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Health Literacy: can your patients be healthy without it

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Often top down deficit model. Rarely starts with where people are at ... Identify the complexity/opportunity for health education using model of health literacy ... – PowerPoint PPT presentation

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Title: Health Literacy: can your patients be healthy without it


1
Health Literacy can your patients be healthy
without it?
  • Christina Zarcadoolas, PhD
  • Mount Sinai School of Medicine
  • Dept. of Community and Preventive Medicine

2
What is health literacy?
  • The wide range of skills, and competencies that
    people develop over their lifetimes to seek out,
    comprehend, evaluate, and use health and
    information and concepts to make informed
    choices, reduce health risks, and increase
    quality of life.
  • (Zarcadoolas, Pleasant Greer, 2003 2006)

3
Approximately half of the adults in the US
read at 8th grade level and lower.Half have Low
Health Literacy.(1993 2003)
4
Fundamental Literacy
  • Reading
  • Writing
  • Speaking
  • Numeracy

The Language of Health Environment
5
Boldface type indicates chronic disease or
condition.Source National Center for Health
Statistics, Mortality Report. Hyattsville, MD
U.S. Department of Healthand Human Services,
2002. (From DHHS The Power of Prevention Steps
to a Healthier US Program and Policy Perspective
2003http//www.healthierus.gov/steps/summit/prevpo
rtfolio/power/index.htmlwe
6
Who are they ? (Kirshner et al. National Adult
Literacy Study. 1993.)
  • From all socio-economic groups
  • Low-income and ethnic minority
  • 45 of all functionally illiterate adults live
    below the poverty line.
  • eg., ½ adults in Central Harlem have not
    completed HS
  • Elderly
  • 66 of U.S. adults aged 60 and over have either
    inadequate or marginal literacy skills. ( note
    doesnt include hearing loss/cognitive def. )

7
One Third Of Medicare Managed Care Enrollees Had
Low Literacy

Gazmarian et al. JAMA 99.
8
Implications Public health
  • A study of Medicaid participants found that those
    reading at the lowest grade levels had average
    annual health care costs of roughly 13,000
    compared with the average for the population
    studied of 3,000 (Weiss, 1999).
  • The National Academy on an Aging Society (1998)
    estimated that excess health care costs generated
    by patients with inadequate health literacy
    (primarily from extra and longer
    hospitalizations) is 73 billion dollars per year.

9
Changing health literacy environment
  • Complex health system
  • Complex and changing science
  • increased need for self-management
  • conflicting media reports about health hazards
  • misconceptions about communicable diseases such
    as smallpox, anthrax, and SARS
  • direct-to-consumer advertising about new drugs
    and
  • vast amounts of health information available on
    the Internet.

10
Implications of Low Health Literacy
  • Report poorer overall health
  • Less likely to make use of screening and
    preventive services
  • Present in later stages of disease
  • Are more likely to be hospitalized
  • Have poorer understanding of treatment and their
    own health
  • Have lower adherence to medical regimens

11
The Cost
  • 1.5 million people in the United States are
    harmed by preventable drug errors each year
  • Treatment of drug-related injuries adds at least
    3.5 billion annually, not counting indirect
    costs such as lost income and ancillary health
    and home care services. (IOM 2006)
  • Low Health Literacy 70 billion yrly. (The
    National Academy on an Aging Society 1998)

12
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13
Not Generally Readable/Useable by many US adults
14
Prescription Errors
  • 5 common prescriptions - 2/3 mostly low-income
    patients of mixed literacy could read the
    wording, but only 1/3 knew what to do next
  • patients with the highest literacy levels erred
    from 5 to 27 of the time
  • 70.7 of patients with low literacy correctly
    stated the instructions Take two tablets by
    mouth twice daily,' only 34.7 could demonstrate
    the number of pills to take
  • (Davis, et.al., Dec. 19,2006 Annals of
    Internal Medicine)

15
The problem with much health outreach /
education/ communications
  • Often top down deficit model
  • Rarely starts with where people are at
  • Seldom mindful of fundamental literacy
  • Not mindful of health environmental literacy
    principles

16
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17
A central solution fix the language and
cultural mismatch between patients and providers/
patients publics
  • Easy to read
  • Easy to navigate
  • Linguistically appropriate
  • Culturally appropriate
  • Relevant

18
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19
Simplifying
20
Clear language is necessary.
  • But it is NOT sufficient.
  • It will not solve the low health literacy
    problems in the US

21
Simplifying does not necessarily lead to
improved health literacy
  • A notice from a health insurer
  • Due to the fact that this drug is not on our
    formulary we are denying your claim for
    reimbursement.
  • Simplified
  • We deny (will not pay) your claim. We are
    denying your claim because this drug is not on
    our list of approved medications.

22
Health literacy demands of previous message
  • The insurance company has the authority to pay or
    not pay bills they do not automatically pay for
    any service or medication, even if the doctor
    recommends it.
  • Insurers use a finite (and often changing) list
    of allowable medications that they will and will
    not pay for.
  • Not all medicines are the same.
  • To greater or lesser degree, consumers must
    understand that they can
  • request an appeal,
  • speak to their doctor about an alternative
    medication and treatment options,
  • think about changing health plans, or even
  • become an advocate for health care reform.

23
What does this important health message demand of
the consumer/reader?
24
Being health literate means much more than
understanding the words and sentences of health
and environmental information.
  • Fundamental literacy
  • Science Literacy
  • Civic Literacy
  • Cultural Literacy

25
NSF, Public Understanding of Science
  • Between 5 and 15 of the public qualify as
    scientifically literate. 
  • 18 can be considered an attentive science
    public.

26
Science Literacy
  • Between 5 and 15 of the public qualify as
    scientifically literate. 
  • 18 can be considered an attentive science
    public.
  • fundamental scientific concepts, scientific
    process
  • Technology technical complexity,
  • scientific uncertainty and that rapid change in
    the accepted science is possible.

27
Science Literacy
  • fundamental scientific concepts, scientific
    process
  • Technology technical complexity,
  • scientific uncertainty and that rapid change in
    the accepted science is possible.

28
Science Literacy
  • Between 5 and 15 of the public qualify as
    scientifically literate. 
  • 18 can be considered an attentive science
    public.
  • fundamental scientific concepts, scientific
    process
  • Technology technical complexity,
  • scientific uncertainty and that rapid change in
    the accepted science is possible.

29
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30
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31
Civic Literacy
32
Civic Literacy
  • judging the source of information
  • media literacy skills
  • knowledge of civic and governmental systems and
    processes
  • knowledge of power, inequity
  • knowledge that personal behaviors and choices
    affect others in a larger community and society

33
photo caption reads Two residents wade through
chest-deep water after finding bread and soda
from a local grocery store after Hurricane
Katrina came through the area in New Orleans,
Louisiana.(AFP)
34
photo caption reads A young man walks through
chest deep flood water after looting a grocery
store in New Orleans on Tuesday, Aug. 30, 2005.
Flood waters continue to rise in New Orleans
after Hurricane Katrina did extensive damage when
it made landfall on Monday. (AP )
35
Cultural Literacy
  • Ability to recognize, understand and use the
    collective beliefs, customs, world-view, and
    social identity
  • Bilateral - experts should understand aspects of
    the culture of the recipient and visa versa.

36
Percent Distribution of Foreign Bornby World
Region of Birth 2000
Other Regions 8.1
Europe 15.3
Latin America 51.0
Asia 25.5
Source Current Population Survey, March 2000,
PGP-3
37
  • The Sioux San Hospital of Rapid City, South
    Dakota, is an Indian Health Service (IHS)
    hospital. (Kibbe Conti,working with Lakota Indians

38
Current focus of my work
  • Health literacy of chronic disease
  • Medication taking ( adherence)
  • Health literacy and emergency preparedness
  • Health literacy and technology
  • Internet
  • Electronic medical records

39
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40
Creating information that is matched to the
health literacy needs of your population
  • Identify the complexity/opportunity for health
    education using model of health literacy
  • Collaborate with target audiences on designing
    needed information/approaches
  • Qualitatively field test material/communication
  • Revise, contextualize, reinforce messages using
    combination of communication models diffusion,
    social marketing, decision making, etc.
  • Evaluate and be ready to revise on an ongoing
    basis

41
Health Literacy Load Analysis
  • Is the message/material to inform and/or educate?
  • Is it intended to produce action or change of
    behavior?
  • Will it be used with mediation?
  • What medium/technology will be used?
  • How culturally appropriate is this message?
  • Who is it tailored to?
  • What does it require the target audience to
    understand about health / health concepts?
  • Is the message reinforced?
  • Are the action steps clear?

42
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43
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44
1.Know your audience
  • the audience you have (or might)
  • the audience you want
  • collaborate with them to develop messages
    and materials

45
2. Know your material
  • the text you have
  • the text you need

46
3. Conduct a Health Literacy Load Analysis
  • What does the material/message assume/require of
    the patient
  • Fundamental literacy
  • Science literacy
  • Civic literacy
  • Cultural literacy

47
What are the demands on a patients health
literacy ( Health Literacy Load)?
  • Where to read whats most important
  • 3X daily (all 3 at once)
  • Can this be stopped before all 30 are taken?
  • Perception of medication and medication taking
  • When to contact physician and why?
  • What to say

48
Health Literacy Load redux?
  • HOW does the patient understand as directed.
  • Dose/response
  • Does the patient trust believe this scientific
    perspective?

49
No.
  • Patients cant be healthy without it.

50
  • Forgive me for not writing a shorter letter for I
    did not have the time.
  • (Poe)

51
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52
christina.zarcadoolas_at_mssm.edu
  • 212-824-7061
  • Mount Sinai School of Medicine
  • Dept. of Community and Preventive Medicine
  • Health and Environmental Literacy Initiative
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