Health Literacy & Health Literate Care

Presented by Jennifer Pearce, MPAHealth Literacy Program Manager

Sutter Center for Integrated Care, Sutter Health

September 12, 2014

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Presentation Objectives

• Define health literacy and understand prevalence of low health literacy among adults

• Understand relationship between health literacy and patient engagement

• Identify interventions to reduce health system demand/complexity and increase patient skills/ability

My Story

Wall Street Journal December 5, 2006

College educated

Health care experience

Prepared for medical appointments

Had support system

PATIENT SKILLS:

Multiple providers (12)

Had Medicaid, then uninsured

Miscommunication led to lack of follow-up care

Didn‘t understand options

SYSTEM BARRIERS:

Nikki didn’t die from lupus, Nikki died of complications of the failing health care system.- Dr. Amylyn Crawford PBS Frontline, Sick Around America

How Is “Health Literacy” Different From “Literacy”?

• Having the basic skills to read, write and compute without regard to context

Literacy

• Reading, writing, computing, communicating and understanding in the context of health care

Health literac

ySource: Weiss B. Epidemiology of Low Health Literacy. Understanding Health Literacy: Implications for Medicine and

Public Health5

Health Literacy Includes One’s Ability To Perform Multiple

Tasks

Healt

h

litera

cyObtain Document

literacy

Process Prose literacy

Understand Quantitative literacy

Communicate: listen and

speak

Numeric literacy

Source: IOM. 2004. Health Literacy: A Prescription to End ConfusionSource: Schwartzberg, J. 2005. Understanding Health Literacy: Implications for Medicine and Public Health

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Mismatch Leads to Harm

Source: Parker, R. and Ratzan, S. 2010. “Health Literacy: A Second Decade of Distinction for Americans', Journal of Health Communication” 15: S2, 20 — 33

Health literac

yPatient

skills/ability

Health system demand/

complexity

Patient Skills: Prevalence Of Low Health

Literacy2003 National Assessment of Adult Literacy

Proficient12%

Below Basic14%

Intermediate52%

Basic22%

8Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy

Adult health literacy by

highest level of education

Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy

Only 1/3 of those with a graduate degree have the skills to effectively manage a chronic illness

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Adult health literacy by

age

Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy

Only 3% of those age 65+ have the skills to effectively manage a chronic illness

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NAAL (2003)

Program for the International Assessment of Adult Competencies (PIAAC) 2012

“Using digital technology, communication tools, and networks to acquire and evaluate information, communicate with others, and perform practical tasks.”

Is This Equitable Access?

• Find a doctor and define the preferred relationship

• Articulate health issues

• Share, access, and evaluate information

• Negotiate decisions

• Develop partnership with the patient

• Identify/review patient preferences and patient’s preferred role

• Identify choices

• Present evidence and help patient reflect

Health literate tools + training promote shared decision making

Improved satisfaction, better outcomes

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Provider competenciesPatient competencies

Source: E. Bernabeo and E. Holmboe (2013). Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care. Health Affairs 32, No. 2: 250-258

• 5 of 35 recent grads said they received no training on health literacy during medical school.

• Dr. Cliff Coleman et al, 2013 Journal of Health Communication Consensus Study - “curricula needed to produce a health care

workforce which is not only aware of the issues around low health literacy, but is

also prepared to address them.”  Echoed by 2010 National Action Plan to Improve Health Literacy – workforce objectives.

Is our health care workforce prepared to engage patients?

Journal of Health Communication, 18:82-102,2013.

Examples of Health Literacy CompetenciesKnowledge

• Knows that educational attainment is an inadequate marker for health literacy skills.

• Knows that the average US adult reads at an 8th-9th grade level.

• Knows that patients learn best when a limited number of new concepts are presented at any given time.

Journal of Health Communication, 18:82-102,2013.

Examples of Health Literacy Competencies

Skills

• Demonstates ability to recognize, avoid and/or constructively correct the use of medical jargon.

• Demonstrates ability to recognize plain language principles in written materials.

• Demonstrates effective use of teach back technique for assessing patient understanding.

Journal of Health Communication, 18:82-102,2013.

Examples of Health Literacy Competencies

Attitudes

• Expresses the attitude that effective communication is essential to the delivery of safe, high quality health care.

• Expresses the attitude that it is a responsibility of the health care sector to address the mismatch between patients’ and health care providers’ communication skills.

Journal of Health Communication, 18:82-102,2013.

How do you do it?

Aware Prepare

Health Literate Care Delivery

Single Item Health Literacy Screener

“How confident are you at filling out medical forms by yourself?”

1. Extremely2. Quite a bit3. Somewhat (cut point)4. A little bit5. Not at all

Source: Stagliano V, Wallace LS. Brief health literacy screening items predict newest vital sign scores. J Am Board Fam Med 2013;26(5):558-565.

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Distinct health literacy tasks Potential navigation pitfalls15

Source: DeWalt, D. A., and J. McNeill. 2013. Integrating health literacy with health care performance measurement. Discussion Paper, Institute of Medicine, Washington, DC. http://www.iom.edu/linktoyourpaper.

Reading abilityEducation

level

Socio-economic status

Universal Precaution Approach

Best Practice – Universal Precaution Approach to Health

Literacy

Source: Smith, Sandra A. (2001). Patient Education and Literacy in Labus, A. & Lauber, A. (Eds.) Preventive Medicine and Patient Education. Philadelphia: WB Saunders, 266-290. 21

Evidence: Easy-to-read is Preferred!

College educated readers’ response to health information written at 5th grade level:

Recall of key messages

Satisfaction

Source: Smith SA. Information giving: Effects on birth outcomes and patient satisfaction. Int Electronic J Health Educ 1998:;3:135-145.

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System Resources

One Patient – One Message Disease and condition management (stoplights)Personal health record (electronic & paper)High risk medication tools

Acute Ambulatory

Skilled &Rehab

Home care,

Palliative & Hospice

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Stoplight tools Condition specific

Symptom management

Medication management

• Heart failure x    

• COPD x    

• Falls x    

• Wounds x    

• Pneumonia x    

• Depression x    

• Nausea   x  

• Constipation   x  

• Pain   x  

• Anxiety   x  

• Diabetes x    

• Stroke x    

• Shortness of breath   x  

• Bleeding x    

• Coumadin     x

• Tamoxifen     x

• Lovenox et al     x

• Plavix et al     x

• Methotrexate     x

• Swallowing/Aspiration   x  

• Weight gain/Edema   x  

• Skin/Pressure ulcer   x  

Health literate

personal health record

(PHR)

Where will you hitch your health literacy wagon?

Health Literate Care Promotes IOM Aims

Patient

Timely

Safe

Equitable

Patient centered

Efficient

Effective

Health Literate Care Resources

http://www.health.gov/communication/interactiveHLCM/#resources

When a health care organization adopts the Health Literate Care Model, health literacy becomes an organizational value infused into all aspects of planning and operations.

Health Aff February 2013 vol. 32 no. 2 357-367

We can no longer afford this …

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Jennifer Pearce, MPAHealth Literacy Program ManagerSutter Center for Integrated CareSutter Health

Contact: pearcej1@sutterhealth.orgwww.suttercenterforintegratedcare.org