In It Together: National Health Literacy Project for Black MSM Training of Trainers Module 7: Approaches to Promote Health Literacy

Welcome Trainer: Michelle Vatalaro Phone: This material was produced by John Snow Inc., under Contract #HHSH I with the Health Resources and Services Administration, U.S. Department of Health and Human Services.

Recap of Module 6 and take-away activity Based on conversations you had with your clients about how they use social media, discuss how your organization might structure outreach on one social media platform to reach your clients. 3

Training goal Participants will be able to explain and demonstrate health literacy approaches that can be employed by health professionals to foster client understanding and action. 4

Goals of this training module By the end of today’s training, you will be able to:  Explain the Universal Precautions approach to Health Literacy and identify ways that your organization can use it to improve service delivery  Demonstrate how to verify client understanding using the Teach- back approach  Recall the 3 questions that form the Ask Me 3™ approach 5

IMPORTANCE OF IMPLEMENTING HEALTH LITERACY APPROACHES 6

7 What is the value of health literacy approaches? Actively implemented health literacy approaches may result in: Improved patient perception of the clinical visit Increased patient activation

Value of health literacy skills People who need health information and services, need health literacy skills to: 8

Value of client health literacy skills People who need health information and services need health literacy skills to:  Find information and services  Communicate needs and preferences  Process the meaning and usefulness of information and services  Understand choices, consequences, and context  Process meaning and utility  Decide which information and services match their needs and preferences so they can act 9

10 Value of health professional health literacy skills Help people find information and services Communicate about health and healthcare Process what people are explicitly and implicitly asking for Understand how to provide useful information and services Decide which information and services work best for different situations and people so they can act

APPROACHES FOR HEALTH LITERACY: THE UNIVERSAL PRECAUTIONS APPROACH 11

The Universal Precautions Approach Primer Universal precautions practices assume that all client and caregivers may have difficulty comprehending health information. Health professionals practicing universal precautions communicate in ways that anyone can understand. 12

The Universal Precautions Approach Primer Health Literacy Universal Precautions aim to:  Simplify communication  Confirm comprehension  Minimize the risk of miscommunication  Make the medical office and health care system easier to navigate  Support clients’ efforts to improve their health 13

Using the Universal Precautions Approach, prepare ideas for how you would make a new clinic’s office environment and systems easier to navigate. Consider:  Design and placement of signs  Design, use, and collection of forms  Availability and types of material  Client links to non-medical support and medicine resources  Staff training and evaluation 14 The Universal Precautions Activity

15 APPROACHES FOR HEALTH LITERACY: THE TEACH-BACK METHOD

Value of the Teach-Back Method  Improve patient understanding and adherence  Decrease call backs and cancelled appointments  Improve patient satisfaction and outcomes 16

Value of the Teach-Back Method  Easily recalled 3-step process:  Explain  Check  Re-explain if needed  Helps health professionals explore how well the information was taught and what needs to be clarified or reviewed  Is successful regardless of patients’ health literacy abilities  Shown to improve outcomes for patients with all literacy levels 17

Tips for Using Teach-Back Method  Rene’s rule: No can do!  Start the conversation with:  I want to make sure that I did a good job explaining everything to you…  We covered a lot and I am concerned that I may have gone through the information too quickly… 18

Tips for Using Teach-Back Method Encourage the client to teach you with  In your own words, tell me…  Explain to me…  How will you explain…  What will you do if…  When will you… 19

Practice Using Teach-Back Method 20

Additional Opportunities to Use the Teach-Back Method  To discuss complex or evolving health information that needs to be communicated over multiple visits  To explain treatment regiments or disease warning signs 21

The Show-Me Approach  Can be used to confirm understanding of a skill or action by ‘showing’ the skill or action  Supports kinesthetic learners 22

Tips for successfully using the Teach-back or Show-me approaches  Use open-ended questions  Self-correct if you begin to use jargon  Document use of and client’s response to teach- back and show-me approaches  Include family members or caregivers 23

APPROACHES FOR HEALTH LITERACY: THE ASK ME 3 ™ APPROACH 24

The 3 questions in the Ask Me 3™ approach 1.What is my main problem? 2.What do I need to do? 3.Why is it important for me to do this? 25

How to use Ask Me 3™ in your client encounters  Use the 3 questions to frame conversations  What is my main problem?  What do I need to do?  Why is it important that I do this?  Incorporate the questions into your teach-back approach 26

1.What is my main problem? 2.What do I need to do? 3.Why is it important for me to do this? 27 Practice Using Ask Me 3™

Vignettes "Ray is a 33 year-old restaurant manager in Alabama who was recently diagnosed as HIV positive. Homophobia is very common in his community and though his close friends and boyfriend know his HIV status, the vast majority of his family and friends do not. Ray is extremely nervous to start his ART treatment program because he’s afraid that people will find out that he’s homosexual and HIV-positive." "Curtis was diagnosed with HIV 2 years ago. With the help of his ART treatment, has achieved viral suppression. Curtis read an internet blog post about how viral suppression of HIV means that one is cured of the disease. Many of the friends he knows socially tell him the same thing. Curtis is still single, and now that he is ‘cured,’ wants to start having sex without condoms again.” “Ricky is a 20 year old college student who is still dating his boyfriend from high school even though he goes to a different school. Because they were so young when they started dating, Ricky has never slept with anyone outside of the relationship and believes his boyfriend has done the same. As part of a routine physical from his doctor, Ricky is shocked to find out that he is HIV positive when he sees his doctor for a routine physical.” “Oliver is 63 years old. Oliver and his husband have been happy together for the past 30 years. In his free time, Oliver likes to play basketball and watch “Scandal”. As he starts to prepare for retirement, Oliver came down with flu-like symptoms and went to see his doctor in order to get checked out. After agreeing to a full patient exam, Oliver is diagnosed as HIV positive.” 28

Recap Today we learned:  How to use the Universal Precautions approach to health literacy to improve service delivery at our organization  How to verify understanding using the Teach-back approach  How to incorporate the questions that form the Ask Me 3™ approach into our client communication 29

Take home Over the next week, reflect on what we have learned over the last 7 sessions, and practice using the health literacy approaches. 30

Module 8 will cover:  The 1-hour training that you will deliver to your community.  The tools and support that will be available to you as you conduct outreach and training 31 Next steps

Thank You Trainer: Michelle Vatalaro Phone: This material was produced by John Snow Inc., under Contract #HHSH I with the Health Resources and Services Administration, U.S. Department of Health and Human Services.