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TakeChargeofYourHealth

AreportfromtheMinnesotaHealthLiteracyPartnership

ByNathanMaas,MASJ

SocialMediaCoordinator,AmeriCorpsVISTA

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HealthLiteracy

Healthliteracyisthe“degreetowhichindividualshavethecapacitytoobtain,processandunderstandbasichealthinformationandservicesneededtomakeappropriatehealthdecisions”.1Healthliteracyrequirespeopletohaveawiderangeofabilities,theyneedtobeable“toread,comprehend,andanalyzeinformation;decodeinstructions,symbols,charts,anddiagrams;weighrisksandbenefits;and,ultimately,makedecisionsandtakeaction”.2Understanding,processingandtakingactionusinghealthinformationiscomplicatedbyspecializedhealthterminology,Englishcompetency,understandingofthehealthcaresystem,stressandmanyotherfactors.Thesefactorscanleaveallofuswithquestionsandstrugglingtounderstandhealthinformationprovided.

Infact,nearlyhalfofalladultsintheUnitedStates—90millionpeople—cannotunderstandandusetheinformationsharedbytheirhealthcareproviders.3The2003NationalAssessmentofAdultLiteracy(NAAL)showsthatonly12percentofadultEnglishspeakingAmericanshaveproficienthealthliteracyskills.4NAALhealthliteracyitemsfocusedoncommonlyencounteredhealthcaresituationssuchascareofillness,dealingwithpreventivecare,andnavigatingthehealthcaresystem.ThreepercentofadultswereunabletoparticipatebecauseofaninabilitytocommunicateinEnglishorSpanishortheyhadamentaldisabilitywhichpreventedthemfrombeingtested.

Lowhealthliteracyimpactsaperson’shealthstatusmorethananyotherfactor,includingeducation,income,employmentorrace.3Thosewithlowhealthliteracyrepresentallsegmentsofsociety.EventhosewhospeakEnglishwellandarehighlyeducatedmayhavelowhealthliteracy,andresearchshowsthatallpatients,notjustthosewithlimitedliteracyskills,prefereasy‐to‐understandhealthinformation5.Lowhealthliteracymayleadtomedicationerrors,problemswithinsurance,inabilitytoaccesshealthcareandpoorhealthchoices6.

Whilelowhealthliteracycanaffectanypatient,thosemostatriskareolderadults,personwithlimitededucation,membersofethnicminoritiesandrecentimmigrantstotheUnitedStates.SeeFigure1forthepercentageofbelowbasichealthliteracyfoundintheseatriskpopulations.

Population PercentinBelowBasicHealthLiteracy

Didnotgraduatefromhighschool

49

HispanicAdults 41

Blackadults 24

Age65+ 29

Figure1

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Lowhealthliteracynotonlyimpactsaperson’shealthbutitalsohasfinancialimpactsbothtoindividualsandthepublic.Thisdrainsbothhealthcaresystemresourcesandtheindividualpatient’sfinancialcapacity.LowhealthliteracyincreaseshealthcarecostsintheUnitedStatesby$106‐238billionannually.7Researchshowsthatin‐patientspendingforapatientwithinadequatehealthliteracywas$993higherthanthatofapatientwithadequatereadingskills.8Thosewithlowhealthliteracyhaveanaveragehealthcarecostof$13,000comparedtoonly$3,000forthosewithhigherhealthliteracylevels.9Alloftheseindividualcostsleadtohigherhealthcarecostsforeveryone.Everyonemustworktogethertoimprovehealthliteracyandprovideclearhealthcommunication,inordertoimproveaccesstohealthcare,eliminateexcesshealthcarespendingandcontroltherisingcostofhealthcare.Lowhealthliteracyisaproblemthataffectsallofus.

HealthLiteracyinMinnesota

Minnesotaisoneofthreestateswith6%ofpeoplelackingbasicproseliteracyskills,whichismuchlowerthanCalifornia(23%),Florida(20%)andNewYork(22%).10Minnesota’spercentageofthoselackingbasicproseliteracyskillsissimilartosurroundingstates:NorthDakota(6%),SouthDakota(7%)andWisconsin(7%).10ThesevenMinneapolis/StPaulmetrocountiesrangefrom4‐7%ofpeoplelackingbasicproseliteracyskills(Figure2).

Figure2

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Minnesotamayhavehigherliteracylevelsthanmanyotherstates.Butevenwithonly6%percenthavingbelowbasicproseliteracylevelsthisstilltranslatesto231,125peoplelackingbasicproseliteracyskills.ThisisroughlythepopulationofSt.Paulandisnotanumberwhichcanbeeasilyignored.

WhiletherearenostatelevelhealthliteracystatisticsforMinnesotawecanlookatdataforthepopulationsmostatriskforlowhealthliteracy:olderadults,personwithlimitededucation,membersofethnicminoritiesandrecentimmigrantstotheUnitedStates.

Olderadults

Minnesotaisaging.Accordingtothe2008censusestimates,12.5%ofMinnesotan’sare65yearsofageorolder.12TheMinnesotastateDemographicCenterestimatesbytheyear2035,thenumberofMinnesotansgreaterthanequaltoage65willincreaseby125%.14Theelderlyrepresentapopulationthatissurvivinglongerwithmorecomplexandlong‐termmedicalneeds.

Limitededucationandpoverty

Nearly12%ofMinnesotansovertheageof25lackhighschoolequivalencyaccordingtothe2000U.S.Census.12TheMinnesotaDepartmentofEducationreportsthereareabout

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80,000adultsenrolledinadultliteracyprogramsaroundthestateeachyear.13Itisestimatedthat200,000adultsareinneedofEnglishasaSecondLanguageservices11.And,almost10%ofMinnesotansarelivingbelowthepovertylevel.12,15

Ethnicminoritiesandimmigrantpopulations

ThefaceofMinnesotaisalsochanging.In2009,over18,000immigrantsmovedtoMinnesota.16MinnesotaisthehometothelargesturbanHmongandSomalipopulationsintheUnitedStates.17Infact,31%ofSomaliaimmigrants(4,173)listedMinnesotaastheirintendedstateofresidencewiththeU.S.DepartmentofHomelandSecurity.16InMinnesota,theHispanic/Latinopopulationisprojectedtonearlytripleby2035,from196,300in2005toanestimated551,600in2035accordingtotheMinnesotaStateDemographicCenter.18Two‐thirdsofthispopulationisprojectedtoliveintheseven‐countyTwinCitiesarea,althoughallregionsofthestateareexpectedtoseeincreases.18

WhyfocusontheInternet?

InMinnesota,67‐71%ofpeopleareInternetusers.19EightmillionUSAmericanadultsusetheinternettofindhealthinformationonatypicalday.EightoutoftenInternetusersgoonlinetofindhealthinformation(Figure3).20WithmoreandmorepeopleusingtheInternettofindhealthinformationitisimportanttoknowwhattheyarelookingfor,iftheyarefindingitandiftheinformationtheyarefindingisaccurateanduseful.

MostUSAmericansstarttheirhealthsearchesusingasearchenginesuchasGoogle.19Themostcommon

Figure3

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searchwasforinformationaboutaspecificdiseaseormedicalproblem(Figure3).20Thirty‐onepercentofhealthinformationseekerssay“theyorsomeonetheyknowhasbeensignificantlyhelpedbyfollowinghealthinformationormedicaladvicefoundontheInternet”.Forty‐eightpercentofpeoplearesearchingonbehalfofsomeoneotherthanthemselves.OverhalfofUSadultssaidtheinformationfoundontheInternetinfluencedadecisionabouthowtotreatanillnessorcondition;changedtheirapproachformaintainingtheirhealthorthehealthofsomeonetheytakecareof;orledthemtoasktheirdoctornewquestionsortogetasecondopinion.Thirty‐fivepercentsaytheinformationaffectedtheirdecisionaboutwhetherornottoseeadoctor.20

EventhoughmoreandmorepeopleareturningtotheInternettofindhealthinformation,somearestillfrustratedorconfusedaboutthehealthinformationtheyfindonline.EveniftheindividualissatisfiedwiththeinformationfoundontheInternet,75%ofpeopledonotconsistentlycheckthesourceanddateofhealthinformationfoundonline.20

Partofthereasonpeopledonotchecksourcesanddatesofhealthinformationisbecausetheinformationisnotreadilyavailable.Arecentstudyconductedby,theOfficeofDiseasePreventionandHealthPromotion,whichispartoftheDepartmentofHealthandHumanServices,reviewed102healthwebsites.NoneofthesewebsitesmetallsixofthecriteriaoutlinedinHealthyPeople2010objective11‐4andthelowestlevelsofcompliancewerecontentsourcesanddateupdated.21Peoplearefindinghealthinformationonlinebutisitaccurateanduseful?Weintendtobridgethisgapbyprovidingpeoplewithinformationabouthowtousetheinternettofindaccurateandusefulhealthinformation.

NeedsAssessmentonInternetUseinMinnesota

Background

AneedsassessmentwasconductedtodeterminehowMinnesotansareusingtheInternettofindhealthinformation.Theneedsassessmentconsistedofavoluntaryandanonymoussurveyoflibraryvisitors.Librarieswerechosenasacommoncommunityresourceandfortheirpotentialtobevisitedbyadiversepopulation.BetweenJanuary5thandFebruary1st,MHLP’sSocialMediaCoordinatorvisited8librariesintheMinneapolis/StPaulmetroarea.Duringatwotothreehourtimeperiod,SocialMediaCoordinatoraskedvisitorstothelibraryiftheywouldbewillingtocompletethesurvey.ThelibrariesvisitedinStPaulinclude:Central,HighlandPark,RondoandSunray.ThelibrariesvisitedinHennepinCountyinclude:Brookdale,Central,RidgedaleandSouthdale.Over130participantscompletedthesurvey.

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Theneedsassessmentsurveyconsistedof11questions.Fourquestionsweredemographic,6questionswereaboutInternetuseand1questionaskedaboutinterestinattendingaclassaboutusingtheInternettofindhealthinformation.Thedemographicquestionsandthequestionaboutattendingafollow‐upclassweremultiplechoicewithanoptiontoselectoneanswer.TheInternetusequestionsweremultiplechoicewiththeoptiontoselectmorethanoneanswer.

Results

Participantsvariedineducationalbackground,ethnicity,ageandsex(Figure5).ThemajoritywereCaucasian(59%).Theparticipantswerealmostevenlysplitbetweenmale(48%)andfemale(47%).Mosthadatleastsomecollegewithonly14%havingahighschooldiploma/GEDorless.Almost50%ofparticipantswerebetweentheagesof26and55.

ThemajorityofparticipantsusedtheInternet.MostaccessedtheInternetathome(65%),atthelibrary(53%)oratwork(33%).AccordingtothePewResearchCenter,79%ofUSadultsareonline22.ParticipantsinoursurveypoolhadmuchhigherInternetusagerates(94%)thanUnitedStatesasawhole.Asmallpercentage(4%)ofparticipantssaidtheydidnotaccesstheInternetinanyway.

Manyofthepeopleonlineareusingsocialmedia.ThePewResearchCenterfoundthat46%ofUSadultsusesocialnetworking,andofthosewhouseonlinesocialnetworks73%haveaFacebookaccount.22Facebook(44%)andYouTube(30%)werethetoptwosocialmediasitesusedbythepeoplewesurveyed.Socialmediaisbeingusedinmanynewandexcitingways.Therespondentsofoursurveyrevealedthatconnectingwithfamilyandfriends(61%)isthenumberonereasonforusingsocialmedia.Theyarealsousingsocialmediatoconnectprofessionally(23%)andtofindhealthinformation(23%).Thirtypercentreportedtheydidnotusesocialmediaofanykind.

Peoplearelookingformanydifferenttypesofhealthinformationonline.Theyareusingavarietyofsourcesandtheyaresearchingforavarietyofreasons.Themajorityofthepeoplesurveyed,62%,reportedusingGooglewhensearchingforhealthinformationonline.WebMDwith42%andMayoclinicwith31%werethetopsitesusedafterGoogle.About20%reporttheyarenotusingtheInternettofindhealthinformation.ParticipantssurveyedareusingtheInternettofindinformationaboutlivingahealthylifestyle(52%),tolookuphealthinformationforfamilymembers(44%),toeducatethemselvesaboutcurrenthealthtopics(41%),todiagnosetheirsymptoms(37%)andtodetermineiftheyshouldvisitadoctor(29%).

ThereisanabundanceofhealthinformationontheInternet,amixtureofgoodandbadinformation.ThemajorityofparticipantsfeelconfidenttheycanfindaccuratehealthinformationontheInternet(68%).Only7%didnotfeeltheycouldfindaccuratehealth

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informationontheInternet.Believingthatonecanfindaccuratehealthinformationdoesnotmeanheorsheisreallyfindingaccuratehealthinformation.

Manyoftheparticipants(52%)indicatedtheywouldbeinterestedorpossiblyinterestedinattendingaclassaboutfindinghealthinformationontheInternet.HealthliteracyandInternetusagelevelsinMinnesota,aswellasresultsfromtheneedsassessmentindicatecreatingaclasstopresentatlibrarieswouldbealogicalandwelcomednextstep. CreatinganAdultBasicEducationHealthLiteracyProgram

ProgramDevelopment

Thehealthliteracyprogramincludesaneducationalclassfocusingonskillsadultsneedtobetterunderstandandtakechargeoftheirownhealthcare.Theclassconsistsofthreesections.Thefirstsectionfocusesonmotivatingattendeestoaskquestionsinallsituationsandwhatquestionstoask.ResourcesusedforthissectionarefromthePartnershipforClearHealthCommunication’sAskMeThreecampaignandtheAgencyforHealthCareResearchandQuality’sQuestionsaretheAnswercampaign,bothcampaignsfocusonmotivatinghealthcareconsumerstoaskquestionoftheirhealthcareproviders.Thesecondsectionfocusesoncreatingavisitplanandpreparingindividualsfortheirmedicalappointments.ThissectionadaptsinformationfromtheNationalInstitutesofHealth’sSeniorHealthwebpageaswellasotherhealthliteracyinformationinthepublicdomain.ThethirdsectionfocusesonusingMedlinePlustofindhealthinformationontheInternet.MedlinePlusisahealthinformationwebsitemaintainedbytheNationalLibraryofMedicineandtheNationalInstitutesofHealthandisconsideredareliableandaccuratesourceforhealthinformationbyhealthcareprofessionals.

TheprogramiscalledTakeChargeofYourHealthCare:AskingQuestions,GettingAnswers.ThefocusoftheprogramistoempowerindividualstoasktheirhealthcareprovidersquestionsandenablepeopletousetheInternettofindaccurateandusefulhealthinformation.TheprogramlastsaboutanhourandisavailableasaPowerPointpresentationontheMinnesotaHealthLiteracyPartnershipwebsitewww.healthliteracymn.org.

HennepinCountylibrariesandtheStPaullibrarieswereapproachedaspossiblelocationsinwhichtoprovidetheprogram.ApartnershipwascreatedwiththeStPaulpubliclibraries.ClasseswereinitiallyscheduledatsevenlibrariesinStPaul.Inordertoincreaseattendanceandawarenessoftheprogram,additionalSt.Paullibraryprogramswereaddedforatotalof12programs.ClasseswereunabletobescheduledatHennepinCountylibrariesduetoschedulingissues.TheHennepinCountylibrariesareinterestedinhostingclassesfromMHLPinthefuture.

ProgramEvaluation

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TheTakeChargeofYourHealthCareprogramwaspresented11timesatSt.PaullibrariesduringthemonthsofMay,JuneandJuly2010.AnadditionalclassisscheduledduringthemonthofOctoberattheWest7thlibrary.Totalattendancefortheclasseswas12.Althoughattendancewaslowerthananticipated,theparticipant’sreactiontotheprogramwaspositive.Eightout12participantscompletedasurveyabouttheclass.Aftercompletionoftheclass,75%ofthosesurveyedreportedfeelingcomfortablefindinghealthinformationontheInternet.Onehundredpercentfeltconfidentintheirabilitytoobtain,understandandactonhealthinformation,aswellastheirabilitytoknowwhatquestionstoaskattheirmedicalappointments.Ninetypercentfeltmoreempoweredtoaskquestionsoftheirhealthcareproviders.Themajoritysaidtheywereinterestedinlearningmoreabouttakingchargeoftheirhealthcareandwouldrecommendtheclasstotheirfriends.

Discussion

Overalltheturnoutoftheprogramwaslowerthananticipated.Evenwiththeadditional5classesandincreasedpromotionalefforts,theturnoutwasstillmuchlowerthanourinitialgoalof50attendeesduringthefirstyearoftheprogram.Althoughattendancewaslowtheclasseswerewellreceivedbasedontheparticipantsurveys.Themajorityofattendeesfeltempoweredbytheclass,indicatedtheywouldrecommendtheclasstotheirfriendsandwereinterestedinlearningmoreabouttakingchargeoftheirhealthcare.

Whenconductingtheneedsassessmentweaskedparticipantstoindicatetheirinterestinattendingaclassatalocallibrary.Wedidnotincludeawayfortheparticipantsinterestedinattendingaclasstobenotifiedbeyondfliersatalocallibrary.Severalotherfactorsmayhavecontributedtothelowattendance.Thereareafewthingswelearnedandcouldadjustinthefuturetoachievehigherattendance.

• Classescouldbeofferedinthefall,winterorspring.Summerclassesatlibrarieshavelowerattendancelevels,thanclassesheldduringtherestoftheyear.Thisapplieseventowell‐attendedclassesduringtherestoftheyear,letalonenewprogramssuchasours.

• Classescouldbeofferedseveraltimesatthesamelocation.Providingclassesatseveraltimeswouldallowformultipleopportunitiestotaketheclassateachlocation.Thiscouldincreaseawarenessabouttheclassandcouldallowinterestintheclasstogrow.

• Classcouldbetaughtasaseriesof3‐4classes.Eachclasscouldpresentadifferenttopic:locatinghealthinsurance,findinghealthinformationontheInternet,importanceofpreventivecare,creatingavisitplan,etc.

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• Classescouldbeofferedtogroupsthatalreadymeetregularly,suchaswellattendedadult‐basic‐educationclasses.InOctober,weareconductingaclassforaseniorexercisegroup.

• Awebversionoftheclasscouldbecreatedforpeopletoview.Thiswouldallowpeopletofittheclassintotheirownschedule.

Overalltheprogramwaswellreceivedbythepeopleattendingtheclasses.ThepilotoftheTakeChargeofYourHealthCareprogramprovidesvaluableinformationtoMHLPandwillhelpguidefutureeffortsfocusedonconsumerempowerment.

Tolearnmoreaboutthisprogramortodownloadmaterials,pleasevisittheMinnesotaHealthLiteracyPartnershipwebsiteatwww.healthliteracymn.org.