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Advancing Clear Health Communication to Positively Impact Health Outcomes

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Title: Advancing Clear Health Communication to Positively Impact Health Outcomes


1
Advancing Clear Health Communication to
Positively Impact Health Outcomes
2
Presentation Sections
  • The Problem Low Health Literacy Scope and
    Impact
  • Finding a Solution
  • The Partnership for Clear Health Communication
  • Ask Me 3
  • How to Become Involved Solutions into Action
  • For Providers How Does Clear Health
    Communication Affect Your Practice
  • Tips for Enhancing Patient Provider
    Communication

3
The ProblemLow Health Literacy
  • Scope and Impact

4
Do You Know Which Critical Public Health Issue
  • Impacts nearly one in every three people living
    in the United States
  • Can hit any population segment, regardless of
    age, race, education or income
  • Costs the healthcare system as much as 58
    billion a year
  • Cant be diagnosed by any new medical technology
    and is not visible to the eye

5
The Issue Low Health Literacy
  • What is health literacy?
  • The ability to read, understand and act on
    health information

6
How Big Is the Problem?
More Than 90 Million People in the US Have
Difficulty Reading
Approximately 40 to 44 Million Adults in the US
Are Functionally Illiterate1 Approximately 50
Million Are Marginally Illiterate1 Average
Reading Skills of Adults in the US Are Between
the 8th and 9th Grade Levels2
Sources 1 Kirsch et al., A First Look at the
Results of the National Adult Literacy Survey
Natl Center for Education Statistics, 1993 2
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. 75128
7
Who Is at Risk for Low Health Literacy?
  • Anyone in the US regardless of age, race,
    education, income or social class can be at
    risk for low health literacy
  • Ethnic minority groups are disproportionately
    affected by low health literacy
  • The majority of people with low literacy skills
    in the US are white, native-born Americans
  • Older patients, recent immigrants, people with
    chronic diseases and those with low socioeconomic
    status are especially vulnerable to low health
    literacy

8
Low Health Literacy Impacts a Patients Ability
to Fully Engage in the Healthcare System
The Largest Study Conducted to Date on Health
Literacy Found That
33 Were unable to read basic health care
materials 42 Could not comprehend directions for
taking medication on an empty stomach 26 Were
unable to understand information on an
appointment slip 43 Did not understand the
rights and responsibilities section of a Medicaid
application 60 Did not understand a standard
informed consent
Source Williams MV, Parker RM, Baker DW, et al.
Inadequate Functional Health Literacy Among
Patients at Two Public Hospitals. JAMA 1995 Dec
6 274(21)1,67782
9
Low Health Literacy Negatively Impacts Health
Outcomes
  • Adults with low health literacy
  • Are often less likely to comply with prescribed
    treatment and self-care regimens1
  • Make more medication or treatment errors1
  • Fail to seek preventive care1
  • Are at a higher risk for hospitalization than
    people with adequate literacy skills2
  • Remain in hospital nearly 2 days longer3
  • Lack the skills needed to negotiate the health
    care system1
  • People with low health literacy AND diabetes
  • Were found to be less likely to have effective
    glycemic control4
  • Were more likely to report vision problems caused
    by their diabetes4

1 Weiss, BD. 20 Common Problems in Primary Care.
McGraw Hill. December 1999 2 Baker DW, Parker RM,
Williams MV, Clark WS. Health Literacy and the
Risk of Hospital Admission. Journal of General
Internal Medicine. 1998 (13) 791-798. 3 Kirsch
IS, Jugebut A, Jenkins L, Kolstad A. Adult
Literacy in America A First Look at the Results
of the National Adult Literacy Survey.
Washington, DC Department of Education 1993. 4
Schillinger D, Grumbach K, Piette J, Wang F,
Osmond D, Daher C, Palacios J, Sullivan GD,
Bindman AB. Association of Health Literacy With
Diabetes Outcomes. JAMA. July 24/31 2002 (288) No
4.
10
Low Health Literacy Impacts Resource Utilization
  • Adults with low literacy
  • Averaged 6 more hospital visits1
  • Stayed in the hospital nearly 2 days longer than
    adults with higher literacy skills1
  • Had fewer doctor visits, but used significantly
    more hospital resources2
  • Had annual health care costs 4 times higher than
    those with higher health literacy3
  • Among adults who stayed overnight in a hospital

1Kirsch IS, Jugebut A, Jenkins L, Kolstad A.
Adult Literacy in America A First Look at the
Results of the National Adult Literacy Survey.
Washington, DC Department of Education 1993.
2Baker DW, Parker RM, Williams MV, Clark WS.
Health Literacy and the Risk of Hospital
Admission. Journal of General Internal Medicine.
1998 (13) 791-798. 3Weiss, BD. 20 Common
Problems in Primary Care. McGraw Hill. December
1999.
11
Implications of Low Health Literacy
  • Poor Health Outcomes
  • Under-utilization of preventive services
  • Over-utilization of health services
  • Unnecessary health care expenditures
  • Limited effectiveness of treatment
  • Needless patient suffering
  • Higher patient dissatisfaction
  • Higher provider frustration

12
Finding a Solution
13
Solutions Focus on Care Providers and Materials
Healthcare Thought Leaders
  • Agree that focusing on the patient-provider
    relationship would provide the most immediate
    and impactful solution to the issue of low HL
  • 2/3 feel that low HL is driven by poor
    patient/doctor communication
  • Believe that providing easy-to-understand health
    information is key

Source A National Survey of Health Industry
Influencers and Change Agents,KRC Research and
Consulting, April 2002
14
The Patient-Provider Relationship
There Is a Disconnect Between Patient and
Provider Bridging the Information Gap Will Help
Improve Health Literacy
70 of physicians say they provide patients
with additional resources to help them
understand their medications
75 of physicians report patients have trouble
understanding Rx information
Source Health Literacy The Prescription Drug
Experience The Front Line Perspective From
Patients, Physicians and Pharmacists, Roper ASW,
May 2002
15
Written Communication
Making Health Information Understandable
Written
  • 87 report reading Rx information
  • Yet only 34 believe others read this same
    information
  • 50 of adults read at below 8th grade reading
    levels
  • 20 of adults read at below 5th grade reading
    levels
  • 40 of seniors read at below 5th grade reading
    levels
  • Consumer healthcare materials written at 10th
    grade or above, where only 50MM can understand
    and act

What Do We Do?
Develop Written Materials at 6th Grade or Below,
Where 160MM Can Understand and Act
Source Health Literacy The Prescription Drug
Experience The Front Line Perspective From
Patients, Physicians and Pharmacists, Roper ASW,
May 2002
16
Example of Health Communication That May Not
Reach a Broad Consumer Audience
70
150
Good Range
TooHigh
TooLow
What You Need to Know About Low Blood Sugar Treat
low blood sugar quickly. If you have signs of
low blood sugar, eat or drink something that has
sugar in it. Some things you can eat are hard
candy, sugar-sweetened soda, orange juice, or a
glass of milk. Special tablets or gel made of
glucose (a form of sugar) can be used to treat
low blood sugar. You can buy these in a drug
store. Always have some of these items handy at
home or with you when you go out in case your
blood sugar drops too low. After treating a low
blood sugar reaction, eat a small snack like half
a sandwich, a glass of milk, or some crackers if
your next meal is more than 30 minutes away.
Source The National Institute of Diabetes and
Digestive and Kidney Diseases
Blood Sugar Is Too Low if It Is Under 70
Blood Sugar Is Too High if It Is Over 240
9th Grade Reading Level
17
Example of Clear Health Communication That
Reaches a Broad Consumer Audience
  • Common visual used to explain concept
  • Uses action captions that clarify the point of
    the visual
  • Creates interaction with the reader

18
Verbal Communication
Up to 80 of Patients Forget What Their Doctor
Tells Them As Soon As They Leave the Doctors
Office ANDNearly 50 of What They Do Remember
is Recalled Incorrectly
  • Patients experience shame around the issue
  • Only 14 of patients say they feel awkward
    admitting they dont understand yet 79 feel
    others dont understand
  • Providers experience time challenges
  • Providers interrupt patients 30 seconds after
    they start speaking if not interrupted,
    patients will speak less than two minutes

What Can We Do?
Create an Environment of TRUST
Source Health Literacy The Prescription Drug
Experience The Front Line Perspective From
Patients, Physicians and Pharmacists, Roper ASW,
May 2002
19
Reaching the Solution
Best Opportunity for Immediate Impact
20
Finding a Solution
  • The Partnership for Clear Health Communication

21
Reaching a Solution
Introducing the Partnership for Clear Health
Communication
  • The Partnership for Clear Health Communication
    is a coalition of national organizations that
    are working together to promote awareness and
    solutions around the issue of low health literacy
    and its effect on health outcomes

22
Partnership Steering Committee Members
Provider Organizations
ThoughtLeaders
  • American Federation of Aging Research
  • California Health Literacy Initiative
  • National Coalition for Literacy
  • National Council for La Raza
  • National Alliance for Caregiving
  • ProLiteracy Health Worldwide
  • American Medical Association Foundation
  • American Nurses Association
  • American Pharmaceutical Association
  • David Baker, MD Northwestern School of
    Medicine
  • National Medical Association
  • National Alliance for Hispanic Health
  • American Public Health Association
  • Janet Ohene-Frempong, President, JO Frempong and
    Associates
  • National Health Council
  • Partnership for Prevention
  • Pfizer Inc (member and convener)

23
Partnership for Clear Health Communication
  • Purpose Advance the Health Literacy issue, gain
    critical mass, leverage credibility and drive
    through the grass roots
  • Who Nationally recognized organizations with
    local membership experienced in building and
    leading coalitions, representing a broad range of
    constituencies in research, policy and service
    delivery
  • What Develop and execute a prioritized and
    coordinated Health Literacy Action Agenda to
    drive Awareness/education, solutions/tools,
    advocacy, policy, research and evaluation

Shared Interest in Improving Health Outcomes
24
National Action Agenda
Expand awareness and educate patients and
providers
Develop and apply practical solutions to improve
patient-provider communication, and motivate the
healthcare system to adopt them
Conduct nationally coordinated research and
evaluation to define the health literacy issue
and evaluate solutions
Conduct an active advocacy program to increase
support for health literacy policy and funding
25
Finding a Solution
26
The Partnerships First Solution
  • Addresses the highest priority Action Agenda
    items
  • Awareness and education
  • Creates a compelling solution and Call to Action
    for patients and providers
  • Is designed to promote clear communication
    between patients and providers to improve health
    outcomes
  • Was developed with health literacy experts, then
    tested and validated

27
For Patients
  • Health information can be confusing at times
  • Everyone wants help with health information
  • Asking questions helps patients understand how
    to prevent or manage illness

Patients Should Not Be Anxious About Asking Their
Health Care Provider Questions!
28
For Providers
Health Care Providers Want Patients to Know
  • All they can about their condition/medication
  • Why this advice/treatment is important for good
    health
  • Steps to take to prevent a condition or keep it
    under control

Provider
Patient
29
Ask Me 3 Creates Shared Responsibility for
Clear Health Communication
Patient
Provider
De-stigmatize andReduce Embarrassmentof Low
Health Literacy
RecognizePatient Coping Mechanisms
30
What Is Ask Me 3
  • Promotes three simple, but essential, questions
    and answers for every healthcare interaction

31
Ask Me 3 Program Materials Availablein English
and Spanish
Organizational Brochure
Website
Provider Brochure
Posters
Patient Brochure
32
Ask Me 3 For Patients
  • Element Poster
  • Description
  • Stimulates curiosity about Ask Me 3
  • Informs patients and staff about the program
  • Implementation (hang poster)
  • In waiting areas
  • In exam rooms
  • On the ceiling, abovethe exam table
  • On a door
  • In a staff break room
  • Hang anywhere where provider-patient interaction
    takes place
  • Anywhere patients might see it!

33
Ask Me 3 For Patients
  • Element Patient brochure
  • Description
  • Educates patients about the Ask Me 3
  • Motivates patients to ask their healthcare
    provider questions
  • Implementation
  • Display in waiting rooms/registration area
  • Distribute to patients upon arrival/sign-in
  • Distribute with any paperwork
  • Distribute during events or with mailings to
    patients

34
Ask Me 3 For Providers
  • Element Provider brochure
  • Description
  • Explains the scope and impact of low health
    literacy
  • Offers communication tips
  • Emphasizes how effective communication can
    positively impact patient health outcomes
  • Implementation
  • Distribute to all staff interacting with patients
    through staff meetings or mailings
  • Conduct departmental in-service training on
    Health Literacy and Clear Health Communication

35
Ask Me 3 For Providers
  • Element Organization brochure
  • Description
  • Explains the scope and impact of low health
    literacy
  • Provides ideas and complementary roles in
    advancing health literacy
  • Implementation
  • Distribute to partner/affiliate organizations

36
Ask Me 3 For Providers
  • www.AskMe3.org
  • Has everything you need to start
    acting/implementing
  • Materials can be downloaded/ordered from this
    website
  • Other health literacy tools available on the
    site
  • Bibliography on health literacy
  • List of literacy resources
  • White paper on health literacy
  • Links to other relevant websites
  • Cultural competence primer

37
How to Become Involved
Solutions Into Action
38
Clear Health Communication We Can All Be a
Part of the Solution
  • Even if you are not in a position to directly
    answer the three questions, keep clear health
    communicationin mind and in your dialogue when
    communicating with patients
  • Many people have trouble understanding medical
    terms. Often, these terms are better understood
    when explained with common words, an example or
    visual interpretation

39
Clear Health Communication in Action
Start by Decreasing the Use of Medical Jargon
Consider Using This One Instead
Instead of Using This Word
Benign Harmless Chronic Happens again and again
does not end Cardiac Heart Edema Swelling build
up of fluid Fatigue Tired Screening Test Intake Wh
at you eat or drink Generic Not a brand
name Adverse events Side effects
40
How Can Your Organization Become Involved?
To Understand the Issue
  • Visit www.clearhealthcommunication.org. It has
    background information and tools on Health
    Literacy/Clear Health Communication

To Know What Percentage of Your Practice Is
Affected
  • Use the prevalence calculator gives the
    approximate percentage of patients at risk of
    low health literacy in a physicians practice

41
How Can Your Organization Become Involved
To Educate Your Staff
  • View the webcast at www.AskMe3.org
  • Conduct an in-service training on health literacy
  • Include an article on the scope and impact of
    health literacy and the solutions in your
    newsletter and on your web site

To Educate Your Patients
  • Download or order the materials you need to start
    acting on Clear Health Communication at
    www.AskMe3.org and display them
  • Request a speaker to speak to a group of your
    patients by calling 1-877-4-ASK-ME-3

42
How Can Your Organization Become Involved?
To Become Actively Engaged
  • Join the Partnership for Clear Health
    Communication. Sign up as a member at
    www.AskMe3.org. Adopt the Action Agenda within
    your own work
  • Learn how to create easy to read materials using
    the Pfizer Principles for Clear Health
    Communication available at www.clearhealthcommun
    ication.org
  • Dedicate a section or panel to health literacy at
    your next convention or meeting. Request a
    speaker by calling 1-877-4-ASK-ME-3

To Advocate for CHC
  • Share your concern about low health literacy and
    Ask Me 3 with your state legislators,
    congressional representatives and senators and
    advocacy groups in which you participate

43
For Providers How Does Clear Health
Communication Affect Your Practice?
  • Tips for Enhancing Patient Provider
    Communication

44
How Does Low Health Literacy Affect Your
Practice?
  • Chances are high that some of your patients are
    among the 90 million who have low health
    literacy
  • You may not know that patients with poor health
    literacy skills are in your care
  • They use well-practiced coping mechanisms that
    effectively mask their problem
  • They are often ashamed to admit they have
    difficulty understanding information and
    instructions

45
Defining the Problem Scope
Coping Mechanisms for Patients With Low Literacy
80
Ask Other Patients
90
Ask for Help From Medical Staff
88
Watch and Copy Others Actions
98
Bring Someone Who Can Read
Source Parikh et al., 1996
46
What Can You Do?
  • Six steps to improving patient understanding
  • Limit the amount of information provided at each
    visit
  • Slow down
  • Avoid medical jargon
  • Use pictures or models to explain important
    concepts
  • Assure understanding with the show-me technique
  • Encourage patients to ask questions

47
What Else Can You Do?
People Have Difficulty Making Appointments
Appointment InstructionsAlso see Urgent Care
(if you are too sick to wait for an
appointment)Making a medical appointment for
the first time, it is straightforward You call
555-2222 and make a appointment at XYZ Health
Services just like you would at any doctor's
office. You can request a specific clinician if
you have someone in mind, or you can explain your
need or problem to the appointment counselor, and
he or she will schedule you with an appropriate
clinician at the earliest possible date. At your
first appointment you will receive a medical
record card -- often referred to as your "gold
card" -- which you will keep and use as your XYZ
Health Services identification.  If you are
unsure about whether you should make an
appointment, you may call the Advice Nurse at
666-7777. Also, in advance of your first
appointment, be sure to read "How to Make the
Most of Your XYZ Visit." Please call 643-7177
to make an appointment in the Specialty Clinics,
including Allergy Travel. Specialty
appointments require a referral. You may also
drop by the Appointment Office to make a medical
appointment. The Appointment Office is located on
the first floor in Room 1111. You may also make
an appointment in the Specialty Clinics by going
to the Specialty Clinic reception desk, located
behind the elevators on the first floor. If you
need to cancel an appointment, please call our
24-hour cancellation line at 643-7033. Please
note that you will be billed for a broken
appointment fee if you do not show up for your
appointment and have not called to cancel it.
  • When making an appointment, provide people with
    simple options and clear facts

Your Name Your Appointment Date Time Place Our
Telephone Number Do not eat or drink for 6 hours
before the day and time on this card.
48
What Else Can You Do?
People Have Trouble Understanding Phone Recordings
  • Phone answered by a tape recording. Speaking
    quickly, the caller is offered numerous options
    and alternatives
  • Speak slowly and clearly
  • Provide an easy way to connect with a live
    person
  • Provide options in other languages

49
What Else Can You Do?
People Have Trouble Reading Signs
  • Some people become confused about whether this
    entry was intended for ambulances or for patients
  • The use of visuals clarify the message
  • Contrast in color makes it easy to read
  • Try to be consistent when hanging signs

50
What Else Can You Do?
People Have Trouble Understanding Maps
  • To make maps easier to follow
  • Match the color in the map with the paint color
    on walls or floors
  • Match the names in the map to the names on the
    signs
  • Use 14 point font size or larger
  • Maps are usually hard to follow
  • Too complicated
  • Codes are hard to understand
  • Names and directions not always match
  • Small fonts

51
How Can Enhanced Communication With Your
Patients Benefit Your Practice?
  • Patients who understand health care information
    may
  • Be more compliant with instructions and
    medications
  • Call back less often
  • Visit less often
  • Have fewer hospitalizations
  • Have better health outcomes
  • Have increased patient satisfaction

Greater Provider Satisfaction
52
The Practical Solution
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