Low Health Literacy and How to Use the Health Binder

North Bay Literacy Council – Literacy and Health Presentation

Funding for the Literacy & Health Project

This project is funded by the Ontario Trillium Foundation, from the Ministry of Culture

The project provides funding for one year (September 2008-2009)

One person for 2 1/2 days per week

Do you know?

Which of the following is the strongest predictor of an individual’s health status?

A) AgeB) IncomeC) Literacy skillsD) Education level E) Racial or ethnic groupF) Average Beer Intake at Metro

Do you know?

Which of the following is the strongest predictor of an individual’s health status?

A) AgeB) IncomeC) Literacy skillsD) Education level E) Racial or ethnic groupF) Average Beer Intake at Metro

True or False? Most people with limited literacy

have low IQs. People will tell you if they have

trouble reading. The number of years of schooling is

a good general guide to determine literacy level

Most people with low literacy skills are poor, immigrants or minorities.

Goals of the Presentation

Discuss the Literacy & Health Project background

Define Health Literacy Recognize the scope and

implications of health literacy issues. Examine & discuss the Health Binder

Literacy & Health Phase 1

FAS interviewsLight bulb reactionTrillium Foundation grant Interviewed health care

providers and low literacy learners

Findings Few health care providers had an

accurate awareness Learners wanted more time and less

jargon Neither health care providers or

literacy learners knew that the Literacy Council would work with health information

Recommendations Train tutor trainers to include health

literacy in training sessions Develop a trainer workshop Develop health information for low

literacy learners Share resources through the internet

Health Literacy

Health literacy is the degree to which people are able to access, understand, appraise and communicate information to engage with the demands of different health contexts in order to promote and maintain good health across the life-course.

Functional Literacy Compute and solve problems at

levels of proficiency necessary to function in society

Ability to read, write and speak in English

Ability to achieve one’s goals and develop one’s knowledge and potential

Physical Literacy

Sensory

Visual Hearing Neurological

Psychological / Mental Health

Cultural/Language Non-English speaking Immigrant status Ethnic interpretation of illness Spiritual and religious beliefs Majority of the lowest level readers

are white and native born

Computational – Health Numeracy

The degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health information needed to make effective health decisions

Analytical Numeracy

This involves the ability to make sense of information, as well as higher functions like inference, estimation, proprtions, percentages, frequencies, and equivalent situations. Information may be from multiple sources, and an example would be deterimining whether an analytical result was within the normal range, or understanding graphs

Statistical Numeracy

An understanding of basic biostatistics involving probability statements, skills to compare different scales (Probability, proportion, percent), to critically analyse quantitative information like life expectancy or risk, and understanding concepts like randomisation and blinding. An example would be making choices between treatments based on standard outcomes of relative or absolute risk

Scope of the Problem LBS (Literacy Basic Skills)- Level 1 22% of adult Canadians are so limited

that they are unable to determine the correct dosage from reading the medicine label.

LBS (Literacy Basic Skills)- Level 2 A further 26% can read provided that the

materials are simple and presented in a familiar context.

LBS- Level 1 Indicates very low literacy skills where the

individual may, for example have difficulty identifying the correct amount of medicine to give a child from the information found on the package. These individuals are generally aware they have a problem

LBS Level 2 Respondents can deal with material that

is simple, clearly laid out and in which the tasks involved are not too complex. This is significant because it identifies people who may have adapted to everyday life, but would have difficulty learning new health related material and making informed decisions. These individuals often do not recognize their own limitations.

What Happens? Problems with: Navigating from one clinic to

another Completing forms Following medication instructions Interactions with providers Coping strategies in general

What Happens? Limited general knowledge (Health

promotion & prevention) Do not ask for clarification Focus on details, hard to get them to

prioritize Don’t understand Likert scales, math Deal in literal/concrete concepts, not

abstract Essential vocabulary only Check answers without understanding

Why worry?

Not keeping appointments—26% Unable to find clinic/office Failure to take meds correctly—42%

did not understand “empty stomach” Incomplete history Overuse of emergency room Lack of informed consent Diagnosis made at later stages Unhealthy/risky behaviors

The Elderly Fewer years of schooling, poorer—fixed

incomes > 50% do not take meds as directed 68% cannot interpret blood sugar value 76% cannot follow Upper GI instructions 2 billion dollars spent per year on hospital

admission for medication errors

Literacy Tests

Always assume and ask in sensitive way—”How do you like to get your information?” or “What things do you like to read?” or “How satisfied are you with how you read?” Treat all the same.

Hints Use repetition Have the student repeat the

information Use the “teach back” method Never ask “Do you understand?” Use models, sketches, pictures,

symbols demonstrations

More Interventions Know what languages and cultures you

will encounter in your community-know what resources you will need

Check the reading level of materials you give to students

Develop partnerships between the health and literacy sectors

Work with your schools to get health education into the K—12 curriculum

Printed Materials Use pictures, photos, videos and other visuals—

including med charts Monosyllabic and simple language Read over the instructions—highlight important

parts with color Lots of white space Review materials for literacy level—rewrite as

necessary, ask students for help Writing style should be clear, concise, organized,

and jargon-free

Assessing level of literature Most pamphlets at 10-12th grade

level Informed consents at 14.3—16th

grade level Internet health resources at similar

grade levels SMOG

Speaking Plainly Request and respect student’s prior

knowledge, opinion and experience Speaking plainly is as important as writing

plainly Avoid jargon Use everyday examples to explain

technical or medical terms Teach in an organized manner Use the “interactive communication loop”

It is all of these things that have made them what they are and these are the things that you cannot come to know

by hearsay; you can only know them if you have lived them.”

Somerset Maughan, The Razor’s Edge (Introduction), 1944.

To Conclude

“ …follow the counsel of Aristotle, to speak as the common people do, to think as wise men do; and so should every man understand him, and the judgment of wise men follow him.”—

Roger Ascham (1515-1568)