The National Action Plan The National Action Plan to Improve Health to Improve Health

Literacy: Literacy: A View from CMSA View from CMS

Frank Funderburk1 & Eileen Zerhusen2

1Director, Division of ResearchStrategic Research & Campaign Management Group, 2Creative Services Group

10/20/2010Presented at Seventh National Conference on Quality Health Care for Culturally Diverse Populations. Baltimore, MD 1

Note: The statements expressed here are those of the authors and do not necessarily reflect the views or policies of CMS

Goals of the National Action Goals of the National Action PlanPlan• Help people understand their health care

options and make better decisions.• Give people trusted health and safety

information that they can use to make better decisions and get the care they need when they need it.

• Use our materials to improve their quality of life.

• Make this information available where people live and work.

• Measure how well we are doing these things.

• Learn how to improve our approaches and materials.

• Share what we learn with others.10/20/2010 2

Health Literacy ConceptsHealth Literacy ConceptsDemonstrated Skill – Have they

shown they can do it? Capacity – Could they do it, if

trained?Motivation – Would they even try to

do it?Shared Function – How do social and

individual factors interact?Next steps – What should we do?

Where should we intervene?10/20/2010 3

Research to Develop Research to Develop Consumer-Based Consumer-Based Communications StrategyCommunications StrategyUnderstand “consumer reality”

◦Values ◦Beliefs ◦Needs◦Behavior◦Barriers◦Motivations◦Reactions to key concepts◦Literature review/Environmental

scan (What is already out there? How can we learn from it?)

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Social Marketing Supports Social Marketing Supports Health Literacy GoalsHealth Literacy GoalsUnderstand target audience –

health literacy, culture, language, attitudes, perceptions

Identify barriers Test materials and messagesDevelop campaignsEvaluate behavioral impact Refine and repeat process

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Some Vulnerable Some Vulnerable PopulationsPopulationsMedicare

◦Chronic Disease◦Seniors◦Disabled (Dual eligibles)◦Low-income

Medicaid/CHIP◦Low-income family◦Low English proficiency

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Using Social Marketing to Using Social Marketing to Improve CommunicationsImprove CommunicationsLow Income SubsidyHome Health CompareDischarge Planning ChecklistUnderstanding Medicare ChoicesMotivational Assessment of

MessagesCHIP EnrollmentToolkit for Making Written

Materials Clear & Effective10/20/2010 7

Mixed Methods Research Mixed Methods Research Strategy for Improving LIS Strategy for Improving LIS EnrollmentEnrollment

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Initial Formative ResearchInitial Formative ResearchApproaches to formative research waves:

◦ Focus groups with audience segments (What to call it? What will motivate you to enroll? What are the barriers? What will be most [least] helpful?)

◦ In-depth interviews (How can we improve communication? Where do you go for information? Why did you go there?)

◦ Cognitive testing (Was that understood? Is this clearer? How would you say this?)

Results/Recommendations◦ Focus on building awareness of benefit◦ Message outside of traditional communication

windows/channels (not during open enrollment, photo-novella vs. written guides)

◦ Lack of perceived need/eligibility◦ Expectation of continuous enrollment

opportunity

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Decision-Making StyleDecision-Making Style

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Understanding the Understanding the AudienceAudience

Psychographic Themes◦ Strong family

orientation◦ Enjoy outdoor activities◦ Want and appreciate “a

good deal”

Communication Themes◦ Down to earth, altruistic

“Stop & Smell the Roses”

◦ Pride, heritage, stability “Buy American”

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Experimental Field StudyExperimental Field Study

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Key Findings – Key Findings – We Can Improve LIS We Can Improve LIS Application RateApplication Rate

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Home Health Compare Home Health Compare Homepage Introduced 2003Homepage Introduced 2003

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Home Health Compare Home Health Compare Redesign 2010Redesign 2010

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Discharge Planning Discharge Planning ChecklistChecklist

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Simple Step-by-Step Simple Step-by-Step RemindersReminders

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Engaging CaregiversEngaging Caregivers

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Simplifying Medicare Simplifying Medicare ChoicesChoices

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Improving Motivational Improving Motivational MessagingMessaging

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Sharing Lessons LearnedSharing Lessons Learned

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Next StepsNext StepsExpand use of alternative

communication channels/techniques (e.g., Edutainment)

Expand to new audience segmentsHelp staff and partners communicate

more effectivelyAddress paradoxical effects of

generally effective health educationExplore ways to measure population

health literacy

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Consumer Empowerment Consumer Empowerment Create a person-centered system

of healthcareConsumer testing is key to health

literacy assessmentTarget and tailor materialsSegment on factors other than

demographicsGet and share the toolkit!

◦ Go to http://www.cms.gov, select Outreach & Education, and then select Outreach. Click on the toolkit to read or download it.

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