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Health Literacy: Helping Patients
Understand Their Care
Community Health Integrated Partnership Webinar
Nancy WeberJacqueline Hill
Ray & Associates, LLC
Our Agenda
Understanding health literacy
Assessing health literacy
Employing health literacy techniques
Enhancing the patient-friendliness of your clinic
Wrap-up
Understanding Health Literacy
Basic Health Literacy Is…
The ability to read, understand, and act on medical information.
It is also:
Cultural competency
Plain language
Patient-friendly written materials
Cultural Competency
Ability of professionals to work across cultures
Appropriately recognizing these factors can produce positive health outcomes:
Contributes to health literacy by improving communication and building trust
Attitudes Language
Preferences
Cultural Beliefs Values Traditions
Prevalence of Limited Health Literacy
Affects 1/3 of American adults
More common among patients who:
Are older
Are of minority background
Have less education
Have low income/are unemployed
Source: Kutner, Greenberg, Jin & Paulsen. 2006. The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy. US Department of Education.
Prevalence of Limited Health Literacy
Source: Weiss. 2007. Health literacy and patient safety: Help patients understand. Manual for clinicians, 2nd edition. American Medical Association Foundation.
Consequences of Limited Health Literacy
Patients with low health literacy may have difficulty with the following:
Understanding medication directions
Completing medical forms
Managing chronic conditions
Understanding consent forms
Consequences of Limited Health Literacy
Low literacy is associated with the following:
Higher health care costs
Poorer health status
Higher probability of hospitalizations
Less health knowledge
Source: Weiss & Palmer. 2004. Relationship between health care costs and very low literacy skills in a medically needy and indigent Medicaid population. Journal of American Board of Family Practice, 17, 44-47.
Patient Coping Strategies
Patients having problems with reading and understanding health information may cope in the following ways:
Bring someone who can read with them
Watch and copy others’ actions
Tell you they can’t read or forgot their glasses
They will NOT ask for help from staff
Patient Abilities
Patient forms and instructions are typically written above the average adult reading level
Adults with adequate literacy skills are generally unable to read and understand similar materials with unfamiliar vocabulary and concepts
Compromised health decreases patients’ ability to understand and act on health information
Why Is Health Literacy Important?
The more health literate patients are, the more likely they are to:
Navigate the healthcare system, including locating providers/services and completing forms
Share personal and health information with providers
Engage in self-care and disease management techniques
Adopt health promoting behaviors, such as exercising and healthy eating
Act on health-related news and announcements
Why Is Health Literacy Important?
More health literate patients are likely to have:
Improved health outcomes
Reduced health care costs
Better quality of care
Higher satisfaction
Providers of health literate patients are likely to have:
Decreased stress and frustration
Improved job satisfaction
Assessing Health Literacy
Red Flag Behaviors
Incomplete or inaccurate patient registration form
Frequently missed appointments
Medication regimen noncompliance
Lack of follow-up with tests & referrals
Patient reported taking medications, but physical indicators do not improve
Red Flag Responses
“I forgot my glasses, I’ll read this when I get home.”
“I forgot my glasses, can you read this to me?”
“Let me take this home to discuss with my family.”
Unable to name medications
Unable to explain medication purpose
Unable to explain medication administration regimen/schedule
Health Literacy Assessment Strategies
Social history
What is the best way for you to learn new things?
How happy are you with the way you read?
How often do you need to have someone help you read instructions or complete medical forms?
Health Literacy Assessment Strategies
Brown bag medication review
Ask patients to bring all medications (Rx, OTC, herbs, vitamins) to clinical visit
During visit, ask patients to name each medication, its purpose, and describe how it is taken
Health Literacy Assessment Strategies
Source: caglecartoons.com
Health Literacy Assessment Strategies
Rapid Estimate of Adult Literacy in Medicine (REALM)
Word recognition test to identify patients at risk for limited health literacy skills
Ask patient to pronounce the following words:
Source: Bass, Wilson & Griffith. 2003. A shortened instrument for literacy screening. Journal of General Internal Medicine, 18(12), 1036-38.
Fat Flu Pill Osteoporosis
Allergic Jaundice Anemia Fatigue
Directed Colitis Constipation
Consider This…
During a medication review, Nurse Practitioner Welden asks Ms. Diaz, who has hypertension and coronary artery disease, to explain the name of each pill, its purpose, and how it should be taken. She is on Lipitor, Lisinopril, topral, Plavix and a diuretic.
What responses would you expect when conducting medication reviews with patients who have limited health literacy?
Inability to state the medication’s purpose
Inability to describe when to take the medicine
Inability to explain importance of medication
Employing Health Literacy Techniques
It’s Not What You Say…
It’s how you say it
Importance of tone and body language
Source: Mehrabian, 1981.
Behaviors to Improve Understanding
Slow down
Use plain, non-medical language
Show or draw pictures
Limit amount of information provided and repeat it
Use the “teach-back” technique
Create a shame-free environment by encouraging questions (e.g., “ask me three”)
Behaviors to Improve Understanding
Use orienting statements
Encourage patients to ask questions or probe to find out if they have unaddressed concerns
Ask patients to explain their understanding of the medical problem and treatment
Sit rather than stand
Listen rather than speak
Plain Language
Technique for making written and oral information easier to understand
Break down complex information
Organize information so that most important points come first
Source: Bliss by Harry Bliss, 5/9/09.
Explaining concepts to patients without medical terms can be challenging.
Sometimes pictures, analogies, and models help.
Plain Language
COPD Cardiologist Asthma Monitor
Arthritis Hypoglycemia Anti-
inflammatory Cholesterol
Teach Back Method
Have patients explain/demonstrate how they will perform their treatment or take their medication.
If patients do not answer correctly, state that you YOU have not explained something correctly.
Restate instructions in a different way and check for comprehension.
Ask Me 3
What is my main problem?
What do I need to do (about the problem)?
Why is it important to do this?
Enhancing the Patient-Friendliness of Your Clinic
Patient-Friendly Practice
Clear signage and directions
Plain language written materials Consent forms
Health history questionnaire
Patient education materials
Alternative non-written materials
Patient-Friendly Written Materials
Benefit all patients
Basic principles Depth and detail of content
Complexity of text
Format of material
User testing
Source: Environmental Protection Agency, 2006.
Patient-Friendly Non-Written Materials
Graphic illustrations Pictures
Pictograms
Models
Computer modalities Static and interactive
internet websites
Remember…
Assess for literacy Social history
Medication review
Improve understanding and compliance Make practice patient friendly
Use plain language
Draw a picture
Have patient “teach back” instructions
Ensure patients can “Ask me 3”
RAY & ASSOCIATES, LLC
Nancy [email protected]
Jacqueline [email protected]
Community Health Integrated Partnership (CHIP)
Peggy [email protected]