Health Literacy: Tools You Can Use Julie Gazmararian, PhD, MPH Kara Jacobson, MPH, CHES Department of Health Policy and Management Rollins School of Public Health Emory University

Overview Overview of health literacy Definition Prevalence Impact Strategies for improved communication Tools Assessment Open discussion

National Adult Literacy Survey (NALS) “Using printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential” (National Literacy Act of 1991) Prose, Document, Quantitative

NALS 2003 Results National Adult Literacy Study, 2003

Health Literacy Healthy People 2010 AHRQ IOM Objective 11-2: Improve health literacy Objective 17-3: Increase review with older patients newly prescribed and OTC medications AHRQ Evidenced-based review of health literacy IOM Priority Areas for National Action: Self-management/Health literacy Report from Committee on Health Literacy

What is Health Literacy? In this report, the committee accepted the definition of health literacy presented by the National Library of Medicine: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Selden et al. 2000; Healthy People 2010, HHS 2000; Ratzan & Parker 2000)

What is Health Literacy? Not only reading skill….BUT ALSO Writing Speaking Listening Numeracy Cultural and Conceptual knowledge

"The health of our country depends on our understanding of basic health information in order to lead a healthy life" U.S. Surgeon General Carmona

Low “health” literacy 1 out of 3 39 Low “health” literacy Low literacy 1 out of 4 Increasing attention – take from Terry’s slide Transition to NBC nightly news, aired, fall 2002 1 out of 3

Health Literacy Challenges Most people cannot understand health information they need It’s hard to be a patient these days and it’s easy to mess up An issue of quality — essential for self-management, reducing disparities and reducing costs

Problems Associated with Low Health Literacy Compliance with medication Poor health status Knowledge of basic self-care Hospitalizations Follow-up visits Physician visits Comprehension of informed consent, medical forms, insurance benefits Costs

Health Outcomes Associated with Literacy General health status Hospitalization Emergency department use Prostate cancer stage Depression Diabetes control HIV control Mammography Pap smear Pneumococcal immunization Influenza immunization STD screening

Behavioral Outcomes Associated with Literacy Substance abuse Breastfeeding Behavioral problems Adherence to medication Smoking

Knowledge-related Outcomes Associated with Literacy Birth control knowledge Cervical cancer screening Emergency department instructions Asthma knowledge Hypertension knowledge

Does Inadequate Literacy Lead to Excess Medicare Hospital Costs? 36 Million Medicare Eligible 44% Functionally Illiterate (16 million) $ 2,262 per Person / Year 25% - 50% Higher Hospital Costs Excess Hospital Costs = $8 - $15 BILLION

The main problem with communication is the assumption that it has occurred. George Bernard Shaw