You talk to your patients but do they understand? Health literacy & your practice

1. You talk to your patients but do they understand? Health literacy & your practice Canadian Respiratory Conference Niagara Falls, ON Presenter: Dr. Linda Shohet The Centre for Literacy April 30, 2011

2. I have no conflict of interest to declare. CRC April 30, 2011, L. Shohet

3. Learning Objectives At the end of the session, you will be able to: ♦ Identify the key elements of health literacy and its distribution in Canada ♦ Assess the strengths and weaknesses in your own practice or work setting related to patients’ health literacy CRC April 30, 2011, L. Shohet

4. Learning Objectives ♦ Explain how you might apply a specific tool or strategy to improve patient understanding CRC April 30, 2011, L. Shohet

5. Let’s take a test Sally, a 66-year-old aboriginal woman with asthma, has been your patient/client for a few months since she was first diagnosed. She has missed several appointments without calling, nods her head quietly when you explain her condition, and has difficulty following instructions to monitor and control her condition. Which of the following might help explain her behaviour? a) She is overwhelmed by the diagnosis. b) She cannot read well. c) She is suffering from early-stage dementia. d) She is intimidated by health care professionals. e) She is not smart. CRC April 30, 2011, L. Shohet

6. Let’s take a test You are not sure why Sally is not managing her care and follow-up, but want to get to the root of the problem before she ends up in a local ER. You therefore: a) Ask Sally what helps her learn best when she needs to master a new skill b) Ask her to take a literacy test. c) Ask her to explain in her own words what she understands about her condition and how to manage it. d) Repeat the explanation and instructions e) Refer her to a local literacy program. CRC April 30, 2011, L. Shohet

7. Let’s take a test Sally tells you that the Asthma binder and instructions you gave her are difficult for her because there is too much information and some of it is very hard to understand. Calling your office is also hard because the message is long and gives more options than she can remember. Using her feedback, you: a) Tell her the material she has received is all that is available in your region b) Look for plain language materials and visual media on asthma that might be easier to understand c) Do a health literacy audit of your office/workspace d)Tell Sally to have someone else call for her. e)Tell Sally that you will give her information in smaller chunks. CRC April 30, 2011, L. Shohet

8. Overview ♦ Literacy and health literacy ♦ The Canadian context ♦ Your own practice and work setting Who are your patients/clients? Design of the work setting ♦ Selected tools and strategies CRC April 30, 2011, L. Shohet

9. Literacy: Change over time FROM ● An absolute condition of literate/illiterate TO ● A continuum of skills/abilities Literacy problem: Any gap between demand of the context and skill of the individual http://mdcme.ca/lms/courses/literacy/literacy/literacy_either_or.asp?page=10 CRC April 30, 2011, L. Shohet

10. International Adult Literacy Surveys IALS 1994 & IALSS 2003 ♦ 2003 data released in May 2005 Compares literacy rates in participating industrialized countries ♦ 5 levels of literacy in 4 domains ♦ 2003 survey measured health literacy http://mdcme.ca/lms/courses/literacy/literacy/literacy_either_or.asp?page=10 CRC April 30, 2011, L. Shohet

11. Health literacy map Distribution of health literacy across Canada: Canadian Council on Learning 2007 http://mdcme.ca/lms/courses/literacy/health/patients_clients.asp?page=19 http://www.ccl-cca.ca/CCL/Reports/HealthLiteracy/?Language=EN CRC April 30, 2011, L. Shohet

12. Health literacy: A new concept Health literacy is the use of a wide range of skills that allows the public and personnel working in all health-related contexts to find, understand, evaluate, communicate, and use health information. http://mdcme.ca/lms/courses/literacy/health/patients_clients.asp?page=16 CRC April 30, 2011, L. Shohet

13. What do we know? ♦ More than half of all Canadians have some difficulty reading/understanding print ♦ The percentage of Quebecers with difficulty is higher ♦ The percentage of population who have difficulty with health information is 60%+ ♦ Difficulties are identifiable in specific population segments CRC April 30, 2011, L. Shohet

14. What do we know? ♦ 90% + of health information is via print ♦ Health literacy is about more than literacy. It is also about other media “literacies”: visual, audio, television, social media…. ♦ Health care providers and systems carry responsibility to be “health-literate” See Calgary Charter CRC April 30, 2011, L. Shohet

15. Areas of health literacy ♦ Fundamental: includes language and numbers ♦ Scientific/technological: includes some understanding of physical and natural sciences, technology, and scientific uncertainty ♦ Civic/community: includes media literacy, knowledge of local, provincial and federal government processes ♦ Cultural: includes recognition of community beliefs, customs, view of the world, and social identity Zarcadoolas, Pleasant & Greer CRC April 30, 2011, L. Shohet

16. ♦ Do I know the communication barriers of my patients/clients? ♦ Do I adapt my talk and the materials I give out to the information and communication needs of my patients/clients? ♦ Could I do more? ♦ Where do I start? Teach-back” technique.  CRC April 30, 2011, L. Shohet

17. Teach-back” technique or “Show me” ♦ Ask patients/clients to explain in their own words or demonstrate what they have been told and what they need to do after they leave you. ♦ Do not make it feel like a test. ♦ Take responsibility. Use it to check how well you explained a concept or a practice. Example: “Can you show me how you’re going to do this when you get home? I want to make sure I did a good job explaining this to you.” Dean Schillinger, MD CRC April 30, 2011, L. Shohet

18. ♦ Plain language and verbal communication ♦ Clear written and web design ♦ Visuals ♦ Modeling “universal precaution” Use for everyone Literacy tests – research only Readability tests CRC April 30, 2011, L. Shohet

19. It’s not always the big words Is & May CRC April 30, 2011, L. Shohet

20. Other tools ♦ Intake forms ♦ Learning preferences CRC April 30, 2011, L. Shohet

21. Health literacy assessments Some Workplace barriers ♦ Office signs written in small or unreadable fonts. ♦ Unclear check-in location or procedure. ♦ Automated phone system that does not include an option to talk to a person or does not allow repetition of menu items. ♦ Lack of privacy in reception area when giving confidential information. ♦ Forms that are hard to read - print is too small, layout is unclear, choice of computerized answers is difficult, too little space for open-ended answers. AHRQ http://mdcme.ca/lms/courses/literacy/whatelse/diminishing_office.asp?page=32 CRC April 30, 2011, L. Shohet

22. Resources ♦ Selected print resources ♦ Selected web resources ♦ Selected articles on respiratory ailments and health literacy ( frm PubMed) CRC April 30, 2011, L. Shohet