Health Literacy Conference Institute for Healthcare Advancement

Health Literacy ConferenceInstitute for Healthcare Advancement: https://www.iha4health.orgMay 6th- 8th, 2015 Irvine, CA

The institute for healthcare advancement (IHA) is dedicated to empowering people to better healthPublish easy-to-read books, and teacher manualsOrganize an annual continuing education health literacy conferenceOffer health literacy rewrite/redesign and original writing and graphic design serviceEvaluate your patient education materials and communications (field testing with focus groups and one-on-one interviews)Sponsor and administer the health literacy discussion listAdminister the Leonard Doak Memorial Scholarship in Health LiteracyRun the La Habra Family Resource CenterHelp residents of Orange County, California, sign up for health insurance1The degree to which individuals and groups can obtain, process, understand, evaluate, and act upon information needed to make public health decisions that benefit the community

PUBLIC HEALTH LITERACY

Michael Paasche-Orlow, M.D2OutlineHealth InsuranceRisk CommunicationStrategies for a more collaborative health literate communityCreating a needs based health literacy initiative, examples from MissouriHealthy Equity & Health Literacy Engaging youth in health discussionsTranslationIntergenerational communication

Health Insurance: Train the Trainer SessionHealth Insurance: What it means to have itWhat health Insurance is and how it worksWhat health insurance covers (and what it may not cover)How to use health insurance (to stay as healthy as possible)How to keep health insurance (now that you have health insurance) Resources: enrollamerica.org: justplainclear.com : definitions for vernacular

Amy DeMarco, MPA, Programs and Operations Manager at IHA

Resources: enrollamerica.orgwww.justplainclear.com Health Insurance Terms

(came up in later session) Talk about it in terms that people understand not in the traditional language (co-pay, deductible, co-insurance) define these as that is important but appeal to emotional aspects: how to keep your family safe, how to ensure they can stay in home, etc. 4Affordable Care Act & Health Literacy Think about MESSAGES and how they resonate in different communities Utilize community based organizations: NGO, Faith organizations, Salons Learned Helplessness: This comes from telling populations over and over again that it wont work out for themGOALS: Less wording, more white space, plain English (no matter what audience, but definitely non English speakers)

Michael Villaire, MSLM (Moderator), Don Rubin, Ph.D., M.D, Catina OLeary, Ph.D., Doreena Wong, Federal govt representative

Its not mere translations- its concepts (co-pay, deductibles, and premiums dont make sense) we need to be talking about the importance of keeping family safe, stay together, etc.

Cover Missouri Coalition resources 5Lessons about clarity from crisis and emergency risk communication Communicating about risk requires extra attention to clarity. Ask yourself as a healthcare practitioner: When do I evoke emotions around risk?Tie consequences to the riskBe Clear about what you know, and what you dont know Use Statements of EMPATHY We continue to have a lack of empathy even though we know that emotions are involved in how people receive and understand health messagesCreate TRUST: Communication does not happen without trust

CDC Senior advisor for Health Literacy, Cynthia Bauer

Clear Communication Index (on-line): have to select a primary audience (be as SPECIFIC as possible) in crisis or risk may not have this luxury , healthy people 2020PEOPLE NOT understanding information is a risk in and of itself is a risk factor, nave assumption about messages and that people will understand and followThere are very real consequences when people dont understand EBOLA- can we be clear about who is at risK?low risk as a descriptor, qualitative descriptors are inadequate ; if you are not empathetic or reassuring you have failed at creating an effective health message Images of suits Fear not reassuranceHealth Literacy EMOTIONS (Fear, ansxiety, confustion, anger) effect how people understand health messages minimum message that you have to get across to the most amount of people- large audiences E-cigs, we thought we knew evertying about cigarrettes- this is science, you have to be humble; if we did a better job about stating what we know and what we dont know then people could be more understanding about the unfolding of information (this happen in NUTRITION all the time) BEST PRACTICES: Whats known, Whats not known, How or Why?, Action Steps, Empathy, Accountability , commitment- people are UNCOMFORTABLE talking about what they dont know but this is an important piece!Food borne illness, risk is smaller than people think it is

6Strategies for a more collaborative health literacy community Linking Research and Practice: 1% Research is translated to Practice! The Average Journal article is read by 12 peopleThe answers are right there, but no one is asking the people that are affected.We need:Participatory design (or user centered design) is keyCommunication as a group Researchers, practitioners, and communities work in tandem

Linda Neuhauser, Masters public health inNutrition, started counseling, no one took her sceince based advice no matter how loud she talked, colleagues confirmed this was the same our job was to tell people what to using scince PHD professor in PUBLIC health UC Berkeley , worked in west Africa health officer in Mauritania , Africa Vaccinations Helath officer , toured the country for 6 mos for new strategy- lots of cultural, political reasons why the scientific plans never got into practice

National library of medicine = translating research into practice

Health Research for Action UC Berkeley: researchers, practiioners, communication experts (health litearyc) what have they learned in 20 yrs? Need to have researchers committed to ACTION, practitioners interested in evidence, experts in communication and health literacy, strong entrepreunership spirit, perserverance.

Average journal article is read by 12 people! UNIVERsities are expanding to social service to REACH MORE PEOPLE

IDEA-O , D- School : organization - participatory user centered design world wide, rapid cycles, very POWERFUL 7Creating a needs-based Health Literacy InitiativeUniversity of Missouri Center for Health Policy Studies show that 40-80% of the medical information that patients receive is forgotten immediately and that nearly of the information is incorrectUse a Teach Back method-Straight Talk with your DoctorImplementation Science how you implement your intervention makes all the difference

Missouri Health Literacy Enhancement, Missouri Foundation for Health when blue cross blue shield went from non-profit to bussiness, MO negotiated the funding for this, limited to 85 MO countiesservice areas Health Literacy Initiative (HLI) Healthcare Foundation of Greater Kansas City (3 MO counties 3 inKS) another Insurance transfer Foundation Deserts

8Health equity and health literacy Health Outcomes in US are worse than in some developed countries (but we spend WAY MORE money)Health Equity and the Social Determinants of Health Sentiments among healthcare practitioners around these issues:We didnt start the fireBUT by not acting we transform Education disparities into healthcare disparitiesHealth Literacy is a crucial component of Health Equity (mitigating the social determinants of health)You Be the Tide that Raises all Boats. - JFK

PANEL - Michael Villaire, MSLM (Moderator)- Founder of IHA , Michael Paasche-Orlow, M.D. Boston University , Robert Logan, Ph.D, National Library of Medicine, Winston G Wong, MD MS Kaiser Permanente

Health Equity- getting rid of the social and environmental determinants of health we are moving towards this Health Literacy- Health Disparity IOM report around unequal treatment , Dept of health and human services Minority Report, gaps with regards to clinical outcomes- Gender, Racial ethnic groups ; clinical outcomes differences in what we would expect to be the standard- gender, race, ethnicity. EtcEnvironmental determiniants of health and social

we didnt start the fire sentiment among healthcare practitioners, these disparities are omnipresent education, econmonics, healthcare- we transform ed disparitites into healthcare disparities ( so we have a role in creating the problem and we should help to elimiate it)

Why is it important to draw these distinctions? US educational CAST system, your vocabularty at kindergarden plays a huge role in your income career!! What research is addressing this? Intermesh the research agenda.

STUDY- HIV medication adherence adherence comparing AA with and without utilizing health literacy these adjusted analysis can be utilised to understand where interventions are important study: osborn, Paasche-Orlow, Davis, Wolf. AJPM 2007.

Hospital end of life decision making- convincing to hospitals to fill education requirements, health literacy, cultural competence- with VIDEO intervention no difference by level of HL or race!!

A Person is Not a Regression Analysis

Client patient relationship social class assumptions

Impact better health and healing to the most vulnerable population- what do you do? Eveidence is not exaclty clear- but the eveidence suggests that health literacy is an intervention you can make that makes a difference over time. Helath literacy needs to be implemented in LOW INCOME populations ; this is where helath literacy and health equity meet

Hayes (MT) case study, home visitations over time, pregnant single moms almost all low income- one group received healthcare visitation as usual, other gorup received the same and received life skills training- sophisticated assesment of moms and then did an assesment of their children, ages 4-5; the differences among groups is stumnning- capacity of learn, stay employed, self confdience, how they care for their children and childrens impacts

Over 30,000 Health Apps- most are not used. So much room for creativity, communication , and empowerment to ask questions ; we shame people so much into silence

Health Literacy vs. Health Communication Health Literacy Tool Shed

You Be the Tide that raises all Boats Health Literacy is a rising tide that lifts all boats

9Engaging Youth 10 years ago, nearly 1 in 4 youth ages 12-19 had pre-diabetes, now this one 1 in 11 of these youth will have full blown diabetes within 5 years (25% of white youth, 50% of Latino and African American youth)

Visit: www.thebiggerpicture.org (Pediatrics 2012)

Dean Schillinger, MD University of CA, San FranThe Bigger Picture Campaign; thebiggerpicture.org Public Health Literacy- degree to which individuals and groups can obtain, process, understand, evaluate, and act upon information needed to make public health decisions that benefit the community

1 in 3 white youth, 1 in 2 latino and black youth

Goal is to change conversation from medical story to the social story!! PLAY THE VIDEO!!

We are the Answer

Open Truth Now.ORG 10Whats In A Word?: The Translation of InformationTranslating Documents: Whats the Goal?

To ensure that the meaning and context of the written message are conveyed as intended. Translating word for word does not work.

Remember to see through the lens of those who we serve

Wilma Alvarado-Little , MA MSW

There are state, national, institutional Guidelines, Translating (writing) is a different skill set from Interpreting (oral) ex: EVERYTHING THAT HITS MY EARS Im OBLIGATED TO INTERPRET

Car seats in spanish baby talk Instructions in Spanish: How to put in a car seat: What kind of messages does this send?

Nutritionally challenging :Bran- culturally hispanics dont eat bran- do you want to increase FIBER? Relationship to the translator is SO IMPORTANT.

How do you know its effective: WHO IS GOING TO BENEFIT?

Starbucks sign success here bad translation= not trusting. IDEAL to have someone from the american translator association Translators will have questions! (SHOW THIS)

From the crowd: Wellness 101 THINK ABOUT WHO IS GOING TO UNDERSTAND THIS

No Tocar = No Touch (Is this what you want for your community?)

Importance of a quality translation!! (impregnate vs embarrass)

American Translators Association. 11Intergenerational Communication Veterans/ Traditionalists (1922-1945)Baby Boomers (1946-1954)Gen X (1964-1982)Millennial (Gen Y) (1982-2000)Linksters (Gen Z) (born after 1995)

Jill Clutter , PHD, MCHES, Georgianna Sergakis, PHD RRT TTS FARC

V/T: Born 1922-1945, great depression, built much of nations infrastructure, patriotic, value home and family, respect authority, strong work ethic Baby boomers- sandwich generations , caring for baby and parents, weighing down our healthcare system 1946-1954- Traditional families, live to work ethic (work is my id) , vietnam war, womens lib/ civil rights, economic expansion, education as a birthright, age of TV (major means of communication), first touch tone phones ; general characteristics: workaholics, competitive, success oriented, challenge authority, value involvement ON THEIR OWN TERMSGeneration X- 64-82, Latch Key kids, two working parents, work hard play hard, INDEPENDENCE, Dessert storm, nixon resignation, non-traditional family units (divorce 50%), Get there mentality about education, first computers1983 first lap top , first cell phones and internet ; General characteristics: self reliant, skeptical non trusting, dislike being labeled, challenge the status quote, distrust authority, independent workers, value fun!Millennial 82-2000 Helicopter parents trophy kids (participation trophy), play hard, work around that multitasking change jobs every 16 months!! Also called GEN y, Columbine / 9-11, Diversity , Indulged by parents, education viewed as great expense, technology dependent , first generation to have own cell phones and electronic devices, GEN Characteristics: Tech Savvy, multi-tasking (not necessarily good at this studies show) , high tolerance, need more supervision and structure (need more structure, guidelines), social, confident, collaborative, work with authorityLinksters- born after 1995, Gen Z, the Facebook Crowd, Cell phone addiction, Child centered parenting, always connected, growing environmental awareness (not a whole lot of research here_) 12IssuesUnder-accommodation / over-accommodation *or the perception of such*Think of what will work with a Baby Boomer vs. a Millenial, this is very different! BE AWARE: Do a Self Assessment: Inventory your:Beliefs, Motivation, Self-Efficacy, Norms & Environment2. Listen3. Understand4. Enact

Baby boomers and millenials- very differentTECHNOLOGY: foreign territory, perhaps resistanceRespect- Baby Boomers grew up as Mr. and Mrs. Loyalty is HUGE (compared to millenials)Talking to BB: use formal titles instead of names, set of side time, place things in historical perspective, appreciating the experienceMillenials: they will see themselves as equals bc they are used to collobarative work, self efficacy is improved with guideleins, clear expectations Successful strategies: allow them a voice, allow them to address work / life balance, faciltate collobaration (, present postivie message, creative, provide respect for the time

assertive not aggressive communication

CHECK THESE SLIDES OUT< SKILLS FOR WORKING INTERGENERATIONALLY

Jill.clutter@osumc.edu , georgianna.sergakis@osumc.edu

Resources: Generations, INC : From boomers to linksters---- managing the friction between generations at work. Johnson M & Johnson

Improving Intergenerational health care communication, Journal of Health Communication Check out other resources

13ResourcesEmail: virginia.newman@bastyr.edu Health Insurance: www.enrollamerica.org www.justplainclear.com CDC Health Literacy and clear communication index: www.cdc.gov/healthliteracy www.cdc.gov/ccindex Health Literacy Explains Racial Disparities in Diabetes Medication Adherence: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3561717/ Dr. Rima Rudd, Needs Assesment for hospitals:http://cdn1.sph.harvard.edu/wp-content/uploads/sites/135/2012/09/healthliteracyenvironment.pdf

ResourcesCDC Top 10 attributes of a health literate organization:https://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdfInstitute for Healthcare Advancement:https://www.iha4health.org The Bigger Picture Campaign: www.thebiggerpicture.orgwww.opentruthnow.org: sugary drinks, health effects, and marketing National Standards on Culturally and Linguistically Appropriate Services US Dept. of Health and Human Services Office of Minority Health: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2 &lvlID=15