oral health literacy

1. HEALTH LITERACY
DR.AESHA ZAFNA
2ND YEAR POST GRADUATE
DEPT.OF COMMUNITY DENTISTRY

2. • Introduction
• Historical Background
• Definitions
• What is health literacy
• Why is health literacy important?
• Health Literacy Framework
• Factors Impacting Health Literacy
• Measuring Health Literacy
• Layers of Health Literacy
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3. • General themes of health literacy
• Implication in Dental Public Health
• Strategies for improving health literacy
• Health Literacy Rates
• Various Programs in India
• Conclusion
• References
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4. INTRODUCTION
• Education is the process of facilitating learning, or the
acquisition of knowledge, skills, values, beliefs, and habits.
• Literacy is the ability to read and write or competence of
knowledge in a specified area.
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5. HISTORICAL BACKGROUND
• Interest in the relationship between literacy and health has
resulted in the development of the construct of health literacy,
a term which was first applied in the 1970s (Simonds 1974).
• Over the last two decades, health literacy research has gained
momentum as an important area of inquiry and public health
priority, particularly in the United States.
• However, there are ongoing debates over the meaning and
definition of the concept.
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6. Literacy - Definition
• Literacy = literate + cy
• Meaning “the ability to read and write”
National Literacy Act (1991)
• The ability to read, write, speak and compute and solve
problems at levels of proficiency necessary to function on
the job and in society, to achieve one’s goals and develop
one’s knowledge and potential.
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7. Importance of Literacy Skills
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8. HEALTH LITERACY
World Health Organisation (WHO):
• Health literacy represents the cognitive and social skills which
determine the motivation and ability of individuals to gain
access to, understand and use information in ways which
promote and maintain good health.
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9. Oral health literacy 9
Nutbeam (1998) :
• Health literacy means more than being able to read pamphlets and
successfully make appointments.
• By improving people’s access to health information and their
capacity to use it effectively, health literacy is critical to
empowerment.

10. • In 1999, the Ad Hoc Committee on Health Literacy for the
Council on Scientific Affairs of the American Medical
Association (AMA) highlighted the importance of patients
possessing basic Health Literacy skills to be able to read and
understand health related materials, and defined health literacy
as: “A constellation of skills, including the ability to perform
basic reading and numerical skills required to function in the
health care environment.”
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11. Ratzan and Parker (2000)
• Health literacy is “the degree to which individuals have the
capacity to obtain, process and understand basic health
information and services needed to make appropriate health
decisions.”
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12. IOM (2004)
• Health literacy is the interaction between skills of individuals
and demands of the healthcare system.
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13. Oral Health Literacy - Defined
Healthy People (2010)
• “The degree to which individuals have the capacity to obtain,
process and understand basic oral health information and
services needed to make appropriate health decisions.”
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14. Importance of Oral health Literacy
• We each recognize that oral health is an integral part of
general health.
• What we may not recognize is that oral health literacy is
essential to our ability to increase access to oral health.
• Health Literacy is inextricably linked to improving oral
health… especially among low income groups
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15. Studies have shown oral health literacy to be associated with:
• Level of knowledge
• Dental care visits
• Caries severity
• Oral health quality of life
• Failed appointments/no shows
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16. • In addition to basic literacy skills, health literacy requires
knowledge of health topics.
• It includes numeracy skills.
• For example, calculating cholesterol and blood sugar levels,
measuring medications, and understanding nutrition labels all
require math skills.
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17. • People with limited health literacy often lack knowledge or
have misinformation about the body as well as the nature
and causes of disease.
• Without this knowledge, they may not understand the
relationship between lifestyle factors such as diet and
exercise and various health outcomes.
• Health information can overwhelm even persons with
advanced literacy skills. What people may have learned
about health or biology during their school years often
becomes outdated or forgotten, or it is incomplete.
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18. Health literacy affects people's ability to:
• Navigate the healthcare system, including filling out complex
forms and locating providers and services
• Share personal information, such as health history, with
providers
• Engage in self-care and chronic-disease management
• Understand mathematical concepts such as probability and risk
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19. • Only 12 percent of adults have Proficient health literacy,
according to the National Assessment of Adult Literacy.
• In other words, nearly nine out of ten adults may lack the skills
needed to manage their health and prevent disease.
• Fourteen percent of adults (30 million people) have Below
Basic health literacy.
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20. • These adults are more likely to report their health as poor and
are more likely to lack health insurance (28%) than adults with
Proficient health literacy.
• Low literacy has been linked to poor health outcomes such as
higher rates of hospitalization and less frequent use of
preventive services.
• Both of these outcomes are associated with higher healthcare
costs.
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21. • Hence health literacy is necessary to understand basic health
information and services needed to make appropriate health
decisions.
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22. Concept of health literacy
• The term ‘literacy’ has been applied to a range of contexts
including, political, financial, environmental, family, media
and health.
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23. Oral health literacy 23

24. Oral health literacy 24

25. HEALTH LITERACY
FRAMEWORK (GILLIS 2006)
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26. HEALTH LITERACY CONCEPTUAL
FRAMEWORK (ROOTMAN, 2009)
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27. Factors Impacting Health Literacy
Health Literacy is dependent upon individual and systemic
factors
• Communication Skills
• Knowledge of health topics
• Culture and Society
• Demands of the healthcare
System
• Demands of the situation/context or Context
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28. Communication Skills
• Dependent on -consumers and providers.
• Include literacy skills—reading, writing, numeracy, speaking,
listening and understanding.
• Context specific -patients and providers.
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29. Knowledge of Health Topics
• Health literacy is dependent on knowledge of consumers and
providers of health topics.
• Patients with limited or inaccurate knowledge about the body
and causes of disease may not:
a) Understand the relationship between lifestyle factors (e.g. diet
and exercise or oral hygiene and diabetes control) and health
outcomes
b) Recognize when they need to seek care
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30. c) Have current prevention information.
d) Providers who do not keep current with the state of the
science cannot provide accurate knowledge and information
and evidence-based services for their patients.
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31. Culture and Society
•How people communicate and understand health information
• How people think and feel about their health
• If and how people value oral health
• When and from whom people seek care
• How people respond to recommendations for lifestyle changes
and treatment
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32. Culture affects providers:
• How providers communicate and understand health information
•How providers think and feel about racial/ethnic/economic
groups other than their own
• How providers value oral health
• When and from whom people seek care
• If and how providers respond to evidence—based
recommendations and guidelines
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33. Demands of Healthcare System
Individuals need to:
• Know how to locate and navigate a health facility
• Read, understand, and complete many kinds of forms to receive
treatment and payment reimbursement
• Articulate their signs and symptoms
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34. •Know about various types of health professionals and what
services they provide and how to access those services
•Know how and when to ask questions or ask for clarification
when they do not understand
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35. Assessing Health Literacy
•The first assessment of health literacy among American
adults found that nearly 80 million are not able to find or
understand relatively simple health related information.
• Current population data on literacy come from the 2003
National Assessment of Adult Literacy (NAAL):
Health literacy data from the NAAL were released in 2006.
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36. Measuring Health Literacy
•Health literacy is measured as functional literacy—people’s
ability to apply reading skills to everyday tasks.
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37. Measuring Health Literacy
Measures of health literacy at the individual level were developed
in the 1990s:
• Rapid Estimate of Adult Literacy in Medicine (REALM)
• Test of Functional Health Literacy in Adults (TOFHLA and
STOFHLA)
• Newest Vital Sign (NVS)
• Literacy Assessment for Diabetes (LAD)
• Rapid Estimate of Adult Literacy in Dentistry (REALD)
• Test of Functional Health Literacy in Dentistry (TOFHLiD )
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38. The Rapid Estimate of Adult Literacy in Medicine (REALM)
• screening instrument to assess an adult patient's ability to read
common medical words and lay terms for body parts and
illnesses.
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39. Oral health literacy 39

40. Oral health literacy 40

41. Short Test of Functional Health Literacy in Adults
(STOFHLA) :
• When being assessed, patients are asked to read and complete
passages that might be found in health care settings by
inserting missing words at selected intervals.
• More specifically, they are prompted to choose the correct
word from a list of four possibilities at each place where a
word has been removed from the text.
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42. • Two generic passages are used:
• the first, which has sixteen missing words, is a set of
instructions disseminated to patients prior to an upper GI
series (X-ray examination) while the
• second, which has twenty missing words, comes from the
patient rights and responsibilities section of a Medicaid
application form.
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43. • Functional health literacy scores are computed as the sum of
patients’ correct answers to the thirty-six total items
comprising the STOFHLA. It is recommended that scores be
interpreted as follows:

44. Newest Vital Sign (NVS)
• It is a new tool designed to quickly and simply assess a
patient’s health literacy skills.
• It can be administered in only 3 minutes and is available in
English and Spanish.
• The patient is given a specially designed ice cream nutrition
label to review and is asked a series of questions about it.
• Based on the number of correct answers, health care providers
can assess the patient’s health literacy level and adjust the way
they communicate to ensure patient understanding.
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45. • A nurse (or other trained clinic staff) is the preferred
administrator of the Newest Vital Sign.
• Administer the NVS at the same time that the patient’s other
vital signs are being taken.
• Record the NVS score in the patient’s chart, preferably near
other vital sign measures.
• Tailor communication to ensure patient understanding.
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46. • Starts by asking 6 questions, one by one, giving the patient as
much time as needed to refer to the nutrition label to answer
the questions.
• Ask the questions in sequence. However, if question 5 is
answered incorrectly, do not ask question 6.
• You can stop asking questions if a patient gets the first four
correct.
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47. • Do not prompt patients who are unable to answer a question.
• Do not show the score sheet to patients.
• Do not tell patients if they have answered correctly or
incorrectly.
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48. • Score by giving 1 point for each correct answer (maximum 6
points).
• Score of 0-1 suggests high likelihood (50% or more) of
limited literacy.
• Score of 2-3 indicates the possibility of limited literacy.
• Score of 4-6 almost always indicates adequate literacy.
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49. Test of Functional Health Literacy in Dentistry
(TOFHLiD)
Test of Reading Comprehension
• HAND PATIENT THE READING COMPREHENSION
PASSAGES TO READ.
a) These instructions are in sentences with some of the words
missing.
b) For every missing word a blank line is drawn. Below it 4
words are written that could go in the blank space.
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50. • PASSAGE A: INSTRUCTIONS FOLLOWING
VARNISH APPLICATION
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51. PASSAGE B: CONSENT FORM FOR DENTAL
TREATMENT
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52. PASSAGE C: MEDICAID RIGHTS AND
RESPONSIBILITIES
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53. Disadvantages of health literacy measures:
Health literacy measures based on functional literacy do not
capture the full range of skills needed for health literacy.
Current assessment tools (for population and individuals) cannot
differentiate among:
• Reading ability
• Lack of health-related background knowledge
• Lack of familiarity with language and materials
• Cultural differences in approaches to health
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54. Who Is at Risk?
The problem of limited health literacy is greater among:
• Older adults
• People with low income levels
• People with less than a high school degree
• Racial and ethnic minority populations
• Persons with Limited English
Proficiency (LEP)
• People with compromised
health status.
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55. • Provided a major impetus to increasing the concept of
health literacy by devoting a chapter to health
communication.
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56. NAAL (National Assessment of Adult Literacy)
• The 2003 National Assessment of Adult Literacy is a
nationally representative assessment of English literacy
among American adults age 16 and older.
• It is now the most current indicator of the nation's
progress in adult skills in literacy, numeracy, and
problem solving in technology-rich environments.
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57. NAAL includes a number of components that capture the
breadth of adult literacy in the United States:
• Background Questionnaire
• Prison Component
• State Assessment of Adult Literacy (SAAL)
• Health Literacy Component
• Fluency Addition to NAAL (FAN)
• Adult Literacy Supplemental Assessment (ALSA)
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58. MEPS (Medical Expenditure Panel
Survey)
• It is a set of large-scale surveys of families and individuals, their
medical providers, and employers across the United States.
• MEPS is the most complete source of data on the cost and use
of health care and health insurance coverage.
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59. Questions
• How often did health providers listen carefully to you?
• How often did health providers explain things in a way you
could understand?
• How often did health providers show respect for what you had to
say?
• How often did health providers spend enough time with you?
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60. Oral Health in America: A Report
of the Surgeon General - 2000
• Highlighted the importance of oral health literacy
• Illustrated the lack of oral health literacy by what the public and
health providers know and practice with regard to preventing or
controlling dental caries, gingivitis and oral cancers.
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61. A National Call to Action to Promote Oral
Health - May 2003
• Change perceptions of oral health among the public, policy
makers and health providers
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62. •Established National Oral Health Literacy Advisory
Committee 2007
• Created a plan of action
• Conducted surveys among dentists, dental hygienists and
dental assistants 2009
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63. • Health literacy in dentistry is multidimensional, context-
specific and is usually influenced by individual literacy skills,
psychosocial dynamics, and various health contexts (i.e.,
anxiety experienced during a dental encounter, complexity of
information being described and/or the ability of the dental
provider to effectively communicate).
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64. Six general themes that help determine why
health literacy is
important for population health:
1. The large number of people affected;
2. Poor health outcomes;
3. Increasing rates of chronic disease;
4. Health care costs;
5. Health information demands; and
6. Equity.
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65. Oral health literacy is defined as “The degree to which
individuals have the capacity to obtain, process and understand
basic oral health information and services needed to make
appropriate health decisions.”
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66. Oral Health Literacy Framework
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67. Oral health literacy is considered to be obtained and
processed the following way:
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68. There are five important key dimensions for oral health literacy.
1. oral health care system knowledge and utilization
2. basic oral health knowledge
3. market and consumer behavior
4. oral health competencies at the workplace
5. political participation
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69. Users (Patients) Need to:
• Know how to locate and navigate a health facility
• Read, understand, and complete many kinds of forms to receive
treatment and payment reimbursement
• Articulate their signs and symptoms
• Listen to providers
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70. • Know about various types of health professionals and what
services they provide and how to access those services
• Know how and when to ask questions or ask for clarification
when they do not understand
• Understand their options in all procedures
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71. Most Importantly
• Users need to understand that oral health is part of total health
and they can keep their oral cavities healthy
• And focus is on caries prevention because that is the priority..
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72. The three distinct levels in oral health literacy:
Functional: basic skills in reading and writing necessary for
effective functioning in an oral health context;
Interactive: more advanced cognitive literacy and social skills
that enable active participation in oral health care;
Critical: the ability to critically analyze and use information to
participate in actions that overcome structural barriers to oral
health.
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73. Health providers:
• Many, including dentists and dental hygienists do not have a
good understanding about how to prevent tooth decay.
• Many/most do not provide dental sealants.
• Most health care providers do not use recommended
communication techniques.
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74. The public and health care providers are largely unaware of the
basic risk factors and preventive procedures for many oral
diseases:
• The fact that dental caries is both infectious and preventable is
not generally known by the public and most health care
providers.
• The relationship between good oral health and well-being is
also not well understood.
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75. Role of providers in improving
Communication with Patients
• Listen carefully to what patient has to say
• Use ‘‘teach-back’’ to confirm what you think you said to your
patient is what he/ she heard.
• Slow down, use short statements
• Use plain language
• Use visual aids (draw or show pictures) when appropriate
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76. • Never ask a question that has a yes/no answer e.g. ‘‘did you
brush your teeth today?’’
• Provide communication skills training for the staff
• Assess the office/clinic to determine user friendliness
• Be patient with patients and staffs
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77. Impact of oral health literacy of parents on the
oral health status of their children
• Many children suffer needlessly from dental caries disease
because too many parents lack information about the
importance of healthy teeth and gums.
• Oral Health literacy is important in the prevention of early
childhood caries (ECC). Parents need both knowledge and skills
to prevent ECC:
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78. Knowledge Needed to Prevent ECC
• importance of oral health
• dental caries can be prevented
• fluorides prevent dental caries
• know level of fluoride in their drinking water
• most bottled water is fluoride deficient
• when to use which fluorides
• when to take infant/child to dental office
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79. Skills Needed to Prevent ECC
• how to routinely clean the infant’s mouth
• how to recognize normal/abnormal teeth (decalcification) how
to re-mineralize decalcified surfaces
• how to inspect the child’s mouth
• how to administer fluoride appropriately
• how to limit the type and amount of sweets
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80. Ask me 3..!!!
Ask Me 3 is a patient education program designed by the
National Patient Safety Foundation to improve communication
between patients and health care providers, encourage patients
to become active members of their health care team, and
promote improved health outcomes.
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?
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81. The IOM Report: Advancing Oral
Health in America Recommended:
•Community-wide public education on the causes of oral
diseases and effectiveness of preventive interventions.
• Professional education on best practices on preventing oral
diseases.
• Professional education on best practices in patient-provider
communication skills.
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82. Mothers need to know
• Drink tap water and use fluoride toothpaste.
• Clean their infants mouth as soon as they begin to bathe the baby
• ‘Lift the lip’ once a month to look for white lines/spots –.
• Limit sweets;
• Yearly once - dental examination;
• Fluoride varnish
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83. Educational Tools
• Video for gravid women & mothers with young children
• Posters, leaflets & magnets of ‘lift the lip’
• Focus on fluoride- posters, leaflets & magnets
• Posters and video
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84. • Literacy rate refers to the percentage of people who are able
to read and write v/s those who are not.
• The working definition of literacy in the Indian census since
1991 is as follows:
Literacy rate: The total percentage of the population of an area
at a particular time aged seven years or above who can read and
write with understanding. Here the denominator is the population
aged seven years or more.
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Health literacy in India

85. • National Literacy Mission (NLM) was set up by the
government of India on 5 May,1988 with an aim to eradicate
illiteracy in the country by imparting functional literacy to non-
literates.
• The NLM initiated its first successful literacy campaign in
Kottayam city of Kerala followed by Ernakulam district of the
same state.
• Till November 2002, 596 districts out of the total 600 districts
of the country had been covered up by the National Literacy
Mission under the total literacy campaign programme. Out of
which, 191 was in the post literacy phase and 238 in the
continuing education phase.
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86. • Indian literacy rate has grown to 74.04% (2011 figure) from
12% at the end of British rule in 1947.
• Although this was a greater than sixfold improvement, the level
is well below the world average literacy rate of 84%, and of all
nations, India currently has the largest illiterate population.
• Despite government programmes, India's literacy rate increased
only "sluggishly", and a 1990 study estimated that it would take
until 2060 for India to achieve universal literacy at then-current
rate of progress.
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87. 4/25/2017 Oral health literacy 87

88. • There is a wide gender disparity in the literacy rate in India:
effective literacy rates (age 7 and above) in 2011 were 82.14% for
men and 65.46% for women.
• The low female literacy rate has had a dramatically negative impact
on family planning and population stabilization efforts in India.
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89. • Studies have indicated that female literacy is a strong predictor
of the use of contraception among married Indian couples, even
when women do not otherwise have economic independence.
• The census provided a positive indication that growth in female
literacy rates (11.8%) was substantially faster than in male
literacy rates (6.9%) in the 2001–2011 decadal period, which
means the gender gap appears to be narrowing.
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90. • A cross sectional questionnaire survey was carried out on 500
subjects by Audrey M D’Cruz in Bangalore in 2013.
• The questionnaire designed by Chew and colleagues (2004) was
modified and used as the survey instrument.
• To be eligible to participate in the study, the participants had to be
aged above 18 years and able to read or write English/Kannada
(local language).
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91. • About 60.4% of the subjects had low health literacy level,
29.4% average and only 10.2% had high health literacy
levels.
• Age and educational qualification had a suggestive
significant difference with the mean health literacy scores
while gender did not have any significant difference.
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92. • September 8 was proclaimed International Literacy
Day by UNESCO on November 17, 1965.
• Its aim is to highlight the importance of literacy to
individuals, communities and societies.
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93. Information Literacy Programmes
Conducted by National
Institutions/Organizations in India
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94. Oral health literacy 95

95. Oral health literacy 96

96. E-Government Projects Initiatives By Statewise
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97. Oral health literacy 98

98. 4/25/2017 Oral health literacy 99

99. Conclusion
• Health literacy is dependent on the demands of the
healthcare and public health systems.
• It is inextricably linked to improving oral health…
especially among low income groups.
• Efforts to improve quality, reduce costs and reduce oral
health disparities cannot succeed without simultaneous
improvements in health literacy of the public, health care
providers and policy makers.
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100. • The primary responsibility for improving health literacy lies with
public health professionals and the healthcare and public health
systems.
• These entities must work together to ensure that health
information and services can be understood and used by all, and
to engage in skill building with healthcare consumers and health
professionals.
• Adult educators can also be productive partners in reaching
adults with limited literacy skills.
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101. References
1. National Family Health Survey (http://www.nfhsindia.org)
2.Census of India - 2001 (http://india.gov.in/knowindia/literacy.php)
3.Census of India - 2011
(http://censusindia.gov.in/2011census/censusinfodashboard/index.ht
ml)
4. Compilation from the official Census 2011 data
(http://www.census2011.co.in/literacy.php)
5. Telangana, India’s 29th State, is Finally Born | The Diplomat
(http://thediplomat.com/2014/06/telangana-indias-29th-state-is-
finally-born/)
6. "Tripura has achieved first position in literacy"
(http://www.deccanherald.com/). decccan herald. 2013-09-08.
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102. 7. Kickbusch, I. (1997). Think health: What makes the
difference? Health Promotion International, 12, 265-272.
8. Nutbeam, D. (1998). Health Promotion Glossary, Health
Promotion International, 13. 349-64.
9. Nutbeam, D. (2000). Health literacy as a pubic health goal: A
challenge for contemporary health education and communication
strategies in the 21st century. Health Promotion International,
15, 259-67.
10. Nutbeam , D. Health literacy as a public health goal: a
challenge for contemporary health education and communication
strategies into the 21st century. Health Promotion International,
2000.15(3):259–67.
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103. PREVIOUS YEAR QUESTIONS