1. Health Literacy Conference Institute for Healthcare Advancement: https://www.iha4health.org
The institute for healthcare advancement (IHA) is dedicated to empowering people to better health
Publish easy-to-read books, and teacher manuals
Organize an annual continuing education health literacy conference
Offer health literacy rewrite/redesign and original writing and graphic design service
Evaluate your patient education materials and communications (field testing with focus groups and one-on-one interviews)
Sponsor and administer the health literacy discussion list
Administer the Leonard Doak Memorial Scholarship in Health Literacy
Run the La Habra Family Resource Center
Help residents of Orange County, California, sign up for health insurance
May 6th- 8th, 2015 Irvine, CA

2. PUBLIC HEALTH LITERACY
The degree to which individuals and groups can obtain, process, understand, evaluate, and act upon information needed to make public health decisions that benefit the community
Michael Paasche-Orlow, M.D

3. Outline Health Insurance Risk Communication
Strategies for a more collaborative health literate community
Creating a needs based health literacy initiative, examples from Missouri
Healthy Equity & Health Literacy
Engaging youth in health discussions
Translation
Intergenerational communication

4. Health Insurance: Train the Trainer Session
Health Insurance: What it means to have it
What health Insurance is and how it works
What health insurance covers (and what it may not cover)
How to use health insurance (to stay as healthy as possible)
How to keep health insurance (now that you have health insurance)
Resources: enrollamerica.org:
justplainclear.com : definitions for vernacular
Amy DeMarco, MPA, Programs and Operations Manager at IHA
Resources: enrollamerica.org
 Health Insurance Terms
(came up in later session) Talk about it in terms that people understand – not in the traditional language (co-pay, deductible, co-insurance) define these as that is important but appeal to emotional aspects: how to keep your family safe, how to ensure they can stay in home, etc.

5. Affordable Care Act & Health Literacy
Think about MESSAGES and how they resonate in different communities
Utilize community based organizations: NGO, Faith organizations, Salons
“Learned Helplessness”: This comes from telling populations over and over again that it won’t work out for them
GOALS: Less wording, more white space, plain English (no matter what audience, but definitely non English speakers)
Michael Villaire, MSLM (Moderator), Don Rubin, Ph.D., M.D, Catina O’Leary, Ph.D., Doreena Wong, Federal govt representative
It’s not mere translations- it’s concepts (co-pay, deductibles, and premiums don’t make sense)  we need to be talking about the importance of keeping family safe, stay together, etc.
Cover Missouri Coalition – resources

6. Lessons about clarity from crisis and emergency risk communication
“Communicating about risk requires extra attention to clarity.”
Ask yourself as a healthcare practitioner:
When do I evoke emotions around risk?
Tie consequences to the risk
Be Clear about what you know, and what you don’t know
Use Statements of EMPATHY
We continue to have a lack of empathy even though we know that emotions are involved in how people receive and understand health messages
Create TRUST: Communication does not happen without trust
CDC Senior advisor for Health Literacy, Cynthia Bauer
Clear Communication Index (on-line): have to select a primary audience (be as SPECIFIC as possible) in crisis or risk may not have this luxury , healthy people 2020
PEOPLE NOT understanding information is a risk in and of itself is a risk factor, naïve assumption about messages and that people will understand and follow
There are very real consequences when people don’t understand
EBOLA- can we be clear about who is at risK?
“low” risk as a descriptor, qualitative descriptors are inadequate ; if you are not empathetic or reassuring you have failed at creating an effective health message
Images of suits Fear not reassurance
Health Literacy EMOTIONS (Fear, ansxiety, confustion, anger) effect how people understand health messages
“minimum message” that you have to get across to the most amount of people- large audiences
E-cigs, we thought we knew evertying about cigarrettes- this is science, you have to be humble; if we did a better job about stating what we know and what we don’t know then people could be more understanding about the unfolding of information (this happen in NUTRITION all the time)
BEST PRACTICES: What’s known, What’s not known, How or Why?, Action Steps, Empathy, Accountability , commitment- people are UNCOMFORTABLE talking about what they don’t know but this is an important piece!
Food borne illness, risk is smaller than people think it is

7. Strategies for a more collaborative health literacy community
Linking Research and Practice: 1% Research is translated to Practice!
 The Average Journal article is read by 12 people
“The answers are right there, but no one is asking the people that are affected.”
We need:
Participatory design (or “user centered” design) is key
Communication as a group
Researchers, practitioners, and communities work in tandem
Linda Neuhauser, Masters public health inNutrition, started counseling, no one took her sceince based advice no matter how loud she talked, colleagues confirmed this was the same “our job was to tell people what to using scince” PHD professor in PUBLIC health UC Berkeley , worked in west Africa health officer in Mauritania , Africa  Vaccinations Helath officer , toured the country for 6 mos for new strategy- lots of cultural, political reasons why the scientific plans never got into practice
National library of medicine = translating research into practice
Health Research for Action UC Berkeley: researchers, practiioners, communication experts (health litearyc) what have they learned in 20 yrs? Need to have researchers committed to ACTION, practitioners interested in evidence, experts in communication and health literacy, strong entrepreunership spirit, perserverance.
Average journal article is read by 12 people! UNIVERsities are expanding to social service to REACH MORE PEOPLE
IDEA-O , D- School : organization - participatory user centered design world wide, rapid cycles, very POWERFUL

8. Creating a needs-based Health Literacy Initiative University of Missouri Center for Health Policy
Studies show that 40-80% of the medical information that patients receive is forgotten immediately and that nearly ½ of the information is incorrect Use a Teach Back method -”Straight Talk” with your Doctor “Implementation Science” – how you implement your intervention makes all the difference
Missouri Health Literacy Enhancement, Missouri Foundation for Health – when blue cross blue shield went from non-profit to bussiness, MO negotiated the funding for this, limited to 85 MO counties”service areas”
Health Literacy Initiative (HLI) Healthcare Foundation of Greater Kansas City (3 MO counties 3 inKS) another Insurance transfer “Foundation Deserts”

9. Health equity and health literacy
Health Outcomes in US are worse than in some developed countries (but we spend WAY MORE money)
Health Equity and the Social Determinants of Health
Sentiments among healthcare practitioners around these issues:
“We didn’t start the fire”
BUT by not acting we transform Education disparities into healthcare disparities
Health Literacy is a crucial component of Health Equity (mitigating the social determinants of health)
“You Be the Tide that Raises all Boats.” JFK
PANEL - Michael Villaire, MSLM (Moderator)- Founder of IHA , Michael Paasche-Orlow, M.D. Boston University , Robert Logan, Ph.D, National Library of Medicine, Winston G Wong, MD MS Kaiser Permanente
Health Equity- getting rid of the social and environmental determinants of health – we are moving towards this
Health Literacy- Health Disparity – IOM report around unequal treatment , Dept of health and human services Minority Report, gaps with regards to clinical outcomes- Gender, Racial ethnic groups ; clinical outcomes differences in what we would expect to be the standard- gender, race, ethnicity…. Etc
Environmental determiniants of health and social
“we didn’t start the fire” sentiment among healthcare practitioners, these disparities are omnipresent – education, econmonics, healthcare- we transform ed disparitites into healthcare disparities ( so we have a role in creating the problem and we should help to elimiate it)
Why is it important to draw these distinctions? US educational CAST system, your vocabularty at kindergarden plays a huge role in your income career!! What research is addressing this?  Intermesh the research agenda.
STUDY- HIV medication adherence – adherence comparing AA with and without utilizing health literacy – these adjusted analysis can be utilised to understand where interventions are important – study: osborn, Paasche-Orlow, Davis, Wolf. AJPM 2007.
Hospital end of life decision making- convincing to hospitals to fill education requirements, health literacy, cultural competence- with VIDEO intervention no difference by level of HL or race!!
“A Person is Not a Regression Analysis”
Client patient relationship – social class assumptions
Impact better health and healing to the most vulnerable population- what do you do? Eveidence is not exaclty clear- but the eveidence suggests that health literacy is an intervention you can make that makes a difference over time.  Helath literacy needs to be implemented in LOW INCOME populations ; this is where helath literacy and health equity meet
Hayes (MT) – case study, home visitations over time, pregnant single moms almost all low income- one group received healthcare visitation as usual, other gorup received the same and received life skills training- “sophisticated assesment of moms” and then did an assesment of their children, ages 4-5; the differences among groups is stumnning- capacity of learn, stay employed, self confdience, how they care for their children … and children’s impacts
Over 30,000 Health Apps- most are not used. So much room for creativity, communication , and empowerment to ask questions ; “we shame people so much into silence”
Health Literacy vs. Health Communication  Health Literacy Tool “Shed”
“You Be the Tide that raises all Boats” – Health Literacy is a rising tide that lifts all boats

10. Engaging Youth
10 years ago, nearly 1 in 4 youth ages had pre-diabetes, now this one 1 in 11 ½ of these youth will have full blown diabetes within 5 years (25% of white youth, 50% of Latino and African American youth) Visit: (Pediatrics 2012)
Dean Schillinger, MD University of CA, San Fran
The Bigger Picture Campaign; thebiggerpicture.org
Public Health Literacy- degree to which individuals and groups can obtain, process, understand, evaluate, and act upon information needed to make public health decisions that benefit the community
1 in 3 white youth, 1 in 2 latino and black youth
Goal is to change conversation from medical story to the social story!! PLAY THE VIDEO!!
“We are the Answer”
Open Truth Now.ORG

11. What’s In A Word?: The Translation of Information
Translating Documents: What’s the Goal? To ensure that the meaning and context of the written message are conveyed as intended. Translating word for word does not work. Remember to see through the lens of those who we serve
Wilma Alvarado-Little , MA MSW
There are state, national, institutional Guidelines, Translating (writing) is a different skill set from Interpreting (oral) ex: EVERYTHING THAT HITS MY EARS I’m OBLIGATED TO INTERPRET
“Car seats in spanish baby talk” Instructions in Spanish: How to put in a car seat: What kind of messages does this send?
Nutritionally challenging :
Bran- culturally hispanics don’t eat bran- do you want to increase FIBER? Relationship to the translator is SO IMPORTANT.
How do you know it’s effective: WHO IS GOING TO BENEFIT?
Starbucks sign – “success here” bad translation= not trusting. IDEAL to have someone from the american translator association
Translators will have questions! (SHOW THIS)
From the crowd: “Wellness 101” – THINK ABOUT WHO IS GOING TO UNDERSTAND THIS
No Tocar = No Touch (Is this what you want for your community?)
Importance of a quality translation!! (impregnate vs embarrass)
American Translators Association.

12. Intergenerational Communication
Veterans/ Traditionalists ( )
Baby Boomers ( )
Gen X ( )
Millennial (Gen Y) ( )
Linksters (Gen Z) (born after 1995)
Jill Clutter , PHD, MCHES, Georgianna Sergakis, PHD RRT TTS FARC
V/T: Born , great depression, built much of nation’s infrastructure, patriotic, value home and family, respect authority, strong work ethic
Baby boomers- “sandwich generations” , caring for baby and parents, weighing down our healthcare system
Traditional families, live to work ethic (work is my id) , vietnam war, women’s lib/ civil rights, economic expansion, education as a birthright, age of TV (major means of communication), first touch tone phones ; general characteristics: workaholics, competitive, success oriented, challenge authority, value involvement ON THEIR OWN TERMS
Generation X , “Latch Key” kids, two working parents, work hard play hard, INDEPENDENCE, Dessert storm, nixon resignation, non-traditional family units (divorce 50%), “Get there” mentality about education, first computers1983 – first lap top , first cell phones and internet ; General characteristics: self reliant, skeptical non trusting, dislike being labeled, challenge the status quote, distrust authority, independent workers, value fun!
Millennial Helicopter parents “trophy kids” (participation trophy), play hard, work around that – multitasking change jobs every 16 months!!
Also called GEN y, Columbine / 9-11, Diversity , Indulged by parents, education viewed as great expense, technology dependent , first generation to have own cell phones and electronic devices, GEN Characteristics: Tech Savvy, multi-tasking (not necessarily good at this studies show) , high tolerance, need more supervision and structure (need more structure, guidelines), social, confident, collaborative, work with authority…
Linksters- born after 1995, Gen Z, “the Facebook Crowd”, Cell phone addiction, Child centered parenting, always connected, growing environmental awareness (not a whole lot of research here_)

13. Issues
Under-accommodation / over-accommodation *or the perception of such*
Think of what will work with a Baby Boomer vs. a Millenial, this is very different!
BE AWARE: Do a Self Assessment: Inventory your:
Beliefs, Motivation, Self-Efficacy, Norms & Environment
2. Listen
3. Understand
4. Enact
Baby boomers and millenials- very different
TECHNOLOGY: foreign territory, perhaps resistance
Respect- Baby Boomers’ grew up as Mr. and Mrs.
Loyalty is HUGE (compared to millenials)
Talking to BB: use formal titles instead of names, set of side time, place things in historical perspective, appreciating the experience
Millenials: they will see themselves as equals bc they are used to collobarative work, self efficacy is improved with guideleins, clear expectations
Successful strategies: allow them a voice, allow them to address work / life balance, faciltate collobaration (, present postivie message, creative, provide respect for the time
“assertive not aggressive communication”
CHECK THESE SLIDES OUT< SKILLS FOR WORKING INTERGENERATIONALLY ,
Resources: Generations, INC : From boomers to linksters---- managing the friction between generations at work. Johnson M & Johnson
Improving Intergenerational health care communication, Journal of Health Communication  Check out other resources

14. Resources
Health Insurance: CDC Health Literacy and clear communication index: Health Literacy Explains Racial Disparities in Diabetes Medication Adherence: Dr. Rima Rudd, Needs Assesment for hospitals: content/uploads/sites/135/2012/09/healthliteracyenvironment.pdf

15. Resources CDC Top 10 attributes of a health literate organization:
Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdf
Institute for Healthcare Advancement:
The Bigger Picture Campaign:
sugary drinks, health effects, and marketing
National Standards on Culturally and Linguistically Appropriate Services
US Dept. of Health and Human Services Office of Minority Health: &lvlID=15