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Health  Literacy:    Making  It  Clear    

Presenta6on  for  UMDNJ-­‐  School  of  Public  Health  October  4,  2012  

 Elissa  Director,  M.A.  

Health  Literacy  Specialist  New  Jersey  Health  Literacy  Coali6on  

ehdirector@njhealthliteracy.org  www.njhealthliteracy.org  

 

Our  Agenda  Today  •  Iden6fy  components  of  health  literacy,  including  public  health  

literacy  •  Discuss  what  it  means  for  prac66oners  to  be  “health  literate”  •  Examine  the  impact  of  limited  health  literacy  on  pa6ent  

health  and  health  care  costs  •  Review  examples  of  materials  that  present  barriers  to        

understanding  health  informa6on    •  Review  best  prac6ces  and  prac6cal  strategies  for  improving  

health  literacy  through  clear  communica6on  

What  Is  the  New  Jersey  Health  Literacy  Coali6on  (NJHLC)?      

•  Our  mission:  –  A  not-­‐for-­‐profit  organiza6on  commi\ed  to  improving  health  outcomes  and  

increasing  the  efficiency  of  the  health  care  system  through  be\er  communica6on  between  health  care  professionals  and  the  diverse  communi6es  they  serve.  

•  Our  partners  and  stakeholders  include  passionate  people  from:  –  hospitals  and  clinics  –  federally  qualified  health  centers  (FQHCs)  –  public  health  agencies  –  pharmaceu6cal  and  biotech  companies  –  health  plans  –  universi6es  –  social  service  and  community-­‐based  organiza6ons  –  adult  literacy  programs  –  corpora6ons    

Achieving  Be+er  Health  Through  Clear  Communica6on  

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Introduc6on  to  Health  Literacy  

Why  Does  Health  Literacy  Ma\er?      

 “Far  too  o9en,  ordinary  ci6zens  are  placed  at  risk  for  unsafe  care    

because  …  [of]  medical  jargon  and  unclear  language.”        

“The  healthcare  industry  needs  to  gear  up  to  employ  prac6ces  that  will    meet  the  needs  of  increasingly  diverse  pa6ent  popula6ons.”    

           

Joint  Commission  on  Accredita6on  of  Healthcare  Organiza6ons  (JCAHO).    Call  to  ac6on  around  public  policy  white  paper,  “’What  Did  the  Doctor  Say?:’  Improving  Health  Literacy  to  Protect  

Pa6ent  Safety."  2007  

What  Are  They  Talking  About?  §  When  should  I  take  my  medicine?  §  What  bu\on  should  I  push  when  I  call  the  clinic  to  make  an  appointment?  §  What  am  I  saying  “yes”  to  on  the  consent  form?  §  What  does  blood  glucose  mean?  §  Why  do  I  need  a  mammogram  if  I’m  not  sick?  §  Can  I  use  a  spoon  from  my  kitchen  to  measure  my  child’s  medicine?  §  How  can  my  family  eat  healthier  if  I  can’t  get  fresh  fruits  and  vegetables  

at  my  neighborhood  market?  

The  bo'om  line:  What  is  my  main  problem?  What  do  I  need  to  do?  Why  is  it  important  for  me  to  do  this?  

   

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The  Cycle  of  Costly  ‘Crisis  Care’  

Ø  A  wide  chasm  oden  separates  what  providers  intend  to  convey  in  wri\en  and  oral  communica6on  and  what  pa6ents  understand.  

Ø  Too  many  people  are  hospitalized  ader  being  given  ambiguous  instruc6ons  about  medica6ons  or  failing  to  recognize  symptoms  of  a  worsening  condi6on.  

Ø  Improved  health  literacy  has  the  poten6al  to  help  address  issues  of  health  care  access,  quality  and  cost.  

Koh,  Howard  K.  et  al,  “New  Federal  Policy  Ini6a6ves  to  Boost  Health  Literacy  Can  Help  the  Na6on  Move  Beyond    the  Cycle  of  Costly  ‘Crisis  Care’”,  Health  Affairs,  January  2012,  published  on  line  before  print.  

Sick patient seeks medical help

Staff at doctors office ask patient to complete complex, confusing forms

Doctor explains patient’s condition and treatment plan using medical jargon

Doctor writes multiple prescriptions and referrals for tests

Doctor does not confirm patient’s understanding

Staff send patient home with a complicated set of written instructions

No one follows up with patient

Patient takes medicines incorrectly and does not follow up on appointments

Patient’s condition gets worse and patient goes to the emergency department

Hospital staff give patient a new treatment plan, referrals, and prescriptions; staff do not confirm patient’s understanding

Patient is discharged, and no one follows up with patient

Cost  of  Low  Health  Literacy  to  the  U.S.  Economy  

$106  -­‐$238  billion  annually    Resul6ng  from:  

•  Medica6on  errors  •  Excess  hospitaliza6ons  •  Longer  hospital  stays  •  More  use  of  emergency  services  •  Higher  level  of  illness  

Vernon,  J.A.,  Trujillo,  A.,  Rosenbaum,  S.,  &  DeBuono,  B.  (2007).    Low  health  literacy:      Implica6ons  for  na6onal  policy,  from    www.healthliteracymissouri.org/uploads/HLM/pdfs.Vernon.Report.pdf    

   

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What  Does  Literacy  Enable  Us  to  Do?  

q     Develop  skills  

q     Acquire  informa6on  

q     Engage  effec6vely  in                conduc6ng  daily  life  

What  are  the  Fundamental  Literacy  Skills  for  21st  Century?  

Could  you  understand  a  paragraph  wri\en  with  these  words?  

 •  expected      return      calculate  

•  op6on      exercise    equal    •  strike      probability    underlying  •  value      present    price  •  net        nega6ve    set  •  spot      below      zero  •  6me      today      using      

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The  Mismatch…  q         88%  of  the  country  is  below  the  proficient  level  in  health  literacy.  (Na6onal    Assessment  of  Adult  Literacy  –  2003)  q         Over  1,000  studies  have    demonstrated  that  most    health  materials  are  wri\en  at  levels  of  complexity  far  beyond    the  reading  skills  of  average  high-­‐school  graduates.        

Some  Health  Literacy  Challenges  

Popula6on  Changes  §  The  elderly    popula6on  is  

growing  §  The  number  of  Americans            with  limited  English  

proficiency    is  growing            The  Na6onal  Pa6ent  Safety  Founda6on  

           

Health  System  Complexity  §  The  number  of  medica6ons  

prescribed  has  increased  §  Hospital  stays  are  shorter  §  Heavier  reliance  on  forms,  

wri\en  direc6ons  §  Greater  self-­‐care  

requirements    §  Verbal  instruc6ons  are  oden  

complex,  delivered  rapidly,  and  easy  to  forget  in  a  stressful  situa6on  

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Na6onal  Assessment  of  Adult  Literacy  (NAAL)  Levels  Ø  Proficient  –  12%  (  26  million)  

 Could  calculate  an  employee’s  share  of  health  insurance  costs  using  a  table  based  on  family  income  and  size.  

 Ø  Intermediate  –  53%  (114  million)  

 Could  iden6fy  three  substances  that  may  interact  with  an  over-­‐the-­‐counter  drug  to  cause  side  effects,  using  informa6on  on  the  over-­‐the-­‐counter  drug  label.  

 Ø  Basic    -­‐  22%  (47  million)  

 Could  give  reasons  why  a  person  with  no  symptoms  of  a  specific  disease  should  be  tested  for  the  disease,  based  on  informa6on  in  a  clearly  wri\en  pamphlet.  

 Ø  Below  Basic      -­‐  14%    (30  million)  

 Could  circle  the  date  of  a  medical  appointment  on  a  hospital  appointment  slip.    “The  Health  Literacy  of  America’s  Adults:    Results  from  the  2003  Na6onal  Assessment  of  Adult  Literacy,”  U.S.  Dept.  of  Educa6on,  Na6onal  Center  for  Educa6on  Sta6s6cs,  September  2006.  

   

 

Evolving  Defini6ons  of  Health  Literacy  

•  “The  degree  to  which  individuals  have  the  capacity  to  obtain,  process,  and  understand  basic  health  informa6on  and  services  needed  to  make  appropriate  health  decisions.”  

 T  Selden  CR,  Zorn  M,  Ratzan  S,  Parker  RM.    2000.    Health  Literacy:    January  1990  Through  1999.    NLM    Publica6on  #CBM2000-­‐1.    Bethesda,  MD:    Na6onal  Library  of  Medicine.          •  “Health  literacy  allows  the  public  and  personnel  working  in  all  health-­‐related  

contexts    to  find,  understand,  evaluate,  communicate  and  use  informa6on.  Health  literacy  is  the  use  of  a  wide  range  of  skills  that  improve  the  ability  of  people  to  act  on  informa6on  in  order  to  live  healthier  lives.    These  skills  include  reading,  wri6ng,  listening,  speaking,  numeracy,  and  cri6cal  analysis,  as  well  as  communica6on  and  interac6on  skills.  

 The  Calgary  Charter  on  Health  Literacy  –  Sponsored  by  The  Centre  for  Literacy  of  Quebec,  October,      2008.  

   

Public  Health  Literacy  “The  degree  to  which  individuals  and  groups  can  obtain,  process,  understand,  evaluate,  and  act  upon  informa6on  needed  to  make  public  health  decisions  that  benefit  the  community.”    Primary  Aims:    Engage  more  stakeholders  in  public  health  efforts;  address  social  and  environmental  determinants  of  health          Freedman,  Darcy  A.  et  al.    “Public  Health  Literacy  Defined”,  American  Journal  of  Preven6ve  Medicine.  2009;  36(5)  pp.  446-­‐450.  

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A  Mul6dimensional  Model  of  Health  Literacy  Health  Literacy  is  a  complex  determinant  of  health.    In  addi6on  to  

Fundamental  Literacy,  it  includes  these  domains:    1.  Scien6fic  Literacy  -­‐    includes  ability  to  understand  and  use  science  and  technology,  

including  some  awareness  of  the  process  of  science.  

2.  Civic  Literacy  –  includes  ability  to  become  aware  of  public  issues  and  knowledge  that  personal  behaviors  and  choices  affect  others  in  a  larger  community  and  society.      Allows  individuals  and  groups  to  make  public  health  decisions  that  benefit  the  community.  

3.  Cultural  Literacy  –      use  of  collec6ve  beliefs,  customs,  worldview,  and  social  iden6ty  in  order  to  interpret  and  act  on  health  informa6on.  

 Zarcadoolas,  C.,    Pleasant,  A.    &  Greer,  D.  (2006).    Advancing  Health  Literacy.      San  Francisco,  CA.  Jossey  Bass.  

Keep  in  Mind  that  Culture  Can  Determine…  

•  Who    is  a  member  of  the  family  •  What      are  the  roles  of  different  family  members    •  Who  makes  family  decisions  •  What    are  beliefs  about  child  care/elder  care  and  care  giving  •  What  is  the  meaning  of  illness  or  disability  •  What    are  acceptable  health  prac6ces  (  preven6ve  care,  non-­‐

tradi6onal  medicine,    etc)  •  What  are  avtudes  toward  health  treatment  (medical,  mental  

health,  dental,  end  of  life  care)  and  health  care  professionals  

v  the  same  thing  as  general  literacy.    A  rocket  scien6st  diagnosed  with  diabetes  may  have  trouble  understanding  a  new  and  complex  self-­‐care  rou6ne.  

 v  only  about  reading.    Obtaining,  understanding  and  ac6ng  on  health  

informa6on  encompasses  a  range  of    skills  including  communica6on/interac6on,  wri6ng,  numeracy,  technology,  and  cri6cal  analysis.  

 v  A  staAc  condiAon.    Factors  that  impact  health  literacy  include  our  health  

status,  our  experiences  and  knowledge,  language  skills,  aging  process,  cultural  beliefs  and  values,  and  emo6ons.  

             Jessica  Ridpath,  Research  Communica6ons  Coordinator,  Group  Health  Research  Ins6tute,  Presenta6on,  Introduc6on  to    Health  Literacy    and  Plain  Language.  September  2009      

   

In  Summary….  Health  Literacy  Is  Not  

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Na6onal  Ac6on  Plan  to  Improve  Health  Literacy  U.S.  Department  of  Health  and  Human  Services  

May  2010  Some  basic  principles:  (1)  Everyone  has  the  right  to  health  informa6on  that  helps  

them  make  informed  decisions.  (2)  Health  literacy  is  part  of  a  person-­‐centered  care  process  

and  essen6al  to  the  delivery  of  cost  effec6ve,  safe,  and  high-­‐quality  health  services.  

(3)  Since  it  is  impossible  to  tell  by  looking  who  is  affected  by  limited  health  literacy,  a  “universal  precauAons  approach”  should  be  adopted.    Clear  communica6on  should  be  the  basis  for  every  health  informa6on  exchange.  

 

“Universal  Precau6ons”    Means…  

Ø We  expect  that  every  encounter  is  at  risk  for  miscommunica6on.  

Ø We  create  a  “shame-­‐free”  environment  of  care.  •  Treat  all  pa6ents  equally  •  An6cipate  communica6on  barriers  •  Communicate  clearly  with  everyone  •  Confirm  understanding  with  everyone  •  Proac6vely  work  to  minimize  barriers  

     DeWalt  DA  ,  Callahan  LF,  Hawk  V,  Broucksou  KA,  Hink  A,  Rudd  R,  et  al.    Health  Literacy  Universal  Precau6ons  Toolkit.  Rockville  (MD):    Agency  for  Healthcare  Research  and  Quality;  2010.  

Other  Na6onal  Health  Literacy  Ini6a6ves  Surgeon  General’s  Report  on  Health  Literacy  –  2008  •  Limited  health  literacy  is  not  an  individual  deficit  but  a  systema6c  problem  

that  should  be  addressed  by  ensuring  that  all  healthcare  and  health  informa6on  systems  are  aligned  with  the  needs  of  the  public  and  with  healthcare  providers.  

Joint  Commission  •  “What  Did  the  Doctor  Say?”    Improving  Health  Literacy  to  Protect  Pa6ent  

Safety,  February  2007  •  Advancing  Effec6ve  Communica6on,  Cultural  Competence,  and  Pa6ent  

and  Family-­‐Centered  Care:    A  Roadmap  for  Hospitals,  August  2010  

Agency  for  Healthcare  Quality  and  Research  (AHRQ)  •  Health  Literacy  Curriculum  for  Pharmacists  (2012)  h+p://www.ahrq.gov/pharmhealthlit/index.html#pharmlitqi  

 

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Impact  of  Low  Health  Literacy  

Which  Pa6ents  Are  at  Risk  for  Low  Health  Literacy?  §  Anyone  in  the  U.S.  

Ø   Not  a  func6on  of  age,  race,  educa6on,  income  or  social  class    

§  Ethnic  and  racial  minority  groups  Ø   Dispropor6onately  affected  by  low  health  literacy  Ø   Carry  a  dispropor6onate  burden  of  diabetes    

§  White,  na6ve  born  Americans  Ø  Comprise  the  majority  of  people  with  low  health  literacy    

§  Older  pa6ents,  recent  immigrants,  people  with  chronic  diseases  and  those  with  low  socioeconomic  status  Ø  Especially  vulnerable  to  low  health  literacy  

“The  Health  Literacy  of  America’s  Adults:    Results  From  the  2003  Na6onal  Assessment  of  Adult  Literacy,”  U.S.  Dept.  of  Educa6on,  Na6onal  Center  for  Educa6on  Sta6s6cs,  September  2006.  

       

Why  Does  Health  Literacy  Ma\er?      People  with  limited  health  literacy  skills  are  more  likely  to:  

–  Report  being  in  poor  health  –  Par6cipate  in  nega6ve  health  behaviors  –  Hold  health  beliefs  that  interfere  with  adherence  –  Present  in  later  stages  of  disease  –  Be  hospitalized/re-­‐hospitalized  –  Misunderstand  instruc6ons  needed  for  self-­‐care  –  Die  at  an  earlier  age,  and  

Are  less  likely  to:  –  Engage  in  preven6ve  behaviors  or  services  (e.g.  mammograms,  

flu  shots,  A1C  tests,  re6nal  eye  exams,  blood  pressure  and  cholesterol  checks)      

–  Manage  a  chronic  disease    

Nielsen  -­‐  Bohlman,  L.,  Panzer,  A.M.,  &  Kindig,  D.A.  (Eds.)  (2004).    Health  Literacy:    A  Prescrip6on  to  End  Confusion.    Washington,    DC:    Na6onal  Academies  Press.  

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Informal  Assessment  of  Health  Literacy  Problems  

Learn  to  recognize  “red  flags”  when  pa6ents:  •  Consistently  have  “headaches”  or  chronically  “forget”  

 their  eyeglasses  when  asked  to  perform  reading  tasks.  •  Oden  say  their  hands  hurt  and  will  fill  out  paperwork  at  home.  •  Regularly  ask  family  members,  friends,  or  others  to  read  wri\en  

materials  aloud.  •  Iden6fy  medica6ons  by  looking  at  the  pills  themselves,  rather  than  

reading  prescrip6on  labels.  •  Are  unable  to  explain  what  medica6ons  are  for  and/or  when  to  take  

their  medica6on.  •  Are  unable  to  follow  through  with  lab  tests  and  referrals  and  frequently  

miss  their  medical  appointments.  •  Take  their  medica6on  incorrectly.  

Weiss,  Barry  MD.    Health  literacy  and  pa6ent  safety:    Help  Pa6ents  Understand.    AMA  Founda6on,  May  2007.  

A  Real  Life  Example  

Mr.  G,  45,  an  Hispanic  immigrant,  na6ve  Spanish  language  speaker,  has  a  job  health  screening.    He  is  told  his  pressure  is  high,  and  he  can’t  work  un6l  it’s  controlled.    He  is  given  a  beta    blocker  and  diure6c  with  instruc6ons  to  take  each  “once  a  day”.      One  week  later  he  comes  to  the  emergency  room.    His  blood    pressure  is  very  low  and  he  is  dizzy.    Doctors  can’t  figure  out  the    problem.    A  Spanish  speaker  asks  him  how    much  medicine  he    took  each  day.    He  replies  “22”.     Why  did  this  happen??    Nielsen  -­‐  Bohlman,  L.,  Panzer,  A.M.,  &  Kindig,  D.A.  (Eds.)  (2004).    Health  Literacy:    A  Prescrip6on  to  End  

Confusion.    Washington,    DC:    Na6onal  Academies  Press.  

Informed  Consent??  

     “If  at  any  6me  I  should  have  an  incurable  and  irreversible  injury,  disease,  or  illness  judged  to  be  a  terminal  condi6on  by  my  a\ending  physician  who  has  personally  examined  me  and  has  determined  that  my  death  is  imminent  except  for  death  delaying  procedures,  I  direct  that  such  procedures  which  would  only  prolong  the  dying  process  be  withheld  or  withdrawn,  and  that  I  be  permi\ed  to  die  naturally  with  only  the  administra6on  of  medica6on,  sustenance,  or  the  performance  of  any  medical  procedure  deemed  necessary  by  my  a\ending  physician  to  provide  me  with  comfort  care.”  

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A  Proposed  Fix  

“I    request  that  I  no  longer  receive  medical  care  solely  to  prolong  my  life  upon  diagnosis  of  a  terminal,  irreversible  condi6on  as  determined  by  my  physician.    However,  I  do  wish  to  receive  medical  care  to  maintain  comfort  under  the  direc6on  of  my  physician.”  

Center  for  Law,  Science  &  Innova6on  Sandra  Day  O’Connor  College  of  Law  Arizona  State  University  

 

 

Prescrip6onPrescrip6on  for  Confusion    

•  6  yr.  old  with  H1N1  influenza  received  prescrip6on  for  Tamiflu  oral  suspension.    

•  Medica6on  bo\le  had  prepackaged  syringe  with  markings  of  30,  45,  and  60  mg.  

•  Label  a\ached  by  pharmacy  specified  the  dose  as  ¾  teaspoonful  twice  a  day  for  5  days  

•  Complex  mathema6cal  equa6on  is  required  to  figure  out  correct  dose  

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1.  How many calories are contained in ½ cup?

2.  Is a bigger number better than a smaller one? (Is the answer the same when you’re looking at the fat line and the protein line?)

3.  What’s the difference between saturated fat and trans fat?

4.  What % of your daily sodium will you get if you eat the whole container?

5.  What’s the difference between “sat” fat and “saturated” fat?

6.  If you’re on a salt free diet, can you eat this? (Please pass the sodium).

Strategies  for  Improving  Communica6on  

Strategies  for  Improving  Understanding  through  Clear  Communica6on  

Keep  in  mind  that…..    Ø  Even  immediately  ader  leaving  their  physicians’  offices,  pa6ents  

are  able  to  recall  50%  or  less  of  important  informa6on  just  given  to    them.  

 Ø Nearly  half  of  the  informa6on  retained  is  incorrect.  

Ø We  need  to  confirm  pa6ent  understanding  at  every  point  along  the  way.  

Schillinger  D,  Pie\e  J,  Grumbach  K,  Wang  F,  Wilson  C,  Daher  C,  et  al.    “Closing  the  Loop:    Physician  Communica6on  with  Diabe6c  Pa6ents  Who  Have  Low  Health  Literacy.”    Archives  of  Internal    Medicine.    163  (1):  83-­‐90.  

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The  Teach-­‐Back  Method  •  Teach  back  (also  known  as  the  “interac6ve  communica6on  loop”)    is  a  way  to  confirm  that  

your  pa6ent  understands  your  message/informa6on.    It  confirms  that  you  have  explained  to  the  pa6ent  what  they  need  to  know  in  a  manner  that  the  pa6ent  understands.      

•  Pa6ent  understanding  is  confirmed  when  they  explain  it    (teach  it  back  to  you)  in  their  own  words  or  show  you  by  demonstra6ng  what  they  have  been  told.  

•  This  is  not  a  test  of  the  pa6ent’s  knowledge.    This  is  a  test  of  how  well  you  explained  the  concept.  

•  Make  teach-­‐back  a  “normal”  part  of  the  encounter  so  pa6ent  doesn’t  feel  singled  out.    Example:    “I  do  this  with  next  part  with  all  my  pa6ents.”  

     •  If  pa6ents  cannot  restate  the  informa6on  correctly,  then  explain  again  by  using  visuals  

(pictures,  videos,  etc.),    using  simpler  words,    or  seeking  assistance  from  colleagues/staff.    Provide  simply  wri\en  materials  for  reinforcement.  

   DeWalt  DA  ,  Callahan  LF,  Hawk  V,  Broucksou  KA,  Hink  A,  Rudd  R,  et  al.    Health  Literacy  Universal    Precau6ons  Toolkit.    Rockville  (MD):    Agency  for  Healthcare  Research  and  Quality;  2010.  

     

Examples  of  Approaches  When  Using  Teach  Back    

v “I  want  to  be  sure  that  I  explained  your  medica6on  correctly.    Please  tell  me  in  your  own  words  how  you  are  going  to  take  this  medicine  each  day  when  you  are  at  home.”  

v “Show  me  how  you  will  use  this  inhaler.”  

v “We’ve  covered  a  lot  today  about  your  diabetes  and  I  want  to  make  sure  I  explained  things  clearly.    Can  you  tell  me  3  things  that  will  help  you  control  your  diabetes?”  

v “Now  that  we’ve  talked  about  adding  fiber  to  your  diet,  what  will  you  look  for  the  next  6me  you  buy  cereal?”  

Try  the  Teach-­‐Back  Method  

 1.    Start  with  one  pa6ent/client  a  day.    Try  the  teach  back.    2.    Write  down  your  reflec6on  of  the  experience.    3.      Include  the  following  ques6ons:  

•  How  did  it  go?  • What  would  you  do  differently?  •  Did  the  pa6ent/customer  seem  to  mind?  •  Did  the  teach-­‐back  uncover  any  miscommunica6on?  

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It’s  Harder  than  You  Think  to  Understand  Medica6ons  

•  Reviewing  medica6ons  with  pa6ents  is  one  of  the  most  important  uses  of  teach  back.  –   A  study  presented  at  the  3rd  Annual  Health  Literacy  Research  Conference  in  October  2011  found  that  for  144  pa6ents  averaging  6.5  prescrip6ons,  it  took  2.6  teach-­‐back  tries  for  the  pa6ents  to  correctly  explain  how  and  when  to  take  their  medica6ons.  

   Kevin  B.  O’Reilly,  The  ABCs  of  Health  Literacy.    American  Medical  News,  amednews.com.    March,    19,  2012.  

Communica6ng  in  “Plain  Language”  Examples:  •  Avoid  –  Stay  away  from;  do  not  use/eat  •  Diet  –  What  you  eat;  your  meals  •  Dosage  –  How  much  medicine  you  should  take  •  Hypertension  -­‐  ??  •  Screening  -­‐  ??  •  Nega6ve  -­‐  ??  •  Normal  range  -­‐  ??  •  Moderate  -­‐  ??  •  Postpartum  -­‐  ??  •  Precancerous  -­‐  ??  •  Risk  factors  -­‐  ??  •  Carbohydrates  -­‐  ??  •  Stable  -­‐  ??  

More  Strategies  You  Can  Use  •  Use  simple  language,  some6mes  referred  to  as  “living  room”  language  instead  of  

medical  terminology.    

•  AA  -­‐-­‐-­‐  Avoid  acronyms!    And  be  sure  to  explain  what  they  mean  when  you  do  use  them.  

•  Encourage  and  invite  pa6ents/clients  to  ask  ques6ons.    You  might  even  say  “It’s  okay  for  you  to  ask  me  ques6ons.”    

•  Use  open  ended  ques6ons  when  discussing  informa6on  with  your  pa6ents.        •  Limit  the  amount  of  informa6on  provided  to  3-­‐5  key  points.    REPEAT  key  points  

frequently.      Focus  on  the    most  cri6cal  “need  to  know”  informa6on    and    convey  the  “need  to  do”    which  is  what  pa6ents  want  to  hear.  

   Osborne,  Helen.    Health  Literacy  from  A  to  Z:    Prac6cal  Ways  to  Communicate  Your  Health  Message.    Jones  &  Bartle\  Learning:    Burlington,  MA,  2011.  

   

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More  Ways  to  Make  Informa6on  Clear  •  Give  specific  direc6ons  using  concrete  terms.      Avoid  vague  statements  

that  require  interpreta6on.    Don’t  say  “You  should  get  some  aerobic  exercise.”      

•  Help  pa6ents  with  calcula6ons,  measurements,  and  making  sense  of  numerical  informa6on.  

•   Introduce  yourself  and  explain  your  role  and  the  roles  of  your  team  in  the  care  process.      

 •  Present  informa6on  in  mul6ple  formats  (oral,  wri\en,  visual,  video,  etc.)  

to  accommodate  various  learning  styles  and  promote  reten6on.    

 Osborne,  Helen.    Health  Literacy  from  A  to  Z:    Prac6cal  Ways  to  Communicate  Your  Health  Message.    Jones  &  Bartle\  Learning:    Burlington,  MA,  2011.    

Addi6onal  Strategies    •  Prepare  commonly  asked  ques6ons  that  can  be  used  when  pa6ents/clients  are  

reluctant    to  ask  ques6ons.    For  example,  when  a  pregnant  woman  says  she  has  no  ques6ons,  you  can  say  “A  lot  of  women  in  their  (x)  month  of  pregnancy  ask  about…  Is  that  a  ques6on  you  want  me  to  answer?”  

•  Assess  pa6ents’  baseline  understanding  before  providing  extensive  informa6on.    (Tailor  to  the  pa6ents’  needs).      

•  Choose  your  words  carefully.    In  addi6on  to  using  “plain  language”,  define  new  or  complicated  terms  such  as  “durable  medical  equipment”,  “second  hand  smoke”,      “salmonella”.      

Bo\om  Line….  

v     Communicate  consistently  and  persistently.    Ø   Healthcare  team  members  use  similar  wording  (such  as  “high  blood  pressure”  not  “hypertension”.  

Ø Staff  use  consistent  language  whether  communica6ng  in  person,  by  phone,  in  wri6ng  or  with  voice-­‐mail  messages.  

Ø Members  of  the  team  call  pa6ents  regularly  to  follow  up  with  them  about  self-­‐care.  

Ø All  staff  use  the  “teach-­‐back  technique”  to  confirm  pa6ents’  understanding.    

 

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Sick patient seeks medical help

Scheduler reminds patient about what to bring to the office visit

Staff at doctor’s office give patient simple forms and offer help with filling them out

As part of assessment, doctor listens to patient describe symptoms

Doctor describes patients condition using plain language

Doctor discusses treatment options with patient and solicits questions

Doctor and patient agree on treatment plan

Doctor asks patient to explain the plan back in patient’s own words

Nurse gives patient simple handout and basic tools to use in complying with treatment; staff help plan appointments

Staff at doctor’s office follow up regularly with patient

Patient’s condition is being well managed

Patient is not feeling well

New Federal Policy Initiatives (Koh, Howard K., Health Affairs, no. 2, 2012)

In  Conclusion  •  Health  literacy  is  a  shared  responsibility  between  pa6ents,  

healthcare  consumers  and  providers.    •  We  all  benefit  from  informa6on  presented  in  a  clear,  

understandable  way  regardless  of  our  literacy  levels.  

•  Health  literacy  enables  individuals  to  make  decisions  and  then  take  ac6ons  that  promote  and  maintain  their  health  and  the  health  of  their  families.  

Health  Literacy  Resources    

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   “Universal  Precau6ons  Toolkit”  h\p://www.nchealthliteracy.org/toolkit/  

Visit  these  websites  to  learn  more  about  health  literacy  

Ø  Health  literacy  news    and  resources,  including  updates  about  health  literacy  ini6a6ves  in  NJ  

 www.njhealthliteracy.org    Ø  Health  Literacy  and  Pa6ent  Safety:    Help  Pa6ents  Understand  h\p://www.ama-­‐assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf    Ø  Helping  pa6ents  to  develop  good  ques6ons  h\p://www.ahrq.gov/ques6onsaretheanswer    Ø  Informa6on  and  Tools  to  Improve  Health  Literacy  and  Public  Health  www.cdc.gov/healthliteracy  

   

Selected  Health  Literacy  Resources  

•  Nielsen-­‐Bohlman  L,  Panzer  AM,  Kindig,  DA,  eds.  Commi\ee  on  Health  Literacy.    Health  Literacy  –  A  Prescrip6on  to  End  Confusion.    Ins6tute  of  Medicine,  Washington,  DC:    Na6onal  Academies  Press,  2004.  

•  Zarcadoolas  C,  Pleasant  A,  Greer  D.    Advancing  Health  Literacy:    A  Framework  for  Understanding  and  Ac6on.    Jossey-­‐Bass:    San  Francisco,  CA,  2006.  

•  Osborne,  Helen.  Health  Literacy  from  A  to  Z:    Prac6cal  Ways  to  Communicate  Your  Health  Message.    Jones  &  Bartle\  Learning:    Burlington,  MA,  2011.