Health%20Literacy%20as%20a%20Factor%20in%20the%20Adoption%20and%20Use%20of%20Personal%20Health%20Records

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Health Literacy as a Factorin the Adoption
andUse of Personal Health Records

• Cynthia Baur, Ph.D.
• Office of Disease Prevention
• and Health Promotion
• U.S. Department of Health and
• Human Services
• September 18, 2006

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Health Literacy at HHS Examples

• HHS Health Literacy Workgroup
• Most agencies also have their own workgroups
• Surgeon Generals Workshop on Improving Health
  Literacy
• NIH/AHRQ/CDC Health Literacy Research Program
• Healthy People 2010 objectives
• Health Literacy Action Plan

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What is Health Literacy?

• Health literacy is the degree to which
  individuals have the capacity to obtain, process,
  and understand basic health information and
  services needed to make appropriate health
  decisions.
• Key concepts
• Obtain -- Understand
• Process -- Decide

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What is the Scope of Health Literacy?

• Health literacy is dependent on both individual
  and systemic factors
• Communication skills of lay people and
  professionals
• Knowledge of lay people and professionals of
  health topics
• Culture
• Demands of the healthcare and public health
  systems
• Demands of the situation/context

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Why is Health Literacy Important?

• Health literacy is important because it affects
  peoples ability to
• Navigate the healthcare system, including
  locating providers and services and filling out
  forms
• Share personal and health information with
  providers
• Engage in self-care and chronic disease
  management
• Adopt health-promoting behaviors, such as
  exercising and eating a healthy diet
• Act on health-related news and announcements
• These intermediate outcomes impact
• Health outcomes
• Healthcare costs
• Quality of care

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Health Literacy in the Adult Population

• Measured by the 2003 National Assessment of Adult
  Literacy (NAAL)
• Nationally representative sample of more than
  19,000 adults
• Health literacy component within the general
  literacy study
• Assessed ability to use and understand prose,
  document and quantitative health information

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Descriptions of Literacy and Health Literacy
Levels

• Proficient Can perform complex and challenging
  literacy activities
• Intermediate Can perform moderately challenging
  literacy activities
• Basic Can perform simple everyday literacy
  activities
• Below Basic Can perform no more than the most
  simple and concrete literacy activities
• Nonliterate in English unable to complete a
  minimum number of screening tasks or could not be
  tested in English or Spanish

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Example of Health Literacy Task and Results

• Standard immunization schedule for children
• 58 of adults answered correctly a question about
  the number of vaccinations a 7 year old should
  receive
• Range of correct answers
• 5 of adults with below basic skills
• 22 of adults with basic skills
• 78 of adults with intermediate skills
• 100 of adults with proficient skills

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Percentage of Adults in Each Literacy Level 2003
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Who is Most Likely to Have the Lowest Health
Literacy Skills?

• Racial and ethnic minorities, except
  Asian/Pacific Islanders
• Persons who spoke languages other than English
  before starting school
• Persons 65 and older
• Persons who did not complete high school
• Persons living below the poverty level
• Persons who do not use the Internet for health
  information

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Below Basic Health Literacy and Health
Information Choices

• 30 million adults in below basic health literacy
  category
• 37 or 11 million no information from newspapers
• 41 or 12 million no information from magazines
• 41 or 12 million no information from books or
  brochures
• 80 or 24 million no information from the
  Internet

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What is the Relevance of these Data for PHRs?

• Adults with limited health literacy skills
• are not accustomed to using the Internet as a
  health resource
• prefer mass media or interpersonal sources of
  health information
• will be unable to handle many of the multiple and
  complex tasks in PHRs

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Examples of PHR Tasks

• Navigating Web sites and other applications
• Seeking out information
• Entering data
• Comparing two or more pieces of information
• Reading charts and graphs
• Writing messages
• Analyzing reports
• Reading textual information

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Relevant Findings from ODPHPs Consumer e-Health
Report

• Intended users diverse perspectives, capacities,
  circumstances and experiences must drive the
  policy, design, implementation and marketing
  processes
• Extensive consumer research is essential
• Access, availability, appropriateness,
  acceptability and applicability of existing tools
  are uneven
• Gap between research-based and commercially-orient
  ed tools

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ODPHP Findings (cont.)

• Evaluation and dissemination strategies must be
  connected to the design process
• Existing community infrastructure exists to help
  connect policymaking, design and dissemination
  and bring tools in line with intended users
• National leadership and vision can help ensure
  agreement on basic principles that include and
  extend beyond privacy

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Contact Information

• 240-453-8262
• Cynthia.Baur_at_hhs.gov