Talk on Health Literacy, given to COPD Educators in October 2013.

1. Health Literacy
Chronic Obstructive Pulmonary Disease
Educator Institute (COPDEI)
Margot Malachowski, MLS
Baystate Health Sciences Library
Springfield, MA
October 2013

2. Introduction
Outreach Librarian
Patients & their families
Teach how to find reliable websites
Look up information on their behalf

3. Resource Library for
Western New England
The Health Sciences Library at Baystate Medical
Center is a Resource Library for the National
Network of Libraries of Medicine (NN/LM). Our
mission is to serve the health information needs
of unaffiliated health care practitioners, librarians,
educators and consumers in Western New
England. We provide free instruction and
assistance to support health literacy.

5. Health Literacy &
Health Numeracy
Basically, understanding
words & numbers

6. Define Health Literacy:
Ability to read +
Understand how the body works +
Understand what causes disease

7. Define Numeracy:
Understand numbers +
Understand prescriptions, test results +
Understand insurance deductibles (?!!)

8. Proficient Health Literacy
12% of US adults
Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

9. Define Proficient:
Training +
Skill +
Experience

10. Proficient Health Literacy
12% of US adults
Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

11. Below Basic
Health Literacy
14% of US adults
Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

12. Define Basic
Health Literacy:
Understand words and
numbers enough to have the
ability to achieve goal
(good health)

13. Below Basic
Health Literacy
14% of US adults
Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

14. Who are the 14%?
51% did not graduate from high school
48% one or more disabilities
36% no medical insurance
35% Hispanic adults
31% over age 65
19% Black adults
Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

16. Who are the 14%?
51% did not graduate from high school
48% one or more disabilities
36% no medical insurance
35% Hispanic adults
31% over age 65
19% Black adults
Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

17. Health Care Outcomes
Do not get preventative care
Develop chronic conditions (COPD)
Higher rates of hospitalization
Do not feel well
Health care costs are higher
(more serious situations)
Ashamed– lack health and knowledge

18. Focus: COPD
Reuters: COPD patients with low
“health literacy” fare worse, 9/13/12
http://www.reuters.com/article/2012/09/13/us-copd-patients-idUSBRE88C0ST20120913

19. Journal of General Internal
Medicine, 2013
Do not know how to use inhaled medications
Do not recognize need for acute medical attention
Feel helpless to manage own disease
5X more likely to go to the ER
8X more likely to be hospitalized
Omachi TA, Sarkar U, Yelin EH, Blanc PD, Katz PP. Lower health literacy is associated with poorer health status and outcomes in chronic
obstructive pulmonary disease. J Gen Intern Med. 2013 Jan;28(1):74-81. doi: 10.1007/s11606-012-2177-3. Epub 2012 Aug 14. PubMed
PMID: 22890622; PubMed Central PMCID: PMC3539035.

20. COPD Helplessness Index
“My breathing problems are controlling my life”
“No matter what I do or how hard I try, I just can’t seem to
get relief from my breathing problems”
“Too often, my breathing problems just seem to hit me
from out of the blue”
“It seems as though fate and other factors beyond my
control affect my breathing problems”
Omachi TA, Katz PP, Yelin EH, Iribarren C, Knight SJ, Blanc PD, Eisner MD. The COPD Helplessness Index: a new tool to measure factors
affecting patient self-management. Chest. 2010 Apr;137(4):823-30. doi: 10.1378/chest.09-0764. Epub 2009 Oct 16. PubMed PMID: 19837823;
PubMed Central PMCID: PMC2851553.

21. Identifying Literacy Level
Rapid Estimate of Adult Literacy in Medicine (REALM):
patients read lists of words and are scored within minutes
Test of Functional Health Literacy Assessment (TOFHLA):
20-minute test measuring numeracy and reading
comprehension

22. Identifying Literacy Level
Can the patient name his/her medications?
Does the patient frequently miss appointments?
Does the patient say “I forgot my reading glasses”?
Does the patient use a surrogate reader?
Roberts NJ, Ghiassi R, Partridge MR. Health literacy in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(4):499-507. Review. PubMed PMID:
19281068; PubMed Central PMCID: PMC2650589.

23. Working with Patients
Relationship-building
Open-ended questions
Using Teach Back
Pictures/videos
Roberts NJ, Ghiassi R, Partridge MR. Health literacy in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(4):499-507. Review. PubMed PMID:
19281068; PubMed Central PMCID: PMC2650589.

24. Conversation

25. Cultural Competence
The culture of our family
The culture of our jobs
(health care providers)

26. Define Cultural
Competence:
Understand other people’s
culture enough to have the
ability to achieve goal
(good health)

27. Patients sharing their stories
http://www.youtube.com/watch?v=dzpBCymhSp0

29. Sources of Information
Health Care Providers
Family and Friends
The Internet

30. Sources of Information
Health Care Providers—70%
http://pewinternet.org/Reports/2013/Health-online.aspx

31. Sources of Information
Family and Friends (anecdotally, this
really means Mom or family member who
is the health care profession)—60%
http://pewinternet.org/Reports/2013/Health-online.aspx

32. Sources of Information
The Internet—80% of internet users
look up health information online
http://pewinternet.org/Reports/2011/HealthTopics.aspx

33. Sources of Information
Health Care Providers—70%
http://pewinternet.org/Reports/2013/Health-online.aspx

34. The right to understand
http://www.ted.com/talks/sandra-fisher-martins-the-right-to-understand.html

35. PlainLanguage.gov
President Obama signed the Plain Writing Act of 2010
on October 13, 2010. The law requires that federal
agencies use "clear Government communication that
the public can understand and use." On January 18,
2011, he issued a new Executive Order, "E.O. 13563 -
Improving Regulation and Regulatory Review. " It states
that "[our regulatory system] must ensure that regulations
are accessible, consistent, written in plain language,
and easy to understand."

36. Before & After:
Losing Weight Safely
Dept. of Health and Human Services
The Dietary Guidelines for Americans recommends a
half hour or more of moderate physical activity on
most days, preferably every day. The activity can
include brisk walking, calisthenics, home care,
gardening, moderate sports exercise, and dancing.

37. Before & After:
Losing Weight Safely
Dept. of Health and Human Services
Do at least 30 minutes of exercise,
like brisk walking, most days of the week.

38. Before & After:
Medicare Fraud Letter
Medicare Beneficiary Services
Investigators at the contractor will review the facts in
your case and decide the most appropriate course of
action. The first step taken with most Medicare health
care providers is to reeducate them about Medicare
regulations and policies. If the practice continues, the
contractor may conduct special audits of the
providers medical records. Often, the contractor
recovers overpayments to health care providers…

39. Before & After:
Medicare Fraud Letter
Medicare Beneficiary Services
…this way. If there is sufficient evidence to show
that the provider is consistently violating Medicare
policies, the contractor will document the violations
and ask the Office of the Inspector General to
prosecute the case. This can lead to expulsion from
the Medicare program, civil monetary penalties, and
imprisonment.

40. Before & After:
Medicare Fraud Letter
Medicare Beneficiary Services
We will take two steps to look into this matter: We
will find out if it was an error or fraud.
We will let you know the result.

41. Patient Education Materials
Important points first
Break it down
Use simple language
Give definitions
Ask someone to read it

42. “Google it”

43. Best Website (!)

44. Use medlineplus.gov for:
Learning about how
your body works and
what causes disease.

45. Define Health Literacy:
Ability to read +
Understand how the body works +
Understand what causes disease

46. medlineplus.gov

47. COPD Patient Info
http://www.lung.org/lung-disease/copd/

48. COPD Patient Info
http://www.copdfoundation.org/

49. Faces of COPD—Robert
http://www.youtube.com/user/COPDFoundation

50. Questions?