Volume IV, No.1

UNDERSTANDING HEALTH INSTRUCTIONS: A MATTER OF HEALTH AND MONEY Imagine the following: Often, health litrracy represents not Medical providers are highly edu-Cecilia, a thirty·five year old woman, only a problem of illiteracy, but an issue cated professionals who tend to use visits her doctor because of stomach of culture and language of origin. As complicated, technical language, which pain . From her response to the forms America becomes increas ingly diverse, is often difficult to understand even for she mu s t complete and her re s ponse to both culturally and linguistically, major other well -educated people . the doctor's questions, it is clear to the doctor that she does not understand what she is being asked to do . But, i t is a busy clinic, and the doctor is losing patience with her. Cecilia, feeling sick and intimidated by the environment, does not ask the questions she need s . The doctor givers her a physical examination, the doctor gives her instructions for medications, some health education materials, and tells her to take her medication "orally" four times a day. The problem is, Cecilia has no idea what the word "orally" means and consequently, does not know how .0 take the medication . Cecilia is illiterate .

Nearly 40 million Americans, or 21% of all American adults are functionally illiterate. They canno t read well enough to perform the basic functions of daily life, much less understand and read healthcare information .

communication challenges face the health care industry. Add to this the number of patients who are deaf or blind, and the challenge to communicate effectively about health information, which is largely written for a literate, seeing, hearing population and the challenges increase greatly.

Language, Learning and Understanding Now add to these challenges, the ponderous language of healthcare . The move to managed care has increased the complexity of the healthcare system even for those patients who have adequate literacy abilities. Words coined for the healthcare industry are often foreign to those outside healthcare. Healthcare providers are highly edu· cated and often u se language with which they are familiar, yet, may not be familiar to le ss educated members of the community.

Literacy, Cost and Access As "Health Literacy Quick Facts" shows (page 4), illiterate patients have a 50% increased risk of re-hospitalization compared with literate pa tients . Understanding and following health instructions is both better for the patient in terms of improving his or her health , but it could also have a major impact on reducing costs. Stud ies have shown direct links exist between education and health status indicators such as life expectancy, infant survival, and maternal survival rates . But, few studies have been done to date that relate literacy to health status and health care costs .

While few studies have been done on the relationship between health literacy, health outcomes and costs, some preliminary studies indicate illiteracy leads to over utilization and/ or misuse of health care serv ices and poor patient

Health Literacy Most healthcare benefits are consid- outcomes. If a patient does not under-"Health Literacy" is defined as the ered to be lega l contracts and are stand how or when to take a medication, ability to apply literacy skills toward written in dense language . The liability she cannot follow instructions that wil l one's healthcare. Patients be able requirements for pharmaceutical and improve her condition . Not following to read and understand health educa· other health care products mean many instructions (lack of compliance), tion materials, informed consent forms, instructions are written like legal causes increased visits to providers and insurance applications, hospital contracts. hospitals and increased visits for discharge instructio ns, and other Additionally, people have diffe rent chronic diseases. Simply put, patients material s. If patients cannot read the ways of learning. Some gather primary who do not understand essential facts instructions, they are less likely to be information through the written word , about their illness cannot obtain able to follow instructions because they others by listening. Those who depend appropriate treatment, which leads to do not understand them. on visual clues learn in different ways poor outcomes and increased costs.

Cecilia's doctor grew frustrated with her, and Cecilia left confused about wha t to do because Cecilia did not say she could not read and her doctor

from people who depend on hearing. Most patient education materials are

currently written at an 11 th grade level. Most adults read at approximately the

Recommendations The Center for Strategic Health Care , Inc. and Pfizer, Inc. sponsored a full day

mistook her confusion with lack of 5th to 9th grade level. Research has conference on Heal th Li teracy. The attention not an inability to read. shown that simplified patient education following are some recommendations

material s at the 5th to 6th grade level, from that conference : Effective communi cation is a key to the same level at which most broadcast

successful health promotion, ' disease and print media use, are preferred even • Increase collaboration between prevention and treatment. How this among more highly educated adults . agencies focusing on literacy, information is presented to the patient Illnes s causes stress which, in turn, healthcare providers, health can have a major impac t on their health reduces a pa tient's attention and ability plans . and community-based

-... and health outcomes . to understand what she is being told. organization s . • Add patient communicat ion

Q WHERE: Women for Healthcare Education, Reform & Equity Desi gn by Spangler Assoc iates, Seattle. WA Newsletter sponsored by Pfizer Pbarmaceuticals, Inc.

courses in medical schools that focus on health communication

Continued on page 3

Why Women's Health Matters! W.H.E.R.E.'s First Anniversary Celebra· tion Luncheon/Awards Presentation was a fabulous success and we would like to thank everyone for making this such a remarkable first time event. Approxi· mately 400 people attended the luncheon from as far away as New York City, Pennsylvania, California, and Nevada. Our featured speaker was Ruth Merkatz, RN, Ph.D., Director, Women's Health Pfizer Pharmaceuticals, Inc. and the first Head of Women's Health, US Food and Drug Administration. Her talk, "Why Women's Health Matters" linked the changes in health coverage to the women's movements.

The event was met with a great deal of enthusiasm and support for W.H.E.R.E. We were delighed to have John Aylward, who plays Dr. Anspaugh on the Emmy Award winning TV series ER., serve as our Master of Ceremonies.

Shirley Bridge received the Founder's Award for her many years of friendship and support. SAFECO Corporation received the best Corporate Contribu-tion for the Health of Women and

Families and Micki Flowers, Healthcare Reporter, KIRO·TV received the best Individual Contribution for the Health of Women and Families.

We would also like to offer a very special and sincere thanks to our sponsors that made this event possible :

Underwriting Sponsors: Compre· hensive Health Education Foundation (CHEF); Franciscan Health System: Women's Care Center;Fred Hutchinson Cancer Research Center; Gordon, Thomas, Honeywell, Malanca, Peterson & Daheim; Group Health Cooperative ; Regence Blue Shield.

Sponsors: Herb and Shirley Bridge; Eli Lilly and Company ; Swedish Medical Center ; Virginia Mason ; Wyeth·Ayerst Laboratories

Special appreciation also goes to SAFECO Corporation for their donation of Girls to Grandmothers: SAFECO's Guide to WeI/n ess, and Southwest Airlines for providing John Aylward's transportation.

Kristi England Director of Development

Continued from page 1 ...Understanding Health Instructions and cultural diversity. Expand research examining the relationship between literacy and health status Improve training for interpreters in cultural aspects of health

• Expand methods to help patients understand heal th education materials and treatment guide· lines.

Note: The National Institute of Literacy, Boston, MA, in cooperation with World Education, has developed a listserve on health and literacy. The list is an on -line group linking literacy professionals,

Memberships , Individuals $35/year Seniors/Students $20/year Includes newsletter and updates through 12/98.

Name

health educators, medical providers, research and policy makers. To participate, send a message to : listproc@literacy.nifl.gov and in the body of the message type: subscribe NIFL- HEALTH, then your first and last names .

Elizabeth Ralston Kathleen O'Connor

Information for this article came from a june 1991 Conference on Health Literacy sponsored by The Center for Health Care Strategies, Inc., and Pfizer Pharmaceuti-cals, Inc. Proceedings may be obtained by calling 1-888-451-3033.

Send to : WHERE

105 - 14th Ave , Suite 3-A

Seattle, WA 98122

Phone: (2 06) 325-7928 Fax: (206) 325-8221

email : oconnor@med.com

www.med.com/where WHERE is a 501(c)3 organization .

YES! I want to help WHERE help consumers. Here's my contribution:

$1000 $500 $250 $100 $___ I would be willing to :

(research, write, raise funds, phone call, etc.)

AFFILIATES COUNCIL Nancy Dapper, Regional Administrator,

Heath Care Financing Administration, Region X

Alene Moris, Co·Founder, Northwest Women's Institute

Nancy Campbell. Dire ctor, Division of Youth Services, King County, Washington

Susan Rotenberg, Executive Director, National Coalition for Mental and Substance Abuse Health

Care in the Criminal Justice System

Sandra Wa lker, MD, Psychiatrist

Brenda Loew, M.Ac ., LAc ., Licensed Acupuncturist and Trad itional Oriental Medicine

Diane Stollenwerk, MPP, Advisor in Government Policy, Sisters of Providence Health System and Peace Health

Susanne Hartung, S.P., Vice Pres ident of Mission and Ethics, Providence Health System: Puget Sound

Rosemary Torres, Science Area Manager, United Information Systems, Inc ., Wash. DC.

Constance Rice, Ph.D., Senior Vice Chancellor, Seanle Community College District

Velma Monteiro·Tribble, Vice President, National Association of Community Leadersh ip Programs, Indianapolis, IN

Debra Conner, CNM, Childbirth and Parenting Reso urces

Kimberly Weiss, Executive Director, National Association of Women Health Care Profes sions, Chicago, IL

Carmen Otero, Presiding Judge (retired), King County Superior Court

Jerilyn Brusseau, Project Director, Peace Trees Vietnam and, Earthstewards Network j

Karen Matsuda, Associate Regional Administrator, DHice of Women's Health, US Public Health Service, Region X

Sharon Schnare, Associate Regional Administrator, DHice of Family Planning, US Public Health Service, Region X

Dorothy Graham, Director, Human Resources, Wash. Energy Company, and President, Health Care Purchasers Associ ation

Pamela Eakes, Founder, Mother's Against Violence in America IMAVIA)

Julia Smith, MD, Internal Medicine/ Primary Care, Virginia Mason/Mercer Island

Nancy Fisher, RN, MD, MPH, Medical Director, Office of Managed' Care , Div. Social & Heath Services, Wash . State

Karen Lane, Senior Vice President, Fred Hutchinson Cancer Research Cenler

Dorothy Mann, Ph.D.Community Violence Prevention Program, I nstitute of Public Policy, University of Washington

Sue Crystal. Special Assistant to the Governor for Health Policy

Nancy Fugate Woods, RN, Ph .D., Assistant Dean, School 01 Nursing, University of Wa shington

and Founder, Co·Director, Center for Women 's Hea lth, School of Nursing, University of Washington

Melinda Stoker, Senior Marketing Services Manager, Krames Communication, San Bruno. Californ ia

Ka thleen Stine, MSN, ARNP, Sisters Health Services for Sexual Mino rity Women

Sandra A. Smith, MPH, President, Practice Development, Inc.

Tamara Bavendam, MD, Director, Pelvic Floor Disorders, Allegheny University of Health Sciences, Philadelph ia, PA

Wendy Weiser, Executive Director, American College of Women's Health Physicians, Schaumburg, lL

Donna Soodalter·Toman, President, OS·Toman and Associates Consulting, Waban, MA

Gloria Rodriguez, CED, Washington Association of Community and Migrant Health Centers

JeH Gingold" JD, Head, Healthcare Practice, Lane Powell Speers Lubersky

Tina Novick. National Federation 01 Jewish Women

bold means new

Address

City State Zip

Phone Fax email

:}

Q ./ ,,\ L . : .-W HER E

105 - 14th Avenue, Ste 3-A Seattle, WA 98122 "'-

Elizabeth Ralston 650 NW 84th Street Seattle, W A 98117

I Health Literacy Quick Facts I I • 22% of all adult Americans (40 - • Using this estimate, of 50% in- I 44 million) are functionally creased risk of hospitalization

illiterate. for patients with inadequate for margi nal Ii teracy for the 16• 44% of the 36 million people million people on Medicare on Medicare are likely to be alone could cause $8 to $15functionally illiterate, based billion per year in unnecessaryon a National Adult Literacy hospitalizations.Survey in 1993.

• One study of diabetes patients,• 32% of patients in an Atlanta showed that less than 60% ofHospital Emergency room all patients with inadequatewere illiterate; 16% were mar- literacy levels knew what aginally literate; and 1 had normal blood sugar level wasadequate literacy skills, based that they had to monitor for on a study conducted there. their diabetes. • Repeated hospitalizations for • Illiteracy often produces feel-these same patients included : ings of personal shame. One14% with inadequate literacy; study of low-literate patients6% with marginal literary ; and who admitted having difficulty5% with adequate literacy. with reading showed 2/3 hadOr, patients with inadequate never told their spouses theyliteracy skills have a 50% could not read and 19% hadincreased risk of being never told anyone they couldreadmitted to a hospital. not read.

L __________________________

HONORARY BOARD

Booth Gardner Governor. Washington State (1984 -19911; Chair, National Governor's Assoc iation (1991)

Senator Patty Murray

Deborah Senn Insurance Commissioner,

State of Was hington

Phyllis Guiterrez Kenney, Representative, Washington State House of Rep resentatives

Martha Choe, Seattle City Counc il

Tina Podlodowski, Seattle City Council

Dr. Mary Stewart Hall , Ph.D ., President, StewarVHal1 and Founder, Executive Ma ster of Not-for-Profit Leadership Program,

Seattle University

W. Featherstone Reid , JD, Chair, State Board of Health,

Washington State

Bob Crittenden Chief, Family Medicine Services,

Harborview Medical Center, and Director, OHice of Education Policy, School of Medicine,

University of Washington

Kathryn Barnard, RN, Ph.D, Professor, Family and Child Nursing, Scho ol of Nursing, University of Washington

Ann Medlock, Founder and Pres ident, The Gir aHe Proje ct

Paula Clapp Co-Founder, Global Partnerships

Shirley Bridge Director. Ben Bridge Jewelers

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