A Silent Epidemic

Georgia Health Sciences

Library Association

March 6, 2008

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A Silent Epidemic

Learning Objectives

1. Discuss the importance of health literacy in relationship to consumer health information and education.

2. Identify 3 interventions to promote health literacy in your library/facility.

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“There is no prescription more valuable than knowledge.”C. Everett Koop MD, Former Surgeon General of the United States

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What is health literacy?

Health literacy is the ability to

read, understand and act on

healthcare information.

Understanding health information is everyone’s right.

Improving health literacy is everyone’s responsibility.

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A Silent Epidemic

Question -

Which of the following is the strongest predictor of health status in America today?• A. Age• B. Income• C. Literacy skills• D. Employment status• E. Educational level• F. Racial or ethnic group

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Importance of Health Literacy

Literacy is a stronger predictor

of health status than age,

income, employment,

education or racial/ethnic group

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A Silent Epidemic

Scope: Occurs regardless of age, race, gender,

education or income level Affects over 90 million adults in the U.S. Costs billions of dollars per year

Diagnosis: Cannot be detected by appearance, a

physical exam, blood test or other diagnostic test.

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How silent is it?

Nondisclosure of limited literacy

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Co-workers - 85% HCP - 75% Spouses - 68% Friends - 62% Children - 52%

Pankh, Nrrss, Baker and Williams (1996) Shame and health literacy: The unspoken connection. Patient Education and Counseling. 27:33-39.

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Video

Help your patients understandAMA Foundation

2007

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Change in complexity in medicine

Medical topic 35 years ago Today

Drugs 650 > 10,000

Treatment for MI 4 weeks bedrest/admit

2-4 day admit

New onset diabetes

2-3 week admit Outpatient

Asthma Theophylline Inhalers, rescue meds, controller meds, peak flow meters, steroids, triggers

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U.S. Literacy Surveys

1993 National Adult Literacy Survey NALS – 26,000 people - English only Prose Document Quantitative

2003 National Assessment of Adult LiteracyNAALS – http://nces.ed.gov/naal 19,000 people – English and Spanish Added fluency and health literacy components

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2003 NAAL Survey

Sample literacy skills

Below basic - Tell how often a person should have a medical test based on an easy-to-read handout

Basic - Answer two questions based on a one-page article about a medical condition

Intermediate - Find the age-range a child should receive a vaccine from a chart listing all vaccines and ages

Proficient - Interpret a table about blood pressure, age and physical activity and understand the relationship between them

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http://nces.ed.gov/naal/

11 million adults are Non-literate in English

30 million adults have Below Basic Literacy skills

63 million adults have Basic Literacy skills

2003 NAAL Key Findings

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2003 NAAL survey

2003 NAAL Level

Total

population

Medicare Recipients

Medicaid

Recipients

Below Basic 14% 27% 30%

Basic 22% 30% 30%

Intermediate 52% 40% 38%

Proficient 12% 3% 2%

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Poor Health Literacy

Mean reading level for Medicaid recipients is 5.6 grade level

• 8.7% are illiterate

• 25% read below the 4th grade level

Mean reading level for Spanish speaking Medicaid recipients is 3.1 grade level

• 1 in 10 Americans is foreign-born (2002)

• 1990 – 2000 - the non-English speaking, adult

population increased from 117,000 to 261,000

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Poor Health Literacy

Last grade completed in school does not equate with reading level Poor readers may read about 2-4 grade

levels below last grade completed in school

Unfamiliar information and anxiety lower reading level by 1-2 grades

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Clear Health Communications

Verbal information

Written materials

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Clear Health Communications

“Words mean what I want

them to mean” Alice in

Wonderland

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Clear Health Communications - Verbal

Create a patient-centered environment(See through the eyes of the patient)

Involve and individualize: Be positive, respectful, caring and sensitive Sit rather than stand Listen rather than speak Make eye contact when culturally appropriate Encourage patients to ask questions

• “What questions do you have for me”?

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Clear Health Communications

Create a Shame- Free Environment

Observe for : Taking too long to fill out a form Filling out only parts of forms Filling out forms incorrectly Asking someone else to complete

forms or read materials Eyes wandering over the page Lack of interest in written materials

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Clear Health Communications

Create a Shame- Free Environment

Listen for: “I forgot my glasses.” “I left my glasses in the car.” “I’ll take this home and read it later.” “I don’t have time to read this - just tell

me the important things I need to know.” “Could you read this for me? I have a

headache.”

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Clear Health Communications

Create a “shame-free” environment

and offer help

“How happy are you with the way you read?”

“What is the easiest way for you to learn and remember?”

“These forms are quite complicated, can I help you complete them?”

“A lot of people have trouble reading and remembering this. Is this difficult for you?”

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Clear Health Communications

“What is clear to you is clear to you. Every patient should be a full partner in his or her medical decisions. This requires crystal-clear communication that is done with compassion and mutual respect.”

Toni Cordell, former adult literacy student and

health literacy advocate

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Clear Health Communications - Written

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“Half of the adult population needs easy-to-read materials; the other half who do not need them want them anyway.”

Sue Stapleford, Health Literacy Institute

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Can you read this?

For lamitpo doolb ragus tnemeganam of setebaid, it

is yrassecen to take the tcerroc nilusni dose.

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Health literacy in a word

KISS

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What’s a librarian to do?

Healthcare consumers

Healthcare providers

Community

Public libraries

Other health librarians

Policy makers

Your organization

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Your turn…

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For consumers

Offer plain language resources and patient education materials:

AV materials

Books

Patient education handouts - Krames, Pritchett and Hull, Channing-Bete

Computer-based resources - Micromedex, Krames, LexiComp

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Clear Health Communications

Slow down

Use plain, non-medical language

Limit information to 3-5 key points

(“need-to-know” information)• 7-digit phone number• Emergency phone number

Be specific and concrete

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Clear Health Communications

Demonstrate, draw pictures, use models

Use non-medical, living room, conversational language

Repeat, repeat, repeat (6x rule)

We remember 20% of what we hear

50% of what we hear and see

90% of what we do

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Patients first

Focus on the patient and family -

not on our teaching, but on what are

they are actually learning

Evaluate learning often Open ended questions Teach back Show me Scenarios

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Clear Health Communications

Ask Me 3

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do

this?

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Health literacy resources for consumers and providers

Partnership for Clear Health Communications

Ask Me 3

http://www.askme3.org/

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Health literacy resources for providers

AMA Foundation. Health literacy and patient safety: Help patients understand. (Kit containing DVD, CD-rom, manual) $35.00

http://www.ama-assn.org/ama/pub/category/9913.html

Institute of Medicine. A Prescription to End Confusion. $44.96 http://www.iom.edu/?id=19750

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Health literacy resources for providers

What did the doctor say? Improving health literacy to protect patient safety. 2007 White Paper. http://www.jointcommission.org/PublicPolicy/health_literacy.htm

Hospitals, Language, and Culture: A Snapshot of the Nation. 2007 White Paper.

http://www.jointcommission.org/PatientSafety/HLC/

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The community

Partner with:

Public health clinics and departments

Pharmacies

Non-profit organizations and social service agencies

Professional schools (physician, nursing, allied health)

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The community

Partner with:

Schools, churches and other religious institutions

Cultural groups Community events and health fairs Literacy groups (adult basic education,

ESL, etc) Senior citizen groups

Reach-out-and-read programs

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Community libraries

Partner to help:

Promote awareness

Provide health education books for children and adult

Health-related “story hours”

Coordinate community programs

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Community libraries

The Humana Foundation, Libraries of the Future and the Dekalb and Fulton county libraries

www.wellzone.org

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Other health libraries

Raise awareness through:

Networking opportunities

Shared resources, projects and presentations

Literacy inservices and train-the- trainer sessions

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Policy makers and media

Legislators

Advocacy

Community events

Medicare and Medicaid officials

Newspapers, radio, TV

Public service announcements

School curriculums/librarians

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Your organization

Work with:

Patient education committees

Interpreter/cultural groups

Physicians and educators

Marketing department:

• Publications

• Intranet and intranet sites

• Closed-circuit TV programming

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Your organization

Special events: MedlinePlus inservices Health Literacy Month Health Education Week Literacy inservices

Special displays: Library displays Bulletin boards Cafeteria

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MLA Involvement

Health Information Literacy “There is a huge need to bring sense to the information universe

if MLA's vision of "quality information for improved health" is to

be achieved. There is at the same time a significant gap in the

awareness by the public and by opinion-leaders and decision

makers of the contributions that health sciences librarians can

make (and are making) to bring order to the chaos.”

MLA website

MLA Health Information Literacy Research Project –http://www.mlanet.org/resources/healthlit/hil_project

overview.html• $250,000 two-year NLM contract - research into hospital-based health

care provider and administrators’ awareness and understanding of health information literacy and its value in support of patient care.

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Health Literacy Resources

www.askme3.org

www.healthliteracy.worlded.org/index

www.hsph.harvard.edu/healthliteracy/

www.jointcommission.org

www.rwjf.org

http://www.healthliteracy.com/

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Literacy Resources

www.nces.ed.gov/naal

www.proliteracy.org

www.wisconsinliteracy.org

www.unesco.org

www.national-coalition-literacy.org/naal

www.ncsall.net

www.nifl.gov/nifl/facts/health

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Final thoughts

Health Literacy is of concern to everyone involved in health promotion and protection, disease prevention and early screening, health care maintenance,and policy making.

Committee on Health Literacy of the Institute of Medicine, 2004

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Take home message

1. Raise awareness

2. Provide education

3. Provide resources

4. Partner with others

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The End!