Health Literacy: What did that doctor say??

May 13, 2009

FacultyMedicine Nursing Pharmacy

Evelyn Kemp Peggy McConnell Charles Collins

Forrest Lang Sue Grover Richard Hess

Public Health Social Work

Brian Martin Robin Lennon-Dearing

ObjectivesParticipants will learn the following: Extent of low literacy Those most at risk Correlates and results of low health literacy Clinical red flags Ways of assessing health literacy Strategies for helping patients with low health literacy

Finally, participants will identify quality improvement project goals that address patients’ health literacy levels.

Agenda for today

11 -11:30 • Introduction to health literacy

• Video followed by group’s discussion of what they see in the video and suggestions for change

• Strategies for helping patients with limited literacy

11:30-12 Practice with standardized pts

Literacy in the US 14% of adults cannot read 21-23% can read a little but not well

enough to:• fill out an application

• read a food label

• read a simple story ● 46% of US population have limited health

literacy. (Paasche-Orlow, 2005.)

What is HealthLiteracy?

Healthy People 2010:

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

LiteracyDemographics

Limited health literacy is greatest among• Older adults

• Poor

• Rural

• Those with limited education

• Minorities

• Those with limited English proficiency

Results of limited literacy

12% of general population do not understand when their next appointment is.

Over 19% do not understand instructions to “take medication on an empty stomach”.

http://www.ama-assn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf

Correlates of Low health literacy

● Poor knowledge of chronic diseases such as HTN, diabetes

● Poor glycemic control● Poor health outcomes● Increased risk of hospital admissions● Length of hospital stay increased by

nearly 2 days

How good are we at detecting low literacy?

Clinicians identify only 47% of low literacy patients. (Rogers, 2006)

Clinical Red Flags Indicating Limited Health Literacy

● Incorrect or incomplete forms.● Frequently missed appointments.● Lack of follow through with diagnostic

testing or referrals.● Medication count, medication refill

history, or lab tests inconsistent with patient report.

● Patient asks no questions.

How we explain things to patients

Video MDI Discussion

Strategies Assess LiteracyCreate a shame-free environment Adjust approach to patient needs● Improve communication Ask-Tell-Ask

Informal Assessmentof Health Literacy

● The Indian Health Service model uses a series of three questions:What did your prescriber tell you the medication is for?How did your prescriber tell you to take the medication?What did your prescriber tell you to expect?

● Conduct a Medication Review:Ask patients to bring in all their medications Ask them to name and explain the purpose of each one – “Brown

Bag Test”

Formal Assessmentof Health Literacy

● Single Item Literacy Screener (SILS)“How often do you need to have someone help

you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?” (Morris, 2006)

Sensitivity 54% - Specificity 83%

1-Never, 2-Rarely, 3-Sometimes, 4-Often, and 5-Always

Score above 2 is considered positive

Creating a Shame-free Environment

● Use ubiquity statements, “Many people have difficulty understanding medical information.”

Convey an attitude of helpfulness, caring and respect.Avoid acting impatient or annoyed.

Involve the entire staff. Offer to help with paperwork.

Adjustments based on patient need

Hearing Vision Cognition

Strategy: Improve CommunicationStrategy: Improve Communication

Speak slowly.Use simple, plain nonmedical language.Focus on 1-3 key messages per visit.Ask how the patient learns best.

• Models, charts, pictures, analogies Include a family member or friend.

Strategy: Improve CommunicationStrategy: Improve Communication

Benign Harmless

Chronic Happens again and again

Cardiac Heart

Edema Swelling; build up of fluid

Fatigue Tired

Screening Test

Intake What you eat or drink

Generic Not a brand name

Adverse events Side effects

Common Language

Jargon

Avoid Use of Medical Jargon

Strategy: Improve communicationStrategy: Improve communication

•Show or draw pictures. •Visual images can improve the patient’s recall of ideas. •Uses captions that clarify the point of the visualUSP Pictograms http://www.usp.org/audiences/consumers/pictograms/

Strategy: Improve communicationStrategy: Improve communication

Ask-Tell-Ask

ASK pt their understanding of their disorder and treatment.

TELL them missed or incorrect information.

ASK for a restatement of their understanding of information given “in your own words”.

*Don’t ask, “Do you understand?”

Remember to do with every patient . . .

Assess health literacy: “How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?”

Ask the patient to restate their understanding of information given “in your own words”.

*Don’t ask, “Do you understand?”

Practice Session - 30 minutes