s09: beginning with the end in mind: functional health literacy’s contributions to chi

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eg nn ng w t t e en n m n : unct onaeg nn ng w t t e en n m n : unct onahealth literacys contributions to CHIhealth literacys contributions to CHI

National Library of Medicine

AMIA Now May 25, 2010

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Functional health literacy (Functional health literacy ( FHLFHL))definitiondefinition

FHL is the currency that enables adults to

participate more fully in society, botheconomically and socially, and to understandan exer a g er egree o con ro over e rlives

,and lifelong-learning skills, critical reflection

, , ,integration into ones life, self-reflection

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Take better care of yourself & others

Exert greater control over your healthImprove the immediate factors that shape whether you

Empower, activate, participateUnderstandin medical terms and abilit to fill outhealth insurance forms are not the primary foci(overcoming deficient skills helps one manage HCDS, but it

environment/health)FHLs metrics are real world, ersonalized outcomesDirectly focused on medical home, patient-centeredcare 4


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Introduce four established areas of traditionalhealth literacy researchDiscuss how functional health literacy addresses

all four areasProvide a few CHI implicationsSpin: Is FHL

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Functional health literacy (Functional health literacy ( FHLFHL))instrumentinstrument

Functional Health Literac Measure film

Derived from Life Skills ProgressionInstrument LSPVariables include: problem solving,

- ,critical reflection

information + activation & empowerment

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Summary traditional health literacySummary traditional health literacy((HLHL) findings:) findings:

HL may be a robust predictor of health

outcomesMay be a more robust control variable thanhealth status, demographics (gender, age,

education, income) ut s a mu t mens ona measureAre abilities to understand medical terms, fill

communication interventions?

end? 8


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1. Assessing the nations health literacy

2. The correlation between health literacyand how someone assesses his/herhealth status

3. Improving the users experience withint e ea t care e ivery system(enhancing health care institutional

4. Health literacy and predicting health

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-- Below = 14 percent (30 million)

Basic = 22 percent (47 million)Intermediate = 52 percent (114 million)Proficient = 12 percent (25 million)

36 percent (77 million) at basic or belowbasicHealth literacy scores are similar to national

prose, ocumen measures -- an aresomewhat better than quantitative literacy,

Emphases: reading, test-taking, experience 10


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--Chan es research focus from

understanding medical terms to theconfidence to better mana e ones lifeand surroundings & its integrationOutcome variables chan e si nificantlInclude -- increase in

-reflection

process from vertical to horizontal 11


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Area #2Area #2 ---- correlation between HL and self correlation between HL and self- -assessment of health statusassessment of health status

If HL (REALM) and health self-assessment (excellent , ,

folks who self-assessed their health as poor about 42percent of them are in a below basic rank and 3 percentare in the roficient rank If health is self-assessed as excellent, then, 8 percent of these folks are in a below basic rank and 19 percent arein a proficient rank Statistically significant correlation -- the more a self-assessment of health status is poor, the more he/shetends to score in the below basic rank. The more a self-

assessment o ea t status is exce ent, t e morehe/she tends to score in the proficient rank Sources: UNC, Northwestern, UCSF, Emory

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#2#2 FHLFHL applied to r of healthapplied to r of healthstatus & HLstatus & HL

FHL changes how you conceive the variable --

places focus on activation/empowerment (morethan overcoming a knowledge deficit)Creates new measures of patient

involvement/activation/self-

Provides metrics to measure the pace

New RQ Is improved FHL (increase in

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#3#3 help persons use health care deliveryhelp persons use health care deliverysystem e.g.system e.g.

locate services

complete formsbalance risks and benefitsinteract with providers and staff read understand and use rint materialsuse health tools e.g. measuring devicesand medication labels

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33rdrd

research area often includes:research area often includes: Improving drug labels

ea a i ity p ain anguage t gra e eveVisual oriented signage & cues

Color coding for different languages

Characteristics of a CHI tool (usability,navigability, look & feel)Combine CHI with interpersonalcommunication reinforcement (Info Rx)

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Assumes hospitals (& HCDS) are anAssumes hospitals (& HCDS) are anobstacle course for most users..obstacle course for most users..

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#4#4 correlation of health literacy & healthcorrelation of health literacy & healthoutcomesoutcomes

Strong, independent association among healthteracy an t e o ow ng:

emergency department use

mortality-

Results are preliminary but consistent

Research does not encompass quality of care at institutionwhere someone receives services, or access toa ro riate services

Sources: UNC, Northwestern, UCSF, Emory18


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Chan es the control variable

Changes the conceptual framework of aninterventionNew RQ: Is consumer activation, self-

-, ,more robust predictor of health

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1. The desirable outcome of CHI & health

intervention is an activated & empoweredpatient/caregiver/person -- begin with end inm n

2. HL is not focused on this goal . s ocuse on t s goa ut t ere slittle current evidence that enhanced FHL is a

outcome of activated patient & both are+

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CHI, health communication interventions

should be targeted to enhance FHLintermediate outcomesIncrease in FHL (as an intermediateoutcome im acts health outcomes(clinical and source utilization)

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an s or your n eres a en on

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The de ree to which individuals have the

capacity to obtain, process, andunderstand basic health information andservices needed to make appropriate

health decisions.

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s09: beginning with the end in mind: functional health literacy’s contributions to chi

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