Becoming a Health Literate Organization: Becoming a Health Literate Organization: Tools You Can Use from DHHS & BeyondTools You Can Use from DHHS & Beyond
Cindy BrachCindy Brach
Center for Delivery, Center for Delivery, Organization, and MarketsOrganization, and Markets
OverviewOverview
Health Literacy BasicsHealth Literacy Basics
10 Attributes of a Health 10 Attributes of a Health Literate OrganizationLiterate Organization
Vision for the FutureVision for the Future
Health Health Literacy Literacy BasicsBasics
Definition of Health LiteracyDefinition of Health Literacy
““The degree to which individuals have the The degree to which individuals have the capacity to obtain, capacity to obtain, communicatecommunicate, , process, and understand basic health process, and understand basic health information and services needed to make information and services needed to make appropriate health decisions.”appropriate health decisions.”
- Affordable Care Act- Affordable Care Act
Percentage of adults in each health literacy level, by race/ethnicity, 2003
14 924
4113 25
9
2219
3425
1823
28
53 58
41 31
5245 59
12 142 4
18 7 3
0%
20%
40%
60%
80%
100%
Proficient
Intermediate
Basic
Below Basic
Prevalence & DisparitiesPrevalence & Disparities
Source: NAAL
New Evidence ReportNew Evidence Report
Report found:found: More evidence of link More evidence of link
between limited between limited health literacy and health literacy and poorer health poorer health outcomesoutcomes
Some evidence Some evidence interventions can interventions can reduce disease reduce disease severity, ER visits, severity, ER visits, and hospital and hospital admissionsadmissions
Health Literacy EquationHealth Literacy Equation
Skills/Abilities x Skills/Abilities x Difficulty/ComplexityDifficulty/Complexity = Health Literacy = Health Literacy
XX ==
Cycle of Crisis CareCycle of Crisis Care
Koh et al. 2012
National Action Plan to National Action Plan to Improve Health LiteracyImprove Health Literacy
Goal 1: Patient education materialsGoal 1: Patient education materials Goal 2: Tools to implement system Goal 2: Tools to implement system
changechange Goal 3:Goal 3: Health education in school Health education in school Goal 4: Adult Ed, ESOL Goal 4: Adult Ed, ESOL Goal 5: PartnershipsGoal 5: Partnerships Goal 6: Fund research and build the fieldGoal 6: Fund research and build the field Goal 7: DisseminationGoal 7: Disseminationwww.health.gov/communication/HLActionPlan/
Health Literate OrganizationsHealth Literate Organizations
A health literate organization makes A health literate organization makes it easier for people to navigate, it easier for people to navigate, understand, and use information and understand, and use information and services to take care of their health.services to take care of their health.
Brach et al. 2012
Attributes of Health Attributes of Health Literate OrganizationsLiterate Organizations
10 attributes of a 10 attributes of a health literate health literate health care health care organizationorganization
A Health Literate OrganizationA Health Literate Organization
1.1. Has leadership that makes health literacy Has leadership that makes health literacy integral to its mission, structure, and integral to its mission, structure, and operations. Leadership: operations. Leadership: – Makes clear and effective communication a Makes clear and effective communication a
priority priority
– Assigns responsibility for health literacy Assigns responsibility for health literacy oversight oversight
– Sets goals for health literacy improvementSets goals for health literacy improvement
– Allocates fiscal and human resources Allocates fiscal and human resources
Attribute 2Attribute 2 A Health Literate Organization A Health Literate Organization
2.2. Integrates health literacy into planning, Integrates health literacy into planning, evaluation measures, patient safety, and evaluation measures, patient safety, and quality improvement.quality improvement.– Incorporates health literacy into all Incorporates health literacy into all
planning activitiesplanning activities
– Conducts ongoing organizational Conducts ongoing organizational assessments assessments
– Measures the success in achieving the Measures the success in achieving the health literacy attributes and identifies health literacy attributes and identifies areas for quality improvementareas for quality improvement
CDC Health Literacy CDC Health Literacy Planning ToolPlanning Tool
Tool available from available from CDC’s health literacy site
Pharmacy Health Literacy Pharmacy Health Literacy Assessment ToolAssessment Tool
3 Parts:3 Parts: Assessment tour by Assessment tour by
objective auditorobjective auditor Pharmacy staff Pharmacy staff
surveysurvey Pharmacy patient Pharmacy patient
focus group guidefocus group guide
Available from the Available from the AHRQ Pharmacy Health Literacy Center
Measuring Patient Experiences: Measuring Patient Experiences: CAHPSCAHPS®® Health Literacy Health Literacy
CAHPS® Item Set for Addressing Health Literacy - Supplement to - Supplement to Clinician/Group CAHPSClinician/Group CAHPS®®
Hospital CAHPSHospital CAHPS® Supplement - coming ® Supplement - coming soonsoon
Health Plan Health Plan CAHPSCAHPS® Supplement - pilot ® Supplement - pilot testingtesting
National Benchmarking DataNational Benchmarking Data
In the last 12 months, how often did: In the last 12 months, how often did:
This provider give you easy to understand This provider give you easy to understand instructions about what to do to take care instructions about what to do to take care of this illness or health condition?of this illness or health condition?
This provider ask you to describe how you This provider ask you to describe how you were going to follow these instructions? were going to follow these instructions?
Someone explain the purpose of a form Someone explain the purpose of a form before you signed it? before you signed it?
Attribute 3Attribute 3 A Health Literate Organization A Health Literate Organization
Prepares the workforce to be health literate and monitors Prepares the workforce to be health literate and monitors progressprogress– Hires diverse staff with health literacy expertise Hires diverse staff with health literacy expertise – Sets and meets goals for training all staff and members of Sets and meets goals for training all staff and members of
governing bodiesgoverning bodies– Provides health literacy training and incorporates health literacy Provides health literacy training and incorporates health literacy
into orientations and other trainingsinto orientations and other trainings– Arranges for staff to take advantage of on-line health literacy Arranges for staff to take advantage of on-line health literacy
training resources training resources
http://www.cdc.gov/healthliteracy/training/index.html
Attribute 4Attribute 4 A Health Literate Organization A Health Literate Organization
Includes populations served in the design, Includes populations served in the design, implementation, and evaluation of health information and implementation, and evaluation of health information and servicesservices– Includes members of the population on governing bodiesIncludes members of the population on governing bodies
– Establish advisory groups that involve individuals with limited Establish advisory groups that involve individuals with limited health literacy, adult educators, and experts in health literacyhealth literacy, adult educators, and experts in health literacy
– Collaborate with community members in design and Collaborate with community members in design and implementation of interventions and development and testing implementation of interventions and development and testing of materials. of materials.
Attribute 5Attribute 5 A Health Literate Organization A Health Literate Organization
Meets needs of populations with a range of Meets needs of populations with a range of health literacy skills while avoiding stigmatizationhealth literacy skills while avoiding stigmatization– Adopts health literacy universal precautions, such as Adopts health literacy universal precautions, such as
offering everyone help with literacy tasks offering everyone help with literacy tasks
– Allocates resources proportionate to the Allocates resources proportionate to the concentration of individuals with limited health literacy concentration of individuals with limited health literacy
Health Literacy Health Literacy Universal PrecautionsUniversal Precautions
Structuring the delivery of care as if Structuring the delivery of care as if everyone may have limited health literacy everyone may have limited health literacy – You can’t tell by lookingYou can’t tell by looking
– Higher literacy skills Higher literacy skills ≠≠ understanding understanding
– Health literacy is a state not a traitHealth literacy is a state not a trait
– Everyone benefits from clear communicationEveryone benefits from clear communication
Health Literacy Health Literacy Universal Precautions ToolkitUniversal Precautions Toolkit
20 Tools 20 Tools Quick Start GuideQuick Start Guide Path to Improvement Path to Improvement Appendices Appendices
– Over 25 resources Over 25 resources such as sample such as sample forms, PowerPoint forms, PowerPoint presentations, and presentations, and worksheetsworksheets
http://ahrq.gov/qual/literacy
Attribute 6Attribute 6 A Health Literate Organization A Health Literate Organization
Uses health literacy strategies in Uses health literacy strategies in interpersonal communications and interpersonal communications and confirms understanding at all points of confirms understanding at all points of contactcontact– Refrains from using medical jargonRefrains from using medical jargon
– Confirms understanding (e.g. Teach-Back)Confirms understanding (e.g. Teach-Back)
– Secures language assistance for speakers Secures language assistance for speakers of languages other than English of languages other than English
– Limits to two to three messages at a time Limits to two to three messages at a time
– Encourages questionsEncourages questions
Reducing Health Reducing Health Literacy DemandsLiteracy Demands
Attribute 7Attribute 7 A Health Literate Organization A Health Literate Organization
Provides easy access to health information and Provides easy access to health information and services and navigation assistanceservices and navigation assistance– Facilitates scheduling appointments with other services Facilitates scheduling appointments with other services – Uses clear signageUses clear signage– Offers assistance with all literacy related tasksOffers assistance with all literacy related tasks– Makes electronic patient portals user-centered and Makes electronic patient portals user-centered and
provides training on how to use themprovides training on how to use them
Guides on Reaching Limited Guides on Reaching Limited Literacy AudiencesLiteracy Audiences
Attribute 8Attribute 8 A Health Literate Organization A Health Literate Organization
Designs and distributes print, audio/visual Designs and distributes print, audio/visual materials, and social media content that is easy to materials, and social media content that is easy to understand and act onunderstand and act on– Involves diverse audiences, including those with limited Involves diverse audiences, including those with limited
health literacy, in development and rigorous user health literacy, in development and rigorous user testing testing
– Uses a quality translation process to produce materials Uses a quality translation process to produce materials in languages other than English in languages other than English
www.cms.gov/WrittenMaterialsToolkit/www.cms.gov/WrittenMaterialsToolkit/
Pill CardsPill Cards
www.ahrq.gov/pharmhealthlit/www.ahrq.gov/pharmhealthlit/
12 units24 unitsInject 24 units before breakfast and 12 units before dinner
Take 2 pills in the morning and 2 pills in the evening
FluidFurosemide
20mg
Take 1 pill at night
Cholesterol
Simvastatin
20mg
InstructionsUsed ForName
Name: Sarah Smith Date Created: 12/15/07Pharmacy phone number: 123-456-7890
12 units24 unitsInject 24 units before breakfast and 12 units before dinner
Take 2 pills in the morning and 2 pills in the evening
FluidFurosemide
20mg
Take 1 pill at night
Cholesterol
Simvastatin
20mg
InstructionsUsed ForName
Name: Sarah Smith Date Created: 12/15/07Pharmacy phone number: 123-456-7890
NightEveningAfternoonMorning
Insulin70/30 Diabetes
(Sugar)
Attribute 9Attribute 9 A Health Literate Organization A Health Literate Organization
Addresses health literacy in high risk Addresses health literacy in high risk situations, including care transitions and situations, including care transitions and communications about medicinescommunications about medicines– Prioritizes high-risk situations (e.g., Prioritizes high-risk situations (e.g.,
informed consent for surgery and other informed consent for surgery and other invasive procedures) invasive procedures)
– Emphasizes high-risk topics (e.g., Emphasizes high-risk topics (e.g., conditions that require extensive self-conditions that require extensive self-management) management)
A Practical Guide to A Practical Guide to Informed ConsentInformed Consent
No more Toni CordellsNo more Toni Cordells Hospital Culture ChangeHospital Culture Change Improving the Improving the processprocess Improving formsImproving forms
– Style guideStyle guide
– SamplesSamples
Guide available on the WebGuide available on the Web
Attribute 10Attribute 10 A Health Literate Organization A Health Literate Organization
Communicates clearly what health plans Communicates clearly what health plans cover and what individuals will have to pay cover and what individuals will have to pay for servicesfor services– Provides easy-to-understand descriptions of Provides easy-to-understand descriptions of
health insurance policies health insurance policies – Communicates the out-of-pocket costs for health Communicates the out-of-pocket costs for health
care services before they are delivered care services before they are delivered
Benefit and Benefit and Coverage InformationCoverage Information
Template for Summary of Benefits Template for Summary of Benefits and Coverage that all private insurers and Coverage that all private insurers will usewill use
Coverage examplesCoverage examples
Glossary of healthGlossary of health insurance termsinsurance terms
Vision Vision for the for the FutureFuture
Vision of National Action Vision of National Action Plan to Improve Health LiteracyPlan to Improve Health Literacy
Provides everyone access to accurate, actionable health Provides everyone access to accurate, actionable health informationinformation
Delivers person-centered health information and servicesDelivers person-centered health information and services Supports life-long learning and skills to promote good Supports life-long learning and skills to promote good
healthhealth
The vision informing the National The vision informing the National Action Plan is of a society that:Action Plan is of a society that:
Koh et al. 2012
Find Other State Health Find Other State Health Literacy ActivityLiteracy Activity
CDC State Health Literacy Activity MapCDC State Health Literacy Activity Map
Federal Health Federal Health Literacy InformationLiteracy Information
AHRQ Health Literacy and Cultural AHRQ Health Literacy and Cultural Competence Browse PageCompetence Browse Page
30,000+ subscribers to AHRQ Email 30,000+ subscribers to AHRQ Email UpdatesUpdates
HHS ResourcesHHS Resources
““If [patients’] understanding is If [patients’] understanding is incorrect or incomplete, we incorrect or incomplete, we did not find the right way to did not find the right way to reach them. Being health reach them. Being health literate is just as important for literate is just as important for clinicians as it is for patients.”clinicians as it is for patients.”
Dr. Regina BenjaminDr. Regina BenjaminSurgeon General Surgeon General
What Questions Do You Have?
www.ahrq.govwww.ahrq.gov
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