations with a range of health literacy skills while avoiding stigmatization
6. Uses health literacy strategies in interpersonal communication and confirms understanding at all points of contact
7. Provide easy access to health information and services and navigation assistance.
8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on
9. Addresses health literacy in high-risk situations, including care transitions and communications about medicine
10. Communicates clearly what health plans cover and what individuals with have to pay for services.
http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf
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Evidence-based Cultural Competency
Interventions
• Cultural competency training
• Racial and ethnic concordance
• Language access services –
interpreters and translators
• Community health workers
Source: Fortier, JP, Bishop D. Setting the Agenda for Research on Cultural Competence in Health Care. Brach C.
editor. OMH and AHRQ. (Publication No. 474). 2004.
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Evidence-based Health Literacy
Interventions
•Health literacy training
•Plain language
•Teach-back technique
• Teaching health literacy in
adult education programs
Source: Berkman N, Sheridan S, Donahue K, et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence
Report/Technical Assessment No. 199. Prepared by RTI International-University of North Carolina Evidence-based Practice Center under
contract No. 290-2007-10056-1. AHRQ Publication Number 11-E006. Rockville, MD. Agency for Healthcare Research and Quality. 2011.
English for speakers of other languages students working
on the HEAL health literacy curriculum
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Online Training for Health Professionals
• Module 1: Introduction to
Health Communication
• Module 2: Health Literacy
• Module 3: Cultural
Competency
• Module 4: Limited English
Proficiency
http://www.hrsa.gov/publichealth/healthliteracy/
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Competencies for Health Professionals
• Awareness
• Attitudes, skills and beliefs
• Communication skills
• Plain language skills (written and oral)
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Diagnosis……………..
Anti-inflammatory…….
Nasal congestion……..
Lesion………….…….
Risk factor……………..
Cause of your illness
Lowers fever and swelling
Stuffy nose
Cut, wound, sore
Will increase your chance of getting…
Avoid Medical Jargon
Use Living Room Language
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Practice Teach-back
Source: American Medical Association Foundation and American Medical Association. Health Literacy and Patient Safety: Help Patients Understand. Chicago, IL: American Medical Association; 2007.
Do you have any
questions?
•Check for understanding
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Working with Interpreters and Translators
Source: Andrulis DP, Brach C. Integrating Literacy, Culture, and Language to Improve Health Care Quality for
Diverse Populations. Am J Health Behav. 2007;31(Suppl 1):S122-133.
• Interpreting
• Translating
Birth control methods brochures in five
languages. Action for Boston Community
Development (ABCD)
Communicating Effectively Through an
Interpreter. Kaiser Permanente.
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RECOMMENDED REGARDING WRITING
IN TERMS OF ITS RECEPTION
IT IS NOT INAPPROPRIATE , WHEN USING PRINT MEDIA TO
IMPART MATERIAL OF A FACTUAL OR INTERPRETIVE NATURE
WHICH HOLDS THE INTENTION OF CONVEYING CRITICAL
INFORMATION TO AND/OR INCLUDING A CRITICAL ACTION BY
ITS PROSPECTIVE RECIPIENTS, TO EMPLOY RELATIVELY
NONCOMPLEX VERBIAGE SO AS TO MAXIMIZE
COMRPEHENSION IN THE AFOREMENTIONED POPULATION.
Source: Lessons in Plain Language 1992, PLAN, Inc.
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The Role of Cultural Brokers and
Community Health Workers
Source: Communicating Effectively Through an Interpreter. Kaiser Permanente.
Video Clip:
Working Effectively
With an Interpreter
Downloaded From: HRSA (2007). Unified Health Communication 101: Addressing Health Literacy, Cultural
Competency, and Limited English Proficiency. http://www.hrsa.gov/healthliteracy/training.htm
http://www.hrsa.gov/healthliteracy/training.htm
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Cultural humility is a lifelong commitment to self-evaluation and self-critique, and developing beneficial and non-paternalistic relationships.
Cultural Humility vs Cultural Competency
Source: http://healthresearch.berkeley.edu/disparities/docs/CulturalHumility.pdf)
Source: Dr. Bankole presentation Tufts University School of Medicine, January 2015
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How do we improve health literacy?
People must…
• Improve skills
• Gain confidence
• Learn the system
• Engage in the system
appropriately
Systems and Providers must…
• Improve skills
• Lower barriers
• Revise policies
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Community Education
• Basic literacy skills
• Health literacy skills
• How to use the healthcare system
• Confidence and trust in health
system
• How to take care of your own
health: preventive care and chronic
disease management
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“Building Bridges” in NYC
Example of two-way learning experience
• Partnership between Harlem Hospital and adult literacy program • Students toured the local hospital
• Intro talk from each department • Students felt more comfortable going there for care
https://www.youtube.com/watch?v=uPM3kSb2Cfw
https://www.youtube.com/watch?v=uPM3kSb2Cfwhttps://www.youtube.com/watch?v=uPM3kSb2Cfw
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Summary of Key Points
• Low health literacy is linked to poor health outcomes
and health disparities
• Health literacy and cultural competency initiatives need to address system challenges and engage the community
• Education/training needs to happen for both sides: the public and the health systems/providers.
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Sabrina Kurtz-Rossi, MEd
Assistant Professor, Tufts University School of Medicine, Health Literacy Consultant
sabrina_kurtz-rossi@comcast.net
Julie McKinney, MS
Moderator of the Health Literacy Discussion List, Health Literacy Consultant
jmckinney11@gmail.com
Thank You!
mailto:sabrina_kurtz-rossi@comcast.netmailto:sabrina_kurtz-rossi@comcast.netmailto:sabrina_kurtz-rossi@comcast.netmailto:jmckinney11@gmail.com
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