Cynthia Baur, Ph.D.

1
The National Action Plan to Improve Health
Literacy

• Cynthia Baur, Ph.D.

• Senior Advisor, Health Literacy
• August 23, 2011

• Office of the Director

• Office of the Associate Director for Communication

2
Key Messages
Government agencies, foundations, and research
universities should prioritize funding for
qualitative and quantitative studies related to
health literacy improvement. Goal 6, National
Action Plan Funders play a critical role in the
dissemination and use of research
findings. Goal 7, National Action Plan
3
What is the Gap?
4

• Health Literacy Hearing the voices of people on
  the receiving end of our communication

5
What is a 2 times greater risk for pneumonia if I
dont get a flu shot? Greater than what?
6
What do these survival rates mean for me? 80
8 of 10 women? 80 of 100? .8? Is one better
than the other?
7
What is Health Literacy?

• Obtain
• Process
• Understand
• Decide

Health Information and Services

• Sources National Library of Medicine, Healthy
  People

8
How is Health Literacy Different from General
Literacy?

• Builds on literacy skills BUT ALSO
• Cultural and contextual factors
• Beliefs, experience and preferences
• Topic area and conceptual knowledge, such as
• knowledge of the body and how it works
• terms for specific health conditions
• scientific results and risk

9
Institute of Medicine Report on Health Literacy

• Limited health literacy is a major public health
  issue
• Interaction of individual skills and social
  complexity creates health literacy problems
• Professionals need health literacy training

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Health Literacy Dynamic
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Literacy in AmericaNational Assessment of Adult
Literacy (NAAL)

• National sample survey conducted in 1992 and 2003
• Performed by U.S. Department of
  Education,National Center for Health Statistics
• In-person interviews with Americans age 16 and
  older (N19,000)
• Tested in English or alternate short test in
  Spanish
• Over sampling of Blacks and Hispanics

• http//nces.ed.gov/naal/

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NAAL Domains

• Emphasized the use of printed everyday materials
  (newspapers, prescriptions, bills) needed to
  function
• 153 items that assessed prose, document, or
  quantitative literacy
• Most items required searching text for specific
  information, short written responses

• http//nces.ed.gov/naal/

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Categories and Sample Health Tasks

• Proficient Calculate employees share of health
  insurance costs for a year
• Intermediate Determine healthy weight range
  medication timing
• Basic Explain why it is difficult to know if
  they have a specific chronic condition
• Below Basic Identify what is permissible to
  drink before a medical test

• http//nces.ed.gov/naal/

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Results from the NAAL
12
Proficient
13
Below Basic
53
Intermediate
Basic
22
77 Million Adults have Basic or Below Basic
Health Literacy

• Kutner et al. National Assessment of Adult
  Literacy, 2006

15
Health Literacy by Age
59

• Kutner et al. National Assessment of Adult
  Literacy, 2006

16
Health Literacy by Race/Ethnicity

• Kutner et al. National Assessment of Adult
  Literacy, 2006

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Health Literacy by Education

• Kutner et al. National Assessment of Adult
  Literacy, 2006

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Outcomes Associated with Limited Health Literacy

• Health outcomes
• Taking medications appropriately
• Interpreting labels and health messages
• Seniors health status and quality of life
• Mortality
• Health services
• Hospitalization
• Emergency care visit
• Flu immunization
• Knowledge and comprehension

• Berkman et al 2011 Health Literacy Interventions
  and Outcomes An Updated Systematic Review

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Why A National Action Plan?
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What is the Plan?
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Seven Goal Areas

• Health information creation and dissemination
• Healthcare services
• Early childhood-university education
• Community-based services
• Partnership and collaboration
• Research and evaluation
• Dissemination of evidence-based practice

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HHS Health Literacy Research

• NIH/AHRQ Understanding and Promoting Health
  Literacy Program Announcement (PAR-10-133)
• R01, R03 and R21
• NIH 85 grants totaling 67 million (2004-2011)
• http//obssr.od.nih.gov/scientific_areas/social_cu
  lture_factors_in_health/health_literacy/index.aspx
  
• Additional research under other Funding
  Opportunity Announcements and contracts
• NIH/AHRQ support of annual research conference
• http//www.bumc.bu.edu/healthliteracyconference/
  

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Ideas for research and intervention topics

• NIH/AHRQ Program Announcement
• National Action Plan Goals
• Research presented at annual conference
• AHRQ systematic review
• http//www.ahrq.gov/clinic/tp/lituptp.htm
• Evaluation of tools
• Organizational audits
• Universal precautions in clear communication
• Clear communication training
• Standards

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Call to Action

• The National Action Plan to Improve Health
  Literacy challenges individuals, organizations
  and communities to fulfill their responsibility
  to make
• health information and services
• ACCURATE, ACCESSIBLE AND ACTIONABLE

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A Challenge

• Is your foundation using its resources to
• improve health literacy OR
• perpetuate and create health literacy barriers?

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• What questions do you have?
• www.cdc.gov/healthliteracy
• http//blogs.cdc.gov/healthliteracy/

• Office of the Director

• Office of the Associate Director for Communication