Using Health Literacy Basics to Improve

Interpretations, Translations, and Patient

Outcomes

Melissa Reyna, MPH, RN, ICCE

Texas Health Resources

9-7-2012

Agenda

• What is health literacy?

• Why is health literacy important?

• How does health literacy affect interpretations and translations?

• Solutions for improving patient outcomes

• How to assess a document’s reading level

• Patient education councils

• Resources

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Do I Look Like An Idiot?

• http://www.youtube.com/watch?v=dMAS2S51bM8

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What is 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 and follow instructions for treatment.” (Healthy People 2020)

• Not only an individual’s traits/abilities, but a system’s/organization’s ability to create a functional environment (IOM, 2012)

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Why is Health Literacy Important?

• ≥ 50% American adults have functional literacy issues (TJC, 2007)

• ≤ 12% American adults have proficient health literacy (National Assessment of Adult Literacy, 2006)

• Healthcare workers overestimate their ability to communicate information (Schillinger, et al., 2003)

• National Tipping Point for health literacy (Koh, et al., 2012)

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Why is Health Literacy Important?

• Sudore, et al. (2009)

↓ Health literacy = ↓ Quality of care received

↓ Health literacy = ↓ Chronic disease management

↓ Health literacy = ↑ Likelihood of readmission

• Schillinger, et al. (2003)

↓ Communication = ↓ Patient satisfaction

↓ Communication = ↓ Patient outcomes

• Levinson, et al. (1997)

↓ Communication = ↑ Litigation

• Boulding, et al. (2011)

↓HCAHPS = ↑ 30-day readmissions

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Why is Health Literacy Important?

• http://www.youtube.com/watch?v=BgTuD7l7LG8

(AMA Foundation, 2007)

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How Does Health Literacy Affect

Interpretations and Translations?

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How Does Health Literacy Affect Interpretations and Translations?

• Advocacy

• Accuracy

• Cultural Awareness

• Professional Development

• Business Case

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Solutions for Improving Patient Outcomes - Interpretations

• Slow down

• Use plain, non-medical language

• Show or draw pictures

• Limit the amount of information provided-and repeat it

• Use the teach-back technique

• Create a shame-free environment-encourage questions

(Weiss, 2007)

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Solutions for Improving Patient Outcomes - Translations

• General Contento Limit to one or two objectiveso Limit to what patients really need to knowo Use non-medical wordso Appropriate content for age & culture

• Text Constructiono At or below 6th-grade levelo One- or two-syllable wordso Short paragraphso Active voiceo Simple tables & graphs

(Weiss, 2007)

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Solutions for Improving Patient Outcomes - Translations

• Fonts and Typestyleo Large font (12 minimum) & serifso No more than two or three fonts styleso Upper- and lower-case text

• Layouto Empty spaceo Headings & subheadings o Bulleted listso Useful illustrations

(Weiss, 2007)

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How to Assess a Document’s Reading Level

• Many different Readability Formulas

• Provide grade reading level for documents

• Examples:o Flesch-Kincaid (Microsoft Word)o Fry Readability Grapho McLaughlin's SMOG Formulao Gunning Fog Formulao Suitability Assessment of Materials (SAM)o Non-English available

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Patient Education Councils

• Provide linguistically- and culturally-appropriate tools, experiences, policy, procedure, etc.

• Multidisciplinary

• Administrators & direct-care specialists

• Place at table for Interpreters and Translators

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Please contact me:

Melissa Reyna, MPH,RN, ICCE

Coordinator of Patient Education

Texas Health Resources

MelissaReyna@texashealth.org

(682)236-6931

Resources

• http://www.youtube.com/watch?v=dMAS2S51bM8

• http://www.youtube.com/watch?v=BgTuD7l7LG8

• www.amafoundation.org/go/healthliteracy

• Boulding, et al. (2011). Relationship Between Patient Satisfaction with Inpatient Care and Hospital Readmission within 30 Days. American Journal of Managed Care, 17(1): 41-48.

• Brach and Noonan (2010). Health Literacy Universal Precautions Toolkit. US Department of Health and Human Services, Agency for Healthcare Research and Quality. AHRQ Publication No. 10-0046-EF.

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Resources• Brach, et al. (2012). Ten Attributes of a Health Literate Organization.

Institute of Medicine.

• Doak, Doak, and Root (1996). Teaching Patients with Low Literacy Skills, Second Edition. JB Lippincott Company.

• Kanack, Susan (2009). Effectively Managing Patient Education: Going Beyond Joint Commission Requirements. HCPro, Inc.

• Koh, et al. (2012). New Federal Policy Initiatives to Boost Health Literacy Can Help Nation Move Beyond the Cycle of Costly ‘Crisis Care.’ Health Affairs, 31(2): 434-443.

• Levinson, et al. (1997). Physician-Patient Communication: The Relationship with Malpractice Claims Among Primary Care Physicians and Surgeons. Journal of the American Medical Association, 227: 553-559.

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Resources

• McGee, Jeanne and McGee & Evers Consulting, Inc. (2010). Toolkit for Making Written Material Clear and Effective. US Department of Health and Human Services, Centers for Medicare and Medicaid. CMS Product No. 11476.

• Schillinger, et al. (2003). Closing the Loop: Physician Communication with Diabetic Patients Who Have Low Health Literacy. Archives of Internal Medicine, 163: 83-90.

• Sudore and Schillinger. (2009). Interventions to Improve Care for Patients with Limited Health Literacy. Journal of Clinical Outcomes Management, 16(1): 20-29.

• Weiss, Barry (2007). Health Literacy and Patient Safety: Help Patients Understand, Second Edition. American Medical Association Foundation and American Medical Association.

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