Health Literacy What’s Done and What’s Left to Do Paul D. Smith, MD, Associate Professor UW Department of Family Medicine

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Topics today Literacy VS health literacy History of health literacy What’s new Where are we now? What’s next

What is Literacy? Literacy is a combination of skills: Verbal Listening Writing Reading

What is Health Literacy? The Institute of Medicine 2004 “The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”

Literacy VS Health Literacy Almost everyone will have difficulty with health literacy at some point. Much harder for those that do not: Read very well. Speak English as their primary language.

Two Sides to the Equation It’s all about effective communication Verbal Written Multi-media It has to be presented in a way that is understandable to most people.

History Health literacy first use in publication Health Education as Social Policy Simonds SK. Health education as social policy. Health Educ Monogr 1974;2:1-25.

History Health literacy appears in medical literature Start to see reports of correlation between literacy and health outcomes

History National Adult Literacy Survey (NALS) First nationwide assessment of adult literacy

History Rapid Estimate of Adult Literacy in Medicine REALM First tool for assessing health literacy Davis T, Long S, Jackson R, Mayeaux E, George R, Murphy P, Crouch M. Rapid Estimate of Adult Literacy in Medicine: A Shortened Screening Instrument. Fam Med 1993; 25:391-5.

History National Institute for Literacy Health and Literacy listserv starts

History American Medical Association Ad Hoc Committee on Health Literacy Report American Medical Association, Council on Scientific Affairs, Ad Hoc Committee on Health Literacy. Health literacy: report of the Council on Scientific Affairs. JAMA 1999 Feb 10;281(6):552-7.

History Department of Health and Human Services Healthy People 2010 Health literacy definition that is commonly used U.S. Department of Health and Human Services. (2000). Healthy People 2010 (2nd ed.) [with Understanding and Improving Health (vol. 1) and Objectives for Improving Health (vol. 2)]. Washington, DC: U.S. Government Printing Office.

History Paul Smith stumbles on issue 1 st attempt at a health literacy grant 1 st of many failures

History National Assessment of Adult Literacy 2 nd adult literacy assessment National representative sample Measured health literacy 12% of adults are proficient in health literacy

History - January 2004 Agency for Healthcare Research and Quality Literacy and Health Outcomes Comprehensive review of the literature

History - April 2004 Institute of Medicine A Prescription to End Confusion Comprehensive evaluation and recommendations

History - July 2004 First Wisconsin Health Literacy Summit David Kindig, PhD ~50 attendees Paul Smith’s first health literacy presentation.

History Wisconsin Literacy, Inc. First meeting of Health Literacy Committee

History Wisconsin Hospital Association Webcast presentations Focus group project funded American Academy of Family Physicians Emotional response: stress, shame, fear

History Health Literacy Summit attendees 3 national speakers Webcast presentations Regional Health Literacy Committees created

History Regional Initiatives Needs analysis Surveys Brochures, PowerPoint Wingspread Conference

History Health Literacy Summit attendees Andrew Pleasant and other national speakers Pre-conference meeting of state representatives

History Projects Nursing health literacy curriculum Improving Hospital Health Literacy Environment Ask Me 3 What to do When Your Child is Sick project

History Wisconsin Literacy Projects Incorporate health literacy into tutor training Reach parent learners with “What to Do..” book Develop learner resources for medication safety

History Joint Commission new regulations Effective communication Cultural Competence Family-Centered care Approved Requirements to Advance Effective Communication, Cultural Competence, and Patient- and Family-Centered Care Hospital Accreditation Program, The Joint Commission, November, 2009.

What’s new? Health literacy resources and links Activities of Regional Health Literacy Committees Health Literacy curricula Health care providers Adult literacy students

What’s new? Health literacy materials library Searchable database Easy to read patient education materials Published articles Health literacy tools

Agency for Healthcare Research and Quality Consumer Assessment of Healthcare Providers and Systems Questions (CAHPS) Health literacy supplement

Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit Universal precautions VS testing for health literacy

Agency for Healthcare Research and Quality Informed Consent and Authorization Toolkit for Minimal Risk Research

What’s new? Department of Health and Human Services Action Plan to Improve Health Literacy Released May 27,

HHS Action Plan to Improve Health Literacy Seven goals 1. Develop and disseminate health and safety information that is accurate, accessible, and actionable.

HHS Action Plan to Improve Health Literacy 2. Promote changes in the health care system that improve health information, communication, informed decision making, and access to health services.

HHS Action Plan to Improve Health Literacy 3. Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level.

HHS Action Plan to Improve Health Literacy 4. Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community.

HHS Action Plan to Improve Health Literacy 5. Build partnerships, develop guidance, and change policies. 6. Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy.

HHS Action Plan to Improve Health Literacy 7. Increase the dissemination and use of evidence-based health literacy practices and interventions.

What’s New? The Joint Commission Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care – A Roadmap for Hospitals evelop_Culturally_Competent_Pt_Centered_Stds.htm

What’s New? Medline Plus website redesign Easy to read materials Interactive videos

Where are we now? Higher level of awareness in WI and nationally Many projects started around the state More research being done Not many definitive answers

Where are we now? Discussions of: Health literacy definition Health literacy measurement Health professional curricula National health literacy advocacy organization

Where are we now? 82 nd health literacy presentation

What’s Next? More research and dissemination of results AHRQ document rating system More health literacy regional conferences

What’s Next? Become part of the healthcare reform? Response to Action Plan?

What’s Next In Wisconsin? Publication of research results Collaboration Guide for hospitals and literacy organizations Easy-to-Understand Writing Guide County specific literacy information?

What’s Next In Wisconsin? Health Literacy Summit IV April 12 – 13, 2011 Conference grant application Health materials development workshop Wingspread Conference follow up

What Can You Do? Learn more Continue to raise awareness Start small Integrate health literacy into current efforts Connect with collaborators

Want a copy? Health literacy resources document

Questions? Comments?