the health literacy environment in community-based dental
TRANSCRIPT
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The Health Literacy Environment in Community-Based Dental Clinics:
Barriers or Facilitators to Health Outcomes
Alice M. Horowitz, PhD November 4, 2014
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Colleagues
• Dental Directors & Managers of the 26 clinics • Dushanka V. Kleinman • Catherine Maybury • Sarah D. Radice • Rima E. Rudd • Min Qi Wang • Maryam Qayumi & Chad Dammling (now 2nd year dental
students)
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Health Literacy is inextricably linked to improving oral health… especially among
low income groups
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Take Away Message
• Efforts to improve quality, reduce costs and reduce oral health disparities cannot succeed without simultaneous improvements in the health literacy of the public, health care providers and policy makers.
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Why is Oral Health Literacy Important?
• All too often
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Oral Health is not considered an integral part of health
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Yet……
• Oral diseases are a neglected epidemic
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A Low Level of Oral Health Literacy is Associated with:
• Low level of knowledge about oral health
• Fewer dental visits • Increased severity of
dental caries
• Higher rates of failed appointments
• Lower oral-health- related quality of life
• Jones M, Lee JY, Rozier RG. Oral health literacy among adult patients seeking dental care. J Am Dent Assoc. 2007;138(9):1199-1208. • Sabbahi DA, Lawrence HP, Limeback H, Rootman I. Development and evaluation of an oral health literacy instrument for adults.
Community Dent Oral Epidemiol. 2009;37(5):451-462. • White S, Chen J, Atchinson R. Relationship of preventive health practices and health literacy: a national study. Am J Health Behav.
2008;32(3):227-242. • Miller D, Lee JY, DeWalt DA, Vann WF Jr. Impact of caregiver literacy on children’s oral health outcomes. Pediatrics. 2010;126(1):107-14. • Holtzman JS, Atchison KA, Gironda MW, Radbod R, Gornbein J. The association between oral health literacy and failed appointments in
adults attending a university-based general dental clinic. Comm Dent Oral Epidemiol. 2013;1-8. doi: 10.1111/cdoe.12089
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Health Literacy Scans of Community-Based Dental Clinics
Based on work by: • Rudd and Anderson: The Health Literacy
Environment of Hospitals and Health Centers • The Agency for Health Care Research and
Quality: Health Literacy Universal Precautions Toolkit.
• Rudd RE, Andersen J. The health literacy environment of hospitals and health centers. Partners for action: Making your healthcare facility literacy-friendly. Boston, MA: Harvard School of Public Health; 2006.
• AHRQ Publication No. 10-0046-E. Rockville, MD. 2010
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Overall Purpose
• To determine the ‘user friendliness’ of the clinics. – Accessibility, signage, facility navigation, educational
materials and patient forms
• Conducted a feasibility study using health literacy environmental scans (HLES) in Maryland in 2012. – 26/32 community-based dental clinics participated. – Participation was completely voluntary on the part of
the dental directors.
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Methods
• Developed instruments for data collection • Interviewed directors • Assessed technology including use of EHR • Assessed print materials
– educational materials and forms used • Conducted patient interviews • Conducted mail survey of dentists and dental
hygienists regarding their use of communication techniques.
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This HLES is part of a
• Statewide model of our oral health literacy assessment that focusses on prevention and early detection of dental caries [tooth decay].
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Oral Health Literacy Environmental Scan On-Site Assessment Pre-Visit Assessment Post-Site Assessment
Website • Clinic & Services Information • Navigation • Layout • Plain Language
Phone • Answered by Person • Callback Received
Dental Director Interview • Hours of Operation • Eligibility Criteria • Services Provided • Interpretation Services • Electronic Health Records • Patient Demographics (Age, Insurance, Income, Race/ethnicity) • Transportation • Evaluate Clinic Services • Outreach Services
Building Exterior • Exterior Signage • Parking • Walk to Clinic from Parking Lot
Print Materials Pamphlets • SAM • SMOG Forms (Health History, Consent) • SMOG • Re-Write in Plain Language
Patient Interviews • Analyze Data
Building Interior Lobby • Security • Signage for Dental Clinic Dental Reception • Signage • Reception Staff Assistance • Video Equipment Walk-through lobby, hallway & operatories • Note Educational Materials on
Walls • Get Copy of Educational
Materials Patient Interviews
Reports • Synthesize Findings into Report
for Dental Director
Provider Survey • Administer Mail Survey • Collect Responses • Analyze Data
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Oral Health Literacy Environmental Scan
Website • Clinic & Services Info • Navigation • Layout • Plain Language
Phone • Answered by Person • Callback Received
Dental Director Interview • Hours of Operation • Eligibility Criteria • Services Provided • Interpretation Services • Electronic Health Records • Patient Demographics (Age, Insurance, Income, Race/ethnicity) • Transportation to Clinic • Evaluate Clinic Services • Outreach Services
Pre-Visit Assessment
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Oral Health Literacy Environmental Scan
Building Exterior • Exterior Signage • Parking • Walk to Clinic from
Parking Lot
Building Interior Lobby • Security • Signage for Dental Clinic Dental Reception • Signage • Reception Staff Assistance • Video Equipment Walk-through lobby, hallway & operatories • Note Educational Materials on Walls • Get Copy of Educational Materials Patient Interviews
On-site Assessment
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Oral Health Literacy Environmental Scan
Print Materials Pamphlets • SAM • SMOG Forms (Health History, Consent) • SMOG • Re-Write in Plain Language
Patient Interviews • Analyze Data
Provider Survey • Administer Mail Survey • Collect Responses • Analyze Data
Post-Site Assessment
Reports • Synthesize Findings into
Reports for Dental Directors
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Results
• Considerable variation among clinic facilities, operations & educational materials
• Less variation in types of insurance, no show rates & methods of communicating with patients
• DDS’s more likely than DH to have taken a communications skills course
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Results
• Technology assessment included website, phone system and use of EHR and educational DVDs/video.
• 18 of the 26 clinics use EHR. – But only 3 systems are integrated with medical
records. – Only 6 sites included oral health education on
their website
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Results
• Printed forms [consent, health history, post-op instructions] were assessed using SMOG readability formula to determine readability.
• Collectively, the forms were rated between 9th and 16th grade reading level.
• Forms tended to use complex dental and legal terminology instead of common words.
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Limitations
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• We did not record communications between provider/patients or office staff/patients.
• Community-based clinics only; • Convenience sample.
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Conclusions
• This study confirmed the feasibility of conducting a HLES in community-based dental clinics.
• Could be used in private practices/clinics and dental/dental hygiene schools.
• Provides guidance for extending the Rudd and AHRQ guidelines into the dental environment.
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• Add text here
Thank you!