Lavoie, M.-health Literacy & Client Teaching

8/3/2019 Lavoie, M.-health Literacy & Client Teaching

1/39

Health LiteracyBackground, Statistics, and Tools


2/39

What is health literacy?

Health literacy is more than the ability to

read and write in your native language.

the degree to which individuals have the

capacity to obtain, process, andunderstand basic health information andservices needed to make appropriatehealth decisions(Egbert & Nanna, 2009, p.5)


3/39

Why do I care about healthliteracy?

Low health literacy has been recognizedas the major public health issue in the

United States (Mancuso, 2008).

Low health literacy costs the country tensof billions of dollars each year.

Low health literacy can not be detected byphysical exam, blood tests, or diagnosticimaging (Betz, Chang, Meeske, Ruccione, & Smith,

2008).


4/39


As health care clients are asked to take amore active role in their own health care,

health literacy becomes a vital issue.

Low or inadequate health literacy affects

people of all ages, races, educationallevels, and social classes (Speros, 2005).


5/39


The National Adult Literacy Survey of

2003 showed no significant change infindings when compared to the previoussurvey done in 1992. Overall, 43%; 93

million adults have basic or below basicliteracy skills (National Center for EducationStatistics, n.d.)


6/39

Class Outline

Statistical information andbackground

In a study of adult clients with low health

literacy 81% could not read the rights andresponsibilities portion of a Medicaidapplication and 74% did not know if theywere eligible for free care (Mettger &

Stableford, 2007).


7/39

Class OutlineStatistical information and

background

Using the Test of Functional Health

Literacy in Adults (TOFHLA), in a 1994study it was found that adult patients withlow health literacy skills averaged 6%

more hospital visits and stayed in thehospital, on average, two days longerthan adult patients with higher healthliteracy skills (Pawlak, 2005).


8/39


Although ethnic minority groups aredisproportionately affected by low health

literacy, the majority of people with lowhealth literacy skills in the United Statesare white, native-born Americans.

Emergency room patients withinadequate literacy skills are over twice aslikely to be hospitalized as those withadequate literacy skills.


9/39


Cultural norms affect health literacy


10/39


The elderly, recent immigrants, people

affiliated with chronic disease, and thoseof low socioeconomic status are especiallyvulnerable to health care issuesassociated with low health literacy.


11/39


According to the National Adult Literacy

Survey(NALS) 75% of Americans withlong-term illness had limited literacy,consequently they may know less abouttheir condition or how to handlesymptoms (National Center forEducational Statisics, n.d.).


12/39

Health care provider competencyneeds

Be cognizant of the challenges that lowhealth literacy presents to the health care

provider and be prepared to deal withthem.

Be able to quickly assess clients for theirlevel of health literacy so that health careteaching can be tailored to the individualclients needs.


13/39


Be aware that many people with low

health literacy are very good at coveringfor their lack of understanding of healthcare information and be able to create anenvironment in which the client feels safeasking questions.


14/39

Class OutlineWarning signs of low healthliteracy

When people are embarrassed,intimidated, or confused during health

encounters, they are less likely to askquestions or seek clarification ofinformation.

Aloofness or withdrawal during providerexplanations of information.


15/39


Registration or other forms filled out

incompletely or incorrectly.

Written materials handed to a friend or

relative or statements such as I cantread this now, I forgot my glasses.


16/39


Missed appointments, frequent errors in

medications, or self care activates thatmay lead the provider to label the patientas non-compliant.

These silent signs of low health literacycan signal the provider to the clientsteaching needs.


17/39


Be familiar with tools used to assess client

level of health literacy.

Learn a technique for assessing reading

level of health care hand-outs and be ableto adapt or create written teachinginformation for the clients level ofunderstanding.


18/39


Be able to verify that the client understands

the taught information. It has been shownthat using the teach-back method canimprove such issues as glycemic control indiabetic clients.

Understand that the non-compliant clientmay have health literacy issues that need tobe addressed in order for them to use healthcare information.


19/39

Class OutlineTesting health literacy

Medical Achievement Reading Test (MART)


20/39


Rapid Estimate of Adult Learning inMedicine (REALM)


21/39


Tests Available

Test of Functional Health Literacy inAdults(TOFHLA) also available in a shortversion (S-TOFHLA), that can be

administered in no more than twelveminutes.


22/39


S-TOHFLA sample question;Your doctor has sent you to have a _________ X-

Raya. stomach

b. diabetes

c. stitches

d. germs

Fill in the blank, the S-TOHFLA has a possibility of 33correct answers, 0-16 correct indicates inadequatehealth literacy, 17-22 correct indicates marginalhealth literacy.


23/39

Class OutlineStatistical information and

background Information Gap

According to a 2002 Roper pole, 70%

of physicians say they provide additionalresources to help patients understandtheir medications, however only 41% ofthose patients say they have received this

type of assistance.


24/39

Class Outlineevaluating written material

Fry Readability Formula

Randomly select three 100-word passages from a

book or an article. Plot the average number of syllables and the average

number of sentences per 100 words on the graph todetermine the grade level of the material.

Choose more passages per book if great variability isobserved and conclude that the book has unevenreadability.

Few books will fall into the long sentences or longwords sections, but when they do, grade level scoresare invalid.


25/39

Graph the average number of sentences on the vertical axis, and theaverage number of syllables on the horizontal axis, where theyconverge gives a grade reading level for the material. The suggestedreading level for medical information is set at tenth grade, but many

experts feel that sixth grade level is more appropriate.


26/39

Fry Readability Formula

Count the number of sentences in each 100 wordsample, average the number of sentences andround to the nearest 1/10th.

Count the number of syllables in each sample, donot count numbers, do count proper names.Average the number of syllables between thethree samples

Example;Average number of sentences = 5.9Average number of syllables = 128


27/39

Other suggestions for readingmaterial

Base the content on a written objective;

explain the purpose and limit the content.

Involve the reader; provide examples,

make the document culture, age, andgender appropriate.


28/39

Other suggestions for readingmaterial

Make it easy to read; use active voice,

and common words, break up complextopics.

Make it look easy to read; sharp contrastand large type, lots of white space, nodense text.


29/39

Clear communication

Using simple language (avoid technical

jargon)

Handing out printed materials to patients

Speaking more slowly


30/39

Clear communication

Reading aloud instruction

Writing out instructions

Presenting 2 or 3 concepts at a time andchecking for understanding

Asking patient how they will followinstructions at home


31/39

Clear communication

Asking if patient would like familymember to be in discussion

Underlining key points in patientinformation handout


32/39

Clear communication

Having patient follow up with office staff

to review instructions

Following up with telephone call to check

understanding/compliance


33/39

Teaching Environment

Provide a private, low noise and

distraction free area.

Give the client an out.

Include the clients support system in theteaching.


34/39

Verify Understanding

Use the teach back method to verify

understanding.

The client repeats back the instruction in their

own words.


35/39

The cost of poor health literacy

Direct medical care costs related to lowhealth literacy are accrued throughadditional hospital and office visits, longerhospital stays, extra tests, procedures,and prescription drugs.


36/39

The cost of poor health literacy

A disproportionate share of these medicalcosts are taxpayer financed (Pawlak,

2005).


37/39

Who pays the cost of lowhealth literacy

Medicaid 47%

Medicare 19%

Employers14%

Patients 14%

Pawlak, 2005


38/39

Conclusion

In the United States the majority ofpeople affected by low health literacy areCaucasian and native born (Speros,2005).


39/39

Conclusion

Health literacy impacts

Access to care

Health maintenance

Compliance with health regime

Cost of health care

Documents

Lavoie, M.-health Literacy & Client Teaching