1. INTEGRATING HEALTH LITERACY WITH BASIC SKILLS & FAMILY LITERACY PRACTICE J. Kimbrough, PhD & J. Gore, MSW

2. Health literacy is the ability to obtain, understand and use health information. Health literacy is an essential life skill for individuals. It helps people seek and use information to take control over their health. Health literacy is a public health imperative. Building health literacy improves overall population health Health literacy is an essential part of social capital. Low health literacy is a strong contributor to health inequities. Health literacy is a critical economic issue. A recent US study estimated that low health literacy costs the economy $73 billion per year. What is health literacy?

3. Who Is at Risk for Low Health Literacy? Anyone in the US – regardless of age, race, education, income or social class – can be at risk for low health literacy –Ethnic minority groups are disproportionately affected by low health literacy –The majority of people with low literacy skills in the US are white, native-born Americans –Older patients, recent immigrants, people with chronic diseases and those with low socioeconomic status are especially vulnerable to low health literacy

4. Why does it matter??? Adults with low health literacy: – Are often less likely to comply with prescribed treatment and self-care regimens – Make more medication or treatment errors – Fail to seek preventive care – Are at a higher risk for hospitalization than people with adequate literacy skills – Remain in hospital nearly 2 days longer – Lack the skills needed to negotiate the health care system People with low health literacy AND diabetes: – Were found to be less likely to have effective glycemic control – Were more likely to report vision problems caused by their diabetes

5. The Largest Study Conducted to Date on Health Literacy Found That… 33%Were unable to read basic health care materials 42%Could not comprehend directions for taking medication on an empty stomach 26%Were unable to understand information on an appointment slip 43%Did not understand the rights and responsibilities section of a Medicaid application 60%Did not understand a standard informed consent

6. US clinical research efforts to identify best practices increased prioritization of health literacy issue; evidenced by policy & national health goals national conferences to share findings leadership from NCSALL Health Literacy Status NC 2005 state conference clinical research at UNC localized projects health department emphasis on readability 2007 NC Institute of Medicine report & emphasis

7. Making an Impact…  Provider awareness & teaching skills  Consumer awareness & self-advocacy skills  General public awareness & demand for high quality healthcare for all

8. Consumer Awareness  One-on-one teaching in a healthcare setting  Health education materials at appropriate literacy levels  Group teaching in an adult education classroom or community-based setting

9. Content vs. skills Critical thinking Shared learning Teaching Health Literacy

10. Shared Goals… Different Roles Medical Professionals  Make health care services & resources available  Offer & explain appropriate screening procedures  Diagnose illnesses & develop a plan for patient care  Prescribe medicines & explain their purposes & side effects  Teach patients how to use medical tools  Suggest measures to protect individual & family health Adult Educators  Enhance students’ ability to complete forms, make inquiries & navigate new environments  Teach students to ask questions about tests, procedures & results  Develop students’ capacity to participate in planning by seeking clarification & offering suggestions  Teach students how to read medicine labels, calculate amounts & timing of dosages  Strengthen students’ ability to read charts and interpret ranges  Help students learn to locate information to guide their health- related decisions Content vs. Skills

11. Health Literacy Skills Basic Skills  Vocabulary  Navigation/reading maps/using health systems  Charts & graphs  Communicating with health professionals  Empowered decision- making Higher Skills  Researching health information – quality vs quackery  Risk & probability  Deconstructing media messages  Advocacy

12. Teaching Health Literacy Skills Health Activities FocusMaterials Adults are Expected to Use Tasks Adults are Expected to Accomplish Health Promotion Enhance and maintain health Food labels & recipes Articles in newspapers & magazines Charts & graphs Health ed. Booklets Purchase food Prepare food from recipes Plan exercise Maintain healthy habits Take care of everyday health (self & family)

13. Teaching Health Literacy Skills Health Activities FocusMaterials Adults are Expected to Use Tasks Adults are Expected to Accomplish Health Protection Safeguard health of individuals & communities Newspaper articles Water report in mail Health & safety posting at work Labels on cleaning products Decide among product options Use products safely Vote on community issues Avoid harmful exposures

14. Teaching Health Literacy Skills Health Activities FocusMaterials Adults are Expected to Use Tasks Adults are Expected to Accomplish Disease Prevention Engage in screening & early detection Postings for vaccinations & screenings Letters reporting test results Articles in newspapers & magazines Charts & graphs Take preventive action Determine risk Engage in screening or diagnostic tests Follow up on recommendations

15. Teaching Health Literacy Skills Health Activities FocusMaterials Adults are Expected to Use Tasks Adults are Expected to Accomplish Health Care & Maintenance Seek health care & form relationship with health care providers Health history forms Medicine labels Health education materials Directions for using health care tools Seek professional care when needed Describe symptoms Follow directions Measure symptoms Manage a chronic disease (follow a regimen, monitor symptoms, adjust regimen as needed, seek care when appropriate)

16. Teaching Health Literacy Skills Health Activities FocusMaterials Adults are Expected to Use Tasks Adults are Expected to Accomplish NavigationAccess health services including coverage and benefits Application forms Statements of rights & responsibilities Informed consent forms Benefit packages & forms Locate facilities Apply for benefits Fill out forms Offer informed consent

17. ADULT ESOL LESSON PLAN – TAKING MEDICATIONS LOW BEGINNING – HIGH BEGINNING ESOL COMPETENCY: Life Skills – Health and Nutrition  Read and interpret medical instructions for prescription and over the counter drugs. CULTURAL FOCUS: A person must follow medical instructions carefully in order to get well. If not taken as directed, medication can be dangerous. CLASSROOM PROCEDURE: 1.Teacher elicits and lists medication vocabulary. Teacher models pronunciation; students repeat. 2.Teacher explains the importance of following for using medication: for example take 2 tablets once a day; take with food. Students add additional common instructions. 3.Teacher elicits definitions of related vocabulary terms such as pill, capsule and teaspoon. Teacher shows examples of empty prescription bottles and over the counter drugs. 4.Teacher models and writes on board a sample conversation between patient and pharmacist. Teacher elicits important questions to prepare when talking to a pharmacist. Students practice role-playing. 5.In small groups, students discuss what is needed in a medicine cabinet. Name purpose for each item. (aspirin/headache, bandages/bleeding). GRAMMATICAL FOCUS: Imperatives and simple instructions: Shake well before using. Use this medicine in your ears. Do not operate machinery while using this medication. VOCABULARY: label medicine medication / drugs information prescription over the counter pharmacy shake well drowsiness/dizziness empty/refill pharmacist side effects pills / tablets / capsules appetite teaspoon / tablespoon overdose external use only emergency avoid take with meals take on an empty stomach take with a glass of water finish all medication unless otherwise prescribed PRONUNCIATION: Produce the beginning, middle and ending sounds in words. ness: drowsiness, dizziness tion: medication, information, prescription ine: medicine add s to pluralize nouns: pill(s), teaspoon(s), capsule(s) COMMUNITY RESOURCES: Bring in First Aid Kit or a variety of medical items (Tylenol, bandages, antibiotic creams, etc.) and empty medication bottles, measuring spoons, etc. TEXT BOOKS: Navigator book 2, p. 84-85 EVALUATION: Students show what is needed to stock a medicine cabinet. Students describe uses of medication. Students answer questions about sample medications. MATERIALS/ADDITIONAL RESOURCES: Activity sheets: Taking Medications, Identifying Over-the-counter Medication

18. 18 What does this medicine treat?

19. 19 Anthony  12 years old and weighs 93 lbs.  Soccer goalie.  Championship game today.  Anthony has allergies: stuffy, runny nose and sneezing; watery eyes.  Should he take this medicine? If so, how much? How often? What side effects should he look for?

20. 20 Drug Facts Label Active Ingredients And what they do

21. Health literacy education Ask Me 3 Coalition Building Becoming an Advocate for Health Literacy

22. What Is Ask Me 3  Promotes three simple, but essential, questions and answers for every healthcare interaction: Why Is It Important for Me to Do This? Context What Do I Need to Do? Treatment What Is My Main Problem? Diagnosis

23. UNCG ESOL lesson plans: http://www.uncg.edu/csr/pubhealthinitiatives.htm Resources on creating additional lesson plans: http://healthliteracy.worlded.org/docs/comp/Materials/curricula.html Picture Stories for Adult ESL Health Literacy: http://www.cal.org/caela/esl_resources/Health/healthindex.html Vocabulary Games http://iteslj.org/Techniques.Koprowski-RecyclyingVocabulary.html Practice Health Forms www.fda.gov/usemedicinesafely/my_medicine_record.htm Resources

24. Find out more about how you can help improve health literacy in your community. Contact the North Carolina Council on Health Literacy for more information and to join our state’s collaborative health literacy effort. Take Action!