health literacy: from individual to institution

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Health Literacy: From Individual to Institution. Fatima Ashraf Office of the Mayor. Literacy. LANGUAGE 50% of NYC adults speak a language other than English at home 25% of NYC adults do not speak English. The Context. LITERACY 60% of NYC adults read at an 8 th grade level or below - PowerPoint PPT Presentation


  • Health Literacy:From Individual to Institution

    Fatima AshrafOffice of the Mayor

  • Literacy

  • The ContextLANGUAGE

    50% of NYC adults speak a language other than English at home

    25% of NYC adults do not speak English


    60% of NYC adults read at an 8th grade level or below

    Remember: reading skills trail last year of school by 2 to 5 years high school diplomas linked to 9th grade skills

  • Key Things to Remember

    There is a culture of literacy

    If you cant read well, words are not helpful

    Even people who can read well, dont read they skim

  • Writing Sample #1Nepo lla eerht sdil eno yb eno dna yllausiv kcehc lla gniriw dna gnibut. Kcehc fi gnihton si nekorb, dehctarcs, tneb, ro esiwrehto degamad.

  • Writing Sample # 2Those referred for ernstropikgle should report to the ernstropikgle evaluation center on the lower level in the left corridor on the right side. Ernstropikgle candidates should be advised that preparation requirements exist that if not consistently adhered to prior to the ernstropikgle may under certain circumstances lead to suboptimal findings.

  • Writing Sample # 3Take two pills once a day.

  • Health Education vs. Health Literacy

  • Health Literacy: DefinitionsHealth literacy is the ability of an individual to read, understand and act upon health related information.

    Health literacy also refers to the capacity of professionals and institutions to communicate effectively so that community members can make informed decisions and take appropriate actions to protect and promote their health.

  • Consequences of low health literacy on the individual:Worse overall health statusPresentation for treatment at later stagesHigher rates of hospitalizationHigher rates of ER utilizationLess knowledge of health and diseaseDifficulty understanding and using health information

  • Institute of Medicine recognizes importance of the institutionsThe problems associated with limited health literacy and interventions to ameliorate them do not start and end with patients.

    Efforts to enhance health literacy skills among individual families must be matched by interventions on the part of the health care sector to improve communications and systems. (IOM, 2004)

  • Responsibilities of the institution:Reducing racial and ethnic disparities in careImproving patient safety and reducing medical errorsImproving health outcomes for people with chronic medical conditionsImproving health literacy knowledge and skills among health care providers

  • Clear & Effective Communication

  • Guidelines forClear and Effective Communication

    Clarity of purpose

    Plain language

    Good document design

    Test your documents with intended users!

  • What is Clarity of Purpose?

    Does the title and opening sentences explain what the purpose of the document is?Who is it intended for?What is the reader supposed to do?

    Does the document contain everything the reader needs to accomplish the intended purpose?

    Is the document focused?Does it contain more than 3 or 4 main points?Does it include information that is not essential?Does it put the most important points up front?

  • What is Plain Language?Techniques that make documents easy to read:Smaller, simpler, more familiar wordsLess jargon and legalese with important words defined Shorter sentences, shorter paragraphsActive voice, conversational tone, personal touch (I, you, we)Vocabulary and concepts are concrete and explicit rather than abstract and impliedLower reading level

    Mayors Office of Adult Education Mayors Office of Correspondence

  • Smaller, Simpler Words with Less Jargon

    Notwithstanding the fact that: ___________

    At this point in time: __________________

    Until such time as: ___________________

    In the event of: ______________________

    Adversely impact: ____________________

    Mayors Office of Adult Education Mayors Office of Correspondence

  • Smaller, Simpler Words with Less Jargon Adjacent to: _________________________

    Heretofore: _________________________

    Previously: __________________________

    Notice of Violation: ___________________

    Statutory Penalty: ____________________

    Mayors Office of Adult Education Mayors Office of Correspondence

  • HHC Open Letter to Immigrant New YorkersOur policy is clear. Any patient information obtained by an HHC employee may not be disclosed to any third party. Our employees know that they may lose their jobs if they violate this policy. Treating all patient information as confidential is critical to the trust we want to build with all our patients. This trust helps us to provide quality health services to you and your family.

  • HHC Open Letter to Immigrant New Yorkers with Plain LanguageOur policy is clear. No HHC employee can give your patient information to ANYONE else. All of our employees know that if they break this promise they can lose their job. We understand that this is the only way that we can keep your trust. We know that we need your trust to give you and your family quality health services.

    Mayors Office of Adult Education Mayors Office of Correspondence

  • What is Good Document Design?

    Techniques that make documents easy to read:Not too dense-looking; good balance of white spaceCan be easily skimmed Information visually chunked into small sectionsHeadings tell the reader the main points and where information is locatedNumbered lists, bullet points, arrowsPictures or graphics support main pointsFont size of 12 or larger with limited use of bold for emphasis and avoid all capsLeft justified with jagged right margin

  • Institutional partnerships:Health Care and Adult EducationSystem of classes with access to 70,000 potential patients.

    Health care providers can get insight into:How adults learnHow to be effective communicatorsHow to assess patients literacy levelHow to break down complicated tasksBe patient (student) centered

  • For more


    Its wonderful to be hereIm a firm believer in the education and empowerment of individuals/patients. We are here today with a panel of people that have solutions from the institutional endwhich is just as important. Reading levels in the cityNot dumbing down because many of our documents are difficult for even us to understand! Think health insurance forms.

    TLC demog stats, remind folks of citywide reading stats

    Difficulties of low literate/low english proficient focus to read. Slow, word by word. First word, last word.

    One difficult word is difficult throughout.

    Notice the assumptions we make.People understand the concept of direct deposit (should be defined)Who is Carmelo? Where is the payroll office?

    Beyond the ability to read, includes listening, speaking, writing, numeracy or arithmatic. Competence to use information that is health enhancing.Focus on skills development rather than remediation of patient defecits or transmission of specific knowledge (not health education)

    Health literacy dependent on factors outside the individual. Cultural, societal, resources.

    because of these well-documented consequences, health literacy is a key issue for effective ambulatory care -- we will never see the true promise of quality primary care with medical homes if we don't address HL Health literacy is fundamental to quality care.

    Re-read, re-emphasize


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