Health LiteracyPresented by Glenda Harbert

Define Health Literacy Describe:◦Strategies for education ◦Plain Language ◦Ask Me Three Teach Back Method ◦Speak Up Campaign

Objectives

What is Health Literacy ?

The degree to which individuals have the capacity to;◦obtain,◦process, and ◦understand

basic health information and services needed to make appropriate health decisions.”

Healthy People 2010

90 million US adults: literacy skills below high school level

Adults with limited literacy:◦ less knowledge of disease management & health promoting

behaviors ◦ report poorer health status◦ less likely to use preventive services◦ higher hospitalization rates & emergency service use

>300 studies show health-related materials far exceed average reading ability of US adults

IOM Key Findings: Health Systems

Health Literacy: A Prescription to End Confusion. Institute of Medicine, 2004

Health Literacy of American Adults

Percent of Americans

National Assessment of Adult Literacy(NAAL): National Center for EducationalStatistics, U.S. Department of Education, 2003

Proficient, 12Be-low Basic, 14

Basic; 22

In-ter-me-diate

53

A 2006 study examined patients’ abilities to understand five common instructions on prescription medications ◦ Both patients with adequate

and low literacy had difficulty understanding at least one of the five instructions.

The shocking facts

Most health care materials are written above the 10th grade level

One out of five American adults reads at the 5th grade level or below

The average American reads at the 8th to 9th grade level

A disproportionate number of minorities and immigrants are estimated to have literacy problems:• 50% of Hispanics• 40% of Blacks• 33% of Asians

More than 66% of US adults age 60 and over have either inadequate or marginal literacy skills.

48%of U.S. adults

cannot read wellenough to use a

bus schedule

The L.A. Workforce Literacy Project, 2004

Functional Literacy

Why does this matter?

UnderstandingREQUIRES Compliance

The newest vital sign

Can you understand?

So what’s your point?

First thing

AUTHORIZATION FOR AND VERIFICATION OF CONSENT TO

HEMODIALYSIS PROCEDURE

If you can’t read a bus schedule or an RX label, can you understand this?

High blood pressure

Significant blood loss

Air embolisms Hemolysis Graft/fistula

infiltrations Infections

Allergic reactions Pyrogenic reactions Hyperkalemia Hypokalemia Loss of Amino

Acids/Protein Chemical imbalances

and metabolic disorders

Decreased blood flow to limbs

I understand that there are risks to my health associated with the hemodialysis treatment, these include:

I understand that there are risks to my health associated with the CCPD treatment

Infections: risk of contamination of the

abdominal cavity via catheter or dialysate fluid with various bacteria or germs, which can result in peritonitis (an infection of the peritoneum).

Peritonitis is potentially serious and must be treated immediately.

There is also a risk of infection at the exit site and also risk of a tunnel infection with various bacteria or viruses.

Say What

Language & English Variants• POS

• WTMI

• LMAO

• OMG

• Parents over shoulder

• Way too much information

• Laugh my a-- off

• Oh my God

Short Message Service (SMS) language or Textese (also known as chatspeak, txt, txtspk, txtk, texting language or txt talk) - English language slang used in mobile phone SMS, social networks and instant messaging. This type of language does not always obey or follow standard English grammar; furthermore, the words used in the writing system may not be found in standard dictionaries

Keith C. Norris, MD, FASN

English as a Second Language

/j i j u E t// j u w i j E t//j u/

Did you eat ? Did you eat yet?

Did you?

Relexification of sentences into a consonant/vowel vocalic pattern consistent with the Niger-Congo African syntax

Kifano S, Smith E: Ebonics and education in the context of culture: Meeting the language and cultural needs of LEP African American students. In: Ebonics: The Urban Education Debate (New Perspectives on Language and Education), 2nd Ed., edited by Ramirez JD, Wiley TG, de Klerk G, Lee E, Wright WE, Tonawanda, NY, Multilingual Matters Limited, 2005, pp 62–95

Keith C. Norris, MD, FASN

How can you tell?

Not By Looking!

Structure delivery of care as if every patient may have limited health literacy- a practice called Universal Precautions

Limited health literacy Affects all segments of

society Can be well spoken,

completed HS or college, hold white collar or even healthcare jobs

May & probably will say they understand

Warning signs of limited health literacy & lack of understaning

Non-adherence with medications Asks fewer questions Does not follow through on tests or referrals States “ I will read this when I get home” Don’t seem to pay attention Looks confused Stare blankly

Communication Barriers to Improving Care

◦Language/cultural barriers

◦Generational barriers: younger & older patients/staff

◦Patients nod yes but may not understand

Sure! That was easy.

Thank God those two are leaving. I’m going back to sleep

Do you understand everything we just told you?

Keith C. Norris, MD, FASN

Convey Message

Confirm

Understanding HOW?

Keith C. Norris, MD, FASN

Recommends making plain language a “universal precaution” in all patient encounters

“What Did the Doctor Say?”

Improving Health Literacy toProtect Patient Safety* Joint Commission Report

*Another in the series of Health Careat the Crossroads reports

What

•Plain language is communication that an audience can understand the first time they read or hear it.

Why

•The concept of using plain language is closely related to the concept of health literacy.

How

•Clear communication is critical to successful health care.

What is plain language?

Helps people understand

information more rapidly

Makes it easier for the person giving the

information

Improves Communication

The benefit of using plain language is like a two-way street.

Patient-friendly word list-replaces medical jargon and other difficult terms◦ Salt instead of sodium◦ High blood pressure instead of hypertension◦ Swollen instead of edema

Use examples and/or analogies whenever possible. Examples-describe:◦ arthritis by saying it’s like “a creaky hinge on a door”◦ enlarged heart like an overblown balloon◦ fluid overload is like drowning in fluid

Choose common, everyday words

A plain language thesaurus is online

Be concise. Sentences should be

no more than 15 words long, on

average.

Paragraphs should contain only one

main idea.

Get rid of unnecessary

information. Focus only on what the patient needs to

know.

Give information in understandable chunks

Simple words (1-2 syllables)

Short sentences (4-6 words)

Short paragraphs (2-3 sentences)

Headings and bullets

Lots of white space

No medical jargon

Universal CommunicationsPrinciples - Print Materials

Normal Education-Understanding Diabetes

Revised

Your body needs sugar for energy. It gets sugar from the food you eat and drink. The insulin your body makes helps turn blood sugar into energy. When your body does not make enough insulin, it cannot get energy from the sugar. Without insulin, the sugar stays in your blood. Then your blood sugar goes too high and you feel tired.

Where blood sugar comes from……Blood sugar comes from the food you eat and drink.

Why insulin is important ……Insulin turns blood sugar into energy – so you have more pep and don’t feel tired all the time.

Why your blood sugar goes high When you don’t have enough insulin, the sugar stays in your blood. Then your blood sugar goes higher than it should.

 

#1. Put the most important information

first.

Emphasize other important information by:

*bulleting indenting

using bold or larger font, or placing the message in a box.

Organize the information with the reader in mindBe clear about what the patient needs to do and when they need to do

it.

Did you know that? Patients with low health

literacy are:

less likely to be

referred for kidney transplant

have worse

control of chronic

diseases

Have higher

mortality

Most patients forget up to 80% of what their Dr tells them as soon as they leave

•Nearly 50% of what they

do remember is recalled

incorrectly

Convey Message

Confirm

Understanding HOW?

Assess if patient understood Do not ask:

◦“Do you understand?” ◦“Do you have any questions?”

What percent of the content can they recalland restate?

Use “teach back” following patient education to discover:

Ask patients to say back in their own words what you just taught or explained

Keep the message simple, e.g. 2-3 critical elements

Ask in a non-shaming way, e.g. “to be sure I/we did a good job of explaining this, please tell me what you heard”◦ I want to make sure I did a good job explaining your

blood pressure medicines, because this can be confusing. Can you tell me what changes we decided to make and how you will take the medicine now?

“Teaching back”

Uses three simple, but essential, questions and answers for every healthcare interaction:

1. What Is My Main Problem?2. What Do I Need To Do?3. Why Is It Important For Me To Do This?

resources at http://www.npsf.org/askme3/

What Is “Ask Me 3”?

Simple &

Focused

•Can you tell me the Main Problem we talked about?

Clear steps

•What Do You Think You Need To Do about it?

WIIFM

•Why Is It Important For You To Do This?

Query for understanding

We are concerned about that you are not being compliant with your Hemodialysis treatments. This is important because your body accumulates too much fluid and toxins if you aren’t complaint and this may cause you to have heart failure or a stroke.

1. What is the main problem? We are worried that are you are

missing too many treatments. This is a big problem because it can:

hurt your heart cause a stroke2. What do you need to do about

it? You need to come to every

treatment. If you can’t get here you need to

call us.3. Why is it important for you to do

this? You could die or You could get kicked out of the

clinic and have no where to get treatments

We are concerned about that you are not being compliant with your binders. This is important because your phosphorus and calcium will not be in balance if you aren’t compliant and this may cause you to have bone disease.

1. What is the main problem? We are worried that are you are not

taking your binder medication enough (with a picture or actual pill).

This is a big problem because it can:hurt your bones and heart 2. What do you need to do about it? You need to follow the diet and take XX

pills every time you eat.3. Why is it important for you to do this? Your bones will get weak and may

break It will hurt your heart so it can’t work

and You could need amputations You could die sooner

Speak up if you have questions or concerns. If you still don’t understand, ask again. It’s your body and you have a right to know.

Pay attention to the care you get. Always make sure you’re getting the right treatments and medicines by the right health care professionals. Don’t assume anything.

Educate yourself about your illness. Learn about the medical tests you get, and your treatment plan.

Ask a trusted family member or friend to be your advocate (advisor or supporter).

Know what medicines you take and why you take them. Medicine errors are the most common health care mistakes.

Use a hospital, clinic, surgery center, or other type of health care organization that has been carefully checked out. For example, The Joint Commission visits hospitals to see if they are meeting The Joint Commission’s quality standards.

Participate in all decisions about your treatment. You are the center of the health care team.

Before you go to the hospital

As a dialysis patient, you have a routine. You go to a dialysis center for dialysis or perform your own dialysis at home. You are actively involved in the daily care of your condition. This should not change when you go to the hospital. You will need to work closely with your hospital caregivers to get the best care. Speak up and let your caregivers know exactly what you need.

Talk to your kidney doctor and your dialysis care team. Ask them to send a rounding sheet to the hospital. The rounding sheet provides details about your dialysis.

Take the name and phone number of your dialysis center with you to the hospital.

Find out which hospitals in your area perform dialysis. If you perform your own dialysis, make sure the hospital has trained staff to help with peritoneal dialysis.

Tell your family your wishes for life support. Ask the dialysis social worker what forms you need to fill out to make your wishes known. Take the forms with you to the hospital. Ask that a copy be put in your chart.

Ask a family member or friend to be your advocate while you are in the hospital. An advocate can ask questions that you may not think about or be able to ask.

How can you use Speak Up?Provide Brochure

PostersWaiting roomsDoctors officesTreatment areas

Patient admission packets

Handbooks Education materials

Waiting room Websites

Speak Up videos can be shown via closed circuit TV

Adapting for out patient Review by PAC Campaign to follow

Network 14

Speak Up Video

Resources Health Literacy Toolkit- AHRQ-www.nchealthliteracy.org Plain language toolkit- printable (PDF) version of this

toolkit contact www.patienthealth@ghc.org Ask Me Three- www.npsf.org/askme3/

◦ Includes patient brochures and posters in Spanish, Arabic, Chinese, French or Russian

Speak Up www.jointcommission.org/speakup/aspx◦ Includes patient brochures and posters in English and Spanish◦ Includes videos in English and Spanish