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Health Literacy for Librarians & Information Specialists
Facilitator's name & position
This workshop was developed collaboratively by Tina and Janet Papadakos, Patient Education Leads at St. Michael’s and Princess Margaret Hospitals in Toronto, Canada to support staff skills competencies related to health literacy.
Acknowledgement
Objectives1. Define health literacy and why it matters
2. Gain skills to support client involvement in their care when preparing information packages
• Use active listening techniques to identify learning needs
• Select resources that are written for adult learners• Select resources that match client’s learning styles• Ensure resources are in plain language
Communication barriers
The ability to make sound health decisions in the context of everyday life – at home, in the community, at the workplace, and in the healthcare system
What is health literacy?
Kickbusch, Wait and Maag, Navigating Health: The Role of Health Literacy, 2005.
1. Fundamental literacy
2. Scientific literacy
3. Civic literacy
4. Cultural literacy
Health literacy has 4 parts
Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.
1. Prose – written words2. Document – charts, graphs, forms etc3. Numeracy – basic math
Fundamental literacy
Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.
Scientific literacy
• Basic understanding of how science and medicine work and evolveWhat science must a patient know to comprehend and decide to act on a specific health message?
Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.
Civic literacy
Can your patient judge:• the validity and quality
of sources of information?
The ability to be involved in health decisions:
Does your patient know:
• where and how to access information?• how to advocate for self and others?
Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.
Cultural literacy
• The shared and dynamic characteristics of a group of people whose collective beliefs, worldview, customs and social identity are a lens through which they interpret and act on health information
Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.
• to understand health instructions
• to read and act upon written health information
• to communicate needs to health professionals
Health literacy involves the ability to:
Scientific literacy
Cultural literacy
Fundamental literacy
Civic literacy
Canadian Council on Learning, 2007
88% of Seniors
Institute of Medicine Report on Health Literacy
• 90 million American adults have trouble understanding and acting on health information
• Health information is unnecessarily complex
• Providers need health literacy training
AHRQ Report
• Evidence shows that patients often misinterpret or do not understand much of the information given to them by clinicians due to low health literacy.
The Agency for Healthcare Research and Quality (AHRQ) Report 2010
• Less use of preventive services• Delayed diagnoses• Less adherence to medical instructions • Poorer self-management skills• Higher health care costs• Poorer Health
Wolf MS, Gazmararian JA, Baker DW. Health Literacy and Functional Health Status Among Older Adults. 2005. Archives of Internal Medicine.
Low health literacy has been linked to:
Health literacy is important for 2 reasons:
1. Changes in medical practice with patients involved in complex self-care regimens
2. Transition from ‘patient’ to ‘health consumer’ (expectations of involvement)
The Agency for Healthcare Research and Quality (AHRQ) Report 2010
Health literacy can improve with better communication.
You can help by providing custom information packages that adhere to health literacy standards for patients and families.
Use active listening techniques to identify learning needs
Select resources that are written for adult learners Select resources that match client’s learning styles Ensure resources are in plain language
Skills you can use to support patient and family understanding and involvement in their care
Use active listening techniques to identify learning needs
Active Listening Techniques:
• Prompts indicate you are listening with minimal verbal or non-verbal cues to encourage patient to verbalize
Nod your head Make eye contact Say “uh huh” Expressions of interest or approval
Prompt
Questions are key to gathering information about your client
2 kinds of questions:
Questions
1. Open 2. Closed:
what, when, where, could, who, tell me about
yes or no
• Restate the factual content of the patient’s message in your own words
“So it sounds like you are clear on your appointment time for your CT Scan but unsure how to get there. Is that right?”
Paraphrase
Recognize the facts (intellectual) of the patient’s message and how the patient feels (emotional)
“It sounds like you are overwhelmed with all of the information you have just been given.”
Empathize
• Recap the key points of the discussion
• Agreement of the problem
“So, you have agreed to undergo radiation treatment and you would like to have the procedure reviewed with you and your family so you know what to expect.”
Summarize
Use active listening techniques to identify learning needs
Select resources that are written for adult learners Select resources that match client’s learning styles Ensure resources are in plain language
Select resources that are written for adult learners
Skills you can use to support patient and family understanding and involvement in their care
Favourite teacher
1. Adults often see learning as a way to solve their real-life problems – especially their urgent ones.
True False
Principles of adult learning
2. Adults tend to take errors personally and are more likely to let them affect self-esteem. Thus, they tend to apply tried-and-true solutions and take fewer risks.
True False
Principles of adult learning
3. Adults relate new knowledge and information to previously learned information and experiences.
True False
Principles of adult learning
4. Adults want to be treated as equals, not as children, (and so want to engage in a learning relationship with the healthcare professional).
True False
Principles of adult learning
5. Adults need to know WHY they should learn, WHAT they will learn, and HOW the learning will take place.
True False
Principles of adult learning
• Respect
• Relevant
• 2-Way Conversation
• Specific and Focused
• Allow time for learning to be applied to patient’s current knowledge, experience and beliefs
• Safe environment (preserve dignity)
Adult learning summary
Use active listening techniques to help client identify learning needs
Select resources that are written for adult learners Select resources that match client’s learning styles Ensure resources are in plain language
Select resources that match clients learning styles
Skills you can use to support patient and family understanding and involvement in their care
Visual Auditory Kinesthetic Reflective
Visual Learners see colour, size and shape
Auditory Learners prefer details, clear vocal presentations and audiotapes
Kinesthetic Learners prefer to put their hands on and touch something
Reflective Learners want to analyze, categorize, review, reflect and ask questions
They create diagrams of what they hear. They like pictures, illustrations & visual cues (i.e., note takers-refer to it later)
They pay attention to the speaker’s voice - the tone, energy, pitch, enthusiasm and modulation
They like participating in groups and moving about doing several different activities at the same time
They like to have time to process information and make decisions
They run movies in their minds and like to read
They play a tape recorder in their minds. They like written text so they can hear what they are reading
The re-live the sensation or the feeling they experienced
They want the facts with a credible source of data. They like models, logic, and knowledge
See it Hear it Touch it/ Do it Think about it
Learning styles
Visual Learners
How they learn:• They create diagrams of what they hear• Need to ‘picture it’
Clues that they are Visual Learners:• Doodling• Says “I can’t see it”
What you can do:• Ask if they would like you to draw it
How they learn:• They pay attention to the speaker’s voice - the tone,
energy, pitch, enthusiasm and modulation
Clues that they are Auditory Learners:• Looking off in the distance• Put their hand by their ear
What you can do:• Speak to them, pace yourself, sequence the
information and ask if they would like you to repeat anything
Auditory learners
Kinesthetic learners How they learn:• They prefer to put their hands on and touch
• Like demonstrations that they can try after you show
Clues that they are Kinesthetic Learners:• Gestures with their hands, puts their hands on things
• Says “I feel…”
What you can do:• Ask if they would like to try it after you show them
How they learn:• They like to have time to process information and make
decisions• Want to analyze, categorize, review, reflect and ask
questions
Clues that they are Reflective Learners:• Pausing and looking in the distance (or down)• Asks broad questions for context
What you can do:• Offer them more data, reading material
Reflective learners
Visual Auditory Kinesthetic Reflective
See it Hear it Touch it/ Do it Think about it
30% 20% 90% 40%
Learning retention is increased with more sensory involvement
Group Sessions
Analogies &Stories
Demos & Models
Statistics &Facts
Pamphlets & Books
Visual Learners
See it
Auditory Learners
Hear it
Kinesthetic Learners
Touch it
Reflective Learners
Think about it
Use active listening techniques to identify learning needs
Select resources that are written for adult learners Select resources that match client’s learning styles Ensure resources are in plain languageEnsure resources are in plain language
Skills you can use to support patient and family understanding and involvement in their care
• The CVD outcomes can be influenced by a number of modifiable risk factors, including nutrition, weight, physical activity, smoking cessation, and alcohol consumption. For most people, appropriate treatments can control symptoms, allowing for return to functional status.
Reading level 13
What you can do to improve your symptoms of heart disease :
• Eat fruit, vegetables and whole grains• Avoid fatty foods like potato chips• Get to a healthy weight• Exercise once a day• Don’t smoke• Drink less than 1 -2 alcoholic drinks a day
After plain language editing: Reading level 8
Universal PrecautionsTaking specific actions
that minimize the risk for everyone when it is unclear which patients may be affected.
Research suggests that clear communication practices and removing literacy-related barriers will improve care for all patients, regardless of their level of health literacy.
AHRQ Publication No. 10-0046-EF Current as of April 2010
Providers don’t always know which patients have limited health literacy
Some patients with limited health literacy: Have completed high school or college Are well spoken Look over written materials and say they understand Hold white collar or health care jobs Function well when not under stress
AHRQ Publication No. 10-0046-EF Current as of April 2010
Many patients with reading problems are ashamed and hide their inability to read
• Of 202 patients interviewed, 42% had inadequate or marginal fundamental health literacy
• Of those patients, 67% had never told their spouses they have trouble reading
• 53.4% had never told their children of their difficulties reading
• 19% of patients had never disclosed their difficulty reading to anyone
Patient Education and CounselingVolume 27, Issue 1, January 1996, Pages 33-39The Role of the Family in Education and Care of the Patient
Ensure resources are in plain language
1.) Learn to recognize plain language
2.) Use the SAM tool when in doubt
Plain language has 3 parts:
1. The use of everyday language and other clear writing strategies
2. Well-structured, logically sequenced and focused information
3. Effective design and layout
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
1. Select resources that use everyday language and other clear writing strategies Evaluate language level (aim for grades 6-8)
Short words (no more than 2 syllables) Short sentences (no more than 10 words) Short paragraphs (no more than 5 sentences) Limited jargon/medical terminology unless it is
defined Consistent terms used (same term is used
throughout for example: either medicine or drugs, needle or shot etc.)
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
Ensure tone is educational, like a book
Remove feelings and opinions
Instead of “we recommend you change your diet” use “change your diet”- and ensure why a diet change would be beneficial is included
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
Ensure content is written to the client
“Take your insulin at the same time everyday” instead of “Insulin should be taken at the same time everyday.”
Select content that uses active sentences
Instead of “This medicine should be taken before dinner” use “Take your medicine before dinner
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
2. Select well-structured, logically sequenced and focused information
Check that content is limited to what the patient needs to know
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
Look for information that presents the context first before getting in to new or complex information
Context First
Side effects of chemotherapy (the context) depend on the type of drugs used and how your body reacts to those drugs (the new information).
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
Check that information is sequenced (numbered for clarity when appropriate)
Check that information is ‘chunked’ (similar topics are together)
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
3. Select resources with effective design and layout
Where possible, select resources that provide visual of verbal images to accompany each of the key pieces of information.
Research shows that the memory has many more access points for visuals than for words and letters.
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
Include only relevant images or graphics that enhance the meaning of the text
Ensure there is a lot of white space
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
Enlarge text to a minimum of 13 pt font to help ensure that patients can see the text
Clean the package to ensure there are no more than 2 different fonts. Sans serif fonts (like Arial) are better for titles and serif fonts (like Times New Roman) are better for text
3. Use effective design and layout
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010
Use the Suitability of Assessment of Materials (SAM) Tool to assess whether resources are suitable.
Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996
• Low health literacy = poor health
You can impact client’s involvement in their care by:
Summary
Using active listening techniques to identify their learning needs Selecting resources that are written for adult learners Selecting resources that match client’s learning styles Ensuring resources are in plain language
Thank you
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