Health Literacy for Librarians & Information Specialists Facilitator's name & position

Health Literacy for Librarians & Information Specialists

Facilitator's name & position

This workshop was developed collaboratively by Tina and Janet Papadakos, Patient Education Leads at St. Michael’s and Princess Margaret Hospitals in Toronto, Canada to support staff skills competencies related to health literacy.

Acknowledgement

Objectives1. Define health literacy and why it matters

2. Gain skills to support client involvement in their care when preparing information packages

• Use active listening techniques to identify learning needs

• Select resources that are written for adult learners• Select resources that match client’s learning styles• Ensure resources are in plain language

Communication barriers

The ability to make sound health decisions in the context of everyday life – at home, in the community, at the workplace, and in the healthcare system

What is health literacy?

Kickbusch, Wait and Maag, Navigating Health: The Role of Health Literacy, 2005.

1. Fundamental literacy

2. Scientific literacy

3. Civic literacy

4. Cultural literacy

Health literacy has 4 parts

Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

1. Prose – written words2. Document – charts, graphs, forms etc3. Numeracy – basic math

Fundamental literacy


Scientific literacy

• Basic understanding of how science and medicine work and evolveWhat science must a patient know to comprehend and decide to act on a specific health message?


Civic literacy

Can your patient judge:• the validity and quality

of sources of information?

The ability to be involved in health decisions:

Does your patient know:

• where and how to access information?• how to advocate for self and others?


Cultural literacy

• The shared and dynamic characteristics of a group of people whose collective beliefs, worldview, customs and social identity are a lens through which they interpret and act on health information


• to understand health instructions

• to read and act upon written health information

• to communicate needs to health professionals

Health literacy involves the ability to:

Scientific literacy

Cultural literacy

Fundamental literacy

Civic literacy

Canadian Council on Learning, 2007

88% of Seniors

Institute of Medicine Report on Health Literacy

• 90 million American adults have trouble understanding and acting on health information

• Health information is unnecessarily complex

• Providers need health literacy training

AHRQ Report

• Evidence shows that patients often misinterpret or do not understand much of the information given to them by clinicians due to low health literacy.

The Agency for Healthcare Research and Quality (AHRQ) Report 2010

• Less use of preventive services• Delayed diagnoses• Less adherence to medical instructions • Poorer self-management skills• Higher health care costs• Poorer Health

Wolf MS, Gazmararian JA, Baker DW. Health Literacy and Functional Health Status Among Older Adults. 2005. Archives of Internal Medicine.

Low health literacy has been linked to:

Health literacy is important for 2 reasons:

1. Changes in medical practice with patients involved in complex self-care regimens

2. Transition from ‘patient’ to ‘health consumer’ (expectations of involvement)

The Agency for Healthcare Research and Quality (AHRQ) Report 2010

Health literacy can improve with better communication.

You can help by providing custom information packages that adhere to health literacy standards for patients and families.

Use active listening techniques to identify learning needs

Select resources that are written for adult learners Select resources that match client’s learning styles Ensure resources are in plain language

Skills you can use to support patient and family understanding and involvement in their care


Active Listening Techniques:

• Prompts indicate you are listening with minimal verbal or non-verbal cues to encourage patient to verbalize

Nod your head Make eye contact Say “uh huh” Expressions of interest or approval

Prompt

Questions are key to gathering information about your client

2 kinds of questions:

Questions

1. Open 2. Closed:

what, when, where, could, who, tell me about

yes or no

• Restate the factual content of the patient’s message in your own words

“So it sounds like you are clear on your appointment time for your CT Scan but unsure how to get there. Is that right?”

Paraphrase

Recognize the facts (intellectual) of the patient’s message and how the patient feels (emotional)

“It sounds like you are overwhelmed with all of the information you have just been given.”

Empathize

• Recap the key points of the discussion

• Agreement of the problem

“So, you have agreed to undergo radiation treatment and you would like to have the procedure reviewed with you and your family so you know what to expect.”

Summarize



Select resources that are written for adult learners


Favourite teacher

1. Adults often see learning as a way to solve their real-life problems – especially their urgent ones.

True False

Principles of adult learning

2. Adults tend to take errors personally and are more likely to let them affect self-esteem. Thus, they tend to apply tried-and-true solutions and take fewer risks.

True False


3. Adults relate new knowledge and information to previously learned information and experiences.

True False


4. Adults want to be treated as equals, not as children, (and so want to engage in a learning relationship with the healthcare professional).

True False


5. Adults need to know WHY they should learn, WHAT they will learn, and HOW the learning will take place.

True False


• Respect

• Relevant

• 2-Way Conversation

• Specific and Focused

• Allow time for learning to be applied to patient’s current knowledge, experience and beliefs

• Safe environment (preserve dignity)

Adult learning summary

Use active listening techniques to help client identify learning needs


Select resources that match clients learning styles


Visual Auditory Kinesthetic Reflective

Visual Learners see colour, size and shape

Auditory Learners prefer details, clear vocal presentations and audiotapes

Kinesthetic Learners prefer to put their hands on and touch something

Reflective Learners want to analyze, categorize, review, reflect and ask questions

They create diagrams of what they hear. They like pictures, illustrations & visual cues (i.e., note takers-refer to it later)

They pay attention to the speaker’s voice - the tone, energy, pitch, enthusiasm and modulation

They like participating in groups and moving about doing several different activities at the same time

They like to have time to process information and make decisions

They run movies in their minds and like to read

They play a tape recorder in their minds. They like written text so they can hear what they are reading

The re-live the sensation or the feeling they experienced

They want the facts with a credible source of data. They like models, logic, and knowledge

See it Hear it Touch it/ Do it Think about it

Learning styles

Visual Learners

How they learn:• They create diagrams of what they hear• Need to ‘picture it’

Clues that they are Visual Learners:• Doodling• Says “I can’t see it”

What you can do:• Ask if they would like you to draw it

How they learn:• They pay attention to the speaker’s voice - the tone,

energy, pitch, enthusiasm and modulation

Clues that they are Auditory Learners:• Looking off in the distance• Put their hand by their ear

What you can do:• Speak to them, pace yourself, sequence the

information and ask if they would like you to repeat anything

Auditory learners

Kinesthetic learners How they learn:• They prefer to put their hands on and touch

• Like demonstrations that they can try after you show

Clues that they are Kinesthetic Learners:• Gestures with their hands, puts their hands on things

• Says “I feel…”

What you can do:• Ask if they would like to try it after you show them

How they learn:• They like to have time to process information and make

decisions• Want to analyze, categorize, review, reflect and ask

questions

Clues that they are Reflective Learners:• Pausing and looking in the distance (or down)• Asks broad questions for context

What you can do:• Offer them more data, reading material

Reflective learners

Visual Auditory Kinesthetic Reflective

See it Hear it Touch it/ Do it Think about it

30% 20% 90% 40%

Learning retention is increased with more sensory involvement

Group Sessions

Analogies &Stories

Demos & Models

Statistics &Facts

Pamphlets & Books

Visual Learners

See it

Auditory Learners

Hear it

Kinesthetic Learners

Touch it

Reflective Learners

Think about it


Select resources that are written for adult learners Select resources that match client’s learning styles Ensure resources are in plain languageEnsure resources are in plain language


• The CVD outcomes can be influenced by a number of modifiable risk factors, including nutrition, weight, physical activity, smoking cessation, and alcohol consumption. For most people, appropriate treatments can control symptoms, allowing for return to functional status.

Reading level 13

What you can do to improve your symptoms of heart disease :

• Eat fruit, vegetables and whole grains• Avoid fatty foods like potato chips• Get to a healthy weight• Exercise once a day• Don’t smoke• Drink less than 1 -2 alcoholic drinks a day

After plain language editing: Reading level 8

Universal PrecautionsTaking specific actions

that minimize the risk for everyone when it is unclear which patients may be affected.

Research suggests that clear communication practices and removing literacy-related barriers will improve care for all patients, regardless of their level of health literacy.

AHRQ Publication No. 10-0046-EF Current as of April 2010

Providers don’t always know which patients have limited health literacy

Some patients with limited health literacy: Have completed high school or college Are well spoken Look over written materials and say they understand Hold white collar or health care jobs Function well when not under stress

AHRQ Publication No. 10-0046-EF Current as of April 2010

Many patients with reading problems are ashamed and hide their inability to read

• Of 202 patients interviewed, 42% had inadequate or marginal fundamental health literacy

• Of those patients, 67% had never told their spouses they have trouble reading

• 53.4% had never told their children of their difficulties reading

• 19% of patients had never disclosed their difficulty reading to anyone

Patient Education and CounselingVolume 27, Issue 1, January 1996, Pages 33-39The Role of the Family in Education and Care of the Patient

Ensure resources are in plain language

1.) Learn to recognize plain language

2.) Use the SAM tool when in doubt

Plain language has 3 parts:

1. The use of everyday language and other clear writing strategies

2. Well-structured, logically sequenced and focused information

3. Effective design and layout

Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996Plain language editing tips also taken from the AHRQ Health Literacy Universal Precautions Toolkit 2010

1. Select resources that use everyday language and other clear writing strategies Evaluate language level (aim for grades 6-8)

Short words (no more than 2 syllables) Short sentences (no more than 10 words) Short paragraphs (no more than 5 sentences) Limited jargon/medical terminology unless it is

defined Consistent terms used (same term is used

throughout for example: either medicine or drugs, needle or shot etc.)


Ensure tone is educational, like a book

Remove feelings and opinions

Instead of “we recommend you change your diet” use “change your diet”- and ensure why a diet change would be beneficial is included


Ensure content is written to the client

“Take your insulin at the same time everyday” instead of “Insulin should be taken at the same time everyday.”

Select content that uses active sentences

Instead of “This medicine should be taken before dinner” use “Take your medicine before dinner


2. Select well-structured, logically sequenced and focused information

Check that content is limited to what the patient needs to know


Look for information that presents the context first before getting in to new or complex information

Context First

Side effects of chemotherapy (the context) depend on the type of drugs used and how your body reacts to those drugs (the new information).


Check that information is sequenced (numbered for clarity when appropriate)

Check that information is ‘chunked’ (similar topics are together)


3. Select resources with effective design and layout

Where possible, select resources that provide visual of verbal images to accompany each of the key pieces of information.

Research shows that the memory has many more access points for visuals than for words and letters.


Include only relevant images or graphics that enhance the meaning of the text

Ensure there is a lot of white space


Enlarge text to a minimum of 13 pt font to help ensure that patients can see the text

Clean the package to ensure there are no more than 2 different fonts. Sans serif fonts (like Arial) are better for titles and serif fonts (like Times New Roman) are better for text

3. Use effective design and layout


Use the Suitability of Assessment of Materials (SAM) Tool to assess whether resources are suitable.

Doak CC, Doak LG, Root JH: Teaching Patients with Low Literacy Skills, Ed 2. Philadelphia, *Lippincott-Raven Publishers, 1996

• Low health literacy = poor health

You can impact client’s involvement in their care by:

Summary

Using active listening techniques to identify their learning needs Selecting resources that are written for adult learners Selecting resources that match client’s learning styles Ensuring resources are in plain language

Thank you

Documents

Health Literacy for Librarians & Information Specialists Facilitator's name & position