Type II Diabetes Claire Sahlberg Redmond, OR

1. Project Decisions Or, why diabetes?

Redmond Family Medical Center Dr. Fixott A private practice in a historic 1918 building 5 office staff 3 dogs 1 physician

Ladybug Gaia Ophelia

Redmond Family Medicine Clinic No EHR The clinic is currently in the process of transitioning to an electronic system. Currently, all notes are dictated and then transcribed. The note is saved in the EHR and also printed and placed in the paper chart No Medical Assistant On my second day, the MA had a family emergency and had to leave for an extended period of time With no other MA’s at the clinic, all of her responsibilities fell to myself and the other staff But lots of fun!

They feel fine at the start… I can’t make them believe they have a disease. Dr. Fixott, on diabetes

The problem with silent diseases Dr. Fixott asked that I create a handout for newly diagnosed diabetic patients Many patients have difficulty understanding the seriousness of the disease and possible consequences My goal was to create a simple, straightforward patient-friendly guide

Age-Adjusted Percentages 2006-2009 Oregon Deschutes County Overweight 36.1% 41.0% Obese 24.5% 15.7% Diabetes 6.8% 5.0% https://www.ohsu.edu/xd/education/student-services/about-us/provost/upload/State-of-Our-Health-2013-monograph.pdf

2. Considerations Why less is more

INFORMATION OVERLOAD

We receive 5X as much information today as we did in 1986 Content in 2016 We receive 5X as much information today as we did in 1986 Studies of visualized information demonstrate:

Increase in willingness to read with color visuals vs black and white 80% Increase in willingness to read with color visuals vs black and white 323% Improvement in following directions with illustrations vs text alone 15% http://neomam.com/interactive/13reasons/ Improvement in medicine label understanding when using text+pictures vs text alone

What does it mean to be “patient friendly?” 2. Assessing the content What does it mean to be “patient friendly?”

Using printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential. The Health Literacy of America’s Adults, 2003

Below Basic Basic Health Literacy Circle the date of a medical appointment on a hospital appointment slip Identify what it is permissible to drink before a medical test based on short instructions Basic Give two reasons a person with no symptoms of a specific disease should be tested for the disease, based on information in a clearly written pamphlet

Intermediate Proficient Health Literacy Find the age range during which children should receive a particular vaccine based on a chart Determine a healthy weight for a specified height based on a BMI graph Proficient Find information required to determine a medical term by searching through a complex document

Health Literacy Adults in the oldest age group, 65 and older, had lower average health literacy than adults in younger age groups Adults with self-reported poor health had lower health literacy scores Adults with no insurance or on Medicaid or Medicare had the lowest health literacy scores

Where does this project fall? Readability Readability The average adult reads at the 8th or 9th grade levels, and 20% read at 5th grade level or below Most materials should be aimed at 5th or 6th grade reading levels Where does this project fall? Fry Readability Formula: 9th grade Raygor Graph: 6th grade PEMAT

Understandability Assessments PEMAT- Patient Education Materials Assessment Tool Content Purpose is evident Does not include information/content that distracts from its purpose Word Choice/Style Common, everyday language Define medical terms if used Material uses the active voice http://www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/pemat/pemat-p.html Numbers Easy and clear to understand User does not need to perform calculations

Understandability Assessments PEMAT- Patient Education Materials Assessment Tools Organization Information is broken into short sections Sections have informative headers Material is in a logical sequence Layout/Design Use of visual cues (arrows, bullets, boxes) to draw attention to key points PEMAT Visual Aids Used whenever they could make content more easily understood Reinforce the content Used simple tables with short and clear row/column headings Illustrations are clear and uncluttered

2. Summary What did I learn?

Thoughts for future improvements Diabetes is a BIG topic The most difficult part of this project was paring down the information It may be useful to have a series of flyers focusing on different aspects of the disease Design Matters The layout and presentation matters just as much as the actual written text Medical materials often seem to be lagging behind in thoughtful design Despite my best efforts… Writing in plain language is extremely hard With more time, I would like to further improve the readability

Thanks! Any questions? Claire Sahlberg, MS3 sahlberg@ohsu.edu

References Alleyne, R. (2011). Welcome to the information age- 174 newspapers a day. The Telegraph. Dowse, R. and M. Ehlers (2005). "Medicine labels incorporating pictograms: do they influence understanding and adherence?" Patient Education and Counseling 58(1): 63-70. Green, R. (1989) The Persuasive Properties of Color. Levie, W. H. and R. Lentz (1982). "Effects of Text Illustrations: A Review of Research." Educational Communication and Technology 30(4): 195-232. Winett, L., et al. (2013). "The State of Our Health 2013." Kutner, M., et al. (2006). The Health Literacy of America's Adults: Results from the 2013 Assessment of Adult Literacy. Washington, DC, NCES. (2008). America's Health Literacy: Why We Need Accessible Health Informaiton. An Issue Brief From the U.S. Department of Health and Human Services. "Readability Formulas." Retrieved April 24, 2016, from http://www.readabilityformulas.com/free-fry-graph-test.php. (2013). "PEMAT for Printable Materials (PEMAT-P)." Retrieved April 23, 2016, from http://www.ahrq.gov/professionals/prevention-chronic-care/improve/self-mgmt/pemat/pemat-p.html.