Health Literacy: A Crisis In Health Care

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Health LiteracyA Crisis In Health Care

• Developed by Stratis Health with the Permission
  of
• the American Medical Association Foundation and
  the American Medical Association

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Definitions

• General Literacy
• An individuals ability to read, write, and
  speak in English, and compute and solve problems
  at levels of proficiency necessary to function on
  the job and in society, to achieve ones goals,
  and develop ones knowledge and potential.
• National Literacy Act of 1991Health
  Literacy
• The degree to which individuals have the
  capacity to obtain, process, and understand basic
  health information and services needed to make
  appropriate health decisions.
• Healthy People 2010

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Self-Assessment
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Implications of low health literacy on patient
care

• 33 Were unable to read basic health care
  materials
• 42 Could not comprehend directions for taking
  medication on an empty stomach
• 26 We unable to understand information on an
  appointment slip
• 43 Do not understand the rights and
  responsibilities section of Medicaid
  application
• 60 Did not understand a standard informed
  consent
• Williams et.al., JAMA 12/6/95

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Cost of poor health literacy Estimate gt50
billion annually

• We all pay!
• 39 paid by Medicare (FICA taxes on workers)
• 17 paid by employers
• 16 paid by patients, out-of-pocket
• 14 paid by Medicaid
• 14 from other public and private sources

Estimated by National Academy on an Aging
Society using 1998 figures
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National Adult Literacy Survey (NALS)

• Conducted in 1992
• N26,000
• Most accurate portrait of literacy in the US
• Scored on 5 levels
• Not accounted for
• Patients who have adequate language skills, but
  do not have adequate health literacy

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Results National Adult Literacy Survey (NALS)
Level
(Kirsh I, Jungeblut A, 1993)
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Why are patients at risk?

• Reliance on the written word for patient
  instruction
• Increasingly complex healthcare system
• More medications
• More tests and procedures
• Growing self-care requirements
• Esoteric language
• An aging population
• A more culturally diverse patient population

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Understanding the problem

• What is it like?
• The following passage simulates what a reader
  with low general literacy sees on the printed
  page
• Read the entire passage out loud
• You have 1 minute to read
• (Hint The words are written backwards and the
  first word is cleaning)

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• GNINAELC Ot erussa hgih ecnamrofrep,
• yllacidoirep naelc eht epat sdaeh dna natspac
• revenehw uoy eciton na noitalumucca fo tsud
• dna nworb-der edixo selcitrap. Esu a nottoc
• baws denetsiom htiw lyporposi lohocla. Eb erus
• on lohocla sehcuot eht rebbur strap, sa ti sdnet
• ot yrd dna yllautneve kcarc eht rebbur. Esu a
• pmad tholc ro egnops ot naelc eht tenibac. A
• dlim paos, ekil gnihsawhsid tnegreted, lliw pleh
• evomer esaerg ro lio.

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What was it like?

• How did you feel while reading this passage?
• How did you feel when you finished reading the
  passage?
• How do you clean the capstan?
• How do you think patients with low health
  literacy feel?

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Understanding the problem

• View As Patients See It
• Video made by the AMA in 2003
• Real patients and real physicians talking about
  literacy issues
• Task Note
• Barriers to access
• Barriers to diagnosis
• Barriers to treatment/care

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Video The Patients Voice

• Discussion
• What ideas hit home with you?
• Did any of the situations seem familiar?
• Did anything surprise you?

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What do we know?

• Low Health Literacy (LHL) is prevalent
• LHL leads to
• Lower health knowledge and less healthy behaviors
• Greater health costs
• Poorer health outcomes
• Techniques and approaches may be used to address
  health literacy

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Strategy Create a shame-free environment

• Recognize red flags
• I forgot my glasses
• Incomplete forms
• Seeking help only when illness is advanced
• Convey an attitude of helpfulness, caring and
  respect (by all staff)
• What is it like being a patient in your setting?
• Are there forms or instructions that could be
  confusing?

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Strategy improve interpersonal communication

• Slow down
• Use plain or living room language
• Focus on key messages (www.askme3.org)
• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?
• Use teach back techniques

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Strategy Develop patient-friendly materials and
forms

• Keep content concise and focused
• Focus only on key points
• Emphasize what the patient should do
• Minimize anatomy and physiology to the basics
• Tips for easy-to-read materials
• Simple words (1-2 syllables)
• Short sentences (4-6 words)
• Short paragraphs (2-3 sentences)
• Limit medical jargon
• Headings, bullets and lots of white space

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Self-Assessment answers
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What can you do right away?

• Do a walk through at your facility and identify
  barriers
• Review registration forms and consider if they
  could be simplified
• Develop a plan to educate all staff about low
  health literacy

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What can you do in the future?

• Form a team to determine a long-term strategy
• Discuss methods for improving communication
  skills with providers and staff
• Incorporate Ask Me 3 components into patient
  information

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• Understanding
• is a two-way street.
• Eleanor Roosevelt

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For More Information

• Other resources
• www.amafoundation.org
• www.askme3.org

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• Brought to you by Stratis Health
• Minnesotas Medicare Quality Improvement
  Organization
• Stratis Health is a non-profit independent
  quality improvement organization
• that collaborates with providers and consumers to
  improve health care.
• This presentation was created by Stratis Health
  under a contract with
• the Centers for Medicare Medicaid Services
  (CMS).
• The contents do not necessarily reflect CMS
  policy.