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Health Literacy: A Crisis In Health Care Minnesota Rural Health Conference July 19, 2005 Duluth, MN


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Title: Health Literacy: A Crisis In Health Care Minnesota Rural Health Conference July 19, 2005 Duluth, MN

Health LiteracyA Crisis In Health
CareMinnesota Rural Health ConferenceJuly 19,
2005Duluth, MN
Developed by Stratis Health with the Permission
of the American Medical Association Foundation
and the American Medical Association
  • 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
  • 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

Implications of low health literacy on patient
  • 33 Unable to read basic health care materials
  • 42 Unable to comprehend directions for taking
    medication on an empty stomach
  • 26 Unable to understand information on
    appointment slip
  • 43 Unable to understand rights and
    responsibilities section of Medicaid
  • 60 Unable to understand standard informed
  • Williams et al., JAMA 12/6/95

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
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

Results National Adult Literacy Survey (NALS)
(Kirsh I, Jungeblut A, 1993)
NALS Results
  • 48, or 90 million, US adults have inadequate or
    marginal literacy skills
  • Does not account for patients who have adequate
    language skills, but do not have adequate health
  • Only 25 of those in Level 1 were new immigrants.
  • Those at levels 1 and 2 did not necessarily
    perceive themselves as being at risk
  • (Kirsh I, Jungeblut A, 1993)

Why are patients at risk?
  • Reliance on written word for patient instruction
  • Increasingly complex health care system
  • More medications
  • More tests and procedures
  • Growing self-care requirements
  • Esoteric language
  • Aging population
  • More culturally diverse patient population

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

  • 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.

Understanding the problem
  • Hear a few examples from As
    Patients See It
  • A video created in 2003 by AMA
  • Real patients and real physicians talking about
    literacy issues

Mr. Day
  • Diagnosed with hypertension
  • Reads at second-grade level

Mr. Bell
  • Reads at fifth-grade level
  • Gets agitated filling out paperwork

Mrs. Cordell-Seiple
  • Film maker
  • Graduated from high school reading at a
    fifth-grade level
  • Didnt know she had undergone a hysterectomy

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

Three strategies
  • I. Create a shame-free environment
  • II. Improve interpersonal communication
  • III. Use patient-friendly educational
    materials and forms

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

Strategy Improve interpersonal communication
  • Slow down
  • Use plain living room language
  • Focus on key messages (
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do this?
  • Use teach back techniques

Strategy IIImprove interpersonal communication
  • Mrs. Greigar (reads at third-grade level)
  • Dr. Alvarez
  • Slow down
  • Use analogies
  • Use plain living room language

Strategy II (continued)
  • Brown bag review
  • Mrs. Tilsley reads at seventh-grade level
  • Dr. Williams

Strategy IIIDevelop patient-friendly
  • Keep content concise and focused
  • Focus only on key points
  • Emphasize what the patient should do
  • Keep anatomy and physiology basic
  • Show or draw simple pictures to enhance

Strategy III
  • Tips for easy-to-read materials
  • Simple words (1-2 syllables)
  • Short sentences (4-6 words)
  • Short paragraphs (2-3 sentences)
  • Limit medical jargon
  • Use headings, bullets, and lots of white space

What can you do by next week?
  1. Explain things clearly in plain non-medical
  2. Focus on the key messages using Ask Me 3.
  3. Use a teach back or show me technique to
    check for understanding.
  4. Use patient-friendly educational materials to
    enhance interaction.
  5. Create a shame-free environment.

What can you do in the future?
  • Form a team to determine a long-term strategy
  • Develop a plan to educate all staff about low
    health literacy
  • Discuss methods for improving communication
    skills with providers and staff
  • Do role play and/or identify key terms/messages
    commonly encountered in your practice
  • Incorporate Ask Me 3 components into patient

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

For more information

  • Karla Weng, MPH, CPHQ
  • Project Manager
  • (952) 853-8570

  • Brought to you by Stratis Health
  • Minnesotas Medicare Quality Improvement
  • 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
  • The contents do not necessarily reflect CMS