HEALTH LITERACY

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HEALTH LITERACY

• What is health literacy?
• Scope of the problem
• Why is health literacy important?
• What can we do to help?
• Resources

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What is health literacy?
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Definitions of Health Literacy

• US Department of Health and Human Services,
  Healthy People 2010
• 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.
• American Medical Association
• A constellation of skills, including the
  ability to perform basic reading and numerical
  tasks required to function in the health care
  environment.

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Definitions of Health Literacy

• Office of the Mayor (New York City)
• Health literacy is the ability to read,
  understand and act upon health related
  information. Health literacy also refers to the
  capacity of professionals and institutions to
  communicate effectively so that community members
  can make informed decision and take appropriate
  actions to protect and promote health.
• Health Literacy Network
• The ability to find, understand and use the
  health information we need to take care of
  ourselves and to improve our health and
  wellbeing.
• Rima Rudd, MSPH, ScD Harvard School of Public
  Health
• The ability to use language to solve
  health-related problems at a proficiency level
  that enables one to function, achieve one's
  health goals and develop health knowledge and
  potential.

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Health literacy depends on both individual and
systemic factors

• 1. Communication skills of lay people and
  professionals
• 2. Patients' knowledge of health topics
• causes of disease, risk factors, when to seek
  care
• 3. Culture
• how people think about health, disease and
  treatment
• 4. Demands of the healthcare and public health
  systems
• how to access care and services, payment,
  insurance
• 5. Demands of the context and particular
  situation
• stress, physical or mental impairment,
  unfamiliarity

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• Health literacy is NOT the same as
• Plain Language. Plain language is a technique for
  communicating clearly. It is one tool for
  improving health literacy.
• Cultural Competency. Cultural competency is the
  ability of professionals to work
  cross-culturally. It can contribute to health
  literacy by improving communication and building
  trust.

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How is health literacy measured?

• Health literacy is a new component of the 2003
  National Assessment of Adult Literacy (NAAL).
• Nationally representative sample of more than
  19,000 adults aged 16 and older in the United
  States
• Assessment of English literacy using prose,
  document and quantitative scales
• Tasks used to measure health literacy were
  organized around three domains
• Clinical Filling out a patient form
• Prevention Following guidelines for
  age-appropriate preventive health services
• Navigation of the healthcare system
  Understanding what a health insurance plan will
  pay for

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Health Literacy Levels

• Proficient Can perform complex and challenging
  literacy activities.
• Intermediate Can perform moderately challenging
  literacy activities.
• Basic Can perform simple everyday literacy
  activities.
• Below Basic Can perform no more than the most
  simple and concrete literacy activities.
• Nonliterate in English Unable to complete a
  minimum number of screening tasks or could not be
  tested because did not speak English or Spanish.

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Circle the date of a medical appointment on a
hospital appointment slip. (101) Give two
reasons a person should be tested for a specific
disease, based on information in a clearly
written pamphlet. (202) Determine what time a
person can take a prescription medication, based
on information on the drug label that relates the
timing of medication to eating. (253) Calculate
an employees share of health insurance costs for
a year, using a table. (382)
0
Below Basic Basic Intermediate Proficien
t
500
Source National Center for Education Statistics,
Institute for Education Sciences
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Basic information about a colonoscopy, as
perceived by a patient with limited literacy
skills
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Scope of the problem
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Percentage of Adults in Each Health Literacy
Level 2003
Source National Center for Education Statistics,
Institute for Education Sciences
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Low health literacy is more prevalent among

• Older adults
• People with low income
• People with limited education
• Minority populations
• People with limited English proficiency (LEP)

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IOM Report (2004)Health Literacy A
Prescription to End Confusion
Nearly half of all American adults--90 million
people--have difficulty understanding and using
health information, and there is a higher rate of
hospitalization and use of emergency services
among patients with limited health literacy.

• Recommendations
• develop and support programs to reduce the
  negative effects of limited health literacy
• incorporate health knowledge and skills into the
  existing curricula of kindergarten through 12th
  grade and adult education and community programs.
• develop culturally and linguistically sensitve
  programs to promote health literacy and health
  education

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• According to the AMA
• 21 of adult Americans are functionally
  illiterate, meaning they read at 5th grade level
  or lower
• An additional 25 of adult Americans are
  marginally literate
• This translates to
• 90 million patients with low health literacy
• and
• 73 billion dollars annually in extra healthcare
  costs
• due to unnecessary doctor visits,
  hospitalizations and longer hospital stays

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Why is health literacy important?
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Patients with limited health literacy may have
difficulty

• Locating providers and services
• Filling out health forms
• Sharing medical history with provider
• Seeking preventive health care
• Managing chronic health conditions
• Understanding directions on medication
• Understanding and acting on health-related news
  and information

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Low health literacy affects

• Health outcomes
• medication errors
• increased doctor visits and hospitalizations
• Healthcare costs
• Quality of care

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What can we do to help?
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Office of the Surgeon General

• Health literacy improvement is one of the Surgeon
  Generals seven public health priorities.
• Health literacy is the currency of success for
  everything I am doing as the Surgeon General.
• Dr. Richard Carmona in his speech to the AMA
  House of Delegates, June 2003.

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Healthy People 2010 Health Literacy Objectives
11-2. Improve the health literacy of persons with
inadequate or marginal literacy skills. 11-6.
Increase the proportion of persons who report
that their healthcare providers have
satisfactory communication skills.
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In the patient visit

• Use plain language and listen carefully
• Use simple language and define technical terms
  avoid medical jargon
• Use the active voice
• Break down complex information into
  understandable pieces
• Organize information so the most important points
  come first
• Use a medically trained interpreter if necessary
• Check for understanding using the teach-back
  method
• Ask open-ended questions
• Use hand signals or visual cues

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Improve the Usability of Health Forms and
Instructions

• Revise forms to ensure clarity and simplicity.
• Test forms with intended users and revise as
  needed.
• Provide forms in multiple languages.
• Offer assistance with completing forms and
  scheduling followup care.

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The Health Education and Adult Literacy
Program(HEAL)
Community Pediatrics at Columbia University and
New York Presbyterian Hospital in partnership
with Community Health Workers at Alianza
Dominicana
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The HEAL program will improve the health outcomes
for parents and children in the outpatient
pediatric clinics.

• Emphasis will be made upon the patients needs in
  order to help them
• Enhance their understanding in regards to
  medication use
• Increase their involvement in planning care
• Improve their adherence to medical instructions

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HEAL Program Goals and Objectives

• The HEAL program aims to decrease medication
  errors with treatments prescribed by
  pediatricians by improving health literacy in the
  population served.
• We will develop, implement, and evaluate a
  culturally and linguistically appropriate
  curriculum targeted to community health workers,
  pediatric providers, and volunteers.
• Objective 1 To develop culturally responsive
  health education material regarding medication
  adherence using the basic tenets of health
  literacy.
• Objective 2 To train pediatric providers and
  CHWs to appropriately address low health literacy
  at different health care settings.
• Objective 3 Implement the HEAL curriculum in
  four pediatric outpatient clinics in the
  Washington Heights/Inwood neighborhoods of
  Northern Manhattan served by NYPH and at the
  various programs served by the CHWI at Alianza
  Dominicana.

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Health Professionals Role in HEAL

• Identify patients with limited literacy levels
• Use simple language, short sentences and define
  technical terms
• Empathize with cultural background, ethnic and
  racial diversity of patients
• Provide information in patients primary language
• Offer assistance with the completion of forms
• Ask open/ended questions
• Use the teach back method to determine
  patients comprehension

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Resources

• AHRQ ReportLiteracy and Health Outcomes (2004)
  www.ahrq.gov/clinic/epcsums/litsum.htm
• Healthy People 2010 (2000) www.healthypeople.gov
• Healthy People 2010 Health Literacy Action
  PlanCommunicating Health Priorities and
  Strategies for Progress (2003)
  http//odphp.osophs.dhhs.gov/projects/healthcomm/
  objective2.htm
• IOM ReportHealth Literacy A Prescription To End
  Confusion (2004) www.iom.edu/report.asp?id19723
• NIH Improving Health Literacy Web page
  www.nih.gov/icd/od/ocpl/resources/improvinghealth
  literacy.htm