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IPE - Health Literacy

Terms in this set (43)

"Actions individuals must take to obtain the greatest benefit from the health care services available to them"
Patient engagement
Misunderstood - Prescriptions
Take 2 tablets on an empty stomach

Take a tablet by mouth twice each day

Two tablets twice daily - (two tablets a day)
Health Literacy
Dependent on individual and systemic factors

Communication skills of lay persons and professionals

Lay and professional knowledge of health topics

Culture

Demands of the healthcare and public health systems

Demands of the situation/context
Clear Communication

Do no blame...
Everyone is at risk for....
Physicians and other health professionals....
Patients may believe they have understood directions...
Difficult for people to separate...
Communication of "risk"...
Additional challenges in understanding how to select....
The individual

Misunderstanding

Try to and believe they are, communicating accurate information

But may be embarrassed to ask questions

Evidence-based information, especially online, from misleading ads and gimmicks

Is a challenge for both the provider and patient

Insurance plans and benefits, especially for those who have not previously been insured
Five core skills of literacy
Reading

Prose

Documents

Writing

Numeracy
Literacy influences one's ability to access....
Information and to navigate the highly literate environments of modern society
Most health care materials are written at a __________________

Most adults read between the __________________

Approximately ______________ are unable to understand printed health care material, and approximately 90 million adults have fair to poor literacy

Twenty one to twenty three percent of adults read at the __________________, approximately fifth grade or lower
10th-grade level or higher

Eighth and ninth grade level

One-half of adults

Lowest reading level
For patients whose primary language is not English, the problem is compounded:

Survey of hospital patients revealed that _____________ of English-speaking patients and ___________ of Spanish-speaking patients had fair to poor literacy

Study of patients 65 and older found that those who couldn't understand basic written medical instructions were much more likely to die within _________________ than those who had no problems grasping the information
35%

62%

6 years
Health literacy is a shared function of.....

Health literacy is an...
Social and individual factors

Interactoin
Change the skill side:
Improve literacy skills of the public

Improve communication skills of professoinal
Change the demand side:
Recalibrate the norm and identify literacy barriers

Lower demands

Remove barriers
Professional concern - Strategic Action Plan 2010-2015 - Vision
ADA and related health organizations, will use and promote clear and accurate and interactive communication with colleagues, patients and policy makers to achieve optimal oral health for all

Vision may be realized when the following promising and best practices there are
Health Literacy in Dentistry

ADA policy defines oral health literacy as the degree to which individuals have the capacity to _________, ____________, and ____________ basic health information and services needed to make appropriate oral health decisions.

It also recognizes that by improving ____________________, patients are better stewards of their own health.

You can improve health literacy by using ____________________ with the patient and confirming _________________ so that the risk of miscommunication is minimized.

You can support patients' efforts to improve their oral health by using _____________ that make the dental office environment and health care system easier to navigate
Obtain, process and understand

Health literacy

Simple communication, comprehension

Strategies
Resources at the ADA
CDC Health Literacy for Public Health Professionals

Effective Communication Tools for Healthcare Professionals

Federal Plain Language Guidelines

Center for Plain Language

Smiles for Life - A national Oral Health Curriculum

California Dental Association Journal, April 2012
Create a respectful and "shame-free" environment and use a _________________________, where all patients are offered assistance to better understand and use printed and written communications
Universal standards approach
Periodically assess _______________ ways to improve communication

Use ___________ and __________ language in talking and writing

Encourage ______________ and dialogue

Use ________________ or _____________ method to check on successful communications by asking patients to repeat their interpretation of instructions and other information that has been provided

Offer ___________ tools designed for easy use with clear directions
Office/clinic

Clear, plain

Question-asking

"Teach-back", "Teach-to-goal"

Take-home
The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

The capacity of an individual to obtain, interpret and understand basic health information and services and the competence to use such information and services in ways which are health-enhancing
Health Literacy
Health Literacy Equation
Skills/Abilities x Difficulty/Complexity = Health Literacy
How is "Health Literacy" different from "Literacy"?

Reading, writing, computing, communicating and understanding in the context of health care...?

Having the basic skills to read, write and compute without regard to context...?
Health literacy

Literacy
Patients are often faced with complex information and treatment decisions. Some of the specific tasks patients are required to carry out may include:
Evaluating information for credibility and quality

Analyzing relative risks and benefits

Calculating dosages

Interpreting rest results

Locating health information
In order to accomplish these tasks, individuals may need to be:
Visually literate (able to understand graphs or other visual information)

Computer literate (able to operate a computer)

Information literate (able to obtain and apply relevant information)

Numerically or computationally literate (able to calculate or reason numerically)
Even people who read well and are comfortable using numbers can face health literacy issues when:

They aren't familiar with....
They have to interpret...
They are diagnosed with...
They have health conditions that require.....
They are voting on an issue affecting...
Medical terms or how their bodies work

Statistics and evaluate risks and benefits that affect their health and safety

Serious illness and are scared and confused

Complicated self-care

The community's health and relying on unfamiliar technical information
At risk: Vulnerable populations
Minority populations

Immigrant populations

Low income

People with chronic mental and/or physical health conditions

Elderly (age 65+)
__________ if US adults age 60 and over have inadequate or marginal literacy sills, and __________ of patients age 60 and older at a public health hospital could not read or understand basic materials such as prescription labels
2/3

81%
Influencing factors:

_________, ___________, and ___________ influences shape attitudes and beliefs and therefore influence health literacy

Lack of __________________ - people with a high school education or lower

_______________ disabilities

______________ declines in older adults

Reading abilities are typically _____________ grade levels below the last year of school completed - Therefor people with a high school diploma, typically read at a __________ or ___________ grade reading level
Cultural, social, and family

Educational opportunity

Learning

Cognitive

3-5, 7th or 8th
Health status:
Report their health as "poor"
Healthcare costs:
Use services to treat disease complications more; less use of service to prevent complications
Stigma and shame:
Psychological effects
Health literacy and health outcomes

Use of ______________ : more likely to skip important preventative measures

Knowledge about __________________________ : more likely to have chronic conditions

Rates of _____________: higher rates of hospitalization and use of emergency services
Preventative Services

Medial conditions and treatment

Hospitalization
Patients with low health literacy:

Are more likely to visit a/an...
Have more...
Are less likely to follow...
Have higher...
Emergency room

Hospital stays

Treatment plans

Mortality rates
Behaviors indicating low literacy:

Patient registration forms that are ______________

Asking _________ for help

Bringing someone _______________

Inability to _______________

Making excuses -

Noncompliance with ______________

Poor adherence to __________________

Postponing _______________ (May I take the instructions home?)

_____________ others

Lack of follow-through with _________________

Patients say they are taking their medication, but _____________________
Incomplete or inaccurate

Staff

Who can read

Keep appointments

"I forgot my glasses"

Medication

Recommended interventions

Decision making

Watching

Laboratory tests, imaging tests, or referrals to consultants

Laboratory tests or physiological parameters do not change in the expected fashion
Tools to evaluate low literacy
REALD-99 - words on the instrument are ranked in order of increasing difficulty and the score is based on the number of words the subject pronounces correctly

REALM - Rapid Estimate of Adult Literacy in Medicine

REALD - Rapid Estimate of Adult Literacy in Dentistry

TAFHLAL - Test of Functional Health Literacy in Adults

TOFHLA - Used to measure functional health literacy - both numeracy and reading comprehension
REALM
Reading level
Count the number of polysyllabic (three syllables or more) words in a chain of 10 sentences

Multiply by three

Find the approximate grade level on the SMOG conversion table
Steps to enhance understanding among patients with low health literacy:

________________, and take time to assess the patients' health literacy skills.


Use _______________ language instead of medical terminology.

_____________________ to enhance understanding and subsequent recall.

Limit information given at each interaction, and repeat instructions.

Use a _________________ approach to confirm understanding. This approach involves asking patients to demonstrate what they have been told (e.g., repeat how to take their medication) to ensure that education has been adequate.

Be ____________________, thereby empowering patients to participate in their own health care.
Slow down

"Living room"

Show or draw pictures

"Teach back" or "show me"

Respectful, caring, and sensitive
_________________ patients are faced with language barriers that undermine their ability to understand information given by healthcare providers as well as instructions on prescriptions and medication bottles, appointment slips, medical educational brochures, doctors directions, and consent forms
Limited English Proficient (LEP)
A strategy for making written and oral information easier to understand

An important tool for improving health literacy
Plain language
Plain language is communication that users can understand the _______________________ they read or hear it
First time
Improve the usability of health information:

Limit the number of ___________, use ______________ and focus on __________

Supplement instruction with ______________

Make written communication look ________________

Improve the usability of information on the _______________

Identify the indented users of the _____________________

Evaluate users' understanding ________________ the introduction of the information and services

Acknowledge ____________ and practice respect
Messages, language, action

Visuals

Easy to read

Internet

Health information and services

Before, during, and after

Cultural differences
Cultural differences
Accepted roles of men and women

Traditional medicine vs. Western medicine

Favorite and forbidden foods

Manner of dress

Body language
Words/Phrases
Leave metaphors to a minimum

Current communication techniques - texting

Inappropriate language/phrases/slang

Some phrases can be confusing

Idiomatic expressions
Enhances communication

Person receiving health information is asked to restate it in their own words - not just repeat it - to ensure that the message is understood and remembered

When understanding is not accurate or complete, the sender repeats the process until the receiver is able to restate the information needed

Consumers can also be asked to act out a medical regimen
Teach-Back Method
Usability of Health Forms and Instructions:

Revise forms to ensure _______________

Test forms with ________________ and revise as needed

Provide _______________ and in multiple languages

Provide ___________ information for assistance

_________ to give assistance in completing forms
Clarity and simplicity

Intended users

Plain language

Clear

Train staff
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