Health Literacy: A Public Health Priority

1
Health Literacy A Public Health Priority

• Cynthia Baur, Ph.D.
• Office of Disease Prevention and Health
  Promotion, Office of Public Health and Science,
  U.S. Department of Health and Human Services

2
HHS Prevention Framework

• Healthy People 2010 Comprehensive set of disease
  prevention and health promotion objectives for
  the Nation
• HealthierUS/Steps to a HealthierUS Prevention
  initiative focused on promoting good health and
  preventing chronic disease

3
Healthy People 2010 Health Communication
Objectives

• 11-1 Internet access in the home
• 11-2 Health literacy
• 11-3 Research evaluation of health
  communication programs
• 11-4 Quality of Internet health Web sites
• 11-5 Centers of Excellence in health
  communication
• 11-6 Provider-patient communication

4
Health Literacy Objective

• Improve the health literacy of persons with
  inadequate or marginal literacy skills
• Healthy People 2010 Objective 11-2

5
HHS commitment to health literacy and prevention

• Secretarys Workgroup on Health Literacy as part
  of the Prevention Initiative
• PreventionA Blueprint for Action
  www.healthierus.gov/steps/documents.html
• Surgeon General Carmona
• Health literacy is the currency of success for
  everything I am doing as the Surgeon General
• Speech to AMA House of Delegates, June 2003
• HHS Health Literacy Workgroup
• Liaisons and workgroups in most agencies

6
What is health 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 Institute of Medicine
  National Library of Medicine

7
Scope of health literacy

• Functional skills
• Knowledge of particular health topics
  (information services)
• Knowledge must be related to decision making
• CORE ISSUE UNDERSTANDING

8
Health literacy research documents

• Health literacy A prescription to end confusion
• IOM Report 2004
• Literacy and health outcomes
• AHRQ Evidence Report 2004
• Understanding health literacy and its barriers
• NLM Current Bibliography 2004

9
Other HHS resources

• Health Literacy and Provider/Patient
  Communication Action Plans
• Develop national focus and agenda
• Assess and alter professional practices
• Invest in training and research
• Enhance access and utility of health information
• Identify metrics for improved communication
• Partner with organizations working to improve
  literacy across the lifespan

10
HHS activities

• Department-wide and agency workgroups
• NIH/AHRQ Health Literacy Program Announcement
• Program assessments
• Benchmarks
• Plain language assessments
• Provider training
• Measurement of HP2010 Objective

11
Health literacy assessment

• 1992 National Adult Literacy Survey (NALS) no
  focus on health tasks
• 2003 National Assessment of Adult Literacy
  Health Literacy Component
• U.S. Department of Education http//nces.ed.gov/n
  aal/

12
2003 National Assessment of Adult Literacy

• Nationally representative assessment of the
  English language literacy skills of Americans age
  16 and older
• Household survey of approximately 20,000
• Data on background characteristics, performance
  of everyday literacy tasks and skills underlying
  performance

13
General skills assessed by health literacy tasks

• Word-level reading skills Decoding and
  recognizing words
• Language comprehension skills Understanding the
  structure and meaning of sentences
• Text search skills Searching text efficiently
• Inferential skills Drawing appropriate
  text-based inferences
• Computation identification skills Identifying
  the calculations required to solve quantitative
  problems
• Computation performance skills Performing any
  required calculations
• Application skills Using newly searched,
  inferred, or computed information to accomplish a
  variety of goals
• Slides on HLC from S. White, August 2004

14
NAAL Health Literacy Component

• Objective data based on respondents performance
  on health-related tasks from everyday life
• Measures ability to understand and use
  health-related print information
• Aspects NOT covered
• Oral communication
• Knowledge
• Jargon and technical terms

15
Bringing to bear general literacy skills on
health tasks

• The health literacy score measures the ability to
  apply general literacy skills to perform a
  variety of health-related tasks
• For example, one must
• Search text effectively and efficiently (a
  general literacy skill) to complete a patient
  information form (a health-related task)
• Draw appropriate inferences (a general literacy
  skill) to follow health screening recommendations
  (a health-related task)
• Perform appropriate computations (a literacy
  skill) to avoid under- or over-dosing (a
  health-related task)

16
Uses of health literacy data

• HLC data can assist in
• Identifying the health literacy skills of target
  audiences
• Guiding the development of health information
  tailored to the literacy strengths and weaknesses
  of target audiences so that the written material
  is less likely to exceed the literacy skills of
  target audiences
• Providing input for development of programs to
  improve health literacy skills

17
Goal increased health literacy in the service of
better decisions and health

• Credible, understandable and applicable
  information for all
• Systems that help and support rather than hinder,
  frustrate or embarrass
• Providers who are informed about what they need
  to communicate to all patients and clients
• Providers who communicate clearly and
  appropriately with all patients and clients