1. Health Literacy Awareness THE NEED TO CREATE HEALTH LITERATE ENVIRONMENTS GLENDA D. KNIGHT, PHD, MPH, CHES CUTTING EDGE HEALTH OPTIONS

2. What is Health Literacy?  “The degree to which individuals have the capacity to obtain process, and understand basic health information and services needed to make appropriate health decision.” (IOM, 2004)  “An individual’s possession of requisite skills for making health related decisions, which means that health literacy must always be examined in the context of the specific tasks that need to be accomplished, The importance of contextual appreciation of health literacy must be underscored.” (Paasche-Orlow & Woof, 2006)

3. More Than Reading and Understanding Health Information Health literacy is a powerful determinant of health status. It incorporates:  Educational  Cultural Values  Social Behaviors  Health Care System Design These are factors which influence expectations and preferences of individuals – they ultimately determine patient successes/challenges

4. Who Is Affected By Limited Health Literacy? National Adult Literacy Survey (NALS) 1992/2003 Level 1 - Below Basic – 14% (functionally illiterate) Level 2 – Basic – 29% (marginally literate) Levels 3 and 4 – Intermediate – 44% (fully functional in society) Level 5 – Proficient – 13% (another 5% of adults non-literate in English) Total - 48% encounter challenges navigating health system

5. Limited Health Literacy Affects All Groups But… it is more prevalent among:  Older adults  Persons with low income  Persons with limited education  Minority populations  Persons with limited English proficiency

6. Common Signs of Limited Health Literacy Element of Shame and Discomfort  Reluctant to complete medical forms in clinical environment  Tend to skip medical appointments  Don’t follow medical instructions  Express need to take medical instructions home  Complain of poor eye-sight or having left reading glasses at home  Express need to discuss health situation with family

7. Effects of Limited Health Literacy  More emergency room services  Hospitalized more often / with longer stays  Tend to not use preventive care  More doctor visits  Don’t understand their medical condition  Don’t adhere to medical regimens  Tend to be victims of delayed diagnosis  At risk for poor health status  At risk for increased mortality  Increase cost of health care  Tremendous impact on healthcare system and society!

8. Strategies to Improve Health Literacy Improving Health literacy  Patients and Caregivers  Health Care Practitioners / Staff  Health Care Providers / Organizations /Staff  Librarians (Medical, Public, Academic) Ultimate goal is to provide information that is understood (or effective communication)

9. Patients and Caregivers Can Improve Health Literacy  Write down questions for doctor at home, take to doctor visits  Write down important information during doctor visits  Ask practitioners to slow down and use plain language  Ask questions when information is not understood  Take initiative to learn about disease or health condition  Take along a relative or friend to doctor visits (re-enforcement)  Take advantage of available resources (Pamphlets, booklets, brochures)  Use the “Ask Me 3” method (What is my main problem? What should I do? Why is it important?)

10. Practitioners Can Improve Health Literacy  Slow the pace of providing information  Use images or pictures to provide information  Use Plain Language, and short sentences  Help patients understand their diseases, medications, and treatments  Allow time during patient visit to answer questions  Call patients after visits to answer questions they may have  Use teach back method (ask patients to repeat back information)  Develop written material at appropriate grade level  Develop patient-friendly, shame free environments

11. Health Care Organizations Can Improve Health Literacy  Provide easy access to information, services, and navigation assistance  Design and distribute educational material that’s easy to understand  Address Health literacy in high risk situations (transitions, medication instructions)  Communicate what health plans cover and what individuals must pay  Use health literacy strategies to communicate and confirm patient understanding

12. Librarians Can Improve Health Literacy Become Change Agents  Partner with patient care teams to assist patients/patrons who have difficulty understanding health information.  Partner with health education staff to improve the staff’s ability to communicate more effectively with patients.  Partner with Quality Assurance programs to implement procedures to improve patient understanding.  Develop and implement library services to help both health professionals and the general public improve their health literacy status.

13. Librarians Can Improve Health Literacy Health Literacy Reference Guide for Librarians The Medical Library Association Guide to Health Literacy. Edited by Marge Kars, Linda M. Baker, and Feleta L. Wilson. New York, NT: Neal-Schuman Publishers; 2008. 314 p. ISBN 978-1-55570-625-8. Composed of 16 chapters divided into four parts:  Part I – Health Literacy: Understanding the Issues  Part II – Health Literacy Issues in Special Populations  Part III – Health Literacy Issues in Public and Hospital Libraries  Part IV – The Future: Ways to Initiate and Become Involved in Health Literacy Programs