1. Using Health Literacy Basics to Improve Interpretations, Translations, and Patient Outcomes Melissa Reyna, MPH, RN, ICCE Texas Health Resources 9-7-2012

2. Agenda What is health literacy? Why is health literacy important? How does health literacy affect interpretations and translations? Solutions for improving patient outcomes How to assess a document’s reading level Patient education councils Resources 2

3. Do I Look Like An Idiot? http://www.youtube.com/watch?v=dMAS 2S51bM8http://www.youtube.com/watch?v=dMAS 2S51bM8 3

4. 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 decisions and follow instructions for treatment.” (Healthy People 2020) Not only an individual’s traits/abilities, but a system’s/organization’s ability to create a functional environment (IOM, 2012) 4

5. Why is Health Literacy Important? ≥ 50% American adults have functional literacy issues (TJC, 2007) ≤ 12% American adults have proficient health literacy (National Assessment of Adult Literacy, 2006) Healthcare workers overestimate their ability to communicate information (Schillinger, et al., 2003) National Tipping Point for health literacy (Koh, et al., 2012) 5

6. Why is Health Literacy Important? Sudore, et al. (2009) ↓ Health literacy = ↓ Quality of care received ↓ Health literacy = ↓ Chronic disease management ↓ Health literacy = ↑ Likelihood of readmission Schillinger, et al. (2003) ↓ Communication = ↓ Patient satisfaction ↓ Communication = ↓ Patient outcomes Levinson, et al. (1997) ↓ Communication = ↑ Litigation Boulding, et al. (2011) ↓HCAHPS = ↑ 30-day readmissions 6

7. Why is Health Literacy Important? http://www.youtube.com/watch?v=BgTu D7l7LG8http://www.youtube.com/watch?v=BgTu D7l7LG8 (AMA Foundation, 2007) 7

8. How Does Health Literacy Affect Interpretations and Translations? 8

9. Advocacy Accuracy Cultural Awareness Professional Development Business Case 9

10. Solutions for Improving Patient Outcomes - Interpretations Slow down Use plain, non-medical language Show or draw pictures Limit the amount of information provided-and repeat it Use the teach-back technique Create a shame-free environment-encourage questions (Weiss, 2007) 10

11. Solutions for Improving Patient Outcomes - Translations General Content o Limit to one or two objectives o Limit to what patients really need to know o Use non-medical words o Appropriate content for age & culture Text Construction o At or below 6 th -grade level o One- or two-syllable words o Short paragraphs o Active voice o Simple tables & graphs (Weiss, 2007) 11

12. Solutions for Improving Patient Outcomes - Translations Fonts and Typestyle o Large font (12 minimum) & serifs o No more than two or three fonts styles o Upper- and lower-case text Layout o Empty space o Headings & subheadings o Bulleted lists o Useful illustrations (Weiss, 2007) 12

13. How to Assess a Document’s Reading Level Many different Readability Formulas Provide grade reading level for documents Examples: o Flesch-Kincaid (Microsoft Word) o Fry Readability Graph o McLaughlin's SMOG Formula o Gunning Fog Formula o Suitability Assessment of Materials (SAM) o Non-English available 13

14. Patient Education Councils Provide linguistically- and culturally- appropriate tools, experiences, policy, procedure, etc. Multidisciplinary Administrators & direct-care specialists Place at table for Interpreters and Translators 14

15. 15 Please contact me: Melissa Reyna, MPH,RN, ICCE Coordinator of Patient Education Texas Health Resources MelissaReyna@texashealth.org (682)236-6931

16. Resources http://www.youtube.com/watch?v=dMAS2S51bM8 http://www.youtube.com/watch?v=BgTuD7l7LG8 www.amafoundation.org/go/healthliteracy Boulding, et al. (2011). Relationship Between Patient Satisfaction with Inpatient Care and Hospital Readmission within 30 Days. American Journal of Managed Care, 17(1): 41-48. Brach and Noonan (2010). Health Literacy Universal Precautions Toolkit. US Department of Health and Human Services, Agency for Healthcare Research and Quality. AHRQ Publication No. 10-0046-EF. 16

17. Resources Brach, et al. (2012). Ten Attributes of a Health Literate Organization. Institute of Medicine. Doak, Doak, and Root (1996). Teaching Patients with Low Literacy Skills, Second Edition. JB Lippincott Company. Kanack, Susan (2009). Effectively Managing Patient Education: Going Beyond Joint Commission Requirements. HCPro, Inc. Koh, et al. (2012). New Federal Policy Initiatives to Boost Health Literacy Can Help Nation Move Beyond the Cycle of Costly ‘Crisis Care.’ Health Affairs, 31(2): 434-443. Levinson, et al. (1997). Physician-Patient Communication: The Relationship with Malpractice Claims Among Primary Care Physicians and Surgeons. Journal of the American Medical Association, 227: 553- 559. 17

18. Resources McGee, Jeanne and McGee & Evers Consulting, Inc. (2010). Toolkit for Making Written Material Clear and Effective. US Department of Health and Human Services, Centers for Medicare and Medicaid. CMS Product No. 11476. Schillinger, et al. (2003). Closing the Loop: Physician Communication with Diabetic Patients Who Have Low Health Literacy. Archives of Internal Medicine, 163: 83-90. Sudore and Schillinger. (2009). Interventions to Improve Care for Patients with Limited Health Literacy. Journal of Clinical Outcomes Management, 16(1): 20-29. Weiss, Barry (2007). Health Literacy and Patient Safety: Help Patients Understand, Second Edition. American Medical Association Foundation and American Medical Association. 18