+ oral health literacy and dental public health. + course created by: jessica richards bs jennifer...

+

Oral Health Literacy and Dental Public Health

+

Course created by:Jessica Richards BS Jennifer S. Holtzman DDS MPHKathryn A. Atchison DDS MPHUCLA School of DentistryAcknowledge the review and input of Michelle McQuistan, DDS, MPH, U. Iowa

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3

Course Competency

3

Demonstrate the ability to communicate and collaborate with relevant stakeholders in order to advocate for oral and general health.

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This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number D83HP19949 Predoctoral Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene, grant amount $650,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

© AAPHD

+ Learning objectives:

Students will be able to:

Define health literacy & oral health literacy for the health care provider and dental public health professional

Describe the individual, community and public health implications of low oral health literacy

Explain the association between health, health literacy, health beliefs and culture

Explain and describe strategies to communicate more clearly with patients, the public, or community

Identify aspects of an oral health literate organization and be able to suggest ways to implement best practices

Describe ways to identify low health literacy through various measurement strategies

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+

6

Lecture 1Definition of health literacy & oral health literacy

6

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+ Lecture Objective

Define health literacy & oral health literacy for the

health care provider and dental public health

professional

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+ What is health literacy?

Watch this 6 minute video to see how complicated the health system is, and why health literacy matters!

http://www.youtube.com/watch?v=ImnlptxIMXs

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+ What is health literacy?

“Health literacy is a shared function of social and individual

factors, which emerges from the interaction of the skills of

individuals and the demands of social systems” 1

1. IOM. 2004. Health literacy: A prescription to end confusion. Washington, DC: The National Academies Press.

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+ What is oral health literacy?

Oral health literacy is “…the degree to which individuals

have the capacity to obtain, process, and understand

basic oral health information and services needed to

make appropriate health decisions”1

1. NIDCR (National Institute of Dental and Craniofacial Research). 2005. The invisible barrier: Literacy and its relationship with oral health. Journal of Public Health Dentistry 65(3):174-192. As cited in IOM (Institute of Medicine). 2011. Advancing Oral Health in America. Washington, DC: The National Academies Press.

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+ What is individual health literacy?

The wide range of skills, and competencies that people develop to seek out, comprehend, evaluate, and use health information and concepts to make informed choices, reduce health risks, and increase quality of life 1

Ability to read, speak, and listen Quantitate Interpret/understand risk and benefit Understand specific knowledge about disease Navigate the health care system Perform a specific task Live/work in a community that supports health

practices

1. Zarcadoolas C, Pleasant A, Greer DS. Understanding health literacy: an expanded model. Health Promot Int. 2005 Jun;20(2):195-203

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+ Levels of Public Health literacy1,2

1. Basic/functional literacy:• Basic skills in reading, writing, and interpreting numbers necessary

to function in daily situations

2. Communicative/interactive literacy: Advanced skills, including science and technology:

• Extract information and derive meaning from different forms of communication

3. Critical & civic literacy: Advanced skills that can be applied to:• Critically analyze information• Recognize and use collective beliefs, customs, world-view and

social identity in order to interpret and act on health information • Support effective social and political action

1. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000, 15(3):259-267


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+ Levels of Public Health literacy1,2

1. Basic/functional literacy: The basic skills in reading, writing, and interpreting

numbers that are necessary to function in everyday situations

1. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000, 15(3):259-267


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+ Levels of Public Health literacy

2. Communicative/interactive literacy: More advanced cognitive and literacy skills, including

competence with science and technology

Combined with social skills, can be used to extract information and derive meaning from different forms of communication

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+ Levels of Public Health literacy

3. Critical literacy/civic literacy: More advanced cognitive and literacy skills that can be

applied to critically analyze information The ability to recognize and use collective beliefs, customs,

world-view and social identity in order to interpret and act on health information

Oriented towards supporting effective social and political action

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+ National assessment of health literacy (NAAL)

A national survey 2003, NAAL:1

First large-scale national assessment in the United States to contain a component designed specifically to measure health literacy

Uses open-ended questions that require short-answer responses

1. Kutner, M., Greenberg, E., Jin,Y., and Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483).U.S. Department of Education. Washington, DC: National Center for Education Statistics.

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+ National Assessment of Adult Literacy (NAAL)

Prose: the ability to read and understand written materials

Document: the ability to find, understand and use information from noncontinuous texts in various formats

Numeracy: the ability to make simple calculations including risks and benefits

1. Kutner, M., Greenberg, E., Jin,Y., and Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483).U.S. Department of Education. Washington, DC: National Center for Education Statistics pages 2-6

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Prose: the ability to read and understand written materials Ex: Prevention, basic health literacy – How does one

prevent dental decay?

Ex. Person determines if a specific medical condition, based on 1-page article


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Example of a health education message

Preventing Dental ProblemsKeep Your Blood Glucose Under Control

High blood glucose can cause problems with your teeth and gums. Work with your health care team to keep your glucose levels as close to normal as you can.

http://www.cdc.gov/diabetes/pubs/tcyd/dental.htm#signs

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+Adults with Below Basic Prose Literacy Levels in 2003 NAAL survey

Percent in Prose Below Basic literacy Population

Percent in Total NAAL Population

Did not graduate from high school

55 15

No English spoken before starting school

44 13

Hispanic adults 39 12Black adults 20 12Age 65+ 26 15Multiple disabilities 21 9

http://nces.ed.gov/NAAL/kf_demographics.asp#2

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Document: the ability to find, understand and use information from non-continuous texts in various formats Ex: (clinical, intermediate) Determine a healthy weight

range for a person from a body mass index (BMI) graph.


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Refer to the chart to answer the following question.Place a point on the chart that would end the upward trend.

Q: Refer to the chart to answer the following question.

Place a point on the chart that would end the upward trend.

AB

C

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Numeracy: the ability to make simple calculations including risks and benefits

Ex: (navigating the health care system, proficient health literacy). Calculate an employee’s share of health insurance costs for a year, using a table that shows how the employee’s monthly cost varies depending on income and family size.


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GARFIELD, Robert M. 16 April 01

Dr. LUBIN, Michael

DOXYCYCLINE

100 MG

Take one tablet on an empty stomach one hour before a meal or two to three hours after a meal unless otherwise

directed by your doctor.

Refer to the medicine label to answer the following question. The patient forgot to take this medicine before lunch at 12:00

noon. What is the earliest time he can take it in the afternoon?

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+ NAAL demographic and health literacy results1

Older adults (65+) More older adults have ‘below basic’ health literacy than

adults in any of the younger age groups

Racial and ethnic minorities Hispanic adults had lower average health literacy than

any adults in any of the other racial/ethnic groups

Non-native speakers of English

Those with less than a high school degree or GED Starting with adults who had graduated from high school

or obtained a GED, average health literacy increased with each higher level of educational attainment

Adults living below the poverty line1. Kutner, M., Greenberg, E., Jin,Y., and Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From

the 2003 National Assessment of Adult Literacy (NCES 2006–483).U.S. Department of Education. Washington, DC: National Center for Education Statistics. Pg 9-14

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+ Clues to low health literacy

Patient: Takes a long time completing forms

Asks to take forms home to complete rather than at the office

States “I have lost my glasses.” Looks confused.

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29

Lecture 2Association of low health literacy and health, dental outcomes, health beliefs and culture

29

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+ Lecture Objective

Describe the individual, community and public health implications of low oral health literacy

Explain the association between health, health literacy, health beliefs and culture

1. IOM. 2004. Health literacy: A prescription to end confusion. Washington, DC: The National Academies Press.

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+ Association of low health literacy and dental outcomes Lower health literacy:

Poorer understanding of medical questionnaires

Higher mortality1

More severe periodontal disease2

Poorer oral health3,4,5

1. Bostock S, Steptoe A. Association between low functional health literacy and mortality in older adults: longitudinal cohort study. BMJ. 2012 Mar 15;344:e1602

2. Wehmeyer MM, Corwin CL, Guthmiller JM, Lee JY. The impact of oral health literacy on periodontal health status. . J Public Health Dent. 2012 Nov 2.

3. Miller E, Lee JY, DeWalt DA, Vann WF Jr. Impact of caregiver literacy on children's oral health outcomes.Pediatrics. 2010 Jul;126(1):107-14

4. Vann WF Jr, Lee JY, Baker D, Divaris K. Oral health literacy among female caregivers: impact on oral health outcomes in early childhood. J Dent Res. 2010 Dec;89(12):1395-400.

5. Garrett GM, Citi AM, Gansky SA. Parental functional health literacy relates to skip pattern questionnaire error and to child oral health. J Calif Dent Assoc. 2012 May;40(5):423-30.

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+ Low health literacy and oral quality of life

Oral pain Difficulty chewing Avoiding eating any food Difficulty speaking/communicating Worry about oral problems Limiting interaction with others (eg, avoids going

out) Being self-conscious about oral/mouth issue

1. Lee JY, Rozier RG, Lee SY, Bender D, Ruiz RE. . Development of a word recognition instrument to test health literacy in dentistry: the REALD-30--a brief communication. Public Health Dent. 2007 Spring;67(2):94-8

2. Richman JA, Lee JY, Rozier RG, Gong DA, Pahel BT, Vann WF Jr. Evaluation of a word recognition instrument to test health literacy in dentistry: the REALD-99. . J Public Health Dent. 2007 Spring;67(2):99-104.

3. Parker EJ, Jamieson LM. Associations between indigenous Australian oral health literacy and self-reported oral health outcomes. BMC Oral Health. 2010 Mar 26;10:3.

4. Divaris K, Lee JY, Baker AD, Vann WF Jr. Caregivers' oral health literacy and their young children's oral health-related quality-of-life. Acta Odontol Scand. 2012 Sep;70(5):390-7.

5. Garrett GM, Citi AM, Gansky SA. Parental functional health literacy relates to skip pattern questionnaire error and to child oral health. J Calif Dent Assoc. 2012 May;40(5):423-30.

© AAPHD

+ Association of low health literacy and dental behaviorsLower health literacy:

Poorer understanding of health information Report fewer oral health promoting behaviors2,3

Toothbrushing1 Interdental cleaning Dental cleanings (prophylaxis) Low-cariogenic diets Limiting cariogenic snacks

1. Parker EJ, Misan G, Chong A, Mills H, Roberts-Thomson K, Horowitz AM, Jamieson LM. An oral health literacy intervention for Indigenous adults in a rural setting in Australia. BMC Public Health. 2012 Jun 20;12:461

2. Mejia GC, Weintraub JA, Cheng NF, Grossman W, Han PZ, Phipps KR, Gansky SA. Language and literacy relate to lack of children's dental sealant use. Community Dent Oral Epidemiol. 2011 Aug;39(4):318-24.

3. Parker EJ, Jamieson LM. Associations between indigenous Australian oral health literacy and self-reported oral health outcomes. BMC Oral Health. 2010 Mar 26;10:3

© AAPHD

+ Low health literacy and failing to show Reasons for failing to show

Forgetting1,2

Health belief1,4

Environmental factors1,2,4

Communication factors1,2

Psychosocial factors 1,3

Cost1,4

Health literacy and number of information sources used to get health information5

1. Herrick J, Gilhooly ML, Geddes DA. Non-attendance at periodontal clinics: forgetting and administrative failure. Journal of dentistry. 1994;22(5):307-9. Epub 1994/10/01.

2. Casaverde NB, Douglass JM. The effect of care coordination on pediatric dental patient attendance. J Dent Child (Chic). 2007;74(2):124-9. Epub 2008/05/15

3. Hallberg U, Camling E, Zickert I, Robertson A, Berggren U. Dental appointment no-shows: why do some parents fail to take their children to the dentist? International journal of paediatric dentistry / the British Paedodontic Society [and] the International Association of Dentistry for Children. 2008;18(1):27-34. Epub 2007/12/19

4. Maserejian NN, Trachtenberg F, Link C, Tavares M. Underutilization of dental care when it is freely available: a prospective study of the New England Children's Amalgam Trial. Journal of public health dentistry. 2008

5. Holtzman J, Atchison KA, Gironda MW, Radbod R, Gornbein J. The association between oral health literacy and failed appointments in adults attending a university based general dental clinic. Community Dentistry and Oral Epidemiology. 2013 Dec 24. doi: 10.1111/cdoe.12089. (NIHMS545230)

© AAPHD

+ Public health implications of low oral health literacy

Those with low health literacy:1

Enter the healthcare system sicker Make more frequent use of emergency rooms and

inpatient care Use fewer preventative strategies Are less likely to adhere to treatment regimens (take

medications appropriately, comply with follow-up care)

1. Berkman ND,.Sheridan SL, Donahue KE , Halpern DJ, and Crotty K. Low Health Literacy and Health Outcomes: An Updated Systematic Review. Ann Intern Med. 2011;155:97-107.

© AAPHD

+ Health and Culture

Cultural competence: a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations. (founding definition Cross, 1989)

Culture: the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group.

Competence is used because it implies having the capacity to function effectively.

Ref: Cross, T. et al (1988, 1989). Toward a culturally competent system of care. Washington, DC: CAASP Technical Assistance Center, Georgetown University Child Development Center; National Center for Cultural Competence. (2009). Conceptual frameworks/models, guiding values and principles. Washington, DC: Georgetown University. Retrieved April 11, 2015 from http://files.eric.ed.gov/fulltext/ED330171.pdf

© AAPHD

+ 5 Essential Elements to an institution’s cultural competence

Valuing diversity

Capacity for cultural self-assessment

Being conscious of cultural interaction

Having institutionalized culture knowledge

Adapting to cultural diversity in their service delivery

Cross et al, 1989

© AAPHD

+ Health literacy and culture

Influence of culture on oral health self-care, diet and use of health services

Acculturation embraces changes in belief, behaviors, and lifestyles

Health beliefs “I’d rather get my teeth pulled than take the

time and money to keep them” “There are many things more important than my

health” “Good health is a matter of good fortune” “Whatever happens to my health is God’s will”

© AAPHD

+ Health beliefs and self-care

Fatalistic beliefs Ex: children will develop dental cavities May access less care Less self-care1

Specific cultural health beliefs Ex: Traditional Chinese beliefs in hot and cold disease

Visible symptoms eg. inflamed/bleeding gums =“hot”disease Treat with a cool substance (eg. powdered alum,

or musk) Invisible symptoms eg. tooth mobility = “cold”

disease1. Norman BJ, Robinson E, Razzoog ME. Societal determinants of cultural factors related to the dental health of a

selected older black population. Spec Care Dentist. 1986 May-Jun;6(3):120-3.

© AAPHD

+ Health beliefs and self-care

Ethnic and religious beliefs May be impolite to have eye contact or touch patients Restrictions of the kinds of preventive medicaments

they will use

Dietary customs Ex: sucking on lemon dipped in sugar Ex: rewarding children with candy

© AAPHD

+ Cultural influence and outcomes

• Assimilation: movement toward the dominant culture

• Rejection: reaffirmation of the traditional culture

• Marginalization: alienation from both cultures

Education, insurance and acculturation are predictors

of access to dental services!

© AAPHD

+ How to implement Cultural Competency

Policy making;

Infra-structure building;

Program administration and evaluation;

Service delivery and enabling supports; and

At the level of the individual.

At the individual level, this means an examination of one’s own attitude and values, and the acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations.

© AAPHD

+ Ways to implement cultural competency (continued)

Re-examination of mission statements

Re-examine state laws, policies, procedures and administrative practices

Emphasize diversity in staff recruitment, hiring and retention; professional development and in-service training

Translate and interpret processes in plain language

Offer health care practices, health promotion, and interventions that address beliefs of racially/ethnically health populations.

© AAPHD

+ Classroom Activity

Divide students into teams

Each team selects an oral disease (e.g. periodontitis, oral cancer) and discusses the implications associated with poor health literacy, culture and health beliefs and managing the disease.

Discuss the health communication issues the health care professionals face related to assuring adequate oral health promotion and disease management to people of differing health literacy, culture and health beliefs.

Each team will report on their discussion and management strategies for the health professionals.

© AAPHD

+

45

Lecture 3The Health Literate Organization

45

© AAPHD

+ Lecture Objectives

Explain and describe strategies to communicate more clearly with patients, the public, and the community

Identify aspects of an oral health literate organization and be able to suggest ways to implement oral health literate best practices

© AAPHD

+Oral health literate organizations

Definition: “makes it easier for people to navigate, understand, and use information and services to take care of their health”1

Create a more equal power relationship between health care providers and patients2

1.Brach C, Dreyer B , Schyve P, Hernandez LM, Baur C, Lemerise AJ, and ParkerR. Attributes of a health literacte organization. Retrieved 2.4.1013 from http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdf

2. Coleman, Clifford, Kurtz-Rossi, Sabrina, McKinney, Julie, Pleasant, Andrew, Rootman, Irving, & Shohet, Linda (2011). Calgary Charter on Health Literacy. Retrieved February 04, 2013, from http://www.nald.ca/library/research/cfl/calgary_charter_2011/calgary_charter_2011.pdf

© AAPHD

+ Framework for a health literate organization

© AAPHD

+ Best practices: Communication in a health literate organization

Use universal health literacy precautions

Universal precautions are recommendations that can be

applied “universally”. The most commonly described

example is the guidelines to reduce transmission of

infectious agents

Recommendations that can be applied in all health care

settings using common principles that can be modified to

reflect setting specific needs

© AAPHD

+ Health Literacy Universal Precautions Toolkit1

Improve health providers’ support for people with limited HL

Ensure that people have the information they need to make informed health decisions

Available at http://www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf

To determine the health literacy of the population within a county visit: http://nces.ed.gov/naal/estimates/index.aspx

1. DeWalt DA, Callahan LF, Hawk VH, Broucksou KA, Hink A, Rudd R, Brach C. Health Literacy Universal Precautions Toolkit. (Prepared by North Carolina Network Consortium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF) Rockville, MD. Agency for Healthcare Research and Quality. April 2010.

© AAPHD

+ Spoken communications

Present yourself as interested in your patient’s questions Use plain non-medical language Speak slowly and clearly Stick to 3-5 main points Avoid using Y/N questions

Instead say: “I want to be sure I explained everything clearly. Can you please tell me what you will tell your (mother, spouse) in your own words?”

Confirm that your patient understands

© AAPHD

+ Nonverbal communication

Use open body language Sit up straight with legs and arms uncrossed Sit at the same level as your patient

Eye contact Look at person when you are speaking with them

© AAPHD

+Improve written communications

Evaluate written materials for reading level and content Use a readability tool like SMOG or Flesch-Kincaid

Visit: http://www.read-able.com Ask patients for feedback on your forms and

education materials Offer help with filling out forms Review post op/dosage instructions

Personalize the materials by adding the patient’s name or specific instructions

Demonstrate the instructions if possible Use Ask 3 in materials

© AAPHD

+Help your patient develop healthy habitsIs patient motivated to make a change?

Help them write an action plan1 Identify an important goal View this as a collaborative effort (Patient and health care

provider) Set small, specific and achievable goals Create an outline of the steps in plain language Assess patient’s confidence in accomplishing the goal Put a copy of the plan in patient’s chart Follow-up with patient to monitor success and challenges Ask how you can help support patient’s efforts

1. DeWalt DA, Callahan LF, Hawk VH, Broucksou KA, Hink A, Rudd R, Brach C. Health Literacy Universal Precautions Toolkit. (Prepared by North Carolina Network Consortium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF) Rockville, MD. Agency for Healthcare Research and Quality. April 2010.

© AAPHD

+Create a supportive environment for people to improve or maintain health

Patients may need non-medical support in order to maintain their health

Ex: you made a referral for follow up treatment. Did it happen? If not, is there something the office can do to address the barrier?

Assess patient’s needs

Listen to your patient. There may be non-health factors that are affecting your patient’s health

© AAPHD

+Evaluate your patient’s support system

Informal support: friends and family provide information, transportation, etc.

Formal support: case managers and agencies can help connect patients to needed services

Community resource list: Transportation services, medication resources, and

aging/caregiver services Directions to your office, including access to public

transit Special services for the elderly Additional community groups that may be helpful

(medication delivery, meals on wheels, etc)

© AAPHD

+ Develop low literate patient education materials

Use symbols and shapes to distinguish different types of information on a handout.

Include white space between sections of a document.

Use the same type of font and limit the number of colors of font that are used in the document.

Include“Ask Me 3”.

Use videos.

© AAPHD

+ Ask Me 3

Patient education program to improve communication between patients and health care providers

Encourages patients to become active members of their health care team

Promote improved health outcomes.

Designed by the National Patient Safety Foundation

http://www.npsf.org/for-healthcare-professionals/programs/ask-me-3/

© AAPHD

+ Ask Me 3

What is my main problem?

What do I need to do?

Why is it important for me to do this?

© AAPHD

+ Oral health literacy is a collaborative effort

Health literacy applies to everyone1 Individuals: use the skills needed to find, understand,

evaluate, communicate, and use information Health care professionals: present information to

improve people’s understanding and ability to act on the information

Systems: provide equal, easy, and shame-free access to health care and health information

1. Coleman, Clifford, Kurtz-Rossi, Sabrina, McKinney, Julie, Pleasant, Andrew, Rootman, Irving, & Shohet, Linda (2011). Calgary Charter on Health Literacy. Retrieved February 04, 2013, from http://www.nald.ca/library/research/cfl/calgary_charter_2011/calgary_charter_2011.pdf

© AAPHD

+ Cultural Competency Activity for Classroom or Homework

CALIFORNIA LEGISLATURE— 2013–2014 REGULAR SESSION

Introduced by Assembly Member Mitchell February 19, 2013

AB-459 Public contracts: healthy and sustainable food.

“Existing law regulates various aspects of the provision of food and beverages in vending machines, including requiring a vendor that operates or maintains a vending machine on designated state property to offer food and beverages in the vending machine that meet accepted nutritional guidelines, as defined, in accordance with certain content percentages. “(see handout for complete text)

Task: Review AB-459 and describe why this is or is not a culturally competent bill that is presented in literate sensitive language. Consider whether you, as a DPH would advocate for or against this Bill.

© AAPHD

+ Readability results for AB-459

Flesch Kincaid Grade Level 9.5

SMOG Index 9.5

Readability Index 9.3

Percent of complex words in tested paragraphs: 15.75%

Discuss whether this level of complexity is literate sensitive, that is, easy or difficult for various people/ groups to understand.

Would you use this Bill in advocacy or health promotion programs, and if yes, how?

© AAPHD

+ How do we measure health literacy? Health literacy metrics focus on skills in

multiple context 1

Reading

Writing

Listening

Speaking

Numeracy

Critical analysis

Communication and interaction skills

1.Pleasant A, Kuruvilla S. A tale of two health literacies: public health and clinical approaches to health literacy. Health Promot Int. 2008 Jun;23(2):152-9

© AAPHD

+ Identifying low health literacy

Shame and stigma: patients are unlikely to self-identify difficulty understanding health information

How do we identify those with low health literacy? REALM (Rapid Estimate of Adult Literacy in Medicine) REALMD (Rapid Estimate of Adult Literacy in Medicine and

Dentistry) REALD (Rapid Estimate of Adult Literacy in Dentistry) TOFHLA (Test of Functional Health Literacy in Adults) TOFHLiD (Test of Functional Health Literacy in Dentistry) NVS (Newest Vital Sign)

© AAPHD

+ Rapid Estimate of Adult Literacy in Medicine (REALM)1 Individual reads a list of words out loud and their

score is based on their pronunciation of words

Available in short and long format

Assesses word recognition, not comprehension

Grade range estimate of reading ability

English only

SAHLSA (Short Assessment of Health Literacy for Spanish-speaking Adults)

1. Davis TC, Crouch M, Long S. Rapid estimate of adult literacy in medicine. FamMed. 1993;25:391-5.

© AAPHD

+ Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALMD)1

1. Atchison KA, Gironda MW, Messadi D, Der-Martirosian C.Screening for oral health literacy in an urban dental clinic. J Public Health Dent. 2010 Fall;70(4):269-75

2. Gironda M, Der-Martirosian C, Messadi D, Holtzman J, Atchison K. J Public Health Dent. 2013 Jan 7. doi: 10.1111/jphd.12005. [Epub ahead of print]A brief 20-item dental/medical health literacy screen (REALMD-20).

© AAPHD

+ REALMD1

1. Atchison KA, Gironda MW, Messadi D, Der-Martirosian C.Screening for oral health literacy in an urban dental clinic. J Public Health Dent. 2010 Fall;70(4):269-75

REALMD-20 words are highlighted

© AAPHD

+ Rapid Estimate of Adult Literacy in Dentistry (REALD) An individual reads a list of words out loud and their score

is based on their ability to pronounce words correctly

Several different formats available REALD 301: 30 common dental words with varying difficulty

REALD 992: REALD 30 words plus additional 69 dental words with varying difficulty

TS-REALD3: Two-stage REALD 30

Available in English only

1.Lee JY, Rozier RG, Lee SY, Bender D, Ruiz RE. Development of a word recognition instrument to test health literacy in dentistry: the REALD-30--a brief communication. J Public Health Dent. 2007 Spring;67(2):94-8.

2. Richman JA, Lee JY, Rozier RG, Gong DA, Pahel BT, Vann WF Jr . Evaluation of a word recognition instrument to test health literacy in dentistry: the REALD-99. J Public Health Dent. 2007 Spring;67(2):99-104.

3. Stucky BD, Lee JY, Lee SY, Rozier RG. Development of the two-stage rapid estimate of adult literacy in dentistry. Community Dent Oral Epidemiol. 2011 Oct;39(5):474-80. doi: 10.1111/j.1600-0528.2011.00619.x. Epub 2011 May 18.

© AAPHD

+ Test of Functional Health Literacy in Adult (TOFHLA)1

Assesses reading comprehension and numeracy

Uses written material that might be given in a hospital

Fill in the blank (Cloze technique) requires an individual to select the correct word to fit in medical instructions

Short form (S-TOFHLA) only includes reading comprehension

Available in English and Spanish

1. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med. 1995 Oct;10(10):537-41.

© AAPHD

+ Test of Functional Health Literacy in Dentistry (TOFHLiD)1

Assesses numeracy and comprehension with questions

related to: fluoridated toothpaste, dental appointment,

fluoride drops and fluoride tablet

Cloze format for follow-up instructions after a dental

procedure

1. Gong DA, Lee JY, Rozier RG, Pahel BT, Richman JA, Vann WF Jr.Development and testing of the Test of Functional Health Literacy in Dentistry (TOFHLiD). J Public Health Dent. 2007 Spring;67(2):105-12.

© AAPHD

+ Test of Functional Health Literacy in Dentistry (TOFHLiD)1

1. Gong DA, Lee JY, Rozier RG, Pahel BT, Richman JA, Vann WF Jr. Development and testing of the Test of Functional Health Literacy in Dentistry (TOFHLiD). J Public Health Dent. 2007 Spring;67(2):105-12.

© AAPHD

+ Newest Vital Sign (NVS) 1

Assesses both reading comprehension and numeracy

Fictional label from a container of ice cream

Questions require the subject to find information embedded in the label and make several computations

No dental equivalent

Available in English and Spanish

1.Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, Hale FA.Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005 Nov-Dec;3(6):514-22.

© AAPHD

+ Classroom Activity: Complete the Newest Vital Sign

Accessed 1/25/2013 at : http://www.pfizerhealthliteracy.com/asset/pdf/NVS_Eng/files/nvs_flipbook_english_final.pdf

© AAPHD

If you eat the entire container, how many calories will you eat?

a. 250

b. 1000

c. 120

d. 480

2501000

120480

25% 25%25%25%

© AAPHD

If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream could you have?

a. Half the container

b. ½ cup

c. One cup

d. A and C are both correct

Half the co

ntainer

½ cup

One cup

A and C are both

corre

ct

25% 25%25%25%

© AAPHD

Your doctor advises you to reduce the amount of saturated

fat in your diet. You usually have 42 grams of saturated fat each day, which includes one

serving of ice cream. If you stop eating ice cream, how many grams of saturated fat would you be consuming each day?

© AAPHD

Your doctor advises you to reduce the amount of saturated fat in your diet. You usually have 42 grams of saturated fat each day, which includes one serving of ice cream. If you stop eating ice cream, how many grams of saturated fat would you be consuming each day?

a. 31

b. 0

c. 33

d. 29

25% 25%25%25%

© AAPHD

If you usually eat 2500 calories in a day, what

percentage of your daily value of calories will you be eating if you eat one

serving?

© AAPHD

If you usually eat 2500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one serving?

a. 5%

b. 8%

c. 10%

d. 12.5%

25% 25%25%25%

© AAPHD

Pretend you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee stings.

Is it safe to eat this ice cream?

© AAPHD

Pretend you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee stings.Is it safe to eat this ice cream?

a. Yes

b. No

YesNo

50%50%

© AAPHD

If you answered that is it is not safe to eat this ice cream, explain why.

a.Because the ice cream contains Carrageenan.

b.Because the ice cream contains high levels of carbohydrates.

c.Because the ice cream contains peanut oil.

d.Because the ice cream contains high levels of fat.

© AAPHD

If you answered that is it is not safe to eat this ice cream, explain why.

Because the ice cream contains: a. Carrageenan

b. high levels of carbohydrates

c. Peanut oil

d. high levels of fat

Carrage

enan

high le

vels of c

arbohydra

tes

Peanut o

il

high le

vels of f

at

25% 25%25%25%

© AAPHD

+ Other health literacy measures

HeLMS (Health Literacy Measurement Scale) modified by Parker1

29 item screener covers 8 domains (eg, attitude towards health, social support, being proactive, and communicating with health professionals) Ex: “Are you able able to make time for things that are

good for your health”

OHLI (Oral Health Literacy Instrument)2

Cloze with passages on dental caries and periodontal disease

OH-LIP (Oral Health Literacy Inventory for Parents)3

Combination of word recognition and comprehension of pediatric oral health terms

1.Parker EJ, Misan G, Chong A, Mills H, Roberts-Thomson K, Horowitz AM, Jamieson LM. An oral health literacy intervention for Indigenous adults in a rural setting in Australia. BMC Public Health. 2012 Jun 20;12:461. doi: 10.1186/1471-2458-12-461.

2. Sabbahi DA, Lawrence HP, Limeback H, Rootman I. Development and evaluation of an oral health literacy instrument for adults. Community Dent Oral Epidemiol. 2009 Oct;37(5):451-62. doi: 10.1111/j.1600-0528.2009.00490.x.

3.Richman JA, Huebner CE, Leggott PJ, Mouradian WE, Mancl LA. Beyond word recognition: understanding pediatric oral health literacy. Pediatr Dent. 2011 Sep-Oct;33(5):420-5.

© AAPHD

+ Challenges to health literacy measurement

Strong consensus that the existing measures of health literacy are inadequate or incomplete

Need to address a broader array of skills and content areas

Need to consider the health literacy capacity of information givers (e.g., health care provider) and information seeker (e.g., a patient)1,2

1. Pleasant A, McKinney J, Rikard RV. Health literacy measurement: a proposed research agenda. J Health Commun. 2011;16 Suppl 3:11-21.

2. Sorenson C, Drummond M, Chalkidou K. Comparative effectiveness research: the experience of the National Institute for Health and Clinical Excellence. J Clin Oncol. 2012 Dec 1;30(34):4267-74.

+ oral health literacy and dental public health. + course created by: jessica richards bs jennifer...

Documents

general health

individual health literacy

department of health

low health literacy

health beliefs

health risks

health resources

health system