1. ROR Conference 10-20-2017 Steven Sparks Health Literacy Director
Oct. 20, 2017
Improving Communication with Parents: Using AHRQ Health Literacy Universal Precautions Toolkit
Steven Sparks
Health Literacy Director

2. It’s just another toolkit. Why should you care?
ROR Conference
It’s just another toolkit. Why should you care?
One of our pediatric patients was prescribed oxycodone 5 mg/5ml. Even though the directions said to take 1 ml every 4 hours as needed for pain, the patient’s mother gave her 5 ml because she though the strength of the medication as supposed to be the dose she gave her child.
The pharmacy gave me the wrong medicine for my child. It was a very strong anti-psychotic instead of antibiotic. Thankfully I read the label carefully and caught it.
One of our providers prescribed Miralax for a child’s constipation. The directions said mix with water. The mother put it in a bath tub and had the child sit it in. It didn’t say to drink it.
“My great aunt was discharged on oral antibiotics. The course of treatment was 21 days and she took the medication 2 capsule, 3x per day. The quantity of meds required was large and the pharmacy put the pills in 3 bottles. She took two capsules from EACH BOTTLE 3x per day. She developed C difficile and was hospitalized again several days after being released.
“My mother was given pain patches for your severe arthritis and was instructed to place the patch somewhere on her body. At a Thanksgiving dinner, we notice that she became drowsy and was slurring her words....when we looked at her more carefully we discovered that she had place a pain patch every where she was hurting”
“My mom had a prescription for Lomotil, it said to take for diarrhea, she did not take is as she already had diarrhea and felt that the pill would make it worse. Is should have said to "stop diarrhea". Some people are literal.”

3. Health literacy can affect:
Use of medicines
Understanding and follow-through on discharge instructions
Accessing best health care
Using health insurance
Asking questions
Engagement in health decisions

4. What’s it like? Allotted Time: 4 minutes
Explain to the audience that you are going to conduct an exercise with them.
Set the scene: You’re in the exam room, and the doctor hands you this sheet with instructions, he/she tells you to take a moment to read it and ask any questions you might have about them.
Ask people to read the passage aloud and try to stay together – choral reading.
Ask comprehension questions about what they just read:
What is this passage about?
Ask people how they felt during the exercise. Encourage them to remember back to how it FELT, not what they were THINKING
8) Mention how this activity is to help people understand and/or empathize with clients who may have low health literacy.

5. Everyone has difficulty with health literacy at some time
ROR Conference
Everyone has difficulty with health literacy at some time
Health and/or life stress
Medication
Illness

6. Everyone has difficulty with health literacy at some time
ROR Conference
Everyone has difficulty with health literacy at some time
Medical studies show most people suffer a 68% hearing loss when naked.

7. 1 of 3 struggle with low health literacy
ROR Conference
1 in 3 Adults: Low
Only 12% proficient!
1 of 3 struggle with low health literacy
(NAAL, 2003)

8. A silent problem Percent who never told: Parikh, N.S., et al.
ROR Conference
A silent problem
Percent who never told:
Parikh, N.S., et al.
Patient Educ Couns, 1996.

9. Who is most at risk for low health literacy?
ROR Conference
Who is most at risk for low health literacy?
Low literacy
Poor health status
Low education level
Seniors
Racial and ethnic groups

10. Improving health literacy can make a difference
8000 books distributed:
4 of 5 parents dealt with a health care problem at home instead of calling a hospital or clinic
3 of 5 parents dealt with a problem at home instead of going to the Emergency Department or Urgent Care

11. What are Health Literacy Universal Precautions?
Simplifying communications for everyone to reduce the risk of miscommunication

12. What are Health Literacy Universal Precautions?
Making the office environment and health care system easier to navigate
Supporting patients’ efforts to improve their health

13. Start on the path of improvement
Improve spoken communication
Improve written communication
Improve self-management and empowerment
Improve supportive systems

14. What’s included Videos and moderator’s guides PowerPoint presentations
Forms
Posters and flyers
Checklists and worksheets
Surveys

15. A sampling of Tools and Tips…

16. Tool 3: Raise Awareness Show a video, lead a discussion
Conduct Presentation

17. Tool 4: Communicate Clearly
ROR Conference
Tool 4: Communicate Clearly
Use plain, non-technical language
Use the patient’s words
Slow down
Limit content
Be specific and concrete
Show pictures, graphics

18. Be sure to come to the Breakout Session at 1:15!
ROR Conference
Tool 5: Use Teach-Back
Be sure to come to the Breakout Session at 1:15!

19. Tool 7: Improve Phone Access
ROR Conference
Tool 7: Improve Phone Access
Ask patients what they think
Carefully design automated menus
Use health-literate language
Use Teach-Back

20. Tool 8: Conduct Brown Bag Medicine Review
ROR Conference
Tool 8: Conduct Brown Bag Medicine Review
Ask patients to bring medicines (not “medications”)
Ask:
What do you take this for?
When do you take this?
Show me how much you take each time

21. Tool 9: Address language differences
ROR Conference
Tool 9: Address language differences
Assess language preferences and needs
Use acceptable language assistance services
Provide written material in preferred language

22. Tool 11: Assess, select & create easy-to-understand materials
ROR Conference
Tool 11: Assess, select & create easy-to-understand materials
Use assessment tools
PEMAT
CDC
SMOG

23. Tool 11: Assess, select & create easy-to-understand materials
ROR Conference
Tool 11: Assess, select & create easy-to-understand materials
Involve patients
Watch for numbers
Consistent denominators (1 of 10 vs. 4 of 10)
Do the math
Remember: There are 3 kinds of people in this world…
Those who are good at math and those who are not.

24. Tool 14: Encourage questions
ROR Conference
Tool 14: Encourage questions
“What questions do you have?”
“Tell me your questions.”
“We discussed a lot of information. What can we review again?”
(NOT) Do you have any questions?

25. Tool 18: Link patients with non-medical support
ROR Conference
Tool 18: Link patients with non-medical support
Ask: “Is there anything in your daily life that makes it hard to take care of your health?”
Maintain updated list of community resources
Use Community Referral Form

26. Tool 20: Connect patients with literacy and math resources
ROR Conference
Tool 20: Connect patients with literacy and math resources
Ask parents about literacy skills; stress importance of parent literacy on children
Provide information on programs
WisconsinLiteracy.org

27. Lots and lots of resources
ROR Conference
Lots and lots of resources
For example:

28. Lots and lots of resources
9 pages to be exact

29. How to get started Download all or part of Toolkit:
Google: Health Literacy Universal Precautions Toolkit

30. How to get started

31. What questions do you have?
ROR Conference
What questions do you have?
Steve Sparks Health Literacy Director