Health Literacy, Health Communication Barriers, and

Helping Employees Understand Their OptionsBeccah Rothschild, MPA

Senior Outreach Leader, Consumer Reports

Today’s Agenda

1. Introducing Consumer Reports2. Two problems in our healthcare system: Health literacy

and overuse/waste3. Employee engagement4. Questions5. Lunch!

Introducing Consumer Reports:

Meet the Consumer Reports Team

Consumer Reports and HealthEarly days:1936: Alka-Seltzer1938: Dangers of smoking1939: Universal healthcare1971: Home exercise machinesAnd more…Today: Best Buy DrugsCancer Screening TestsChoosing WiselyHospital SafetySurprise Medical BillsSunscreensInsect repellants (Zika advice)Bike helmetsBlood Glucose Meters Blood Pressure monitorsAnd more….

Two problems in our current healthcare system are:

1.Low Health Literacy Skills2.Overuse and Waste

Problem #1: Low Health Literacy Skills5 SNOITSEUQ ot ksA ruoY rotcoD erofeB uoY ekaT scitoibitnA

1. oD I yllaer deen scitoibitna? scitoibitnA thgif lairetcab snoitcefni, ekilperts taorht, gnipoohw hguoc, dna citamotpmys reddalb snoitcefni. tuByeht t’nod thgif sesuriv – ekil nommoc sdloc, eht ulf, ro tsom eros staorhtdna sunis snoitcefni. ksA fi uoy evah a lairetcab noitcefni.

2. tahW era eht sksir? scitoibitnA nac esuac aehrraid, gnitimov, dna erom. yehT nac osla deal ot “scitoibitna ecnatsiser” – fi uoy esu scitoibitnanehw uoy t’nod deen meht, yeht yam ton krow nehw uoy od deen meht.

3. erA ereht relpmis, refas snoitpo? semitemoS lla uoy deen si ytnelp fodiuqil. uoY nac osla ksa tuoba citoibitnastnemtnoi dna spord rofsnoitidnoc ekil knip eye ro s’remmisw rae.

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DefinitionsGeneral Literacy: “Using printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential.”-National Assessment of Adult Literacy, 2003

Health Literacy: “The degree to which individuals have the capacity to obtain, process, understand, and act on basic health information and services needed to make appropriate health decisions.” -Healthy People 2010

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U.S. Reading Levels The average American adult reads between the 7th -

9th grade level; Most adults read 3 grade levels below the highest

grade they completed; and Most health information is written above the 10th grade

level.

Over 90 million adults in the U.S. have trouble understanding and acting on health information.

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What Is It Like?“I bought cough medicine at the drugstore and couldn’t read the label on it. I overdosed and fainted. I didn’t know it would make me sick. I thought it was safe.”-California adult literacy student

“I just have to trust the doctor; I put a huge amount of trust in the medical staff. I just sign forms without really understanding them.”-California adult literacy student

How Well Do People Understand How to Take Their Medicine?

How Well Do People Understand Health Insurance Paperwork?

How Well Do People Understand Diabetes Meal Plan Instructions?

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How Well Do Parents Understand Pediatric Dosing Instructions?

How Well Do New Yorkers Understand Parking Instructions?

How Well Do Bathroom Users Understand Flushing Instructions?

How Well Do Ice Cream Eaters Understand How Much Fat Is In 1 Cup?

“Approximately 30% of healthcare costs (more than $750 billion annually) are spent on wasted care.”

-American College of Physicians

What are the causes?

Problem #2: Overuse and Waste

Patients are requesting tests, treatments, & procedures that they don’t need

In today’s health marketplace, being a compliant patient isn’t good enough any more

Providers are performing services that are unnecessary and may be harmful

Cultural norms and misleading advertising can lead to inappropriate care

TV Doctors

What are the common communication challenges and barriers, in addition to limited health literacy skills?

5 Communication Barriers

1. Too general2. Unfamiliar3. Contradictory4. Unclear5. Passive

The message is: Resources

•Review of cognitive psychology research.

•2012 report on healthcare communication from U.S. Institute of Medicine.

•CR surveys and focus group studies.

•80 years of health reporting

Lack of perceived relevance

1. Too general2. Unfamiliar3. Contradictory4. Unclear5. Passive

The message is:

“It’s not my problem!”The overuse of preventive screening

May harm thousands of patients NATIONWIDE.

Wastes billions of healthcare $ NATIONWIDE.

Means the NATION’S healthcare system is not delivering the right care.

May harm YOU and YOUR FAMILY.

May waste $ YOU spend on healthcare.

Means that YOU and YOUR FAMILY are not getting the right healthcare.

“Heath Ratings Center Impact Benefit Screening Tests,” Consumer Reports National Research Center, Feb. 17, 2012.

People prefer the status quo

1. Too general2. Unfamiliar3. Contradictory4. Unclear5. Passive

The message is: Survey of more than 8,000 CR subscribers, ages 40-60, with no history of heart disease:

•Half had already had an EKG.•Two-thirds said that they would have a complete battery of tests if it was free.•Nearly all agreed it was better to “have a scare that turned out to be nothing than to not get tested.”

Watch your language!Positive framing

“Advantage, appropriate, benefit, careful, prevent, protect”

Negative framing

“Adverse effects, lack of benefit, loss, risk”

More effective for reinforcing a health action—i.e. getting a flu shot

More effective for convincing people NOT to act—i.e. avoiding taking antibiotics long term for back pain.

Sprenger, A., Kane, J., Schuler-Adair, E. “Health actions not to do: lessons for consumer decision-making,” prepared by Consumer Reports Health Ratings Center for AHRQ, Feb. 2011.

Misinformation

1. Too general2. Unfamiliar3. Contradictory4. Unclear5. Passive

The message is:

Misinformation

Tell the Whole StoryBefore reading<16% interested in topics

After reading•Half interested in receiving more info•Two-thirds said they would talk to their doctor about the topic•43% changed their mind about a topic

“Choosing Wisely pamphlet evaluation,” Consumer Insight, Consumer Reports, Jan. 2013.

Information is Complex

1. Too general2. Unfamiliar3. Contradictory4. Unclear5. Passive

The message is:

Use Simple Terms and Resources

Use Social Media and Videos

Choosing Wisely Video

Choosing Wisely Wednesday

No Substitute Actions

1. Too general2. Unfamiliar3. Contradictory4. Unclear5. Passive

The message is:

Give Clear Advice

Employee Engagement: A case study on the appropriate use of healthcare

From 2012-2013, we tried…

Too longToo boring

Too much

All about CW

Attitudinal Statements Toward Appropriate Care (2014)These four statements registered high agreement among more than 2/3 of respondents (n=3,000), with women agreeing more than men.

Improved communication between you and your doctors leads to better clinical outcomes. (72%)

When you actively participate in your healthcare, you make better healthcare decisions and get better healthcare. (71%)

You should have full access to the notes your healthcare providers take during your medical visits. (71%)

By talking with your doctor, asking questions and discussing your options, you will get better healthcare. (71%)

The common themes are communication, participation, and access to information.

From 2014 – 2016, we tried again:Short & Clear

EngagingCategorized

CW - PSA

And We Landed Here…Making Healthy Choices

The Issue: Patients are faced with many healthcare choices. Employers are interested in helping their employees make smart healthcare decisions. Note: IBM initiated the project

The Solution: Consumer Reports created Making Healthy Choices, a toolset including a video series, mobile app, and website – utilizing Choosing Wisely materials – a med at helping employees understand how to make the right healthcare choices and what questions to ask.

ConsumerHealthChoices.org/Healthy

Making Healthy Choices: The issue and the solution

IBM: Hosted on health intranet site and employee wellness tools; offered incentives including CR subscriptions

Case Western Reserve: Included in university-wide newsletter and wellness intranet site; distributed posters and wallet cards at campus wide summer-event; offered $100 Visa gift cards via lottery system

Bath Iron Works: Included in employee newsletter and announcements to employees at staff meetings; offered iPad Air 2 via lottery system

Preliminary Integration Methods

Making Healthy Choices: Lessons Learned from Employees

“That it is ok to ask your doctor the reason for specific treatments. I think the patient

can feel at a disadvantage in these situations and it's good to have the

background to ask "why" questions.”

“That some tests or procedures could actually have a negative

impact on the patient.”

“Sometimes the best treatment is no

treatment.”

“Antibiotics should not be used for viral infections.”

“To not rely on one source of information.”

“We (generationally) over-depend on the ever expanding technology and decrease the use of common sense. These MHC series are making us more aware of common sense practices

that need to be revitalized.”

“I'll review those questions before going to my doctor appointment next time.”

After using the Making Healthy Choices tools: 92% reported that they would ask their doctor questions

before agreeing to a test, treatment, or procedure. 55% will request fewer medical tests/medicines. 73% will return to Making Healthy Choices in the future to

seek out specific information of interest. 93% will recommend it to family/friends.

Employee Feedback

Making Healthy Choices:Lessons Learned from Employers

• Offer an incentive• Make the content easily accessible• Be clear that:

– Participation / use is optional– Making Healthy Choices is a free tool offered by a trusted non-

profit organization– Making Healthy Choices is not affiliated with your health

insurance plan

Lessons Learned From Consumer Reports About Employee EngagementEmployees don’t necessarily trust the messenger

They might not trust you Some people will never be engaged

Practice what you preach It’s about the conversation

Measurement is hard Clinical, economic, behavioral Behavior change interventions

Cultural relevance Be cognizant of communication barriers & health literacy Be patient with culture change Experiment

“The problem with communication is the assumption that it has

occurred.”

-GB Shaw

Choosing Wisely: ConsumerHealthChoices.org/Choosing

Getting Started with Making Healthy Choices:ConsumerHealthChoices.org/Starting

Implementation Guide: ConsumerHealthChoices.org/Implementation

Twitter: @Beccah_Health

Vimeo: http://vimeopro.com/consumerhealthchoices/portfolio

Email: Beccah Rothschild, rrothschild@consumer.org

Questions?