Effectiveness of a Web-Based Health Literacy Curriculum at a Community Residency Program Margaret Z. Cassey MPH, Scott S. Yen MD, & Z. Harry Piotrowski, MS West Suburban Medical Center, Resurrection Health Care, Oak Park, IL Support was Provided by HRSA Residency Training Primary Care Grant, D58HP (Program CFDA 93:884). 7/03-6/06.

April 20062MZC, SY, ZHP Problem Statement: Health literacy increasingly recognized as critical factor affecting physician- patient communication Healthy People 2010 “ASK ME 3” AMA/Pfizer initiative How to incorporate health literacy into residency curriculum

April 20063MZC, SY, ZHP Solution: Web Curriculum Anytime/anywhere answer Similar efficacy to traditional instruction Ideally suited to community residency program Uniform curriculum Easy tracking of resident completion Accessible to learners who are increasingly computer literate Direct transfer of responses into a database

April 20064MZC, SY, ZHP Objective Implement a web-based health literacy curriculum Assess resident use and feasibility of web-based instruction Evaluate resident learning with pre and post modules in one approximately 45 minute exercise

April 20065MZC, SY, ZHP Methods Annually with all IM + FM residents N=48 Noon conference introduction/“ask me 3” Internet learning and self-assessment exercise Web-based internet exercise N=48 Pre-post assessment of readability Pre-post assessment of skills and application

April 20066MZC, SY, ZHP Website: HLActivity1 See file in FMDRL: 1.Reading level assessment activity (submit form) 2.Health literacy education & examples 3.MS word tool used for assessing readability 4.Repeat readability assessment used with tool for translating clinical guideline and patient education handout (submit form)

April 20067MZC, SY, ZHP Definitions: Flesch Reading Ease (FRE) target was set at > or = 70 for this exercise. Difficulty ranges from 1 – 100 with 100 being easiest to read Flesch-Kincaid Grade Level (FKGL) target was set < or = 7.9 for this exercise This is less than or equal to the 7 th grade reading level in the United States (~ age 12 years old.) The expected schooling range is from 1 – 12 in the United States

April 20068MZC, SY, ZHP Results: FRE & FKGL FRE = Flesch Reading Ease FKGL = Flesch-Kincaid Grade Level

April 20069MZC, SY, ZHP Web HLActivity2 See file in FMDRL: Submission of Two Forms 1.“Guideline recommendations” translation activity 2.“General patient education handout” translation activity

April MZC, SY, ZHP FRE Results: Translations

April MZC, SY, ZHP FKGL Results: Translations

April MZC, SY, ZHP Qualitative Results: Sample Resident Feedback At The End of the Exercise Web-based health literacy curriculum effective Writing exercise moved out of theoretical to practical realm as residents learned to experiment with language techniques to clarify and simplify communication Quotes from the residents “Surprisingly, it’s mentioned that 90 million of the American population have a sort of difficulty understanding what we might tell them in the clinic. The tools mentioned to ease this issue to our patients are very helpful” “…gives wonderful ideas on how to simplify education materials and made me aware of a readability tool in Word”

April MZC, SY, ZHP Readability Qualitative Results

April MZC, SY, ZHP Commentary “Most Helpful part of activity” “Realizing the depth and scope of this issue” “Realizing that what we say or handout may actually be way above our patient's reading/listening comprehension”

April MZC, SY, ZHP Techniques Used With Process FrontPage Extensions Forms Creates file on server, s content to investigator, provides print out for resident Server file is comma delimited text file with quotation mark field separators Imports into Excel or Statistics programs with variable labels Automatic data capture and allows for elimination of duplicate entries or input errors

April MZC, SY, ZHP Contact Information Margaret Z. Cassey, MPH Scott Yen, MD Z. Harry Piotrowski, MS