How to Understand and

Implement Health Literacy

Presented by: Dr. Nickell M. Dixon

HEALTH DISPARITIES REDUCTION/ MINORITY HEALTH SECTION

OFFICE OF HEALTH POLICY AND INNOVATION

Objectives

•List barriers to good communication in public health

•Provide an example for each barrier

•List techniques to improve health communication.

•Define plain language

•Describe communication strategies you can apply in

your daily work

2

OUTLINE

What is literacy

Health literacy

framework

Identifying and

Assessing Health

Literacy

Who is responsible

for improving health

literacy

What can you do

Strategic Planning

Patient/Physician

communication

Patient Centered

Approach

Follow Up

3

WHAT IS HEALTH

LITERACY?

4

Consider Patricia Olsen, the 42-year-old woman who was asked if she had taken her

antibiotic premedication and responded:

Patient: “Yes…well actually, No, I didn’t. Tell me again why I’m supposed to take that

medication.”

Dental Hygienist: “Pat, when I saw you last year you told me that you had had an

artificial heart valve placed in your heart. Do you remember our discussion about that?”

Patient: “I remember my doctor telling me about my heart valve but I also remember her

saying that I don’t have to worry about it.”

Dental Hygienist: “I know; and, most of the time that’s true. However, the mouth is a

warm and moist environment and many germs live and grow in our mouths. When we

clean your teeth it’s common for some of these germs to get into your bloodstream and

travel through your body. Normally, your body’s defense mechanisms remove these

germs within a short amount of time. However, when a person has an artificial heart

valve, like you do, there is a risk that the bacteria might attach themselves to that valve

and begin to grow. This can cause an infection around the blood vessel that could

become serious. That is why we want you take an antibiotic before you have dental

procedures done. That way, if any bacteria do get into your bloodstream, the medication

will be waiting there to destroy them before they can attach to your blood vessel and

cause a problem.”

Patient: “Now that you say that, I do remember my doctor telling me that I would have to

take antibiotics if I ever have surgery. I guess I just didn’t think getting my teeth cleaned

was such a big deal. Now that you’ve explained it to me it makes more sense.”

Dental Hygienist: “Pat, just so that I know I’ve explained it clearly to you, would you

please tell me why we want you to take antibiotics before your dental appointments?”

5

What is Health Literacy?

A set of skills that people need to function

effectively in the health care environment

Degree to which individuals have the capacity

to obtain, process, and understand basic health

information and services needed to make

appropriate health decisions.

6

Source: Berkman et al (2011). Health literacy interventions and outcomes: an updated systematic review, pg. ES1. 1Institute of Medicine

7

Why is it important?

Better health outcomes

• health-related decisions should be based on clear and

correct understanding of relevant health information and

services.

People who have low literacy are most likely not health

literate.

People with limited health literacy may not be able to

navigate the health care system and to find the right

resources.

Over 70 millions adults in our country with limited

health literacy cannot fully benefit from medical care

and the health care system.

8 (Howard, Gazmararian, & Parker, The impact of low health literacy on medical costs of medicare

managed care enrollees, 2005)

Health Literacy in the U.S.

77 million adults have basic or below health literacy skills

9

Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center

for Education Statistics (2006).

Health Literacy by Racial Group

10 http://health.gov/communication/literacy/issuebrief/

Economic Impact

It is estimated that limited health literacy

costs the U.S. health care system

between $50 and $73 billion per year

11

Source: American Medical Association Foundation (2009). Health literacy and patient safety: manual for clinicians, pg. 7.

Health Literacy and Healthcare Costs

Annual Healthcare Costs of Medicaid Enrollees

12

Source: Weiss, et al (2004). J Am Board Fam Pract.

(<3rd-grade reading level) (>4th-grade reading level)

Increased Healthcare Costs

Annual health costs for individuals with low health literacy skills are four times higher than for people with higher skills.

(Howard, Gazmararian, & Parker, The impact of low health literacy on medical costs of medicare managed care enrollees, 2005)

13

Pop Quiz

Health Literacy develops over a

lifetime?

True

False

14

Pop Quiz

1. Health Literacy develops over a

lifetime?

True

False

15

HEALTH LITERACY

FRAMEWORK

16

(Squiers et al, 2012)

22

18

MODERATORS

Health Literacy and Health

Disparities

There is a strong correlation between health literacy and health

disparities.

o Health disparities: “Differences in health that occur by gender,

race or ethnicity, income or education, disability, living in a rural

locality, or sexual orientation.

HHS reports that the cultural and linguistic differences among

patients directly impact their health literacy levels, which, in

turn, contributes to an increased prevalence of health

disparities among minorities.

19

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966655/

Health Literacy and Health

Disparities

Studies show that when controlling for health literacy, racial

and ethnic disparities in health care quality and outcomes often

disappear.

20

http://www.chcs.org/media/CHCS_Health_Literacy_Fact_Sheets_2013.pdf

High-Risk Groups

Elderly

Minorities

Limited English Proficiency (LEP)

patients

Low income

Homeless

Prisoners

Persons with limited education

Learning Disabled

(Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011)

21

26

MEDIATORS

22

Individuals with Low

Health Literacy Literacy

23

Poor compliance with medical treatment

Often appear to be noncompliant with medical

treatment.

may miss appointments

forget to take medications

fail to follow self-treatment regimens

24 Brown, M. T., & Bussell, J. K. (2011). Medication Adherence: WHO Cares? Mayo Clinic Proceedings, 86(4), 304–314.

doi:10.4065/mcp.2010.0575

POOR HEALTH OUTCOMES

25

Poor Health Outcomes

Poor literacy skills often result in poor health outcomes for individuals.

• Diabetes

• Hypertension

• Cancer

Fail to seek preventive care and are at more than double the risk for hospitalization

Report poorer health status than people with better literacy skills.

Adult patients with low health literacy in primary care clinics were less able to describe how they would take 5 medications and had a greater probability of misunderstanding instructions on 1 or more labels.

Higher all cause mortality

26

http://health.gov/communication/literacy/quickguide/factsbasic.htm

IDENTIFYING AND

ASSESSING HEALTH

LITERACY

27

POSSIBLE SIGNS OF

LOW HEALTH LITERACY

Your patients’ may

frequently say:

• I forgot my glasses

• My eyes are tired

• I’ll take this home for

my family to read

• What does this say? I

don’t understand this

Your patients’ behavior

may include:

• Not getting their

prescriptions filled, or not

taking their medications as

prescribed

• Consistently arriving late to

appointments

• Returning forms without

completing them

• Requiring several calls

between appointments to

clarify instructions

28

Testing for Health Literacy

There are several test that can be used to measure

Health Literacy in patients:

Test of Functional Health Literacy in Adults

(TOFHLA)

Newest Vital Sign (NVS)

The Short Assessment of Health Literacy-Spanish

and English (SAHL-S & E)

Rapid Estimate of Adult Literacy in Medicine-Short

Form (REALM-SF)

Short Assessment of Health Literacy for Adults

Spanish(SAHLSA-50)

29

Oral Health Literacy

Questions

1) How often do you have somebody help you read hospital materials?

2) How confident are you filling out medical forms by yourself?

3) How often do you have problems learning about your medical condition because of difficulty understanding written information?

30

PATIENT/PHYSICIAN

COMMUNICATION

31

Patient-physician relationship

Patients ’ most common complaint is the lack

of information provided by physicians

Majority of malpractice suits arise from

communication errors; not incompetence

32 Silverman, Kurtz and Draper: Skills for communicating with patients 2005

The Seven Learning Styles

1. Visual (spatial):You prefer using pictures, images, and spatial understanding.

2. Aural (auditory-musical): You prefer using sound and music.

3. Verbal (linguistic): You prefer using words, both in speech and writing.

4. Physical (kinesthetic): You prefer using your body, hands and sense of touch.

5. Logical (mathematical): You prefer using logic, reasoning and systems.

6. Social (interpersonal): You prefer to learn in groups or with other people.

7. Solitary (intrapersonal): You prefer to work alone and use self-study.

Medical

Hypertension

Insomnia

Benign

Hazardous

Disorder

Option

Routinely

Adverse

Plain Language

High blood pressure

Can’t sleep

NOT cancer

Dangerous

Problem

Choice

Often

Bad

Plain Language

34

http://www.plainlanguage.gov/

Instead of saying Periodontal disease, you might say:

“The gum tissue and jaw bone surrounds and supports the teeth,

just like the foundation of a house surrounds and supports our

homes. If we don’t take care of problems in the foundation of the

home, it doesn’t matter how good the condition of the home might

be, a weak foundation won’t be able to support it. The same is true

of your gum tissue, no matter how healthy your teeth are, if the

gum tissue and bone that support your teeth aren’t healthy, you

might still lose your teeth.”

35

Tips to Identify a Patient’s

Preferred Language

Ask the patient for their preferred spoken and

written language.

• Display a poster of common languages spoken by

patients

• Ask them to point to their language of preference.

Make available and encourage patients to

carry “I speak….” or “Language ID” cards.

• Many phone interpreter companies provide

language posters and cards at no charge.

36

Interpreter

Individuals who are not trained to be an interpreter

make more clinically significant mistakes.

Unacceptable language assistance:

• Untrained/Uncertified clinicians or staff

• The patient’s family and friends

• Minor children

37 http://khn.org/news/trained-interpreters-help-avoid-medical-mishaps-michelle-andrews-052212/

Trained health care interpreters can reduce liability, help

ensure appropriate utilization, and increase client

adherence and satisfaction with services.

Trained interpreters help to assure effective

communication between the client and provider, support

effective use of time during the clinical encounter, and

improve outcomes.

Services for Non-English

Speaking or Residents

39

Don’t Assume

► If the information is critical, make sure you or someone in your office reviews the information with your patient and/or the patient’s caregiver.

When reviewing a handout:

► Circle or highlight the most important points as you talk about them.

► Personalize the material by adding the patient’s name, medicines, and/or specific care instructions.

► Use teach-back to confirm understanding.

► Emphasize the importance of the material by referring to it during follow up phone calls, emails, and future office visits. You may need to give the material to the patient more than once.

40

Fry Method

1. Randomly select three 100-word segments of your writing.

2. Count the number of syllables in each 100- word block and calculate

the average.

3. Count the number of sentences in each 100- word block and calculate

the average.

4. Plot the point on the graph (see below) where the numbers from steps 2

and 3 intersect.

Are you pregnant? Do you get health coverage from an Iowa

program? If you do, your baby will also be covered. Coverage

will last until the end of the month of your baby’s first

birthday. The baby must live with you in Iowa.

Grade 3, according to Fry’s Readability Graph

Health Literacy and Culture

The Institute of Medicine has called for the need to view

health literacy in the context of language and culture.

43

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910560/

Consider Culture, Customs,

and Beliefs Tool

Religion, culture, beliefs, and ethnic

customs can influence

how patients understand health concepts

how they take care of their health

how they make decisions related to their

health

44 http://www.med.unc.edu/tarc/files/HLUPTRheum.pdf

Cultural, Beliefs and Concepts

(989) 686-2643

http://www.tlcprojects.org/NEAT/CulturalCompetence.html

Teach Back Method

Studies have shown that 40-80 percent of the medical information

patients receive is forgotten immediately and nearly half of the

information retained is incorrect.

One of the easiest ways to close the gap of communication

between clinician and patient is to employ the “teach-back”

method, also known as the “show-me” method or “closing the

loop.”

Teach-back is a way to confirm that you have explained to the

patient what they need to know in a manner that the patient

understands.

Patient understanding is confirmed when they explain it back to

you. It can also help the clinic staff members identify explanations

and communication strategies that are most commonly understood

by patients

46

Teach-Back

Use the Teach-Back or Show Me method to ensure

patients understand the information you give

47

http://webmm.ahrq.gov/case.aspx?caseID=53#figure1.

Use Teach Back Method when discussing

brushing teeth, flossing etc.

Dental Hygienist: “Let’s review the most effective way to floss

your teeth. I’ll have you watch me floss your teeth first and then,

just to make certain that I’ve explained this clearly, I’ll have you

demonstrate the technique back for me.”

48

WHO IS RESPONSIBLE

FOR IMPROVING

HEALTH LITERACY?

49

Who is responsible for

improving health literacy?

Public health professionals, health care

providers, and the health care and public health

systems have primary responsibility.

Health literacy has direct impact on the three

pillars of medical and health services

provision:

• Increased quality

• Improved patient/consumer experience and

patient outcomes

• Reduced costs

50

Making Changes

The Institute of Medicine stated in order to address the

challenge of health literacy requires system-level

changes for both health professionals and organizations.

Systems change include using the universal health

literacy precaution methods which include:

Form changes,

Sending forms before appointments,

No heavy use of patient portal, better

communication with patients,

Uses of decision aids to help with patient

understanding

51

(Easton, Entwistle, & Williams, 2013; Weiss, 2014)

NIDCR Work Group on Functional

Health Literacy (2004)

The National Institute of Dental and Craniofacial Research

(NIDCR) convened a Working Group on Functional Oral

Health Literacy in January 2004.

The workgroup used existing health literacy knowledge from

the medical field to begin building an understanding of oral

health literacy.

The workgroup was interested in the ways in which the issue

of health literacy affected the adoption of effective disease

prevention methods, patient adherence to treatment regimens,

and ultimately, improved oral health status.

In addition, the potential impact of oral health literacy on

clinical research was also acknowledged.

52

The ADA’s House of Delegates

meeting in 2006 The delegates adopted the following six oral health literacy-related resolutions:

Res. 14H-2006: “The ADA recognizes that limited oral health literacy is a potential barrier to effective prevention, diagnosis and treatment of oral disease.”

Res. 16H-2006: Directed the ADA’s Council on Access, Prevention and Inter-professional Relations (CAPIR) to work with the Council on Government Affairs and other appropriate ADA agencies to develop and implement an advocacy strategy, based on the 2006 School Health Policies and Programs Study (SHPPS) data, to increase the number of school districts requiring oral health education for K-12 students.

Res. 17H-2006: Authorized the ADA President to appoint a three-year National Oral Health Literacy Advisory Committee (NOHLAC) of 12 national health literacy experts from dentistry, public health, literacy and other advocacy organizations.

Res. 18H-2006: Directed the CAPIR to design and execute a comprehensive oral health literacy awareness and education strategy targeting the entire dental team. The NOHLAC is will provide recommendations for this plan.

Res. 19H-2006: Instructed CDEL and other appropriate ADA agencies to encourage the development of undergraduate, graduate and continuing education programs to train dentists and allied dental team members to effectively communicate with patients with limited literacy skills.

Res. 23H-2006: Requested ADA agencies to develop guidelines for the creation of educational products to meet the needs of patients with limited literacy skills, including the involvement of targeted audiences in materials development.

53

WHAT CAN YOU DO?

54

Dental practice-related malpractice

statistics for the years 1990-2004:

The National Practitioner Data Bank Public Use File (NPDB) Summary Report:

34,691 malpractice reports regarding dentist

137 malpractice reports regarding dental residents

17 malpractice reports regarding dental hygienists

19 malpractice reports regarding denturists

8 malpractice reports regarding dental assistants

The reasons for these Patient-Clinician Related Malpractice Lawsuits were categorized as follows:

Inadequate explanation of diagnoses

Inadequate explanation of treatment

Patient feels ignored

Clinician fails to understand the perspective of patient

Clinician discounts or devalues views of patients or relatives

Patient feels rushed

55

CLAS

Enhanced in April 2013

Focuses on health equity

For use by both health

care and health service

organizations

CLAS Standards

Eliminate Health/care Inequities

Improve Quality of Services

Advance Health Equity

CLAS

CLAS standards require health care providers to:

Provide free language assistance to individuals who are not

proficient in English

Notify individuals in their preferred language, verbally and in

writing, of the availability of language assistance

Establish competence of individuals who provide language

assistance rather than using untrained interpreters minors

Provide easy-to-read handouts and posters in common

languages other than English

Include Health Literacy in

Staff Training and Orientation

Training staff will increase awareness of the need for addressing health literacy and improve their skills for communicating with the public.

Include information on health literacy in staff orientation.

Make a presentation on health literacy at your next staff meeting.

Circulate relevant research and reports on health literacy to colleagues.

Post and share health literacy resources.

58

A Health Literate Healthcare Organization 1. Has leadership that makes health literacy integral to its mission, structure, and operations.

2. Integrates health literacy into planning, evaluation measures, patient safety, and quality

improvement.

3. Prepares the workforce to be health literate and monitors progress.

4. Includes populations served in the design, implementation, and evaluation of health information

and services.

5. Meets the needs of populations with a range of health literacy skills while avoiding

stigmatization.

6. Uses health literacy strategies in interpersonal communications and confirms understanding at

all points of contact.

7. Provides easy access to health information and services and navigation assistance.

8. Designs and distributes print, audiovisual, and social media content that is easy to understand

and act on.

9. Addresses health literacy in high-risk situations, including care transitions and communications

about medicines.

10. Communicates clearly what health plans cover and what individuals will have to pay for

services.

Roundtable on Health Literacy; Board on Population Health and Public Health Practice; Institute of Medicine. How Can Health Care Organizations Become

More Health Literate: Workshop Summary. Washington (DC): National Academies Press (US); 2012 Jul 18. 2, Attributes of a Health Literate Health Care

Organization. Available from: http://www.ncbi.nlm.nih.gov/books/NBK201212/

59

Has leadership that makes health

literacy integral to its mission,

structure, and operations.

Is health literacy apart of your mission?

How does health literacy impact the

structure of your office?

What operations are in place to address

health literacy in your office?

Does your office leadership have

training in health literacy?

60

Integrates health literacy into planning,

evaluation measures, patient safety, and

quality improvement.

Are patients with low health literacy

giving extra time in appointments?

What evaluations measures are in place

to assess health literacy in your office?

How is information delivered to

patients?

How are medication instructions

written?

61

Prepares the workforce to be health

literate and monitors progress.

Are there trainings in place for staff to

stay abreast on health literacy yearly?

Have all physicians and nurses take

CME and CNE offered on health

literacy and cultural competency?

Are behavior changes toward being

better with low health literate patients on

the staff performance evaluation?

62

Includes populations served in the design,

implementation, and evaluation of health

information and services.

* Are there audits on medical records to

determine all languages of patients in

the office?

* Are patients literacy/health literacy

levels tested?

* Is there a survey that asks the patients to

grade how the office is doing on various

areas of health literacy?

63

Meets the needs of populations

with a range of health literacy

skills while avoiding stigmatization. * How do patients get linked to non-medical

support?

* Are their less than five steps in getting a patient

a referral?

* How has the staff taking time to understand the

diverse cultures, religions and sexual

backgrounds of your patients?

* Have you used an interpreter service for all

clients who are ESL even if family member

interprets?

64

Uses health literacy strategies in

interpersonal communications and

confirms understanding at all points of

contact * Have written materials in patients’

spoken language?

* Use the Teach Back method with

all patients?

* How does your physician or office

encourage patients to ask

questions?

65

Provides easy access to health

information and services and

navigation assistance.

* Do you have patient navigators in

place?

* Are patients who do not have

computer access able to get their

results and questions easy?

66

Designs and distributes print,

audiovisual, and social media content

that is easy to understand and act on.

* Are patient materials tested for

readability and understandability?

* Is all information giving to patients on a

5th grade reading level?

* Are there any usage of decision aids to

help with decision making between the

patient and physician?

67

Addresses health literacy in high-risk

situations, including care transitions and

communications about medicines.

* Are there measures to help those with

low health literacy lessen injuries due to

medication and or treatment adherence?

68

Communicates clearly what health

plans cover and what individuals will

have to pay for services.

* Does the staff have a cheat sheet for

patients to understand their insurance

plan before seeing the physician?

* Is the physician knowledgeable of health

plans and order treatment accordingly as

not to increase fees to the patient?

* Are all services and fees are written

down for the patient and explained

thoroughly for the client to agree or

disagree with.?

69

STRATEGIC

PLANNING

70

Your Strategic Plan is to plan the best way to implement the

Health Literacy Universal Precautions rules, the toolkit is here to

help with the implementation.

71

Use Health Literacy Universal

Precautions Toolkit

Agency for Healthcare Research and Quality created the Universal

Precaution Health Literacy Toolkit

Because limited health literacy is common and is hard to recognize,

experts recommend using health literacy universal precautions.

Practices should assume that all patients and caregivers may have

difficulty comprehending health information and should

communicate in ways that anyone can understand.

Health literacy universal precautions are aimed at:

■ simplifying communication with and confirming comprehension for all

patients, so that the risk of

miscommunication is minimized8

■ making the office environment and health care system easier to navigate

■ supporting patients’ efforts to improve their health

72

Steps to Implementing

Universal Precaution

1. Raise Awareness

2. Form a Group

3. Bring Team Members together

4. Create a Health Literacy Improvement Plan

73

PATIENT CENTERED

APPROACH

74

Patient Advocacy

Part of health literacy is getting the patient to become better

advocates for their health.

This usually takes skill building of the patient.

Most hospitals, health departments, and clinics used

community health workers, health educators , volunteers and

other staff to spend some time with patients to help build these

skills including:

• Asking physician questions

• Shared decision making

• Medication Awareness

• Numeracy

75

Ask Me 3

Ask Me 3 is a patient education program designed to improve

communication between patients and health care providers,

encourage patients to become active members of their health care

team, and promote improved health outcomes.

The program encourages patients to ask their health care providers

three questions:

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this?

https://youtu.be/B3EB-icaNKQ

76

http://www.npsf.org/?page=askme3

“Don’t Ask, Don’t Tell”

Not revealing information due to the patient not asking about it does not work in the medical community especially for those who aren’t health literate

Those with low health literacy sometimes do not know what to ask or how to ask a question

Example of this are immunizations and testing.

• It is the physician's jobs to stress the importance of immunization and treatment options

http://sph.umich.edu/richmedia/sph/ophp/08.25.11_GrandRounds/08.25.11_GrandRounds.html

77

Decision Making

Not all patients agree on the same way of making decision about their

health.

Some believe :

The doctors should make all their decisions

The doctor and patient should make the decision together

The patient should make the decision with their families

The patient should make the decision alone

The patient will not make any decision.

78

Use Decision Aids in every situation

Patient decision aids are tools that help people

become involved in decision making.

making explicit the decision that needs to be made

providing information about the options and outcomes

clarifying personal values

Complement, rather than replace

Help those with low literacy make better decisions

and lessen decisional regret while also gaining

knowledge

There are numerous decisions aids already in

existence

http://shareddecisions.mayoclinic.org/decision-aid-information/decision-aids-for-chronic-disease 79

80

Shared Decision Making

Shared decision making (SDM) has been defined as: ‘an

approach where clinicians and patients share the best available

evidence when faced with the task of making decisions, and

where patients are supported to consider options, to achieve

informed preferences

81 Implementing shared decision making in the NHS.

Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R

BMJ. 2010 Oct 14; 341():c5146.

6 steps to SDM

1) Invite Patient to participate

2) Present Options

3) Provide information on benefits and risks

4) Assist patients in evaluating options based on their goals and

concerns

5) Facilitate deliberation and decision making

6) Assist with implementation

82

NUMERACY AND

MEDICATION

83

What is Numeracy?

Numeracy is the type of math skills needed to function in

everyday life, in the home, workplace, and community

(Withnall 1995).

When applied to health behaviors, it describes the degree to

which individuals have the capacity to access, process,

interpret, and act on graphical and probabilistic health

information.

As a cognitive and functional skill, low numeracy correlates

with poor outcomes in the management of chronic diseases;

Numeracy is therefore an essential component of patients'

capacity to adhere to medication regimens.

84

Numeracy

In particular, people differ in

numeracy.

Among uninsured adults, we

estimated that:

28.8 percent are at a Below

Basic level of numeracy

33.4 percent are at a Basic

level

29.3 percent are at an

Intermediate level

8.6 percent are at a Proficient

level of numeric literacy

85

Adult Numeracy

Below basic Basic Intermediate Profecieint

Numeracy

Numeracy skills are needed to :

select a health plan

choose treatments

understand medication instructions include education-based skills

and emergent decision-based abilities

We estimate that the skills needed to make many complex,

informed health decisions (e.g., management of chronic diseases)

require a Proficient level of numeric literacy, given how numeric

information is often provided.

86

CREATE A CHEAT SHEET

FOR NUMERACY

Create a cheat sheet to

help those with low

numeracy understand

basic measurements they

will use when taking

medication.

IE. difference

between MG and

MM and cup vs

ounces.

Maybe your clinic would

want to create this and

give it out to your

patients.

87

Summary of Recommendations for

Presenting Numerical Concepts

Recommendation

Use the fewest and simplest mathematical constructs

Remove nonessential information

Order information from most to least important or along a discernible hierarchy

Use several formats for presentation, e.g., verbal, quantitative, visual

Consider using constructive framing or anecdotes

Present benefits and risks, loss and gains, negative and positive

Realize positive is more likely to be chosen

Consider the best time frame for presenting risk

When using graphs, use most appropriate format and explain it to the patient

When applicable, show full denominator or full range of scale and explain both the numerator and denominator

Tailor information to the patient

Make communication interactive

Reinforce important messages with repeat instruction

Confirm comprehension

88

FOLLOW UP

89

Follow Up With Patients

Follow-up is the act of making contact with a patient or caregiver at a later, specified date to check on the patient’s progress since his or her last appointment.

Appropriate follow-up can help you to identify misunderstandings and answer questions, or make further assessments and adjust treatments.

Choose the ways your office will follow up.

Phone.

Secure email.

Texting.

Postal mail.

Automated calling system

Note Patient Portal isn't an option

Summary

Understanding and implementing Health Literacy

is beneficial for the patient, the healthcare

community and economically the nation.

Health Literacy changes start with understanding

the patient, training staff, updating materials, and

continuing education amongst health care

workers.

Decisions aids are a great tool to help those with

low literacy.

91

Health Literacy Communication

Checklist

Plain Language

Proper Use of Interpreters

Making Patient Materials readable for a 4th grade level

Consider Culture of the Patient

Use teach Back Method

Tell even IF they don’t ASK

Use Decision Aids

Medication Brown Bag

Follow up with patients ( less Patient Portal)

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Questions & Comments

Dr. NICKELL M. DIXON, DrPH, MPH

HEALTH EQUITY INITIATIVE COORDINATOR

HEALTH DISPARITIES REDUCTION AND MINORITY HEALTH SECTION

PHONE: 517-373-6865

FAX: 517-241-1200

CAPITOL VIEW BLDG., 7th Floor 201 TOWNSEND STREET

LANSING, MI 48913

E-MAIL:dixonn2@michigan.gov

www.michigan.gov/mdch

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