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Literacy and Health Literacy: Prerequisites to Effective Health Care Decision Making
National Coalition for Literacy
December 5, 2007Washington, DC
Presented by Joyce Dubow, AARP
Presentation Overview
Profile of the Medicare population Information burden and the
importance of patient engagement Implications of poor health literacy
skills on ability to navigate Medicare
Strategies to meet needs Policy implications
75-7920%
85+13%
70-7423%
80-415%
65-6929%
Source:http://www.cms.hhs.gov/DataCompendium/018_2006_Data_Compendium.asp
People on Medicare:Age, 2005
Some college or more
41%
High School30%
Not a High School Grad
29%
Education
Source: MedPAC analysis of the Medicare Current Beneficiary Survey, Cost and Use file, 2004
People on Medicare:
Today’s Medicare Program
Medicare
The OriginalMedicare Plan
Coordinated Care Plans
Private FFS
HMOs
POS
PPOs
MSA
PSO
Demos
Part D Part D
What is expected of Medicare beneficiaries
Recognize differences among Medicare coverage options
Decide whether to buy Rx coverage Identify differences among similar
plans Choose “best” doctors and hospitals Navigate within a plan Choose most appropriate treatment
options Understand rights and responsibilities
Numeracy
Source: Kripalani and Jacobson, www/ahrq.gov/qual/pharmlit/pharmtrain2.htm
Health Literacy
“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
IOM, Health Literacy: a Prescription to End Confusion
Source: Kripalani and Jacobsonwww.ahrq.gov/qual/pharmlit/pharmtrain2.htm
Average Health Literacy Scores of Adults by Age,
2003
190
200
210
220
230
240
250
260
16-18 19-24 25-39 40-49 50-64 65+
Age
Ave
rag
e S
core
Source: Results from the 2003 NAAL
Source: Literacy in Everyday Life: Results from the 2003 NAAL
Source Kripalani and Jacobson, www.ahrq.gov/qual/pharmlit/pharmtrain
Consequences of Inadequate Health
Literacy Poor health outcomes Low health literacy is an independent risk
factor for hospital admission among Medicare managed care enrollees.
Risk of non-compliance Errors Poor decisions Anxiety Inertia
People with Chronic Conditions Report Getting Conflicting Advice
18%
17%
16%
14%
0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%
Had duplicate tests orprocedures
Received conflictinginformation from
providers
Received informationabout drug interactionsupon filling prescription
Received differentdiagnoses from different
providers
Percent of Population with Chronic Conditions Reporting Problem
Source: Jane Horvath, Partnership for Solutions (Chronic Illness and Caregiving, a survey conducted by Harris Interactive, Inc., 2000.)
Engagement Fosters Desirable Patient Behaviors (Hibbard)
Informed choice role —using performance information to validate choice of provider
Co-producer role —having skills and confidence to partner with providers and to be vigilant in ensuring that one’s own care is safe
Evaluator role —understanding and acting on information on performance and understanding how such information affects one’s life.
Health Literacy Level and Decision Making
Health literacy influences decision making confidence to make decisions ability to use comparative information
(Patient activation influences engagement in self-management
behaviors )
Challenges Cognitive overload
Need to help people take into account multiple variables in making decisions
Statistical concepts not well understood (e.g., absolute vs. relative performance; average/percentage; benchmarks; statistical uncertainty.
Lack of Interest? Adequacy and timeliness of relevant
and meaningful information
What Works? Symbols vs. numbers Simplifying
Focus on key messages Present recommended actions steps
clearly Rank ordering by performance vs.
alphabetical ordering Summarizing
“Teach Back”
What Works? “Evaluable” formats (can be
as important as content) Framing makes a difference. Use of alternative media (e.g.,
interactive data bases)
Other Strategies
Test materials with diverse groups for comprehension and appeal
Use simple language, (e.g., “plain English”) white space, large fonts culturally sensitive; “age-appropriate” colors; avoid fancy graphics
Policy Challenges
Medicare must address needs of a very diverse beneficiary population: diverse skills diverse preferences diverse needs diverse SES
Advance health literacy as a policy issue
Summary: Help Beneficiaries
Use Information Lower cognitive effort required to use information
Reduce amount of information Computer-aided decision tools Evaluable displays
Highlight meaning and significance Framing; Provide information that helps consumers understand the
implications of their choices Give a better idea of what the actual experience of a choice might
be like. Narratives
Design information displays to highlight the meaning of important information that might otherwise be overlooked
Conclusions
Emphasis on private plans/market competition and consumerism in Medicare requires an “informed consumer”
Adequate funding for information and education programs, including counseling programs, is required to address diverse beneficiary needs