Health Literacy: A Universal Precautions Approach

PATRICIA DEVINE, MLS National Network of Libraries of Medicine, Pacific NW Region 1 Introductions

Objectives 2 Define health literacy and the challenges patients face. Recognize the impact low health literacy has on patient care. Understand the Universal Precaution approach to health information literacy. List strategies to improve health information literacy. Describe health literacy services provided by medical libraries.

Part I. Health Literacy and the Challenges Patients Face Health.gov to make appropriate health decisions. the basic health information services needed understand process obtain Having the capacity to What Is Health Literacy?

Part I. Health Literacy and the Challenges Patients Face Health literacy also refers to the capacity of professionals and institutions to communicate effectively so that community members can make informed decisions and take appropriate actions to protect and promote their health. New York City Mayor's office

Health Literacy Adults’ Skills: “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Healthy People 2010) Our Expectations and System Demands: Managing medications, remembering and following spoken and written directions, interpretation 5 Health Literacy: An Interaction

Adults’ Skills 6 A majority of U.S. adults have difficulty using print materials to accomplish everyday tasks such as: Calculate a 15% tip on a bill Use a bus schedule to determine time of arrival Use labels to compare and contrast safety ratings on a piece of equipment such as a bicycle helmet Read an over-the-counter medicine box to determine how much medicine to give a child of a specified weight and age Determine the point-of-view [bias] in an editorial

The following groups are more likely to have limited literacy skills: Elderly Minorities Limited English Proficiency (LEP) patients Low income Homeless Prisoners Persons with limited education 7 High-Risk Groups

Track experiences  Watch for side effects and seek appropriate help as needed  Take action for missed dose when needed Calculate  Measure doses  Count pills  Track amount of meds left and refill as necessary  Use clocks and calendars to set time/day Read  Labels & inserts  Names of medicines  Dosage instructions  Read between the lines [eg, BID, TID, QID] Listen to explanations and directions Talk to busy professionals  Describe new feelings (e.g., side effects)  Present problems  Ask questions 8 We Expect Patients to…

Health Literacy Statistics and Trends Two key findings from a 2003 study from the National Center for Education and Statistics: Nearly half of adults in the U.S. have basic or below basic literacy skills. 77 million U.S. adults have basic or below basic health literacy skills. Two key findings from a 2003 study from the National Center for Education and Statistics: Nearly half of adults in the U.S. have basic or below basic literacy skills. 77 million U.S. adults have basic or below basic health literacy skills. Part I. Health Literacy and the Challenges Patients Face

Health Literacy Statistics and Trends What do these statistics really mean? Most adults having below basic health literacy skills (30 million adults) would not be able to circle the date of their next appointment on a medical appointment slip or identify what is permissible to drink before a medical test based on a set of short instructions. What do these statistics really mean? Most adults having below basic health literacy skills (30 million adults) would not be able to circle the date of their next appointment on a medical appointment slip or identify what is permissible to drink before a medical test based on a set of short instructions. Part I. Health Literacy and the Challenges Patients Face

Communication skills Numeracy skills Patient and health care provider knowledge about health Culture and language Demands of the health care system Health literacy is dependent on a variety of individual and system factors. Some examples include: Factors that Affect Health Literacy

Why Is Health Literacy Important? Part II. The Impacts of Low Health Literacy

Why Is Health Literacy Important? Low health literacy is increasingly recognized as a barrier to quality patient care and is linked to: Under-utilization of preventive services such as mammograms, pap smears, and prostate exams Reduced medication adherence, especially in patients 65 and over Continued Low health literacy is increasingly recognized as a barrier to quality patient care and is linked to: Under-utilization of preventive services such as mammograms, pap smears, and prostate exams Reduced medication adherence, especially in patients 65 and over Continued Part II. The Impacts of Low Health Literacy

Patients’ Experiences 14 People commonly hide their difficulty with reading or understanding. Many feel ashamed of poor reading or understanding. People with limited literacy often avoid reading.

“How would you take this medicine?” 395 primary care patients in 3 states 46% did not understand instructions ≥ 1 labels 38% with adequate literacy missed at least 1 label 15 Medication Errors

16 Misinterpretation of Warning Labels

Patient-Level Consequences 17 Poorer health outcomes Increased hospitalizations Greater use of emergency care Missed prescription refills Difficulty understanding medication instructions and warning labels  Inappropriate dosing or timing of meds  Failure to recognize side effects or drug interactions

18 American College of Physicians Health Literacy Video What Patients are Saying

19 What surprised you about the patients featured in this video? What types of tasks were the patients in this video asked to complete? How could these patients’ experiences have been improved?

Societal Consequences 20 Nonadherence  Missed refills  Inappropriate dosing or timing of meds  Failure to recognize side effects or drug interactions Increased emergency department costs among low health literacy patients Undermines efforts to increase patient self- management and engagement in care

Why Is Health Literacy Important? Health information is key to Patient and provider communication Shared health care decision making Understanding and following directions Recognizing when to seek care Learning and adopting healthy behaviors Health information is key to Patient and provider communication Shared health care decision making Understanding and following directions Recognizing when to seek care Learning and adopting healthy behaviors Part II. The Impacts of Low Health Literacy

Universal Precautions Approach 22 Specific actions that minimize risk for everyone when it is unclear which patients may be affected, such as:  Use gloves to lower risk of spreading bloodborne disease.  Utilize proper disposal techniques. Universal precautions and health literacy:  Assume each patient will not understand at least part of the information they are given.  Structure services and patient interactions to minimize risk.  Allow patients to make informed decisions.

Universal Precautions and Health Literacy 23 Some patients with limited health literacy: Have completed high school or college. Are well spoken. Look over written materials and say they understand. Hold white collar or health care jobs. Function well when not under stress.

Strategies to Improve Health Literacy Improve spoken communication. 2. Improve written communication. 3. Improve self-management and empowerment. 4. Improve supportive systems.

John Smith Dr. Red Take two tablets by mouth twice daily. Humibid LA 600MG 1 refill “Show me how many pills you would take in 1 day.” 25 Teach-Back Continued

Written Communication 26

Using the Teach-Back Method 27

Improve Self-management and Empowerment 28 Encourage questions. Make action plans. Improve medication adherence and accuracy. Get patient feedback.

Common Community Resources Patients May Need Food pantries and Goodwill locations Transportation services Domestic violence shelters Youth mentoring programs Budget management programs Teen pregnancy programs Support groups Services for the hearing or visually impaired Aging and caregiver services Employment assistance programs 29 Link Patients to Support Systems

Librarians as Partners 30 Librarians, especially medical librarians, are health information experts. They have: Skills to help you and your patients locate appropriate, authoritative information to help meet your needs. Information for you to give to your patients. Ability to save you and your patients a time by doing expert research on your requested topic.

MedlinePlus is the National Library of Medicine's consumer health portal intended for both patients and health professionals. Best Starting Places on the Web

MedlinePlus provides: Information on more than 750 health topics and on drugs and herbal supplements A full-text medical encyclopedia Current health news Links to information from the National Institutes of Health and other trusted sources Interactive tutorials that are particularly appropriate for patients with low health literacy MedlinePlus provides: Information on more than 750 health topics and on drugs and herbal supplements A full-text medical encyclopedia Current health news Links to information from the National Institutes of Health and other trusted sources Interactive tutorials that are particularly appropriate for patients with low health literacy Part III. Strategies to Improve Health Information Literacy

Info RX Project 33

Librarians as Partners When you write an InfoRx, a librarian canInfoRx “fill it” in a number of ways: By preparing an information packet for patients to take home. By demonstrating how to access information either in the library or online. By referring patients to community support services, if needed. continued When you write an InfoRx, a librarian canInfoRx “fill it” in a number of ways: By preparing an information packet for patients to take home. By demonstrating how to access information either in the library or online. By referring patients to community support services, if needed. continued Part IV: Health Literacy Services Provided by Libraries

Librarians as Partners If your organization does not have a library, there is a directory of medical libraries available through the National Network of Libraries of Medicine.directory of medical libraries The Medical Library Association can also direct you to other resources and services.Medical Library Association The National Center for Education Statistics has a national directory of public libraries.national directory of public libraries If your organization does not have a library, there is a directory of medical libraries available through the National Network of Libraries of Medicine.directory of medical libraries The Medical Library Association can also direct you to other resources and services.Medical Library Association The National Center for Education Statistics has a national directory of public libraries.national directory of public libraries Part IV: Health Literacy Services Provided by Libraries

Thank you! 36 Questions?