Putting Health Literacy into Putting Health Literacy into

Practice: A Pediatric ApproachPractice: A Pediatric ApproachBenard Dreyer, MD, FAAP

Mary Ann Abrams, MD, MPH, FAAP

Connie Arnold, PhD

Norma Kenoyer

May 23, 200711:00 – 12:30 Central Time

(9am PST/ 10am MST/ 12pm EST)

Web Conference Objectives

• Gain awareness of health literacy, its impact, and relationship to quality care

• Understand the patient and family perspective• Develop skills and techniques to address low

health literacy• Learn principles for selecting or developing plain

language print materials• Identify resources within the AAP for addressing

low health literacy

“An individual’s ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.”

National Literacy Act of 1991

General Literacy: Definition

National Assessment of Adult Literacy (NAAL)*

n = 19,714

● Most up to date portrait of literacy in U.S.

● Scored on 4 levels

● Lowest 2 levels cannot:

◦ Use a bus schedule or bar graph

◦ Explain the difference in two types of employee benefits

◦ Write a simple letter explaining an error on a bill

* National Center for Educational Statistics, U.S. Department of Education

2003 National Assessment of Adult Literacy

Intermediate

Basic

Below Basic

Proficient

14%

13%

44%

29%

93 Million Adults have Basic or Below Basic Literacy

Health Literacy: A Definition

Obtain, process, understand basic health information and services

Make appropriate health care decisions (act on information)

Access /navigate healthcare system

IOM Report on Health Literacy• 90 million adults have trouble

understanding and acting on health information

• Complex text must be simplified and

attention paid to culture and language• Providers need health literacy training

Healthy People 2010• Improve health communication/health literacy

IOM, 2004: Health Literacy…

“is fundamental to quality care…”

Relates to 3 of the 6 aims in IOM Quality Chasm Report:

• Safety• Patient-centered

care• Equitable

treatment

Limited Health Literacy: The Problem

A “mismatch” between patients’ capacities and

the demands placed on them by:

• The nature of their illness

• Self-management expectations

• Heath providers

• Health systems

2003 Health Literacy Assessment

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

Basic

Below Basic

Proficient

14%

12%

53%

22%

Intermediate

n=19,000 U.S. Adults

Health Literacy of America’s Adults• Below Basic: Circle date on doctor’s

appointment slip• Basic: Give 2 reasons a person with no

symptoms should get tested for cancer based on a clearly written pamphlet

• Intermediate: Determine what time to take Rx medicine based on label, use immunization schedule, interpret a growth chart

• Proficient: Calculate employee share of health insurance costs using table

*67% probability individual can perform task

Low Parental Literacy and Pediatric Asthma

Outcome related

to Asthma

Likelihood compared to children of higher

literacy parents

Hospitalizations 4.6

Emergency Room Visits 1.4

Missed Days of School 2.8

DeWalt et al. Ambulatory Pediatrics 2007;7:25–31

Pregnant Women: Concern about Effect of Smoking on Baby

40

Arnold, Davis, et al. Preventive Medicine 2001;32(4):313-20

66

37

0

10

20

30

50

60

70

80

90

100

Literate Low Literate

Percent

Mothers Breastfeed for at least 2 Months

Kaufman et al. Southern Medical Journal 2001;94(3):293-6.

54

23

0

10

20

30

40

50

60

70

80

90

100

Literate Low Literate

Percent

Mothers Access a Medical Home for Newborn Infant

50

14

0

10

20

30

40

50

60

70

80

90

100

Literate Low Literate

Sanders et al. E-PAS (Pediatric Academic Societies) 2006; 59:4138.1

Percent

Quality & Safety-related Consequences of Low Health

Literacy

• Excess use of emergency department• Excess hospitalizations• Longer lengths of stay• Decreased adherence• Poorer health outcomes• Increased medication errors

Amy Tilman

"When I'm confused or worried about my child, I'm not able to read things that I can normally read every day."

A Demonstration Exercise

• The following paragraph of instructions simulates what a reader with low literacy sees on the printed page

• Read the paragraph out loud.

• You have 15 seconds to read.

• Hint: The words are written backwards and the first word is “cleaning”

GNINAELC – Ot erussa hgih ecnamrofrep, yllacidoirep naelc eht epat sdaeh dna natspac revenehw uoy eciton na noitalumucca fo tsud dna nworb-der edixo selcitrap. Esu a nottoc baws denetsiom htiw lyporposi lohocla. Eb erus on lohocla sehcuot eht rebbur strap, sa ti sdnet ot yrd dna yllautneve kcarc eht rebbur. Esu a pmad tholc ro egnops ot naelc eht tenibac. A dlim paos, ekil gnihsawhsid tnegreted, lliw pleh evomer esaerg ro lio.

Test your Comprehension…

You are not alone if…

• You did not get past the first line.

• You were not able to understand the

instructions on how to clean the equipment.

How many of your patients are

struggling just to ‘de-code’ words?

Cleaning – to assure high performance, periodically clean the tape heads and capstan whenever you notice an accumulation of dust and brown-red oxide particles. Use a cotton swab moistened with isopropyl alcohol. Be sure no alcohol touches the rubber parts as it tends to dry and eventually crack the rubber. Use a damp cloth or sponge to clean the cabinet. A mild soap like dishwasher detergent will help remove grease or oil.