Health Literacy: From Individual to Institution

1. Health Literacy:From Individual to Institution Fatima Ashraf Office of the Mayor

2. Literacy

3. LANGUAGE 50% of NYC adults speak a language other than English at home 25% of NYC adults do not speak English The Context LITERACY • 60% of NYC adults read at an 8th grade level or below • Remember: reading skills trail last year of school by 2 to 5 years … high school diplomas linked to 9th grade skills

4. Key Things to Remember • There is a culture of literacy … • If you can’t read well, words are not helpful • Even people who can read well, don’t “read” … they skim

5. Writing Sample #1 Nepo lla eerht sdil eno yb eno dna yllausiv kcehc lla gniriw dna gnibut. Kcehc fi gnihton si nekorb, dehctarcs, tneb, ro esiwrehto degamad.

6. Writing Sample # 2 Those referred for ernstropikgle should report to the ernstropikgle evaluation center on the lower level in the left corridor on the right side. Ernstropikgle candidates should be advised that preparation requirements exist that if not consistently adhered to prior to the ernstropikgle may under certain circumstances lead to suboptimal findings.

7. Writing Sample # 3 Take two pills once a day.

8. Health Education vs. Health Literacy

9. Health Literacy: Definitions • Health literacy is the ability of an individual to read, understand and act upon health related information. • Health literacy also refers to the capacity of professionals and institutions to communicate effectively so that community members can make informed decisions and take appropriate actions to protect and promote their health.

10. Consequences of low health literacy on the individual: • Worse overall health status • Presentation for treatment at later stages • Higher rates of hospitalization • Higher rates of ER utilization • Less knowledge of health and disease • Difficulty understanding and using health information

11. Institute of Medicine recognizes importance of the institutions • “The problems associated with limited health literacy and interventions to ameliorate them do not start and end with patients.” • “Efforts to enhance health literacy skills among individual families must be matched by interventions on the part of the health care sector to improve communications and systems.” (IOM, 2004)

12. Responsibilities of the institution: • Reducing racial and ethnic disparities in care • Improving patient safety and reducing medical errors • Improving health outcomes for people with chronic medical conditions • Improving health literacy knowledge and skills among health care providers

13. Clear & Effective Communication

14. Guidelines forClear and Effective Communication • Clarity of purpose • Plain language • Good document design Test your documents with intended users!

15. What is Clarity of Purpose? • Does the title and opening sentences explain what the purpose • of the document is? • Who is it intended for? • What is the reader supposed to do? • Does the document contain everything the reader needs to accomplish the intended purpose? • Is the document focused? • Does it contain more than 3 or 4 main points? • Does it include information that is not essential? • Does it put the most important points up front?

17. What is Plain Language? • Techniques that make documents easy to read: • Smaller, simpler, more familiar words • Less jargon and legalese with important words defined • Shorter sentences, shorter paragraphs • Active voice, conversational tone, personal touch (I, you, we) • Vocabulary and concepts are concrete and explicit rather than abstract and implied • Lower reading level Mayor’s Office of Adult EducationMayor’s Office of Correspondence

18. Smaller, Simpler Words with Less Jargon • Notwithstanding the fact that: ___________ • At this point in time: __________________ • Until such time as: ___________________ • In the event of: ______________________ • Adversely impact: ____________________ Mayor’s Office of Adult EducationMayor’s Office of Correspondence

19. Smaller, Simpler Words with Less Jargon • Adjacent to: _________________________ • Heretofore: _________________________ • Previously: __________________________ • Notice of Violation: ___________________ • Statutory Penalty: ____________________ Mayor’s Office of Adult EducationMayor’s Office of Correspondence

20. HHC Open Letter to Immigrant New Yorkers Our policy is clear. Any patient information obtained by an HHC employee may not be disclosed to any third party. Our employees know that they may lose their jobs if they violate this policy. Treating all patient information as confidential is critical to the trust we want to build with all our patients. This trust helps us to provide quality health services to you and your family.

21. HHC Open Letter to Immigrant New Yorkers with Plain Language Our policy is clear. No HHC employee can give your patient information to ANYONE else. All of our employees know that if they break this promise they can lose their job. We understand that this is the only way that we can keep your trust. We know that we need your trust to give you and your family quality health services. Mayor’s Office of Adult EducationMayor’s Office of Correspondence

22. What is Good Document Design? • Techniques that make documents easy to read: • Not too dense-looking; good balance of white space • Can be easily skimmed • Information visually chunked into small sections • Headings tell the reader the main points and where information is located • Numbered lists, bullet points, arrows • Pictures or graphics support main points • Font size of 12 or larger with limited use of bold for emphasis and avoid all caps • Left justified with jagged right margin

24. Institutional partnerships:Health Care and Adult Education • System of classes with access to 70,000 potential patients. • Health care providers can get insight into: • How adults learn • How to be effective communicators • How to assess patient’s literacy level • How to break down complicated tasks • Be patient (student) centered

25. For more information www.nyc.gov/healthliteracy Fatima Ashraf fashraf@cityhall.nyc.gov 212-788-3152