5. What Is Health Literacy? This slide contains video clips of patients discussing their health literacy experiences. Patients describe in their own words their difficulties reading medication labels, understanding informed consent forms, and following a drug regimen. In the words of one patient, "It's just a language that I'm not familiar with." The video is produced by the Academy of Educational Development in collaboration with the Institute of Medicine with special thanks to the American Medical Association Foundation and the National Center for the Study of Adult Learning and Literacy.
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20. Percentage of Adults in Each Literacy Level: 2003 Source: National Center for Education Statistics, Institute for Education Sciences
21. Nonliterate in English Source: National Center for Education Statistics, Institute for Education Sciences
22. Difficulty of Selected Health Literacy Tasks Below Basic Basic Intermediate Proficient Circle the date of a medical appointment on a hospital appointment slip. (101) Give two reasons a person should be tested for a specific disease, based on information in a clearly written pamphlet. (202) Determine what time a person can take a prescription medication, based on information on the drug label that relates the timing of medication to eating. (253) Calculate an employee’s share of health insurance costs for a year, using a table. (382) Source: National Center for Education Statistics, Institute for Education Sciences 500 0 Average score: 245
23. Percentage of Adults in the Below Basic Health Literacy NAAL Population: 2003 1 The “Did not obtain health information over the Internet” category does not include prison inmates. 2 Disabilities include vision, hearing, learning disability, and other health problems. Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, 2003 National Assessment of Adult Literacy (NAAL)
24. Percentage of Adults in Each Health Literacy Level, by Self-Assessment of Overall Health: 2003 Source: U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, 2003 National Assessment of Adult Literacy
25. Sources of Health Information Percentage of adults with Below Basic or Basic health literacy who get little or no health information from the following sources: Source: National Center for Education Statistics, Institute for Education Sciences 29% 33% Radio or TV 30% 35% Healthcare Providers 40% 47% Family or Friends 51% 59% Newspapers 45% 62% Books or Brochures 47% 64% Magazines 70% 85% Internet Basic Below Basic Source
Note on #3 Culture: Culture is broadly defined to encompass the values, norms, symbols, ways of living, traditions, history, and institutions shared by a groups of people (this definition is from the Pink Book Making Health Communication Programs Work ). Demographic factors are discussed in greater detail in the “Improving the Usability of Health Information” section.
What do we mean by this last bullet? Possessing the skills needed for basic literacy does not guarantee that a person can read and comprehend all types of written text. Example: Health professionals may converse easily with colleagues in their specialized field but find it difficult to communicate with patients or the lay public.
What do we mean by the second bullet? Health information learned in school is often outdated or forgotten. Health information provided in a stressful or unfamiliar situation is unlikely to be retained. In addition: Healthcare professionals must deal with information abundance and constant medical advances. Their information may be outdated or incomplete.
Healthcare professionals have their own culture and language (for example, the “culture of medicine”). This can affect how they communicate with the public.
In addition: Recommendations from health professionals are numerous and may be confusing, contradictory, or not oriented toward actions that individuals can take.
Remember, health literacy is the ability of individuals to understand health information.
Give an example or tell a story here.
HANDOUT REALM is a medical-word recognition and pronunciation test. It can be administered and scored in under 3 minutes. Participants read from a list of 66 common medical terms that patients may be expected to read in order to participate effectively in their own healthcare. The words are arranged in thee columns according to the number of syllables and pronunciation difficulty. Scores can be converted into four reading grade levels. The TOFHLA includes a 17-item test of numerical ability and a 50-item test of reading comprehension. The test draws on materials commonly used in healthcare settings (for example, the patient “Rights and Responsibilities” section of a Medicaid application). Total scores for the TOFHLA are divided into three levels: inadequate, marginal, and adequate. There is also an abbreviated version called the S-TOFHLA that takes 12 minutes or less to administer. Both the IOM and AHRQ reports conclude that REALM and TOFHLA are assessments of reading ability, and, as such, are inadequate measures of health literacy.
Health literacy measures are unable to account for the demands of the healthcare system and the demands of the situation/context. The take away point = we need better tools!
Tell story here.
In the studies cited in the next three slides, health literacy was measured by the Rapid Estimate of Adult Literacy (REALM) or Test of Functional Health Literacy in Adults (TOFHLA). Persons with limited health literacy were compared to those with adequate health literacy. Although an increasing number of studies have linked limited health literacy to poor health, the causal relationship between health literacy and health is unknown. For example, persons with poor health literacy may skip preventive measures because of lack of financial resources.
In these studies, health literacy was measured by the Rapid Estimate of Adult Literacy (REALM) or Test of Functional Health Literacy in Adults (TOFHLA). Persons with limited health literacy were compared to those with adequate health literacy. Although an increasing number of studies have linked limited health literacy to poor health, the causal relationship between health literacy and health is unknown.
In these studies, health literacy was measured by the Rapid Estimate of Adult Literacy (REALM) or Test of Functional Health Literacy in Adults (TOFHLA). Persons with limited health literacy were compared to those with adequate health literacy. Although an increasing number of studies have linked limited health literacy to poor health, the causal relationship between health literacy and health is unknown.
Former Secretary Tommy Thompson identified health literacy as a priority in the Department’s Prevention Initiative. Health literacy was the topic of one of the five Secretary’s Workgroups in Prevention. The workgroups provided the basis for the report Prevention: A Blueprint for Action .
Surgeon General Carmona chaired the Secretary’s workgroup and continues his commitment to improving health literacy by including it as one of his public health priorities.
HANDOUT Healthy People 2010 is a set of health objectives for the Nation to achieve over the first decade of the new century. It can be used by many different people, states, communities, professional organizations, and others to help them develop programs to improve health. Healthy People 2010 is designed to achieve two overarching goals: Goal 1: Increase Quality and Years of Healthy Life The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life. Goal 2: Eliminate Health Disparities The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population. Each of the 28 focus area chapters also contains a concise goal statement. This statement frames the overall purpose of the focus area.
NIH PA: The next application due date is October 13, 2006; a letter of intent is due on September 13, 2006. R01: http://grants.nih.gov/grants/guide/pa-files/PAR-04-116.html R03: http://grants.nih.gov/grants/guide/pa-files/PAR-04-117.html
The Department workgroup is composed of members from HHS agencies and offices. We meet every-other month. In addition, individual agencies have their own health literacy workgroups (HRSA, AHRQ, NIH, FDA) and health literacy coordinators. There is an HHS health literacy workgroup Web site on the HHS intranet . The site contains information on the workgroup, upcoming meetings, a list of health literacy coordinators from each agency, and relevant reports and resources – including the toolkit and action plan. You may want to add agency-specific information. Check with health literacy coordinators from other agencies if you want to make comparisons.
The information in the following slides is a summary of best practices in print communication that can aid in improving health literacy. Many of these concepts are discussed indepth in the National Cancer Institute’s Making Health Communication Programs Work (a.k.a. the “Pink Book”) and in the Centers for Disease Control and Prevention’s tool CDCynergy .
Source: Based on the OMH cultural competency definition. HANDOUT OMH has developed a comprehensive set of standards for Culturally and Linguistically Appropriate Services (CLAS) to help health professionals respond to cultural and linguistic issues presented by diverse populations. The CLAS standards provide consistent definitions of culturally and linguistically appropriate services. They address organizational structures and policies that help healthcare professionals respond to cultural and linguistic issues presented by diverse populations.
These are just a few plain language techniques; others include using pronouns, headers, lists, and bullets. A plain language document is one in which people can, with reasonable time and effort: find what they need; understand what they find; and act appropriately on that understanding. To learn more about plain language, consider signing up for the Plain Language course offered through HHS University. Visit www.plainlanguage.gov.
OMB polices can be found at: http://www.firstgov.gov/webcontent/policies_and_implementation.shtml
For more on usability, visit www.usability.gov.
26% of patients at a public hospital couldn’t understand from their appointment card when their next appointment was scheduled.
Hablamos Juntos is working on developing a set of universal symbols for healthcare. For more information visit http://www.hablamosjuntos.org/.
Public Law 109-18 authorized $25 million in grants over five years to establish patient navigator programs in low-income and rural communities nationwide. Under the system, patient navigators would help uninsured patients evaluate their treatment options, as well as help them obtain referrals, find clinical trials, and apply for financial assistance.
In addition to senior staff, target all those who review documents for clearance.
Optional interactive piece: Have participants break up into these five groups according to their primary job functions. Have each group come up with two concrete examples of how they can integrate health literacy into their work. Then regroup and report back. (Suggested time: 10 minutes) After you’ve heard examples from each group, go through the following slides together.
Public = non-HHS lay and professional audiences This section can be adapted, depending on your audience.
Note on this last bullet : This is similar to efforts to encourage journalists to cover the public health dimensions embedded in otherwise routine stories about crime and accidents. When pitching a story, use real-life examples.
Please note, this may not be appropriate for all FOAs (for example, if you are working with animals).
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