Health Education Adult Literacy

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1. Culturally Effective Pediatric Care in a Community-based Health Program

3. American Academy of Pediatrics’ Culturally Effective Care Toolkit Denice Cora-Bramble, MD, MBA Lead Author, AAP Culturally Effective Care Toolkit Senior Vice President, Children’s National Medical Center Goldberg Center for Community Pediatric Health Professor of Pediatrics, George Washington University

4. Overview Culturally Effective Care AAP toolkit development Website architecture Case studies & application of toolkit resources Q&A

5. Case Study to Frame the Discussion Your last case of the day is a 6 y.o. Hispanic male referred by the school nurse because of a fever of 400C. His mother accompanies the patient but does not speak English. The patient speaks and understands both English & Spanish. Your only on-site trained interpreter left for the day and you only know a few words in Spanish. What are your next steps?

6. Culturally Effective Care

7. Culturally Effective Care “The delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of cultural distinctions. Such understanding should take into account the beliefs, values, actions, customs and unique health care needs of distinct population groups. Providers will thus enhance interpersonal and communication skills, thereby strengthening the physician-patient relationship and maximizing the health status of patients”. AAP Committee on Pediatric Workforce: Ensuring Culturally Effective Pediatric Care: Implications for Education and Health Policy Pediatrics 2004;114;1677-1685

8. Quality of Care Institute of Medicine. Crossing the Quality Chasm: a New Health System for the 21st Century. Washington, DC: National Academies Press, 2001

9. Diversifying U.S. Population

10. How do these changes impact the clinical setting? In California, Latino children comprise the largest group of children US Census Bureau, 2000 By the year 2020, an estimated 1 in 5 children in the US will be Latino Changing America: Indicators of Social and Economic Well-Being by Race and Hispanic Origin; Council of Economic Advisors for the President’s Initiative on Race, 1998

11. AAP Toolkit Development

12. Toolkit Development Team Lead Author: Denice Cora-Bramble, MD, MBA, FAAP Lead Staff: Regina M. Shaefer, MPH Review Group Julio Bracero, MD, Section on Medical Students, Residents, and Fellowship Trainees Colleen Kraft, MD, FAAP, Council on Community Pediatrics Alice Kuo, MD, PhD, MEd, FAAP, Council on Community Pediatrics Dennis Vickers, MD, MPH, FAAP, Medical Home Initiatives William Zurhellen, MD, FAAP, Section on Administration and Practice Management, Practice Management Online Editorial Board Mary Brown, MD, FAAP, American Academy of Pediatrics Board of Directors

13. Culturally Effective Care Toolkit Needs Assessment Results September 2009

14. Culturally Effective Care Toolkit Needs Assessment Results September 2009

15. Culturally Effective Care Toolkit Needs Assessment Results September 2009

16. Website Architecture

18. Case studies & application of toolkit resources

19. Case Study #1 Your last case of the day is a 6 y.o. Hispanic male referred by the school nurse because of a fever of 400C. His mother accompanies the patient but does not speak English. The patient speaks and understands both English & Spanish. The only on-site trained interpreter left for the day and you only know a few words in Spanish. What are your next steps?

20. Linguistic Barriers Studies have documented the multiplicity of adverse effects that language barriers have in health care including: Impaired health status, nonadherence to medication regiments, higher resource use for diagnostic testing and others Flores G: Dolor Aqui? Fiebre?: Arch Pediatr Adolesc Med; Vol156, 638-640; 2002

21. Linguistic Barriers One study identified language problems as the single greatest barrier to health care access for Latino children. Flores G and Abreau M: Access Barriers to Health Care for Latino Children; Arch Pediatr Adolesc Med, Vol 152(11), 1119-1125; 1998

22. Interpretive Services Medical interpreter as an essential component of effective communication between the limited English proficient (LEP) patient and health care provider Professional in-house, ad hoc, untrained family member, non-clinical hospital employee, stranger Untrained commit many errors Flores G et at.: Errors in Medical Interpretation and Their Potential Clinical Consequences. Pediatrics; Vol 111(1); 6-14; 2003

23. Clinically Significant Medical Errors Omissions Drug allergies Past medical history Chief complaint Substitutions Abx for 2 days instead of 10 HC to entire body instead of lesion Flores G et at.: Errors in Medical Interpretation and Their Potential Clinical Consequences. Pediatrics; Vol 111(1); 6-14; 2003

25. Toolkit Resource: Interpretive Services Section Options for providing interpretive services Pros & cons associated with different options Cost & payer payment Integrating interpretive services into office systems & practice What to look for in hiring/contracting for interpretive services Pitfalls to avoid Tips for working effectively with interpreters Assessing the need for interpretive services

27. Case #2 You have been treating a 7 year old with severe and poorly controlled asthma. The parents refuse to use the inhaled steroids as prescribed and continue to rely on traditional medicine. What are the next steps in managing this patient?

28. Asthma Disparities: More than Access Barriers African American and Latino children enrolled in Medicaid managed care had worse asthma status and were less likely to be using preventive asthma medications than White children. This disparity persisted after adjusting for socioeconomic status. Lieu T et al.: Ethnic Variation in Asthma Status and Management Practices Among Children in Managed Medicaid; Pediatrics 109(5); 857-865; 2002

29. Sociocultural Determinants of Health Parental and child health beliefs Knowledge of asthma and asthma management Competition with other basic life needs Environmental factors Can parents afford to control the environmental triggers? Mansour M et al.: Barriers to Asthma Care in Urban Children: Parent Perspectives. Pediatrics 106(3);512-519

30. Sociocultural Determinants of Health Racial and ethnic differences in health beliefs and concepts of disease Differences in beliefs about the value of prevention Fears about steroids Lack of regularity in the life of the family Lieu T et al.: Ethnic Variation in Asthma Status and Management Practices Among Children in Managed Medicaid; Pediatrics 109(5); 857-865; 2002

31. Understanding Pediatric Asthma Disparities While the control and treatment for asthma is primarily based on medications, some parents have strong personal and cultural beliefs against the use of medications.

32. Belief Systems and Asthma 60% of Dominican mothers believed that their child did not have asthma in absence of symptoms 88% thought that medicines are overused in the US 72% did not use prescribed medicines but substituted traditional practices instead Bearison DJ et al.: Medical Management of Asthma and Folk Medicine in a Hispanic Community. J Pediatr Psychol; 24(4);385-392;2002

33. Traditional Practices Used in the Treatment of Asthma Ethnomedical therapies Prayer Vicks VapoRub or “alcanfor” “Siete jarabes” “Agua maravilla” “Te de manzanilla” Pachter L et al.: Ethnomedical (Folk) Remedies for Childhood Asthma in a Mainland Puerto Rican Community. Arch Pediatr Adolesc Med, Vol149(9);982-988;1995

34. Culturally Effective Toolkit: Health Beliefs and Practices Clinic and Emergency Department Use Pain and Analgesia Traditional Practices, Alternative Medicine and Indigenous Healers Bed Sharing and SIDS Birth and Early Infancy Death and Dying Role of Women Role of Family

35. Culturally Effective Care Toolkit: What Is Culturally Effective Pediatric Care?

36. Final Thoughts “But culture in all its richness, does not simply explain health behaviors, nor does sensitivity to culture solve health disparities. Rather, culture works dynamically, in conjunction with economic and social factors, to affect health behaviors and to alleviate or exacerbate health disparities.” Gregg J, et al: Loosing Culture on the Way to Competence: The Use and Misuse of Culture in Medical Education. Academic Medicine;2006;81(6);542-547

37. Contact Information Please submit your questions via the question pane. Denice Cora-Bramble, MD, MBA Professor of Pediatrics, George Washington Univ. Senior Vice President Children’s National Medical Center Goldberg Center for Community Pediatric Health 111 Michigan Ave., N.W. Washington, D.C. 20010 (202) 476-5857 [email protected]

39. LEPLEP

40. Patient Population Mostly Latino: Dominican, Mexican Low SES: 73.3% born into poor families Limited English Proficiency : 40% children have LEP Health Literacy Level: 83.8% ranging from limited to possibly limited HL using NVS U.S. Census 2000. Manhattan, New York Community District 12. Retrieved from http://www.infoshare.org. Citizen Committee for Children, NYC 2005 Personal communication: Larson, Nevarra 2011. Census 2000: 72% latino /67% dominican. Now mexican, central andn south american Latinos are at highest risk for poor health literacy. Almost half (41%) of Latinos lack basic health literacy, compared to 24% of Blacks and 9% of Whites.[10] CCC: Citizens Committee for Children: keeping trackCensus 2000: 72% latino /67% dominican. Now mexican, central andn south american Latinos are at highest risk for poor health literacy. Almost half (41%) of Latinos lack basic health literacy, compared to 24% of Blacks and 9% of Whites.[10] CCC: Citizens Committee for Children: keeping track

41. Impact of Low Health Literacy Health outcomes Healthcare costs Quality of care Medication administration practices Health Literacy Interventions and Outcomes: An Updated Systematic Review, Structured Abstract. Agency for Healthcare Research and Quality, March 28, 2011 Yin, et al. Parents medication administration errors: Role of dosing instruments and health literacy. Arch Pediatric Adolesc Med 2010; 164 (2): 181-186. Nielsen-Bohlman, L., Panzer, A. M., & Kindig, D. A. (Eds.) (2004). Health literacy: A prescription to end confusion. Washington, DC: National Academies Press. Healthy People 2010: Health communication. 2000: 11-20. Office of Disease Prevention and Health Promotion Low Health Literacy Linked To Higher Risk of Death and More Emergency Room Visits and Hospitalizations Dosing error rates of home administration of medications to children have been reported to be as high as 50%. [1] Healthy People 2010: Health communication. 2000: 11-20. Office of Disease Prevention and Health Promotion. http://www.healthypeople.gov/document/html/volume1/11healthcom.htm. Accessed September 13 Families with low health literacy are at particular risk for medication administration errors.[i] [i] Yin, et al. Parents medication administration errors: Role of dosing instruments and health literacy. Arch Pediatric Adolesc Med 2010; 164 (2): 181-186. 45% US population ( 90 million) has limited literacy/difficulty: Locating providers and services, Filling out health forms,Sharing medical history with provider Seeking preventive health care,Managing chronic health conditions, Understanding directions on medication, Understanding and acting on health-related news and information In a recent health literacy study educating parents about appropriate care of upper respiratory infections, it was found that 42.8% of 154 survey community respondents had marginal or inadequate health literacy as measured by the standardized S-TOFHLA (Test of Functional Health Literacy in Adults). In the same study, baseline surveys showed that 64.1% of caregivers misinterpreted what it means to take a medicine twice a day. Furthermore, a minority of caregivers (28.9%) picked the correct measurement tool for dispensing an antibiotic to a 5 month old and only 60.3% of caregivers were able to choose correctly for a four year old (Stockwell, unpublished data). Low Health Literacy Linked To Higher Risk of Death and More Emergency Room Visits and Hospitalizations Dosing error rates of home administration of medications to children have been reported to be as high as 50%. [1] Healthy People 2010: Health communication. 2000: 11-20. Office of Disease Prevention and Health Promotion. http://www.healthypeople.gov/document/html/volume1/11healthcom.htm. Accessed September 13 Families with low health literacy are at particular risk for medication administration errors.[i] [i] Yin, et al. Parents medication administration errors: Role of dosing instruments and health literacy. Arch Pediatric Adolesc Med 2010; 164 (2): 181-186. 45% US population ( 90 million) has limited literacy/difficulty: Locating providers and services, Filling out health forms,Sharing medical history with provider Seeking preventive health care,Managing chronic health conditions, Understanding directions on medication, Understanding and acting on health-related news and information In a recent health literacy study educating parents about appropriate care of upper respiratory infections, it was found that 42.8% of 154 survey community respondents had marginal or inadequate health literacy as measured by the standardized S-TOFHLA (Test of Functional Health Literacy in Adults). In the same study, baseline surveys showed that 64.1% of caregivers misinterpreted what it means to take a medicine twice a day. Furthermore, a minority of caregivers (28.9%) picked the correct measurement tool for dispensing an antibiotic to a 5 month old and only 60.3% of caregivers were able to choose correctly for a four year old (Stockwell, unpublished data).

42. HEAL: Health Education Adult Health Literacy Modeled after the Health Education and Literacy for Parents Project at Bellevue Hospital, NYC Goal: Improve health literacy of the population served with a focus on medication administration

43. HEAL Educational interventions can improve health knowledge, behaviors and use of healthcare resources among patients with low health literacy (HL). Interventions must integrate HL with cultural and linguistic competency Interventions must address service needs of patients and training needs of providers Yin, H. S., Dreyer, B. P., van Schaick, L., Foltin, G. L., Dinglas, C., & Mendelsohn, A. L. (2008). Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch Pediatr Adolesc Med, 162(9), 814-822. Paasche-Orlow, M. K., Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. Am J Health Behav, 31, S19–S26. Educational interventions can improve health knowledge, behaviors and use of healthcare resources among patients with low health literacy.2 . Yin, H. S., Dreyer, B. P., van Schaick, L., Foltin, G. L., Dinglas, C., & Mendelsohn, A. L. (2008). Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch Pediatr Adolesc Med, 162(9), 814-822. To be successful, these interventions must integrate health literacy with cultural and linguistic competency, narrowing the communication gap between providers, patients, and their caregivers. In their conceptual causal model of the health literacy-health outcomes relationship, Paasche-Orlow and Wolf describe the factors related to health literacy that affect patient-provider interactions and health outcomes. Patient factors include knowledge, beliefs, and participation in decision-making. Provider factors include communication skills, teaching ability, time, and patient-centered care. Paasche-Orlow, M. K., Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. Am J Health Behav, 31, S19–S26. Educational interventions can improve health knowledge, behaviors and use of healthcare resources among patients with low health literacy.2 . Yin, H. S., Dreyer, B. P., van Schaick, L., Foltin, G. L., Dinglas, C., & Mendelsohn, A. L. (2008). Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch Pediatr Adolesc Med, 162(9), 814-822. To be successful, these interventions must integrate health literacy with cultural and linguistic competency, narrowing the communication gap between providers, patients, and their caregivers. In their conceptual causal model of the health literacy-health outcomes relationship, Paasche-Orlow and Wolf describe the factors related to health literacy that affect patient-provider interactions and health outcomes. Patient factors include knowledge, beliefs, and participation in decision-making. Provider factors include communication skills, teaching ability, time, and patient-centered care. Paasche-Orlow, M. K., Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. Am J Health Behav, 31, S19–S26.

44. HEAL: Principles Used Partnership model Participatory, collaborative process Link to existing coalitions, organizations Alianza Dominicana, founded in 1982, is the largest non-profit community development, social service organization in northern Manhattan and the Bronx, with an annual budget of over $12 million and more than 350 full and part-time staff. Annually, Alianza serves more than 17,000 individuals throughout the City of New York. To address the community's multiple and complex needs, Alianza has developed dozens of innovative neighborhood-based initiatives.  The organization currently provides services of more than twenty distinct types, including multidisciplinary cultural activities, neighborhood economic development projects, employment and training programs, family-focused and youth development projects, as well as health and mental health services. Alianza has become the leading national authority on Dominican immigrant communities and is considered a pioneer in many program areas. It has served as a catalyst to the development and creation of many programs and initiatives of both local and national scope. Best Beginnings (a collaborative effort with Alianza Dominicana that is a primary prevention program to reduce child abuse and neglect); The Community Pediatrics at Columbia University has a long standing history of leadership in community-based initiatives to improve the health of children in Washington Heights Alianza Dominicana, founded in 1982, is the largest non-profit community development, social service organization in northern Manhattan and the Bronx, with an annual budget of over $12 million and more than 350 full and part-time staff. Annually, Alianza serves more than 17,000individuals throughout the City of New York. To address the community's multiple and complex needs, Alianza has developed dozens of innovative neighborhood-based initiatives.  The organization currently provides services of more than twenty distinct types, including multidisciplinary cultural activities, neighborhood economic development projects, employment and training programs, family-focused and youth development projects, as well as health and mental health services. Alianza has become the leading national authority on Dominican immigrant communities and is considered a pioneer in many program areas. It has served as acatalyst to the development and creation of many programs and initiatives of both local and national scope. Best Beginnings (a collaborative effort with Alianza Dominicana that is a primary prevention program to reduce child abuse and neglect); The Community Pediatrics at Columbia University has a long standing history of leadership in community-based initiatives to improve the health of children in Washington Heights

45. Target Population All patients in community based-hospital affiliated practices Clients served by a Home Visiting Program ( Best Beginnings/ Alianza Dominicana)

46. CBO’s: Best beg, oddysey house, head start ( columbia, PS5 and PS8, Ft George) Clinical: ACN, ERCBO’s: Best beg, oddysey house, head start ( columbia, PS5 and PS8, Ft George) Clinical: ACN, ER

47. The curriculum emphasizes the “teach-back” method to identify misunderstandings and allow clients to enhance personal knowledge. Train the trainer manual Emphasis is made on patients’ needs The curriculum emphasizes the “teach-back” method to identify misunderstandings and allow clients to enhance personal knowledge. Train the trainer manual Emphasis is made on patients’ needs

48. Curriculum Development: Focus Groups Three focus groups in community setting (two in Spanish/one in English) 22 participants Domains: communication, medications, expectations, physician qualities, clinic qualities and home remedies. Qualitative analysis was performed. Four researchers identified initial themes. Two separate coders further defined themes (overall domains) and identified codes (specific ideas emerging under those domains). Disagreements were discussed amongst the two coders. The most commonly identified domains are listed here and include?Qualitative analysis was performed. Four researchers identified initial themes. Two separate coders further defined themes (overall domains) and identified codes (specific ideas emerging under those domains). Disagreements were discussed amongst the two coders. The most commonly identified domains are listed here and include?

49. These are the themes that informed our curriculumThese are the themes that informed our curriculum

51. HOW DO I CHOOSE AN OVER THE COUNTER COLD MEDICINE?

55. Measuring Liquid Medicines

57. Physician Training: Parent/Patient Exit Interviews Clinical observation at two randomly selected clinics 20 physicians observed using a checklist Communication issues identified: Allowing the patient’s parent to describe the problem uninterrupted Asking if the patient’s parent has questions before the end of the visit Using visual methods Identifying additional resources Knowing and using the teach-back method, particularly regarding medication instructions Asking about the patient parent’s ability to follow treatment plans Using the translator phone when needed

58. Content of Training for Physicians and FSWs Principles of health literacy Communication skills: effectively communicate with families who may have low health literacy levels. Teach back method: identify misunderstandings and allow clients/patients to enhance personal knowledge. Williams, M. V., Davis, T., Parker, R. M., Weiss, B. D. (2002). The role of health literacy in patient-physician communication. Fam Med, 34(5), 383-9. Andrulis, D. P., & Brach, C. (2007). Integrating literacy, culture, and language to improve health care quality for diverse populations. American Journal of Health Behavior, 31(Suppl 1), S122-133. Turner, T., Cull, W. L., Bayldon, B., Klass, P., Sanders, L. M., Frintner, M. P., et al. (2009). Pediatricians and health literacy: Descriptive results from a national survey. Pediatrics, 124, S299-S305.

60. TRAINING Physicians Pediatric residents General Pediatric Faculty Medical students Volunteers (from surrounding colleges) Family Support Workers Those trained will learn skills to identify and effectively communicate with low literacy families.Those trained will learn skills to identify and effectively communicate with low literacy families.

61. Waiting Rooms at community based-hospital affiliated practices Clients’ homes enrolled in home visiting program driven by volunteers, pediatric residents and medical students; takes place in waiting room : Family Support Workers teach the curriculum at home visits driven by volunteers, pediatric residents and medical students; takes place in waiting room : Family Support Workers teach the curriculum at home visits

63. Caregivers Encountered in Waiting Rooms with HEAL Curriculum 82% percent of caregivers encountered in the waiting rooms demonstrated an interest and were very receptive to the information in the curriculum.82% percent of caregivers encountered in the waiting rooms demonstrated an interest and were very receptive to the information in the curriculum.

64. Rate of HEAL Topics Discussed Dodi, It is important to note that two of the components (Common Cold and Antibiotics) were not part of the curriculum initially, but were added in 2009. As a result, the rate at which it was addressed in the waiting room is much lower than the rest. Home Remedies and Over the Counter continue to be a topic of growing interest among parents. Dodi, It is important to note that two of the components (Common Cold and Antibiotics) were not part of the curriculum initially, but were added in 2009. As a result, the rate at which it was addressed in the waiting room is much lower than the rest. Home Remedies and Over the Counter continue to be a topic of growing interest among parents.

66. Using the Wilcoxon, non-parametric test there was a significant increase in the FSW test scores (W=-3.493, p=0.0005). In other words, after training, the mean score of the FSWs increased from 59% to 88%. There was no significant impact on the pre/post of Physicians…However, let me know if you would still like me to show those numbers.Using the Wilcoxon, non-parametric test there was a significant increase in the FSW test scores (W=-3.493, p=0.0005). In other words, after training, the mean score of the FSWs increased from 59% to 88%. There was no significant impact on the pre/post of Physicians…However, let me know if you would still like me to show those numbers.

67. Feedback Logs

68. Out of 289 caregivers who had the opportunity to discuss “Understanding Prescribed Medication Labels, only 191 demonstrated confidence in applying the information from the label. Out of 311 who had the opportunity to discuss the use of OTC meds, only 194 demonstrated that they understood the proper use of OTC meds in accordance with what is disclosed in the label. Out of 270 patients who talked about home remedies with voluntee, only 134 admitted using them. While those who admitted using them to volunteers only 82 caregivers said that they would disclose the us of home remedies with their doctors.Out of 289 caregivers who had the opportunity to discuss “Understanding Prescribed Medication Labels, only 191 demonstrated confidence in applying the information from the label. Out of 311 who had the opportunity to discuss the use of OTC meds, only 194 demonstrated that they understood the proper use of OTC meds in accordance with what is disclosed in the label. Out of 270 patients who talked about home remedies with voluntee, only 134 admitted using them. While those who admitted using them to volunteers only 82 caregivers said that they would disclose the us of home remedies with their doctors.

70. Revised HEAL Curriculum PREPARING FOR A VISIT TO THE DOCTOR Preparations Prior to a Medical Visit My Child’s Medical History Medical Words That You May Hear or See TREATING THE COMMON COLD & FLU What Is a Cold and How to Treat It? Distinguishing Between the Common Cold & Flu How to Treat & Prevent the Flu USING ANTIBIOTICS What Does it Treat? Safe Way to Use Antibiotics Results of Misusing Antibiotics PRESCRIBED MEDICATION Understanding Prescribed Medication Labels OVER-THE-COUNTER MEDICINE Understanding OTC Medication Label Selecting OTC Medications for Children Over 6 MEDICATION MANAGEMENT How to Give Medicine Medication Logs HOME REMEDIES Common Home Remedies Used in the Community Disclosing the Use of Home Remedies to Medical Providers

71. Implementing HEAL in Research Melissa Stockwell MD MPH, Elaine Larson RN PhD, Dodi Meyer, MD, Marina Catallozzi MD, Anu Subramony MD MBA Appropriate Care of Upper Respiratory Infections (ACURI) Collaborative and Multidisciplinary Pilot Research Study (CaMPR, 2009) funded by CUMC CTSA Goal: determine impact of 3 health literacy modules with regard to treatment of the common cold in a Latino Head start population Appropriate Care of Upper Respiratory Infections (ACURI) funded by NIH/ NIMHD : Randomized control study to evaluate a health literacy intervention among Latino Early Head Start/Head Start parents. Goals: Increase health literacy levels regarding upper respiratory infections (URI) , decrease pediatric emergency department visits for viral URI, determine the cost effectiveness of this intervention

72. Implementing HEAL in research Anu Subramony MD MBA, Melissa Stockwell MD MPH, Elaine Larson RN PhD, Dodi Meyer, MD Decreasing Medication Administration Errors: A Health Literacy Intervention Collaborative and Multidisciplinary Pilot Research Study (CaMPR, 2010) funded by CUMC CTSA Goals: decrease medication errors in our community by developing an web based educational module to be implemented at discharge form our emergency room Build a multidisciplinary team with expertise in health literacy, multimedia technology, medication safety, clinical trials, and health disparities research in order to decrease medication errors in the local community, develop a web-based educational module to teach caregivers how to administer medications correctly, plan an evaluation and assessment of the feasibility of using a web-based module in the pediatric emergency department (PED) setting Build a multidisciplinary team with expertise in health literacy, multimedia technology, medication safety, clinical trials, and health disparities research in order to decrease medication errors in the local community, develop a web-based educational module to teach caregivers how to administer medications correctly, plan an evaluation and assessment of the feasibility of using a web-based module in the pediatric emergency department (PED) setting

73. ACURI:Collaborative and Multidisciplinary Pilot Research Study (CaMPR), funded by The Irving Institute for Clinical and Translational Research of Columbia: pilot study completed in 2009. Goal: determine impact of 3 health literacy modules with regard to treatment of the common cold in a Latino Head start population B. Appropriate Care of Upper Respiratory Infections (ACURI): randomized control study to evaluate a health literacy intervention in among Latino Early Head Start parents. Goals: 1) Increase health literacy levels regarding upper respiratory infections (URI) 2) Decrease pediatric emergency department visits for viral URI, 3) determine the cost effectiveness of this intervention ACURI:Collaborative and Multidisciplinary Pilot Research Study (CaMPR), funded by The Irving Institute for Clinical and Translational Research of Columbia: pilot study completed in 2009. Goal: determine impact of 3 health literacy modules with regard to treatment of the common cold in a Latino Head start population B. Appropriate Care of Upper Respiratory Infections (ACURI): randomized control study to evaluate a health literacy intervention in among Latino Early Head Start parents. Goals: 1) Increase health literacy levels regarding upper respiratory infections (URI) 2) Decrease pediatric emergency department visits for viral URI, 3) determine the cost effectiveness of this intervention

75. Conclusions Patients and clients are receptive to the curriculum Physicians and FSW recognize need for training in this area Developing and Implementing a Culturally-Responsive Health Literacy Program in a Pediatric Immigrant Community (unpublished data)

76. This report illustrates a process for health literacy curriculum development and implementation that is applicable to any community regardless of demographic served, health topic addressed, language used or health belief embraced This report illustrates a process for health literacy curriculum development and implementation that is applicable to any community regardless of demographic served, health topic addressed, language used or health belief embraced

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