1. Putting Information Into Health Literacy The Health Information Literacy Curriculum Originally sponsored by the Medical Library Association Originally funded by the National Library of Medicine Contract Number HHSN276200663511/NO1-LM-6-3511 Updated by the NN/LM MCR September 2012

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? A set of skills that people need to function effectively in the health care environment Source: Berkman et al (2011). Health literacy interventions and outcomes: an updated systematic review, pg. ES1.

4. Why is this Important? Estimated over 300 languages spoken in the United States More than 90 million Americans have low health literacy Source: The Joint Commission (2011). Facts About Patient-Centered Communications, p1.

5. Role of Health Communication and Health Information Technology Effective use of communication and technology can increase health literacy; Support shared decision-making; Provide new opportunities to connect with culturally diverse and hard-to-reach populations Source: Healthy People 2020: Health Communication and Health Information Technology Objectives.

6. 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

7. 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

8. Economic Impact Limited literacy costs the U.S. health care system between $50 and $73 billion per year Source: American Medical Association Foundation (2009). Health literacy and patient safety: manual for clinicians, pg. 7.

9. Health Literacy and Healthcare Costs 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. Health Literacy and Child Health Most written child health information remains too complex for most US adults to understand Adults with low health literacy are between 1.2 and 4 times more likely to exhibit negative parenting or child preventive care behaviors – including maternal depression, errors in dosing child medication, and decreased use of preventive-care services Source: Sanders et al (2009), Archives of Pediatrics & Adolescent Medicine. Literacy and Child Health: A Systematic Review, pg. 7.

11. Health Literacy and Cancer Screening Men with lower health literacy are 1.5 times less likely to know about colorectal cancer screening test, and 3.5 times more like to have never heard about it Women with limited health literacy were significantly less likely to ever have had a cervical cancer screening, with the majority of prevention materials written at a level of grade 12 Source: Dolan et al (2004), J Clin Oncol., Garbers et al (2004), Prev Chronic Dis.

12. 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: Bennett et al (2009), Cho et all (2008), White et al (2008).

13. Health Literacy and Asthma Limited literacy had a significant impact on quality of life, risk of ER visit or hospitalization, or worse disease control for African Americans and Latino adults – more so than socioeconomic factors Source: Curtis et all (2012). Journal of Asthma.

14. Health Literacy and Diabetes Education Patients with low literacy had significantly lower increase in knowledge regarding diabetes-related concepts than those with higher literacy in a before and after multimedia educational intervention Source: Kandula et al (2009) Patient Education and Counseling.

15. 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

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

17. Health Literacy in the U.S. 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). Intermediate Proficient Below Basic Basic 53% 22% 13% 12%

18. 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

19. 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.

20. Health Literacy From the Patients Perspective Mr. Bell Mrs. Cordell Source: Help Your Patients Understand. AMA Foundation Health Literacy.

21. Strategies to Improve Health Literacy Use plain language Limit information (3-5 key points) Use easy-to-read print materials Practice teach-back Use Information Rx

22. Medical Hypertension Insomnia Benign Hazardous Disorder Option Routinely Adverse Plain Language High blood pressure Cant sleep NOT cancer Dangerous Problem Choice Often Bad Plain Language

23. Teach-Back Method Source: Help Your Patients Understand. AMA Foundation Health Literacy.

24. Easy-to-Read Materials Deciphering Medspeak Brochures HIV Cancer Diabetes Other Source: www.mlanet.org/resources/medspeak/.www.mlanet.org/resources/medspeak/

25. Information Rx

26. www.MedlinePlus.gov

27. Interactive Health Tutorials

28. www.NIHSeniorHealth.gov

29. Source: www.library.tufts.edu/hsl/spiral/www.library.tufts.edu/hsl/spiral/

30. 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* MedlinePlus.gov* Noah-health.org* NIHSeniorHealth.gov Source: Medical Library Association. www.mlanet.org.www.mlanet.org

31. 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

32. 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

33. 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

34. Thank You! Questions? Comments?