1. Peggy Sissel-Phelan, Ed.D. Best Practices Working Group Health Literacy Section Arkansas Public Health Association Annual Conference May 12, 2011

2. Introduction of Concepts  Introduction of Concepts Rationale for Plain Language  Rationale for Plain Language Health Literacy Best Practices Plain Language  Skill Building Resources  Resources

3. Definition ~  Definition ~  Need ~  Scope ~

4. Definition ~ Health literacy is the use of a wide range of skills that improve the ability of people to act on information in order to live healthier lives. Health literacy is the use of a wide range of skills that improve the ability of people to act on information in order to live healthier lives. These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills. These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills. Health literacy allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate, and use information. Health literacy allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate, and use information. (Calgary Charter on Health Literacy, 2008)

5. Need ~  Need ~ 97 million adults in U.S. struggle with literacy 97 million adults in U.S. struggle with literacy That’s one third of the U.S. population... That’s one third of the U.S. population... Half of all adults 16+ Half of all adults 16+ l Find which foods contain a specific vitamin l Interpret a growth chart or table l Identify a specific location on a map l Use fractions Cannot

6. Race Race Class Class Ethnicity Ethnicity Education Education Isolation Isolation Poverty Poverty Age Age Gender Gender Cultural beliefs Cultural beliefs Language Language Need ~ Health Care Disparities Health Care Disparities

7. Primary Care Primary Care Prevention Prevention Access Access Diagnosis Diagnosis Treatment Treatment Specialties Specialties Prognosis Prognosis Insurance Insurance Medication Medication Compliance Compliance Need ~ Health Care Complexity Health Care Complexity

8. Need ~ NAAL results for Below Basic Group  37% have a HS or some college education  52% speak English as birth language  54% have no physical or mental disabilities Kutner M et al, Nat Center for Educ Statistics 2005

10. Definition ~  Definition ~ Understanding+ Actions = Outcomes Understanding+ Actions = Outcomes  Need ~ Widespread +Immediate Widespread +Immediate  Scope ~ The Public + The personnel in all health-related areas The Public + The personnel in all health-related areas

11. Practitioner’s role - give best possible care - communicate about the care Practitioner’s goal - best possible outcome - patient understanding

12. Practitioner’s responsibility - culturally competent - assume that everyone may have difficulty understanding - have knowledge of barriers to care - create environment that helps all patients understand

13. Patients have the right to understand health- care information that is necessary for them to safely care for themselves, and to choose among available alternatives. Healthcare providers have a duty to provide information in simple, clear, and plain language and to check that patients have understood the information before ending the conversation. The 2005 White House Conference on Aging; Mini-Conference on Health Literacy and Health Disparities.

14. - Locate - Form Questions - Understand - Act is clear and simple is clear and simple the goal - patients are better able to: the goal - patients are better able to:

15. Plain language guidelines have common set of principles Provider should: - identify the audience - adapt to their needs and abilities - have clear communication objective. Shohet & Renaud Critical Analysis on Best Practices in Health Literacy CANADIAN JOURNAL OF PUBLIC HEALTH Volume 97 (S2) pp. S10 - 13 2006

16. COMPLEX Passive sentences Long paragraphs Poly-syllable words Clinical language Past/mixed tense 3 rd person (they, s/he) PLAIN Active sentences Short paragraphs Mono or bi-syllable Colloquial language Present tense 2 nd or 1 st person (you, I 2 nd or 1 st person (you, I)

17. Health language/ Word Choice - No jargon and technical language - Use lay terms about health concepts - Terms clearly defined and explained - No abbreviations, acronyms and statistics

18. We are disseminating information about…. We are giving out information about… How do you administer the medication? How do you give the medicine? This product has an extensive list of symptoms that it treats… This medicine can help with many things like fever, or pain, etc…. It’ s Not Just Medical Terms...

19. Signage Intake forms Medications Treatment plan Self care directives Communication style Adequate time Feedback loop Pictures Sequence Demonstrations Video

20. Plain Writing Act of 2010 (Public Law No: 111-274) Federal agencies must use “plain writing” All “covered documents” issued to public ~ Letters, publications, forms, notices, instructions ~ Anything relevant to federal benefits or requirements

21. Alternative Words Using Plain Language Based on: Plain Language Alternatives for Patient Information and Consent Materials Copyright © Sharon Nancekivell 2002-2007. All rights reserved. Electronic or print redistribution of this work for nonprofit purposes is permitted, provided this notice is attached in its entirety. All unauthorized, for-profit redistribution is prohibited. AbdomenStomach /area around stomach Abscess Swollen area filled with a thick yellow or green liquid called pus

22. AccompanyGo with Aerosol Spray Swallow it Clump of blood By mouth Blood clot Biopsy Taking a small bit of tissue to test

23. Resources 1. Universal Precautions Tool Kit http://www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf 2. National Action Plan to Improve Health Literacy http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_ Action_Plan.pdf

24. Universal Precautions Tool Kit

25. Resources 3. Plain Language Alternatives for Patient Information and Consent Materials Copyright © Sharon Nancekivell 2002-2007. http://healthcare.partners.org/phsirb/consfrm_files/Plain_Language_Alternative s_for_Patient_Information_and_Consent_Materials.pdf 4. Pfizer Clear Health Communication Initiative http://www.pfizerhealthliteracy.com 5. NYU Patient and Family Resource Center http://www.nyupatientlibrary.org/medcenter/build-skills

26. Resources 6. Center for Health Care Strategies Health Literacy Fact Sheets http://www.chcs.org/publications3960/publications_show.htm?doc_ id=291711 7. Institute for Healthcare Advancement www.iha4health.org Michael Villaire, MSLM Director, Programs and Operations mvillaire@iha4health.org (800) 434-4633 x202 8. American Medical Association Health Literacy Program and Kit www. ama-assn.org

27. Resources 9. Help Your Patients Understand.” Video Available from AMA Foundation http://www.ama-assn.org/ama/pub/category/8035.html 10. http://www. plainlanguage.gov