What the Heck is Health Literacy?Emily Beauregard, MPH

Health Planning Coordinator Family Health Centers, Inc

Mary Beth Wright, RN, BSNPatient/Family Nurse Clinician

Kosair Children’s Hospital

Objectives

• Define Health Literacy

• Discuss the Impact of Poor Health Literacy

• Discuss implementing best practice methods for Health Literacy– Teach Back/Show Back Method

• Discuss Health Literacy Kentucky

Do You Know What Critical Public Health Issue…

• Can hit any population segment, regardless or age, race, education or income?

• Costs between $106 billion to $238 billion of the U.S. personal health care expenditures? (3.)

• Can’t be diagnosed by any new medical technology and is not visible to the eye?

The Answer

What is Health Literacy?

• The ability to read, understand, and act on health information.

• It’s communication between patient and provider.

• Not just how well a person can read.

Will Your Patient/Family Understand?

• When you are in respiratory distress or have an asthma exacerbation, take two inhalations of your bronchodilator (beta agonist) immediately and if you don’t improve call your physician or go to the nearest emergency room.

Who is at Risk?

• Anyone regardless of age, race, education, income or social class can be at risk for low HEALTH literacy.

• Almost 9 out of 10 adults lack the skills needed to manage their health and prevent disease. (1)

• Some groups have a higher risk– Ethnic minority groups– Older patients – Recent immigrants– People with chronic diseases – Low socioeconomic status

American Medical AssociationHealth Literacy Video

• http://www.youtube.com/watch?v=BgTuD7l7LG8&feature=related

Universal Precautions

• Just as clinicians should assume everyone has an infectious disease, health care providers should assume everyone has difficulty processing and understanding basic health information.

• In the Joint Commission’s sentinel event database, 65% of the identified adverse events have been found to have communication failures as the underlying root cause. How much of this was health literacy problems?

Impact of Low Health Literacy

• Poor health outcomes• Needless patient suffering• Under-utilization of preventive services• Over-utilization of health services• Unnecessary health care cost• Limited effectiveness of treatment• Higher patient dissatisfaction • Higher provider frustration

To the Non-Health Care Professional

Outer Space

Same words – Different meaning

• What’s the color of your stools? • The doctor did not see any growth on your

vocal cords. (Are they too small?)• If you have an acute (a cute) attack take

your rescue medicine. (I don’t think attacks are cute.)

• You have to be in Contact Isolation. (Contacts are for eyes???)

• There is a disconnect between the patient/family and the provider.

• What we think we are saying or asking is not what they are understanding.

Start With What You Can Improve

• Do a Health Literacy Check on yourself.• Are you using Plain Everyday Language?• Are you providing easy to understand

written and verbal medical information?• Are you allowing your patients/families to

have open an “ask me questions” environment?

• Are you allowing a “Shame Free” environment?

• INVOLVE THE PERSON– Assess their needs – knowledge level, readiness to

learn, how they best learn

• Have the person work with you in the learning process– Each time you do the procedure, give the medicine,

go into the room – describe to the patient what you are doing, explain all the steps.

– Keep these words in your mind –• What does this patient/family need to know• What does this patient/family need to do

• Stop asking – Do you understand?

• Instead ask – – Tell me what you know about…. TEACH

BACK– Show me how to do…. SHOW BACK– Tell me what you are going to watch for…..– Tell me what you are going to do when you go

home about …

• Stop asking – Do you have questions?

• Instead ask:

What questions do you have?

What are your concerns?

What do you want to go over together again?

Improvements You Can Make

• Limit the use of medical language and define medical language that is needed.

• Remember that even well educated people do not understand the medical language.

• Keep it short and simple.• Involve as many of the senses as possible.

– Use discussion– Use written materials – Use hands on as much as possible– Use visuals – realistic medical equipment, charts,

graphs, dolls

Active Learning – Involve Person

Interesting statistics about retention of learning. People usually remember:

• 10% of what we read• 20% of what we hear• 30% of what we see• 50% of what we see and hear• 70% of what we say • 90% of what we say as we do

Best Way to LearnOnly Way to Evaluate

• Hands on doing the task/teaching yourself.• TEACH BACK and SHOW BACK. • Provide the education and then ask them to teach back. • Let them know you want them to TEACH BACK and/or

SHOW BACK to you to make sure you gave them the best information to care for themselves at home.

• DO not place blame if they did not understand. Rephrase your teaching and evaluate again.

Six steps to improve patient understanding from the American Medical Assoc. (AMA)

• Limit the amount of information you give at one time

• Slow down• Avoid medical jargon• Use pictures or models to explain important

concepts• Check understanding with the “teach-back”-

show-back” technique• Encourage patients/family to ask questions

Do A Health Literacy Check On Your Work Place

• Think Plain Everyday Language – Signage – Forms– Patient/Family education sheets

• Guidelines from American Medical Association say written materials should be at 6th grade reading level or below.

• Use simple non-medical language and define any medical or technical terms you used

• Put most important points first• Bulleted list are prefer over paragraphs• Use headings and subheadings to separate text• Use universal symbols and clear signage• Use simple sentence structure• Use active voice• Use one or two syllable words• Have good amount of empty or white space• Use 12 font or larger

What Can We Improve With Good Health Literacy?

• Patients who understand health care information may– Be more compliant with instructions including

medications– Call back less often– Visit the HCP less often– Have fewer hospitalizations– Have better health outcomes– Have increased patient satisfaction

Best Practices at Family Health Centers

• Patient-approved handouts (6th grade level)

• Health Literacy Committee

• Monthly emails

• Health literacy month

Best Practices at Kosair Children’s Hospital Norton Healthcare

• Health Literacy taught in System Orientation• Web Based Training on Medication Teaching

EVERY DOSE, EVERY TIME• Education Response of TEACH BACK and/or

SHOW BACK on every patient teaching record• Family Advisory Council• Written materials approved using Health Literacy

Guidelines

Best Practices at Kosair Children’s Hospital

Best Practices at Kosair Children’s Hospital

What Can We Do To Improve Health Literacy and Improve

Communication • Increase awareness• Health Literacy KY Summit • Health Literacy KY Partnership• Talk the Talk where ever you go• Make good health communication a part of

your communication style• Go Patient/Family Friendly- INVOLVE the

person

Useful Resources

• Health Literacy KY Partnership• http://healthliteracyky.org/resources.htm

• Medline Plus• http://www.nlm.nih.gov/medlineplus/

Good Health Literacy Saves Lives

It is the right thing to do!!!

Make sure your client understands what

you think

you told them

TEACH BACK/SHOW BACK

References

1. Kutner M., Greenberg E., LJin Y and Paulsen C. The Health Literacy of American’s Adults: Results from 2003 National Assessment of Adult Literacy. U.S. Department of Education. Washington, DC: National Center for Education Statistics. 2006

2. Williams MV, Parker RM, Baker DW, et al. Inadequate Functional Health Literacy Among Patients at Two Public Hospitals. JAMA 1995 Dec 6; 274(21):1,677–82

3. Low Health Literacy: Implication for National Health Policy

Kirsch et al., “A First Look at the Results of the National Adult Literacy Survey” Nat’l Center for Education Statistics, 1993

Stedman L, Kaestle C. Literacy and Reading Performance in the US From 1880 to Present. In: Kaestle C, Editor. Literacy in the US: Readers and Reading Since 1880. New Haven (CT): Yale University Press; 1991. P. 75–128

Partnership for Clear Health Communication

Ask Me 3 Intervention – What is my main problem? What do I need to do? Why is it important for me to do this?

“What Did the Doctor Say?:” Improving Health Literacy to Protect Patient Safety – The Joint Commission White Paper

American Medical Association – Health Literacy