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TRANSCRIPT
Improving Client Health Outcomes,
One Word at a Time
Your doctor tells you:
“You have a 1 in 10 chance of having
Disease A and a 1 in 20 chance of having
Disease B in the next 10 years.”
Which disease are you at
highest risk for?
Disease A
However, studies have found that people
with low health literacy were more likely to
say Disease B.
Lipkus et al, 2001 Medical Decision Making; Peters et al, 2007 Health Affairs
True or False?
A person with low health literacy skills has
a low IQ?
False
Health literacy is not about intelligence!
Doak et al, 1995 Teaching Patients with Low Literacy Skills
Immediately after leaving a doctor’s office,
patients forget 50% of the critical
information shared at that visit?
Do you know why?
Regardless of a patient’s reading ability, the
medical setting in and of itself can have a
negative impact on health literacy skills.
Davis et al, 2002 Health Literacy and Cancer Communication
Health Literacy is…….
The ability to get information, understand it, and use it to lower risk and better health. (University of Maryland)
To actively self manage, patients need to be able to:
Access
Understand
Evaluate
Communicate
Apply
Vulnerable Groups
Older adults (over 65 years)
Low income, unemployed
Born outside of Canada
Limited proficiency in English/French
Low education level
* Low health literacy disproportionately
affects people with chronic disease.
Canadians’ Health Literacy Skills
Low Health Literacy
60 % of adults (16 +)
88 % of seniors (66 +)
Health Literacy in Canada: A healthy understanding, 2008
Outcomes Reduced health related knowledge
Poorer self management skills
Less use of preventative care services
Medication errors and “non-adherence”
More use of emergency services
Higher mortality (seniors)
Higher health care costs
AHRQ, 2011; Canadian Council on Learning,2008
Clinical outcomes
2 x risk of Hbg A1c and Retinopathy
1.5 x risk of late stage presentation of
cancer
1.5 x risk of depression/anxiety
> 1.5 x risk hospitalization
4 x risk of maternal literacy /infant mortality
Dewalt et al JGIM, 2004
Health Literacy Impacts:
Access to care
Patient Safety
Quality of care
Patient’s experience
Health outcomes
What affects health literacy?
Personal Factors
System factors Health
Literacy
Interaction of the person and the health care context
Personal factors: Life!
Physical and emotional health: pain, fatigue,
anxiety, lack of sleep
Knowledge and cultural beliefs about
health
Experience with the condition and the
healthcare system
Motivation and self confidence
System factors
• Communication skills Providers
• Complexity and design of information
Patient Education Materials
• Nature of the environment
Places
System expectations
We expect (rely on) patients and families to
be:
Informed
Activated
Computer literate
Self managing
Partners in care
Individuals Skills vs System Demands
Average literacy skills of working adults=
grade 7/8 (lower in vulnerable
populations)
Most health information at reading level
of ≥ Grade 10
Research/informed consent often at a
college level
Verbal communication- too fast in a
“foreign” language
Imbalance
Person’s capacity
System demands
“This is Bad Enough”
A patient’s perspective
What can we do?
Foster better conditions for self
management!
Universal precautions (Routine
Practices) in health literacy means…
We expect that every encounter is at risk for miscommunication.
We create a shame-free environment of care: ◦ Treat all patients equally
◦ Anticipate communication barriers
◦ Communicate clearly with everyone
◦ Confirm understanding with everyone
◦ Proactively work to minimize barriers
(Dewalt et al, 2010)
Create a Shame-Free Environment
Setting
Instructions
Supports
Encourage questions
Time to respond
Privacy
Body Language
Clear Language
Clear Language Myths
Myth: We’ll “dumb everything down.”
Myth: Plain language will insult adults.
Myth: Plain language creates legal risk.
Myth: Plain language is just common sense.
Clear Language: Writing and
Speaking
Familiar, everyday (non-medical) language.
Simple explanations
Friendly
Positive tone.
Make it Simple!
Cardiovascular
Assessment
Influenza
Ambulate
Diet
Discharge
Confidential
Discontinue
Fluids
What is clear design?
Designing print and web-based materials to make:
◦ material look inviting and easy to read
◦ Information accessible-easy to find, read and remember
◦ purposeful
“Clear print”, CNIB Accessibility Guidelines
Most importantly, check for
understanding!
The responsibility for communicating clearly is ours.
“As clinicians, what we say does not matter unless our patients are able to understand the information we give them well enough to use it to make good health-care decisions. Otherwise, we didn’t reach them, and that is the same as if we didn’t treat them.”
Regina Benjamin, US Surgeon General
Teach Back Method
One of the top patient safety practices
Not a test of the patient, but how
well we explained a concept.
National Quality Forum, 2010; Schillinger et al, 2003; Kripalani & Weiss, 2006
“Closing the loop”
Teach Check Clarify Confirm
understanding
Schillinger et al, 2003
Assess understanding
Stop asking, “Do you understand?” to
assess comprehension.
Invite questions
Incorrect: “Do you have any questions?”
Correct: “What questions do you have for
me?”
Health Care Provider Response
October 2012-May 2013
-346 providers attended workshops
97% agreed or strongly agreed that their understanding of the issue of health literacy increased.
97% agreed or strongly agreed that they understood health system barriers faced by patients.
95% agreed or strongly agreed that they learned how to implement improved methods of verbal and written communication.
In Summary
Low health literacy affects health, safety as well as the quality of care and experience.
Anyone can have difficulty understanding health information.
Promote understanding by:
Creating a shame-free environment
Using clear language and design
Using resources to reinforce learning
Using teach back to check for comprehension
“The greatest problem with communication
is the illusion it has occurred.”
George Bernard Shaw
Thank you!
Visit our website for more information
www.swselfmanagement.ca