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Health Literacy

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Red Flags. Key phrases; examples 'I forgot my glasses.' 'I don't have time to read this today. ... Journal of the American Medical Association, 287: 495-501. ... – PowerPoint PPT presentation

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Title: Health Literacy


1
Health Literacy
  • Presenters

2
Definitions
  • 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.
  • Healthy People 2010, Health Communication
    Terminology

3
Introduction / AMA Video
  • American Medical Associations Health Literacy
    Video (2320)
  • For a copy of this video, please visit the AMAs
    catalog, and request Health Literacy Educational
    Kit 2007

4
Health Literacy
5
National Adult Literacy Survey (NALS)
  • 26,000 U.S. adults were interviewed
  • Scored on 5 levels
  • Result 48 of U.S. population have inadequate
    (Level 1) or marginal (Level 2) literacy skills.

6
NALS Level 1Inadequate Literacy (21)
  • Able to
  • Sign name
  • Find a country in an article
  • Total a bank deposit entry
  • Cannot consistently
  • Understand the gist of an article
  • Use a bus schedule
  • Enter information on a Social Security application

7
NALS Level 2Marginal Literacy (27)
  • Able to
  • Find intersection on street map
  • Locate information in newspaper article
  • Determine difference in price on tickets
  • Cannot consistently
  • Use a bus schedule
  • Identify information from a bar graph
  • Write a brief letter of complaint

8
Risks of Inadequate Health Literacy
  • ½ of the U.S. population may be at risk
  • Misunderstanding
  • Mistakes
  • Excess hospitalizations
  • Poor health outcomes

9
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.

10
What Is It Like?
  • 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 damp
    tholc ro egnops ot naelc eht tenibac. A dlim
    paos, ekil gnihsawhsid tnegreted, lliw pleh
    evomer esaerg ro lio.

11
What Is It Like?
  • How do you clean the capstan?

12
Factors Contributing to Health Literacy
  • Patient Factors
  • General literacy
  • Age
  • Experience with health care system
  • Cultural and language factors
  • Situational Factors
  • Complexity of information
  • How information is communicated

13
Health Care System Factors
  • Reliance on the written word for patient
    instruction
  • Increasingly complex health system
  • More medications
  • More tests and procedures
  • Shorter hospital stays
  • Growing self-care requirements
  • Less hands-on patient education

14
Implications
  • Problems with
  • Interactions with providers
  • Completing forms
  • Following medication instructions
  • Appointment slips
  • Informed consents
  • Discharge instructions
  • Health education materials
  • Insurance applications
  • Finding clinic/office

15
Implications
  • Overuse of emergency room
  • Incomplete history
  • Lack of informed consent (legal issues)
  • Diagnosis made at later stages
  • Unhealthy/risky behaviors

16
Informed Consent
  • Informed consent and living wills often need
    post-college level comprehension
  • Must explain verbally as well as give written
    just handing them the form to sign is not
    informed consent
  • Legal right to understand alternatives for care
    and cost of care
  • Keep it short and avoid legal jargon

17
Barriers
  • Barriers to Access
  • Insurance forms
  • Intake forms
  • Medical history questionnaire
  • Informed consents
  • Barriers to Diagnosis
  • Patient provides mistaken information
  • Patient misunderstands physicians questions
  • Physician misunderstands patient
  • Barriers to Treatment
  • Misunderstanding of treatment directions may lead
    to serious mistakes or non-compliance

18
Red Flags
  • Key phrases examples
  • I forgot my glasses.
  • I dont have time to read this today.
  • Incomplete registration forms
  • Patients are non-compliant with medications
  • When asked, patient unable to explain timing or
    purpose of medication
  • Angry, slippery, clowning or passive when asked
    questions

19
Creating a Shame-free Environment
  • Setting must be welcoming, shame-free from moment
    patient enters
  • Think from a patient perspective, what their
    experience is like from start to finish
  • Creating this environment must include front
    staff, nurses, and other auxiliary employees

20
Creating a Shame-free Environment
  • Reducing Shame Practical Solutions
  • Have staff help with forms
  • Follow-up visits with phone calls
  • Pre-visit phone calls for new patients, asking
    how they prefer to receive information
  • Quality control for a patient friendly environment

21
Creating a Shame-free Environment
  • Make sure patients are clear
  • About their diagnoses
  • Know exactly what they need to do
  • How to take medications, possible side effects
  • Treatment regimen, follow-ups
  • Why this plan is in their best interest
  • Conduct a Medication Review
  • Sample included in worksheet packet

22
Creating a Shame-free Environment
  • Doctor-Patient Communication
  • Be curious, listen
  • Ask before you advise
  • Give the patient time to respond
  • Discuss how you can best help the patient care
    for themselves
  • Ask patients how they want information
    communicated to them
  • Be positive, hopeful, empowering with speech

23
Creating a Shame-free Environment
  • Staff-Patient Communication
  • First impressionsbig difference
  • Helpful attitude
  • Check non-verbal communication
  • Have staff call patients by name
  • Respectful, caring, safe office environment
  • Treat all patients as you would your own family
    parents, siblings, children, etc

24
Creating a Shame-free Environment
  • Office Strategies Office Checklist
  • What is the mood of the office?
  • What types of non-verbal communication are used
    around the office?
  • Is there a systems approach to education?
  • Are the messages created in the office consistent
    throughout the patients visit?
  • Does the staff have a genuine interest in the
    patients, their lives, and health management?

25
Enhancing Patient Interaction and Communication
  • Doctor Your foot infection is so severe that we
    will not be able to treat it locally.
  • Patient I hope that I dont have to travel far,
    doctor. Im afraid of flying.
  • Have you ever experienced a scenario such as
    this?

26
5 Steps Enhancing Patient Interaction
  • Conduct patient-centered visits
  • Listen more, speak less
  • Avoid clinical monologue
  • Encourage questions
  • Understand and address patient concerns
  • Explain in plain language
  • Slow your pace of speech
  • Use analogies, comparisons to everyday life
  • Arthritis is like a creaky hinge on a door.
  • Plain, non-medical language

27
5 Steps Enhancing Patient Interaction
  • Focus on key messages and repeat
  • Limit information by focusing on 1-3 key messages
    per visit
  • Review the key points, repeat several times
  • Have other staff reinforce the messages
  • Example of this in practice with Strep Throat, 3
    key messages for the patient to take away
  • Take one pill in the morning and one pill in the
    evening.
  • Take the medicine every day for 10 days, even if
    you feel better before then.
  • Stopping the pills before 10 days can result in
    serious heart problems.

28
5 Steps Enhancing Patient Interaction
  • Use a teach back or show me technique to
    check for understanding
  • Ask the patient to demonstrate their
    understanding.
  • How will you explain your condition to your
    spouse?
  • I want to be sure I explained everything
    clearly, so can you please explain it back to me
    so I can be sure I did.
  • Do not ask Do you understand?

29
5 Steps Enhancing Patient Interaction
  • Use patient-friendly materials to enhance
    communication
  • Show or draw simple pictures
  • Focus on key points
  • Emphasis should be on what the patient needs to
    do
  • Minimize information about anatomy and physiology
  • Be sensitive to cultural preferences
  • Written Material guidelines
  • Simple words (1-2 syllables)
  • Short sentences (4-6 words)
  • Short paragraphs (2-3 sentences)
  • No medical jargon
  • Headings and bullets
  • Lots of white space use large, serif fonts

30
Other suggestions
  • Quiet room with minimal distractions
  • Give instructions to several family members, in
    addition to the patient
  • If you are rushed, get someone else to do it
    (dont just skip or rush through)

31
Other Suggestions
  • Start with the most important information first
    and limit new information
  • No more than one or two instructions at a time
    and check on each as you go Chunk and Check
  • Avoid yes-or-no-questions
  • Read over instructions highlight important
    parts with color

32
Culturally Competent Health Care Systems
  • Interpreters or bilingual providers
  • Cultural diversity training for staff
  • Linguistically and culturally appropriate health
    education and information materials
  • Tailored healthcare setting

33
Use of interpreters
  • Deaf, blind or foreign language
  • Use professionals not family
  • Look at the patient, not the interpreter
  • Use simple language, avoid abstractions, similes,
    metaphors they do not translate well
  • Consult often, allow enough time
  • Schedule several patients for days when
    interpreters are available

34
Linguistic Competency
35
Research
  • Low health literacy leads to
  • Lower health knowledge and less healthy behaviors
  • Poorer health outcomes
  • Greater health costs
  • Increased likelihood of hospitalization
  • Specific communication techniques (such as
    teach-back method) may enhance health literacy.

36
Research
  • Less healthy behaviors of patients with low
    literacy
  • More exposure to violence
  • Pregnant women more likely to smoke
  • Less breastfeeding
  • Less likely to get flu vaccine or pneumovax

37
Research
  • Literacy is the single best predictor of health
    status.
  • Patients with low literacy were
  • 69 more likely to have late stage diagnosis of
    prostate CA at presentation (Bennet, J Clin
    Oncol, 1998).
  • 4 times more likely to be non-compliant with
    Anti-HIV meds (Kalichman S, et al. JGIM, 1999).

38
References
  • Health Literacy Train the Trainers Program,
    January 26, 2006. Sponsored by The Community and
    Family Medicine Department, St. Louis University
    School of Medicine and The Family Medicine AHEC
    Program Office with a grant from The AMA
    Foundation and the Medical Society of Virginia.
    References
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  • Baker, D.W., Parker, R.M., William, M.V., et al.
    (1996). The health care experience of patients
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  • Baker, D.W., Parker, R.M., Williams, M.V., Clark,
    W.S., Nurss, J. (1997). The relationship of
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39
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