Literacy and health the patient s point of view
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Literacy and Health: The Patient's Point of View. Paul D. Smith, MD, Associate Professor UW Department of Family Medicine [email protected] Welcome. Health Care Organizations Community-Based Literacy Organizations Technical Colleges Public Health. Thanks. Sponsors

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Literacy and health the patient s point of view

Literacy and Health:The Patient's Point of View

Paul D. Smith, MD, Associate Professor

UW Department of Family Medicine

[email protected]


Welcome

Welcome

  • Health Care Organizations

  • Community-Based Literacy Organizations

  • Technical Colleges

  • Public Health


Thanks

Thanks

  • Sponsors

  • Michele Erikson

  • Georgia Weier

  • Many others


Topics today

Topics today

  • Research about literacy and health

  • Focus group results

  • What can we do?


Literacy and health the patient s point of view

Literacy skills


What is literacy

What is Literacy?

National Assessment of Adult Literacy (NAAL 2003)

“Using printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential.”


More than just reading grade level

More than just reading grade level

  • Prose Literacy

    • Written text like instructions or newspaper article

  • Document literacy

    • Short forms or graphically displayed information found in everyday life

  • Quantitative Literacy

    • Arithmetic using numbers imbedded in print


Reading levels

Reading Levels

  • 20% of American adults read at or below the 5th grade level.

  • Most health care materials are written above the 10th grade level.


2004 comprehensive reports

2004 Comprehensive Reports

  • Agency for Healthcare Research and Quality (AHRQ)

    • Literacy and Health Outcomes

  • The Institute of Medicine

    • The IOM report Health Literacy:

      A Prescription to End Confusion


What is health literacy

What is Health Literacy?

The Institute of Medicine 2004

“The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”


What is health literacy1

What is Health Literacy?

The Institute of Medicine 2004

“The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”


What is health literacy2

What is Health Literacy?

The Institute of Medicine 2004

“The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”


In their own words

In Their Own Words

  • Insert video clip here


The impact of low literacy on health

The Impact of Low Literacy on Health

  • Poorer health knowledge

  • Poorer health status

  • Higher mortality

  • More hospitalizations

  • Higher health care costs


Poorer health knowledge

Poorer Health Knowledge

  • Understanding prescription labels

    • 5 prescription bottles

    • 395 patients

      • 19% low literacy (6th grade or less)

      • 29% marginal literacy (7-8th grade)

      • 52% adequate literacy (9th grade and over)

Literacy and Misunderstanding Prescription Labels. Davis et al. Ann Intern Med 2006;145:887-894


Poorer health knowledge1

Poorer Health Knowledge

  • At least one incorrect

    • 63% low literacy

    • 51% marginal literacy

    • 38% adequate literacy

Literacy and Misunderstanding Prescription Labels. Davis et al. Ann Intern Med 2006;145:887-894


Poorer health knowledge2

Poorer Health Knowledge

“Take two tablets twice daily”

Stated correctly Demonstrated correctly

71% low literacy 35%

84% marginal literacy 63%

89% adequate literacy 80%

“Show me how many pills you would take in one day.” Counted out 4 tablets-correct


Poorer health status

Poorer Health Status

  • 2923 new Medicare enrollees

  • Inadequate literacy had increased frequency of:

    • Diabetes

    • Hypertension

    • Heart failure

    • Arthritis


Poorer health status1

Poorer Health Status

  • Medical Outcomes Study (SF-36)

  • Inadequate literacy had

    • Decreased:

      • Physical function

      • Mental health

    • Increased

      • Limitations in activity due to physical health

      • Pain that interferes with normal work activities


Poorer health status2

Poorer Health Status

Diabetics with retinopathy

36%

19%


Increased mortality

Increased Mortality

  • Five Year Prospective Study

  • 2512 people age 70-79

  • Reading level 8th grade or less

Sudore R, et al. Limited Literacy and Mortality in the Elderly. J Gen Intern Med 2006; 21:806-812.


Increased mortality1

Increased Mortality

Risk of Death Hazard ratio: 1.75


More hospitalizations

More Hospitalizations

2 year hospitalization rate for patients visiting ED

31%

14%


Increased health care costs

Increased Health Care Costs

Based on 1992 National Adult Literacy Survey data

Majority from increased hospitalizations

1998 - $73 Billion

Other private,

3.2

Other public,

7.6

Medicare, 28.3

Medicaid, 10.3

Patients, 11.5

Employers,

12.1

Friedland R. New Estimates of the high cost of inadequate health literacy. In Pfizer Inc. Proceedings Report from Promoting Health Literacy: A Call to Action. New York City, October 7-8, 1998:6-10.


Low literacy is overlooked

Low Literacy is Overlooked

  • Patients do not volunteer their literacy problem

    • Many are ashamed

    • Some do not recognize their inadequate literacy

    • Lack of trust


The big secret

The Big Secret

  • % of low literate adults that have not told their:


Non compliance has a new cause

Non-Compliance has a New Cause

  • Medications

  • Testing

  • Consultations


In their own words1

In Their Own Words

  • Six focus groups

    • Racine

    • Madison

    • Osh Kosh


In their own words2

In Their Own Words

  • Adult basic education (ABE)

  • English language learners (ELL)

  • English as a second language (ESL)


Main themes

Main Themes

  • Translators

  • Understanding

  • Emotional cost


Translators

Translators

  • Generally OK at hospitals.

  • Only Spanish, if at all, at doctors’ offices.

  • Should be available for all languages.


Translators1

Translators

  • Pride in not needing a translator.

  • Females reluctant to discuss personal problems with male translator.

  • Confidentiality not mentioned.


Understanding

Understanding

  • Length

    • Short questions

    • Short answers

    • Short words


Understanding1

Understanding

  • Speed

    • Speaking too fast

    • Takes time to formulate answers


Understanding2

Understanding

  • Easier written materials

    • Shorter sentences 10-15 words

    • Shorter words

    • Explain big words

  • Consents


Emotional cost

Emotional Cost

  • Shame common with ABE

  • Significant anxiety

    • Asking for help

    • Uncertainty about understanding


Focus group summary

Focus Group Summary

  • No single solution to address all issues.

  • ABE and ELL have some similar and some different issues.

  • There is a significant emotional impact.


How do we fix this problem

How do we fix this problem?

Education


How do we fix this problem1

How do we fix this problem?

Universal Design

If it works for people with low literacy or

low English skills, it will work for everyone.


Where do we start

Where do we start?

Be a catalyst for change


Where do we start1

Where do we start?

Raise Awareness

  • Your organization

    • Leadership

    • Staff

  • Statewide organizations

  • Legislators


Where do we start2

Where do we start?

  • Regional breakout groups

  • Regional follow up meetings

    • Steering Committee volunteers needed

    • Sponsors needed


Where do we start3

Where do we start?

  • Local collaborative projects

    • Walking Interview

    • Test written materials

  • Funding


Where do we start4

Where do we start?

  • Health Literacy Curriculum

  • Redesign and share documents

    • Medical consent forms


Where do we start5

Where do we start?

  • Universal Design

  • Health Literacy Definition

    • The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed tomake appropriate decisions regarding their health.


Summary

Summary

Low literacy affects health

Most of our documents are written

at a reading level that is too high.


Summary1

Summary

Raising awareness is the first step

What’s next is up to YOU.


Literacy and health the patient s point of view

“Action expresses priorities.”

---Mohandas Gandhi


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