1 HEALTH LITERACY ● What is health literacy? ● Scope of the problem ● Why is health literacy important? ● What can we do to help? ● Resources

2 What is health literacy?

3 Definitions of Health Literacy US Department of Health and Human Services, Healthy People 2010 “ Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” American Medical Association “ A constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment.”

4 Definitions of Health Literacy Office of the Mayor (New York City) “Health literacy is the ability to read, understand and act upon health related information. Health literacy also refers to the capacity of professionals and institutions to communicate effectively so that community members can make informed decision and take appropriate actions to protect and promote health.” Health Literacy Network “The ability to find, understand and use the health information we need to take care of ourselves and to improve our health and wellbeing.” Rima Rudd, MSPH, ScD; Harvard School of Public Health “The ability to use language to solve health-related problems at a proficiency level that enables one to function, achieve one's health goals and develop health knowledge and potential.”

5 1. Communication skills of lay people and professionals 2. Patients' knowledge of health topics –causes of disease, risk factors, when to seek care 3. Culture –how people think about health, disease and treatment 4. Demands of the healthcare and public health systems –how to access care and services, payment, insurance 5. Demands of the context and particular situation –stress, physical or mental impairment, unfamiliarity Health literacy depends on both individual and systemic factors

6 Health literacy is NOT the same as: Plain Language. Plain language is a technique for communicating clearly. It is one tool for improving health literacy. Cultural Competency. Cultural competency is the ability of professionals to work cross-culturally. It can contribute to health literacy by improving communication and building trust.

7 How is health literacy measured? ● Health literacy is a new component of the 2003 National Assessment of Adult Literacy (NAAL). – Nationally representative sample of more than 19,000 adults aged 16 and older in the United States – Assessment of English literacy using prose, document and quantitative scales ● Tasks used to measure health literacy were organized around three domains: – Clinical: Filling out a patient form – Prevention: Following guidelines for age-appropriate preventive health services – Navigation of the healthcare system: Understanding what a health insurance plan will pay for

8 Health Literacy Levels ● Proficient: Can perform complex and challenging literacy activities. ● Intermediate: Can perform moderately challenging literacy activities. ● Basic: Can perform simple everyday literacy activities. ● Below Basic: Can perform no more than the most simple and concrete literacy activities. ● Nonliterate in English: Unable to complete a minimum number of screening tasks or could not be tested because did not speak English or Spanish.

9 Below Basic Basic Intermediate Proficient Circle the date of a medical appointment on a hospital appointment slip. (101) Give two reasons a person should be tested for a specific disease, based on information in a clearly written pamphlet. (202) Determine what time a person can take a prescription medication, based on information on the drug label that relates the timing of medication to eating. (253) Calculate an employee’s share of health insurance costs for a year, using a table. (382) Source: National Center for Education Statistics, Institute for Education Sciences 500 0

10 Basic information about a colonoscopy, as perceived by a patient with limited literacy skills

11 Scope of the problem

12 Percentage of Adults in Each Health Literacy Level: 2003 Source: National Center for Education Statistics, Institute for Education Sciences

13 –Older adults –People with low income –People with limited education –Minority populations –People with limited English proficiency (LEP) Low health literacy is more prevalent among:

14 IOM Report (2004) Health Literacy: A Prescription to End Confusion “Nearly half of all American adults--90 million people--have difficulty understanding and using health information, and there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy.” Recommendations: ● develop and support programs to reduce the negative effects of limited health literacy ● incorporate health knowledge and skills into the existing curricula of kindergarten through 12th grade and adult education and community programs. ● develop culturally and linguistically sensitve programs to promote health literacy and health education

15 According to the AMA: –21% of adult Americans are functionally illiterate, meaning they read at 5 th grade level or lower –An additional 25% of adult Americans are marginally literate This translates to: 90 million patients with low health literacy and $73 billion dollars annually in extra healthcare costs due to unnecessary doctor visits, hospitalizations and longer hospital stays

16 Why is health literacy important?

17 Patients with limited health literacy may have difficulty: Locating providers and services Filling out health forms Sharing medical history with provider Seeking preventive health care Managing chronic health conditions Understanding directions on medication Understanding and acting on health-related news and information

18 Low health literacy affects: Health outcomes –medication errors –increased doctor visits and hospitalizations Healthcare costs Quality of care

19 What can we do to help?

20 Office of the Surgeon General – Health literacy improvement is one of the Surgeon General’s seven public health priorities. – “Health literacy is the currency of success for everything I am doing as the Surgeon General.” —Dr. Richard Carmona in his speech to the AMA House of Delegates, June 2003.

21 Healthy People 2010 Health Literacy Objectives Improve the health literacy of persons with inadequate or marginal literacy skills Increase the proportion of persons who report that their healthcare providers have satisfactory communication skills.

22 In the patient visit ● Use plain language and listen carefully – Use simple language and define technical terms – avoid medical jargon – Use the active voice – Break down complex information into understandable pieces – Organize information so the most important points come first – Use a medically trained interpreter if necessary – Check for understanding using the “teach-back” method – Ask open-ended questions – Use hand signals or visual cues

23 Improve the Usability of Health Forms and Instructions ● Revise forms to ensure clarity and simplicity. ● Test forms with intended users and revise as needed. ● Provide forms in multiple languages. ● Offer assistance with completing forms and scheduling followup care.

24 The Health Education and Adult Literacy Program (HEAL) Community Pediatrics at Columbia University and New York Presbyterian Hospital in partnership with Community Health Workers at Alianza Dominicana

25 Emphasis will be made upon the patients’ needs in order to help them… Enhance their understanding in regards to medication use Increase their involvement in planning care Improve their adherence to medical instructions The HEAL program will improve the health outcomes for parents and children in the outpatient pediatric clinics.

26 HEAL Program Goals and Objectives The HEAL program aims to decrease medication errors with treatments prescribed by pediatricians by improving health literacy in the population served. We will develop, implement, and evaluate a culturally and linguistically appropriate curriculum targeted to community health workers, pediatric providers, and volunteers. Objective 1: To develop culturally responsive health education material regarding medication adherence using the basic tenets of health literacy. Objective 2: To train pediatric providers and CHWs to appropriately address low health literacy at different health care settings. Objective 3: Implement the HEAL curriculum in four pediatric outpatient clinics in the Washington Heights/Inwood neighborhoods of Northern Manhattan served by NYPH and at the various programs served by the CHWI at Alianza Dominicana.

27 Health Professional’s Role in HEAL Identify patients with limited literacy levels Use simple language, short sentences and define technical terms Empathize with cultural background, ethnic and racial diversity of patients Provide information in patient’s primary language Offer assistance with the completion of forms Ask open/ended questions Use the “teach back method” to determine patient’s comprehension

28 Resources – AHRQ Report—Literacy and Health Outcomes (2004): – Healthy People 2010 (2000): – Healthy People 2010 Health Literacy Action Plan— Communicating Health: Priorities and Strategies for Progress (2003): objective2.htmhttp://odphp.osophs.dhhs.gov/projects/healthcomm/ objective2.htm – IOM Report—Health Literacy: A Prescription To End Confusion (2004): – NIH Improving Health Literacy Web page: m m