0 1

ldquoLow literacy shown to produce adverse affects on health outcomesrdquo Centers for Health Care Strategies Inc

ldquoEqual Protectionrdquo Improve Healthcare Outcomes by

Improving Health Literacy

ldquoEqual Protectionrdquo

ldquo The Wayrdquo to Improve Upon Health Care Outcomes and Access is To Improve Upon Health Literacy

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services 2006 and

Literacy Def The ability to read write and speak English and compute to solve problems at the level necessary to perform on the job and to develop ones knowledge about a particular point

ldquoHealthrdquo literacy Def A plethora or combination of skills that constitute the ability to perform the basic reading and numerical tasks for functioning in the health care environment and acting on health care information

Underlying Influences of Health Literacy

Health literacy is a complex phenomenon that involves individuals families communities and systems

Social Environments for Building Healthy Communities

by The United States Task Force for Preventive Health

Services

Health the product of multiple levels of influence

Social factors an important determinant of health

Interventions Promote health enhancing social environments Therapeutic early childhood development centers Family housing

A Pervasive Problem

Low health literacy is a wide spread problem affecting more than 90 million adults in the United States (Kirsch Jungeblut Jenkins amp Kolstad 1993) Low health literacy results in patientsrsquo inadequate engagement in and benefit from health care advances as well as medical errors Low health literacy is likely to be a major contributor of adverse health outcomes (AMA 1999 )

Affects

Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases less healthy behaviors higher rates of hospitalizations and overall poorer health (Gazmararian Baker Williams Parker Scott Green Fehrenbach Ren amp Koplan 1999 Schillinger Grumbach Piette Wang Osmond Daher Palacios Sullivan amp Bindman 2002 Williams Parker Baker Pitkin Coates amp Nurss 1995)

Health Literacy

Preventive InterventionsEducation and Training

Explore the role of K-12 education systems in increasing levels of health literacy and improving health communication skills

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

ldquoEqual Protectionrdquo

ldquo The Wayrdquo to Improve Upon Health Care Outcomes and Access is To Improve Upon Health Literacy

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services 2006 and

Literacy Def The ability to read write and speak English and compute to solve problems at the level necessary to perform on the job and to develop ones knowledge about a particular point

ldquoHealthrdquo literacy Def A plethora or combination of skills that constitute the ability to perform the basic reading and numerical tasks for functioning in the health care environment and acting on health care information

Underlying Influences of Health Literacy

Health literacy is a complex phenomenon that involves individuals families communities and systems

Social Environments for Building Healthy Communities

by The United States Task Force for Preventive Health

Services

Health the product of multiple levels of influence

Social factors an important determinant of health

Interventions Promote health enhancing social environments Therapeutic early childhood development centers Family housing

A Pervasive Problem

Low health literacy is a wide spread problem affecting more than 90 million adults in the United States (Kirsch Jungeblut Jenkins amp Kolstad 1993) Low health literacy results in patientsrsquo inadequate engagement in and benefit from health care advances as well as medical errors Low health literacy is likely to be a major contributor of adverse health outcomes (AMA 1999 )

Affects

Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases less healthy behaviors higher rates of hospitalizations and overall poorer health (Gazmararian Baker Williams Parker Scott Green Fehrenbach Ren amp Koplan 1999 Schillinger Grumbach Piette Wang Osmond Daher Palacios Sullivan amp Bindman 2002 Williams Parker Baker Pitkin Coates amp Nurss 1995)

Health Literacy

Preventive InterventionsEducation and Training

Explore the role of K-12 education systems in increasing levels of health literacy and improving health communication skills

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Literacy Def The ability to read write and speak English and compute to solve problems at the level necessary to perform on the job and to develop ones knowledge about a particular point

ldquoHealthrdquo literacy Def A plethora or combination of skills that constitute the ability to perform the basic reading and numerical tasks for functioning in the health care environment and acting on health care information

Underlying Influences of Health Literacy

Health literacy is a complex phenomenon that involves individuals families communities and systems

Social Environments for Building Healthy Communities

by The United States Task Force for Preventive Health

Services

Health the product of multiple levels of influence

Social factors an important determinant of health

Interventions Promote health enhancing social environments Therapeutic early childhood development centers Family housing

A Pervasive Problem

Low health literacy is a wide spread problem affecting more than 90 million adults in the United States (Kirsch Jungeblut Jenkins amp Kolstad 1993) Low health literacy results in patientsrsquo inadequate engagement in and benefit from health care advances as well as medical errors Low health literacy is likely to be a major contributor of adverse health outcomes (AMA 1999 )

Affects

Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases less healthy behaviors higher rates of hospitalizations and overall poorer health (Gazmararian Baker Williams Parker Scott Green Fehrenbach Ren amp Koplan 1999 Schillinger Grumbach Piette Wang Osmond Daher Palacios Sullivan amp Bindman 2002 Williams Parker Baker Pitkin Coates amp Nurss 1995)

Health Literacy

Preventive InterventionsEducation and Training

Explore the role of K-12 education systems in increasing levels of health literacy and improving health communication skills

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Underlying Influences of Health Literacy

Health literacy is a complex phenomenon that involves individuals families communities and systems

Social Environments for Building Healthy Communities

by The United States Task Force for Preventive Health

Services

Health the product of multiple levels of influence

Social factors an important determinant of health

Interventions Promote health enhancing social environments Therapeutic early childhood development centers Family housing

A Pervasive Problem

Low health literacy is a wide spread problem affecting more than 90 million adults in the United States (Kirsch Jungeblut Jenkins amp Kolstad 1993) Low health literacy results in patientsrsquo inadequate engagement in and benefit from health care advances as well as medical errors Low health literacy is likely to be a major contributor of adverse health outcomes (AMA 1999 )

Affects

Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases less healthy behaviors higher rates of hospitalizations and overall poorer health (Gazmararian Baker Williams Parker Scott Green Fehrenbach Ren amp Koplan 1999 Schillinger Grumbach Piette Wang Osmond Daher Palacios Sullivan amp Bindman 2002 Williams Parker Baker Pitkin Coates amp Nurss 1995)

Health Literacy

Preventive InterventionsEducation and Training

Explore the role of K-12 education systems in increasing levels of health literacy and improving health communication skills

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Social Environments for Building Healthy Communities

by The United States Task Force for Preventive Health

Services

Health the product of multiple levels of influence

Social factors an important determinant of health

Interventions Promote health enhancing social environments Therapeutic early childhood development centers Family housing

A Pervasive Problem

Low health literacy is a wide spread problem affecting more than 90 million adults in the United States (Kirsch Jungeblut Jenkins amp Kolstad 1993) Low health literacy results in patientsrsquo inadequate engagement in and benefit from health care advances as well as medical errors Low health literacy is likely to be a major contributor of adverse health outcomes (AMA 1999 )

Affects

Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases less healthy behaviors higher rates of hospitalizations and overall poorer health (Gazmararian Baker Williams Parker Scott Green Fehrenbach Ren amp Koplan 1999 Schillinger Grumbach Piette Wang Osmond Daher Palacios Sullivan amp Bindman 2002 Williams Parker Baker Pitkin Coates amp Nurss 1995)

Health Literacy

Preventive InterventionsEducation and Training

Explore the role of K-12 education systems in increasing levels of health literacy and improving health communication skills

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

A Pervasive Problem

Low health literacy is a wide spread problem affecting more than 90 million adults in the United States (Kirsch Jungeblut Jenkins amp Kolstad 1993) Low health literacy results in patientsrsquo inadequate engagement in and benefit from health care advances as well as medical errors Low health literacy is likely to be a major contributor of adverse health outcomes (AMA 1999 )

Affects

Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases less healthy behaviors higher rates of hospitalizations and overall poorer health (Gazmararian Baker Williams Parker Scott Green Fehrenbach Ren amp Koplan 1999 Schillinger Grumbach Piette Wang Osmond Daher Palacios Sullivan amp Bindman 2002 Williams Parker Baker Pitkin Coates amp Nurss 1995)

Health Literacy

Preventive InterventionsEducation and Training

Explore the role of K-12 education systems in increasing levels of health literacy and improving health communication skills

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Affects

Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases less healthy behaviors higher rates of hospitalizations and overall poorer health (Gazmararian Baker Williams Parker Scott Green Fehrenbach Ren amp Koplan 1999 Schillinger Grumbach Piette Wang Osmond Daher Palacios Sullivan amp Bindman 2002 Williams Parker Baker Pitkin Coates amp Nurss 1995)

Health Literacy

Preventive InterventionsEducation and Training

Explore the role of K-12 education systems in increasing levels of health literacy and improving health communication skills

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Health Literacy

Preventive InterventionsEducation and Training

Explore the role of K-12 education systems in increasing levels of health literacy and improving health communication skills

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Preventive Intervention Conrsquot

Evaluate the effectiveness of health literacy interventions directed at the general public different audience segments patients providers or the health care or public health systems For instance how can health care systems be designed to better support the information needs of consumers with different levels of health literacy

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Preventive Intervention Conrsquot

How effective are interventions within the healthcare system that are designed to increase the access of intended audiences to relevant health information and appropriate materials (eg print or audiovisual materials Internet-based information translators library information resources and services and patient advocates) Examine the development and dissemination of effective information sources

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment 87 by United States Department of Health

and Human Services

Report Findings ldquo Low literacy may impair functioning in the health care environment affect patient physician communication dynamics and inadvertently lead to substandard medical carerdquo

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

6 Studies measured the relationship between literacy levels and knowledge of the use of the health care system 1) Mammography 2) Cervical cancer screening 3) Childhood health maintenance procedures

and parental understanding of child diagnosis and medication

4) Emergency department discharge instructions

5) Heart health knowledge 6) Informed consent

Results All but one demonstrated a statistically significant association between higher literacy level and knowledge of matters relating to use of these health services

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

3 Studies assessed the relationship between literacy and diabetes outcomes

Results Two found statistically significant associations

1) Scores on NART correlate with glycemic control

2) Lower TOFHLA scores were related to worse glycosylated hemoglobin levels and reports of retinopathy and cerebrovascular disease

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

2 Studies assessed literacy levels and 3 measures of health promotion and disease prevention interventions

Screening for STDs Cancer screening and Immunizations

Results 9th grade and above reading level was associated with 10 increase of having gonorrhea test in past year

Breast and cervical cancer screening preventive measure revealed women with inadequate literacy had significantly greater odds of never having a pap smear or no mammogram in the past 2 years

Low literacy had higher odds of not having flu or pneumococcal immunization

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Three Essential Language RegistersPromoted by Metropolitan Nashville Tennessee Public School System

1) Formal Register Uses standard sentence syntax and word choice of applicable subject matter Uses complete sentences and specific word choices

2) Consultative Register Formal register used in conversation Word choices may not be as specific as standard formal register

3) Casual Register Language used between and among friends Word choices are general instead of specific Conversation utilizes non-verbal prompts and body English

The method of applying language registers employed by Metro Nashville Schools accommodates the evidence report by USDHHS relevant to reading ability and readability

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Validity of TOFHLA(Test of Functional Health Literacy in Adults)

Short FormAs A Measuring Instrument

Screen patients in medical clinics

When patients are able to ask questions and get answers they understand they are able to participate in making medical decisions

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Demographics

Certain groups have an especially high prevalence of low literacy They include

1) people who completed fewer years of education

2) persons of certain racial or ethnic groups the elderlyand persons with lower cognitive ability and

3)Living in the South or Northeast (rather than the West and Midwest) female sex incarceration and income status classified as poor or near poor

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Demographics Conrsquot

Minority patients for example may be more likely than whites to refuse recommended services and delay seeking healthcare These behaviors and attitudes can develop as a result of a poor cultural match between minority patients and their providers mistrust misunderstanding of provider instructions poor prior interactions with health care systems inadequate access to private physician offices and clinics or simply from a lack of knowledge of how to best use health care services

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Evidence Regarding Disparities Reported by The Institute of Medicine (IOM) ashellip ldquoUnequal

Treatmentrdquo

1048707 African Americans and Hispanics tend to receive a lower quality of healthcare across a range of disease areas (including cancer cardiovascular disease HIVAIDS diabetes mental health and other chronic and infectious diseases) and clinical services

1048707 African Americans are more likely than whites to receive less desirable services such as amputation of all or part of a limb 1048707 Disparities are found even when clinical factors such as stage of disease present-tation co-morbidities age and severity of disease are taken into account 1048707 Disparities are found across a range of clinical settings including public and pri-vate hospitals teaching and non-teaching hospitals etc and

1048707 Disparities in care are associated with higher mortality among minorities who do not receive the same services as whites (eg surgical treatment for small-cell lung cancer)

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Media Response to Unequal Treatment

USA Today March 22 ldquoRacial Bias in Health Carerdquo

ldquoIn unassailable terms the report found that even when their insurance and income are the same as those of whites minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments including heart disease cancer diabetes and HIVAIDS By stripping away the pretense that the differences can be explained by minorities lack of access to timely care the report should spur doctors and patients to question why racial disparities are tolerated in medicinerdquo

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Summary

Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical-decision making More importantly health care professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing cultural and linguistic diversity of patients seen in todayrsquos health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

If patients cannot comprehend needed health information attempts to improve the quality of care and reduce health care costs and disparities may be in jeopardy

The report recommends that health care systems should develop and support programs to reduce the negative effects of limited health literacy and that health knowledge and skills be incorporated into the existing curricula of kindergarten through 12th grade classes as well as into adult education and community programs Furthermore programs to promote health literacy health education and health promotion programs should be developed with involvement from the people who will use them And all such efforts must be sensitive to cultural and language preferences

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Health Literacy Principles

Never assume understanding Speak slowly and use ldquoliving roomrdquo language Use visual aids where possible Deal with a minimum of concepts and prioritize

them USE TEACH-BACK Repeat until understanding is achieved httpwwwbigshouldersdubscomclientsAMA

Consent06htm

Referral Sources

Literacy and Health Outcomes

Evidence ReportTechnology Assessment

87 by United States Department of Health and Human Services

The Institute of Medicine (IOM) Centers for Health Care Strategies Inc

Intervention Targets

Literacy and misunderstanding prescription drug labels

Preventing Medication Errors Quality Chasm Series

Interpreting and acting upon preventive health information

Improving Patient Safety Through Informed Consent for Patients with Limited Health Literacy

Patient comprehension of emergency department care and instructions are patients aware of when they do not understand

What Did the Doctor Say Improving Health Literacy to Protect Patient Safety

Intervention Targets

Literacy and misunderstanding prescription drug labels

Preventing Medication Errors Quality Chasm Series

Interpreting and acting upon preventive health information

Improving Patient Safety Through Informed Consent for Patients with Limited Health Literacy

Patient comprehension of emergency department care and instructions are patients aware of when they do not understand

What Did the Doctor Say Improving Health Literacy to Protect Patient Safety