1. The Health Information Literacy Curriculum Sponsored by the Medical Library Association Funded by the National Library of Medicine Contract Number HHSN276200663511/NO1-LM-6-3511 2008

2. Learning Objectives Recognize the impact low health literacy has on patient care Name five strategies and resources to improve health literacy Describe the health literacy services offered by the library

3. 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. Healthy People 2010

4. What factors affect Health Literacy? Health literacy is dependent on individual and system factors Communication skills Information and knowledge Culture and language Demands of the system

5. Why is Health Literacy Important? Low health literacy is linked to… Under-utilization of services Increased medication errors Poor knowledge about health Increased hospitalizations Poor health outcomes Increased healthcare costs

6. Health Literacy and Cancer Screening Women with low health literacy are less likely to have had a mammogram or Pap test than women with higher health literacy skills Source: Davis, et al (1996). Caner. Lindau, et al (2002). Am J Obstet Gynecol.

7. Health Literacy and HIV / AIDS Knowledge Source: Kalichman, et al (2000). Am J Prev Med.

8. Health Literacy and Diabetes Management Percent of patients with diabetes correctly answering questions according to literacy level (low, moderate, high) Need to Know: symptoms of low blood sugar (hypoglycemia) Need to Do: correct action for hypoglycemic symptoms Low Moderate High Low Moderate High Source: Williams, et al (1998). Arch Int Med.

9. Health Literacy and Healthcare Costs $2,891 $10,688 Annual Healthcare Costs of Medicaid Enrollees Source: Weiss, et al (2004). J Am Board Fam Pract. (<3 rd -grade reading level)(>4 th -grade reading level)

10. How is Information Critical to Health Literacy? Health information is key to: Patient and provider communication Shared health care decision making Understanding and following directions Recognizing when to seek care Learning and adopting healthy behaviors

11. What are the Challenges? Health literacy in the U.S. Readability of health materials Health information and the Internet

12. Health Literacy in the U.S. Intermediate Basi c Below Basic Proficient 13% 12% 53 % 22% 77 million adults have basic or below health literacy skills Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics (2006). Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics (2006). http://nces.ed.gov/naal/health.asp http://nces.ed.gov/naal/health.asp

13. Readability of Health Information Over 300 studies show health-related materials far exceed the reading ability of U.S. adults Increasing number of studies show similar results when looking at the readability of online health information Source: NLM BibliographyUnderstanding Health Literacy and Its Barriers (2004). www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html

14. Health Information and the Internet 80% of Internet users search for health information 75% rarely or never check the source and date 72% express trust in most or all information found online Source: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC:Pew Internet & American Life Project. Source: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC: Pew Internet & American Life Project. www.pewinternet.org/PPF/c/5/topics.aspwww.pewinternet.org/PPF/c/5/topics.asp

15. Health Literacy From the Patients Perspective Source: Help Your Patients Understand. AMA Foundation Health Literacy. www.ama-assn.org/ama/pub/ category/9913.html www.ama-assn.org/ama/pub/ category/9913.htmlwww.ama-assn.org/ama/pub/ category/9913.html Mrs. Cordell Mr. Bell

16. Strategies to Improve Health Literacy Use living room language Limit information (3-5 key points) Use easy-to-read print materials Practice teach-back Use Information Rx Address culture and language needs

17. Living Room Language Name common terms for… Hypertension Insomnia Benign Hazardous Disorder Option Poultry Routinely

18. Ask Me 3 – National Patient Safety Foundation www.npsf.org/askme3

19. Teach-Back Method Source: Help Your Patients Understand. AMA Foundation Health Literacy. Source: Help Your Patients Understand. AMA Foundation Health Literacy. www.ama- assn.org/ama/pub/category/9913.htmlwww.ama- assn.org/ama/pub/category/9913.html

20. Easy-to-Read Materials Deciphering Medspeak Brochures HIV Cancer Diabetes Other www.mlanet.org/resources/medspeak/index.html

21. Information Rx

22. www.MedlinePlus.gov

23. Interactive Health Tutorials

24. www.NIHSeniorHealth.gov

25. www.library.tufts.edu/hsl/spiral/

26. Top 10 Most Useful Consumer Health Websites Cancer.gov * CDC.gov * Familydoctor.org * Healthfinder.gov * HIVInsite.ucsf.edu * * Available in Spanish KidsHealth.org * Mayoclinic.com Medem.com MedlinePlus.gov * Noah-health.org * Source: Medical Library Association. www.mlanet.org www.mlanet.org

27. How Can Librarians Help? Free access to the Internet Information Rx Program Patient information packets Consumer health collection Native language resources Teaching and training Virtual chat / email assistance Health literacy workgroup

28. Why Now? Why Hospitals? The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care. The Joint Commission Source: What did the Doctor Say?: Improving Health Literacy To Protect Patient Safety. The Joint Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm www.jointcommission.org/PublicPolicy/health_literacy.htm

29. Take Home Points Accurate and reliable health information is critical to health literacy Use Information Rx to refer patients to reliable health information and to the library for help Librarians are available to address the health literacy needs of patients and providers

30. Thank You! Questions? Comments?

31. References AHRQ ReportLiteracy and Health Outcomes (2004) www.ahrq.gov/clinic/epcsums/litsum.htm www.ahrq.gov/clinic/epcsums/litsum.htm AMA Foundation Health Literacy www.ama-assn.org/ama/pub/about-ama/our-people/affiliated- groups/ama-foundation/our-programs/public-health/health- literacy-program.shtml AMA Foundation Health Literacy www.ama-assn.org/ama/pub/about-ama/our-people/affiliated- groups/ama-foundation/our-programs/public-health/health- literacy-program.shtml www.ama-assn.org/ama/pub/about-ama/our-people/affiliated- groups/ama-foundation/our-programs/public-health/health- literacy-program.shtml www.ama-assn.org/ama/pub/about-ama/our-people/affiliated- groups/ama-foundation/our-programs/public-health/health- literacy-program.shtml Fox, S. & Fallows, D. (2003) Internet Health Resources. Washington, DC:Pew Internet & American Life Project Fox, S. & Fallows, D. (2003) Internet Health Resources. Washington, DC: Pew Internet & American Life Project www.pewinternet.org/Reports/2003/Internet-Health- Resources.aspx www.pewinternet.org/Reports/2003/Internet-Health- Resources.aspx Healthy People 2010, Health Communication, Objective 11-2 www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm IOM ReportHealth Literacy: A Prescription To End Confusion (2004) www.iom.edu/CMS/3775/3827/19723.aspxwww.iom.edu/CMS/3775/3827/19723.aspx

32. References NLM BibliographyUnderstanding Health Literacy and Its Barriers (2004) www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html The Health Literacy of Americas Adults: Results from the 2003 National Assessment of Adult Literacy (2007) http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483 The Health Literacy of Americas Adults: Results from the 2003 National Assessment of Adult Literacy (2007) http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483 http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483 The Joint Commission Report: What did the Doctor Say?: Improving Health Literacy To Protect Patient Safety (2007) www.jointcommission.org/PublicPolicy/health_literacy.htm The Joint Commission Report: What did the Doctor Say?: Improving Health Literacy To Protect Patient Safety (2007) www.jointcommission.org/PublicPolicy/health_literacy.htm www.jointcommission.org/PublicPolicy/health_literacy.htm Medical Library Association Top 10 Most Useful Consumer Health Websites www.mlanet.org/resources/medspeak/topten.html Medical Library Association Top 10 Most Useful Consumer Health Websites www.mlanet.org/resources/medspeak/topten.html www.mlanet.org/resources/medspeak/topten.html

33. Pilot Site Librarians Martha Prescott, Berkshire Medical Center Health Sciences Library Tori Koch and Kim Hart, Billings Clinic Medical Library Andrea Harrow, Good Samaritan Hospital Health Sciences Library Holly Kimborowicz, Lake Hospital System Medical Library Jeff Mason and Mary Chipanshi, Regina General Hospital Health Sciences Library Julie Smith, St. Joseph Hospital Burlew Library Denise Rumschlag and Carolyn Martin, St. Vincent Hospital Library Lenora Kinzie, Stormont-Vail Healthcare Stauffer Health Sciences Library, and Scarlett Fisher-Herreman, Topeka & Shawnee County Public Library Geneva Bush Staggs and Beverly Rossini, University of South Alabama Biomedical Library Acknowledgements

34. Project Advisors Elliot Siegel, Robert Logan, Angela Ruffin, Lisa Boyd, Susan Barns, Cindy Olney, Kathy Schilling, Marge Kars, Terry Jankowski, Barbara Bibel, and Cathy Boss Health Information Literacy Research Project Sabrina Kurtz-Rossi, Project Coordinator Jean P. Shipman, Co-Principal Investigator Carla J. Funk, Co-Principal Investigator Acknowledgements