health literacy: a prescription for better health and health care … · 2020-01-23 · low health...
TRANSCRIPT
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Health Literacy: A Prescription for Better Health and
Health Care for Rural Residents
Steven Sparks. MS Health Literacy Director
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Literacy Levels
• Below Basic — no more than the most simple & concrete literacy skills
• Basic — skills needed to perform simple, everyday literacy activities
• Intermediate — skills needed to perform moderately challenging activities
• Proficient — skills needed for more complex & challenging literacy activities
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Adult Literacy Levels
0%
10%
20%
30%
40%
50%
60%
Prose Document Quantitative
43%
34%
55%
34-55% of adults are at below basic
and basic literacy levels
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A silent problem
Parikh, N.S., et al. Patient Educ Couns, 1996.
Percent who never told:
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What is Health Literacy?
“The degree to which an individual has the
capacity to obtain, communicate, process,
and understand basic health information
and services to make appropriate health
decisions.”
-The Affordable Care Act of 2010
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Health Literacy means a
person is able to understand:
• Instructions on prescription bottles
• Appointment slips
• Medical brochures, provider instructions
and consent forms
• Complex health care systems
• Insurance benefits
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Health literacy affected by 1.Literacy skills of patient
2.Communication skills of the provider
3.Demands placed on the patient
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Demands of medications
Persons with limited health literacy are less likely
to take medications effectively:
• Adherence: 20% greater risk of hospital
readmission
• 46% of all literacy levels misunderstood
one or more dosage instructions
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Health literacy of U.S. Adults
14%
22%
52%
12%
Below Basic
Basic
Intermediate
Proficient
(NAAL, 2003)
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Adults proficient in health literacy
All Adults Rural Adults
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You can’t tell by looking…
• 2013 study:
– 63%: patients with high likelihood
of limited health literacy
– 19% estimated by nurses
Nurse Overestimation of Patient Health Literacy, Journal of Health Communication, 2013 (18)
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• Poor health status
– Poor: 68%
• Low education level
– Some HS/less than HS Grad: 76%
• Insurance
– Those on Medicaid: 57%
Who is most at risk for low health literacy?
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Ethnicity:
– Entire population 36%
– White 28%
– Native Americans 48%
– Blacks 58%
– Hispanics 66%
Who is most at risk for low health literacy?
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• Seniors
– Seniors 65+: 59%
– Seniors 75+: 70%
• Persons with Disabilities
– Persons with physical/other disabilities - 49%
Who is most at risk for low health literacy?
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More people with characteristics typically
associated with low health literacy:
• Poverty
• Age
• Education
• Inadequate/lack of health insurance
• Absence of usual sources of care
Rural: Greater concentration of low health literacy
Health Literacy and Urbanicity, Halverson et. al, 2013
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The challenge of finding health information in rural areas
• Lack of public transit
• Geographic isolation
• Reduced access to health care providers
• Hesitancy to question provider
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The rural solution
• Public Health
• Self-reliance
• Dependence on pharmacists,
nurses, school nurses
• Churches
• Libraries
• The Internet……but……
“I’ll take care of it myself.”
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Internet not always a good option for rural residents
• Internet less reliable
• Options very confusing
• Low literacy reduces internet use
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Implications of Low Health Literacy
How health literacy affects
what you do every day
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Implications: Use of Preventive Services
Persons with limited health literacy
skills are more likely to skip preventive
measures such as:
• Mammograms
• Pap smears
• Flu shots
20
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Implications: Chronic Conditions
Persons with limited health literacy skills:
• More likely to have chronic conditions and
less likely to manage them effectively
• Less knowledge of their illness
• Diabetes: greater risk of death
• Cancer:
– Later stages of diagnosis
– Obtain less information from materials
21
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Implications: Hospitalization and Health Status
Persons with limited health literacy skills:
• More preventable hospital visits and
admissions.
• More ED visits
• Significantly more likely to report their health
as “poor.”
22
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Implications: Mortality
Persons with limited health literacy skills:
• Are more likely to die earlier
23
19.7
10.6
0
5
10
15
20
%
Low Literacy Higher Literacy
Risk of Death Hazard ratio: 1.75
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Low health literacy increases US health care costs by $50-$73 billion annually.*
*National Academy on an Aging Society
Implications: Health Care Costs
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Clues to low health literacy
• Incomplete forms
• Missed appointments
• Noncompliance with medications
• Inability to explain medication purpose
• Overstating how well they are doing
• Excuses: “I forgot my glasses”
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• Almost everyone will have difficulty with health
literacy at some point.
• Much harder for those that do not:
– Read very well.
– Speak English as their primary language.
Literacy Health
Literacy Vs.
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The triple threat to effective health communication
P. Schyve. J Gen Intern Med.
Nov. 2007: 22: 360-361
TRIPLE THREAT
Language difference
Cultural difference
Low health literacy
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You may be thinking…..
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Adopt Universal Precautions
Since you can’t always tell by looking….
• Take actions that minimize risk for everyone
• Use plain language with everyone
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8 Steps to Better Communication
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Create Shame-Free Environment
Even highly
educated people
prefer simple,
understandable
health
information.
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20% of American adults read at or below the 5th grade level.
Most health care materials are written above the 10th grade level.
Practice plain, simple language
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Use Plain Language
Prevents osteoporosis
Keeps bones strong
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Plain language resources www.JustPlainClear.com
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Use Short Words & Sentences
• Return in one week.
• Bring your insurance card with you.
• Please sign in.
• Take this form to your boss tomorrow.
• Pay your premium by next Friday.
• Drink plenty of orange juice.
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Sentences with one idea
No: Help may be available for you to pay your medical bills and to find out if you qualify, here’s what you should do.
Yes: We may be able to help you pay your medical bills. Find out if you qualify. Follow these steps.
Use one-idea sentences
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Use active voice
Passive: You will be asked to give information about your medical history.
Active: We will ask for information about your medical history.
Avoid:
It shall be signed
You will be notified
Use:
You must sign
We will notify you
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Use concrete language (say what you mean)
Exercise regularly
Don’t lift anything heavy
Get adequate rest
Exercise 3-5 days per
week for 40 minutes
Don’t lift anything over 10
pounds.
Get at least 7 hours/night
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Slow down
Speak clearly and at a moderate pace.
sorrymyemaillookslikethisbutmycomputerdroppedandmyspacebarbroke
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Organize for understanding
Only “need to know” concepts
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Chunking
• Break up material into manageable
chunks
• Limit to 5 pieces of information at a
time; 3 even better
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Before….
Straight Leg Raise
Lying on your back, bend your opposite
knee straight and slowly lift your other leg
up approximately 12 in, hold for 3s, and
lower slowly.
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After….
Straight Leg Raise
• Lie on your back
• Bend left leg
• Lift right leg 12 inches
• Hold for 3 seconds
• Lower slowly
Literacy and the Older Adult, from Topics in Geriatric Rehabilitation, Oct-Dec2005, Vol. 21 Issue 4, p275
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Show or draw pictures
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Relevant pictures
Which would be best to illustrate a stop smoking message?
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Help with numbers
Pop Quiz on Numeracy
1. A person talking Drug A has a 1% chance of
having an allergic reaction. If 1,000 people take
Drug A, how many would you expect to have an
allergic reaction?
2. A person taking Drug B has a 1 in 1,000 chance
of an allergic reaction. What percent of people
taking Drug B will have an allergic reaction?
Answer: 10
Answer: 0.1%
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Help with numbers
• Less is more—only relevant information
• Reduce need for calculations
• Pictographs, diagrams, charts
• Frequency, not percent
• Familiar objects as
analogies
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• Asking people to repeat in their own words what they need to know or do, in a non-shaming way.
• NOT a test of the person, but of how well you explained a concept.
• A chance to check for understanding and, if necessary, re-teach the information.
Verify understanding using “Teach Back”
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Ask to demonstrate understanding “We have gone over a lot of information today. What will you tell your boss about your health condition?” “I want to be sure I explained everything clearly. Please tell me how can you avoid losing your health insurance.”
Do not ask: “Do you understand?”
Using Teach Back…
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Teach Back Tips
• Start slowly – once a day?
• Plan and practice your approach
• Use handouts
Once you get used to Teach-Back, it doesn’t take any more time.
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Ask the right questions
– Is there something else you want to address
in the visit today?
– Is there anything else you want to address
in the visit today?
Reducing patients’ unmet concerns in primary care: The difference one word can make.
Heritage j, et al. J Gen Int Med 2007:22;1429-1433.
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Encouraging questions
• “What questions do you have?”
• “Tell me your questions.”
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If you only remember three things:
1. Practice plain language
2. Slow down
3. Teach back-confirm understanding
(3 Best Practices: DeWalt et al, 2010)