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Promoting Health Literacy through Easy-to-Read Materials. Cheryl Rowan, MSLS Public Health Coordinator National Network of Libraries of Medicine, South Central Region. Agenda. Introduction The Problem of Health Literacy Internet Resources Writing/Examining Easy-to-Read Materials

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Promoting health literacy through easy to read materials l.jpg

Promoting Health LiteracythroughEasy-to-Read Materials

Cheryl Rowan, MSLS

Public Health Coordinator

National Network of Libraries of Medicine,

South Central Region


Agenda l.jpg
Agenda

  • Introduction

  • The Problem of Health Literacy

  • Internet Resources

  • Writing/Examining Easy-to-Read Materials

  • Assessment Exercise

  • Testing for Readability


Slide3 l.jpg

Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

Your physician has recommended that you have a colonoscopy. Colonoscopy is a test for colon cancer. It involves inserting a flexible viewing scope into your rectum. You must drink a special liquid the night before the examination to clean out your colon.

Weiss, Barry: Health Literacy and Patient Safety: Help Patients Understand; AMA Foundation


The literacy problem l.jpg
The Literacy Problem Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.


National assessment of adult literacy naal l.jpg
National Assessment of Adult Literacy Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc. (NAAL)

  • Conducted in 2003

  • More than 19,000 adults

  • One-on-one administration

  • GOAL: assess literacy in English

  • http://nces.ed.gov/NAAL


Results of naal literacy statistics l.jpg
Results of NAAL: Literacy Statistics Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

  • Functionally illiterate = 23% of adults

  • Marginal literacy skills = 28% of adults

  • Proficient = Only 13% of adults

  • 66% of adults over age 60 have inadequate or marginal literacy skills

  • Average reading level in the U.S. is 8th grade; 20% read at 5th grade level or below


Numbers by literacy level l.jpg
Numbers by Literacy Level Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

Millionsof adults


Three types of literacy l.jpg
Three Types of Literacy Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

  • Prose

  • Document

  • Quantitative


Prose literacy l.jpg
Prose Literacy Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

  • Requires ability to search, comprehend, and use continuous text


Slide10 l.jpg

Prose Literacy - NALS Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.


Document literacy l.jpg
Document Literacy Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

  • Non-continuous text

  • Requires ability to search, comprehend, and

    use information


Slide12 l.jpg

Document Literacy - NALS Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.


Quantitative literacy l.jpg
Quantitative Literacy Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

  • Requires ability to identify and perform computations, using numbers within printed materials.


Readability studies l.jpg
Readability Studies Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

  • Numerous studies document mismatch between patient reading skills and the readability level of health materials.

    ReadabilityPatient Skills

    (mean grade level)

    • Wilson (2003) 11th6th

    • Davis (1994) 10th7th

    • Jackson (1991) 12th5th

    • Meade (1989) 10th6th


Determinants of health l.jpg
Determinants of Health Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

  • Age

  • Income

  • Literacy Skills

  • Employment Status

  • Education Level

  • Race or Ethnic Group


Factors affecting learning ability l.jpg
Factors Affecting Learning Ability Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc.

  • Stress

  • Illness

  • Age

  • Cultural Barriers

  • Language Barriers


Slide18 l.jpg

http://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.htmlhttp://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html


What is health literacy l.jpg
What is Health Literacy?http://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html

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

*Ratzan, S., and R. Parker. (2000); Healthy People 2010 and Healthy People 2020


Functional health literacy l.jpg
Functionalhttp://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.htmlHealth Literacy

“The ability to read and comprehend prescription bottles, appointment slips, and the other essential health related materials required to successfully function as a patient”*

*AMA Council of Scientific Affairs


Health literacy levels l.jpg
Health Literacy Levelshttp://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html

Millionsof adults


Task appointment slip l.jpg
Task: Appointment Sliphttp://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html

  • Locate information in a simple document.

  • When is your next appointment? Where?

CLINIC APPOINTMENT

CLINIC: Diabetic

DAY: Thursday DATE: April 2nd HOUR: 6:45

YOU MUST BRING YOUR PLASTIC CARD WITH YOU


Task prescription label l.jpg
Task: Prescription Labelhttp://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html

  • Applying information in a document

  • If you were going to eat lunch at noon, what time should you take your medicine?

Bouvier, Patricia

FF9418262 Dr. Hibbert, Julius

DOXYCYCLINE 100 MG

Take medication on empty stomach one hour before or two to three hours after a meal unless otherwise directed by your doctor.


Medication safety and health literacy l.jpg

What’s “plenty” of water?http://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html

“Medicine will make you feel dizzy”

“Don’t take medicine if you’ve been in the sun too long.”

Medication Safety and Health Literacy


Costs of low health literacy l.jpg
“Costs” of Low Health Literacy http://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html


Why is health literacy important l.jpg
Why is Health Literacy Important?http://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html

  • To fill out a patient information form

  • To understand health-related instructions

  • To follow discharge instructions

  • To identify signs

  • To keep appointments

  • To understand insurance

  • To sign consent forms


Slide27 l.jpg

Is this safe for someone on a low salt diet?http://www.acpfoundation.org/materials-and-guides/video/videos-for-patients/health-literacy-video.html

Chili with Beans

Nutrition Facts

Serving Size: 1 cup (253 g)

Serving per container: 2

Amount per Serving:

Calories 260

Caloriesfrom Fat 72

% Daily Value

Total Fat 8g

13%

17%

Saturated Fat 3g

Cholesterol 130 mg

44%

Sodium 1010 mg

42%

Carbohydrates 22g

7%

7%

Dietary Fiber 9g

Dietary Fiber 9g

36%

36%

Sugars 4g

Note: We rarely say, “Pass the sodium, please.”


Slide28 l.jpg

After being diagnosed with recurrent aphthous stomatitis involving the epithelium of the buccal mucosa, Winston did what he thought was necessary:

[which is a funny thing to do for a canker sore]



And furthermore l.jpg
And, furthermore… loss when naked.

  • Up to 80% of patients forget what a doctor told them as soon as they leave the office!

  • Nearly 50% of what they do remember is remembered incorrectly!


Improving oral communication l.jpg
Improving Oral Communication loss when naked.

  • Communication is two-way

  • Use “teach back” instructions

  • Avoid medical jargon

  • Use commonly understood words

  • Limit information

  • Videos


Internet resources l.jpg
Internet Resources loss when naked.


Medlineplus l.jpg
MedlinePlus loss when naked.

http://medlineplus.gov

  • Easy-to-Read materials

  • Medical Dictionary

    • Understanding Medical Words tutorial

  • Interactive tutorials

  • How to write easy-to-read materials: http://www.nlm.nih.gov/medlineplus/etr.html


Nihseniorhealth l.jpg
NIHSeniorHealth loss when naked.

http://nihseniorhealth.gov/

  • Developed with the National Institute on Aging

  • Senior-friendly features:

    • Text Size

    • Contrast

    • Speech

    • Short segments of information


Healthy roads media l.jpg
Healthy Roads Media loss when naked.

http://www.healthyroadsmedia.org

  • Materials in 20+ languages

  • Various formats:

    • Written

    • Audio

    • Multimedia

    • Web video

    • iPod video


Nn lm scr l.jpg
NN/LM SCR loss when naked.

  • Consumer Health Manual

  • Websites

  • Research information

  • Bibliography

  • http://nnlm.gov/outreach/consumer/hlthlit.html


Plain english plain language l.jpg
Plain English/Plain Language loss when naked.

http://www.plainlanguage.gov

  • Promote the use of plain language for all government communications

  • Examples, word suggestions, thesaurus

  • Separate section for health literacy


Key players l.jpg
Key Players loss when naked.

  • Partnership for Clear Health Communication/AskMe3 Initiative

    http://www.npsf.org/askme3/

  • Centers for Disease Control and Prevention – Simply Put

    http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf

    U.S. Department of Health & Human Services, Office of Disease Prevention and Health Promotion

    http://www.health.gov/communication/literacy

  • “Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites” (U.S. Dept. HHS)

    http://www.health.gov/healthliteracyonline/index.htm


More key players l.jpg
More Key Players loss when naked.

  • Hablamos Juntos – “Universal Symbols in Health Care Workbook”

    http://www.rwjf.org/pr/product.jsp?id=15864

  • Clear Health Communications (Pfizer) http://www.pfizerhealthliteracy.com/

  • Health Literacy Consulting

    http://www.healthliteracy.com

  • North Carolina Program on Health Literacy

    New “Health Literacy Universal Precautions Toolkit”

    http://nchealthliteracy.org/

  • Agency for Healthcare Research and Quality (AHRQ)

    http://www.ahrq.gov/browse/hlitix.htm


Now you be the patient l.jpg
Now loss when naked.You Be the Patient

You just been you told have acute platypuscitis

What types of information would you like to receive from your healthcare provider?


Writing examining selecting easy to read materials l.jpg
Writing/Examining/Selecting loss when naked.Easy-to-Read Materials


Basic tips for message content l.jpg
Basic Tips for Message Content loss when naked.

  • Limit the number of messages

  • Tell readers what you want them to do

  • Tell readers what they’ll gain from reading your material

  • Choose your words carefully

  • Suitable for the audience


Cultural competency l.jpg
Cultural Competency loss when naked.

  • Tailor messages to intended audience

  • Avoid stereotypes

  • Relevant photos/artwork

  • Appropriate symbols

  • Realistic recommended behaviors

  • Back-translate and field test translated material

  • “…more than a patients’ rights issue…critical to safety and quality of care”*


Cultural competence l.jpg
Cultural Competence? loss when naked.

  • Pepsi’s “Come alive with the Pepsi generation” slogan

  • Chevy selling the Nova in South America

  • Gerber baby food sales in Africa


Example food pyramid l.jpg
Example: Food Pyramid loss when naked.

Standard Version

Culturally Modified Version


Text is important l.jpg
Text is Important loss when naked.

  • 12 point or larger font size

  • Avoid ALL CAPITAL LETTERS; they are hard to read

  • Use common fonts such as Arial or Tahoma; avoid script

    Eat fruits and vegetables

    Eat fruits and vegetables

  • Use boldface type and underlining to cue readers to important text


Present tense action verbs l.jpg
Present Tense & Action Verbs loss when naked.

  • Wrap the cut in a clean cloth.

  • Keep it dry.

Avoid:

Give consideration to

Make payment

Is concerned with

Use:

Consider

Pay

Concerns


Active voice l.jpg
Active Voice loss when naked.

  • Roll to the left

  • Put your feet on the floor

  • Sit up

  • Grab the railing

Avoid:

It shall be signed

You shall be notified

Use:

You must sign

We will notify you


General terms l.jpg
General Terms loss when naked.

Avoid

Use

  • Accordingly

  • Afford an opportunity

  • At a later date

  • Close proximity

  • In the event that

  • Incumbent upon

  • Utilize

  • So

  • Allow

  • Later

  • Near

  • If

  • Must

  • Use


Medical terms l.jpg
Medical Terms loss when naked.

Physician

Cardiac


Medical terms52 l.jpg
Medical Terms loss when naked.

Tablets

Nasal Congestion


Medical terms53 l.jpg
Medical Terms loss when naked.

Hazardous

Radiology


Logical sequence of instructions l.jpg
Logical Sequence of Instructions loss when naked.

  • Wash your hands with soap and water.

  • Place the fresh bandage on a clean towel.

  • Take off the old bandage gently.

  • Wash the burned area gently.

  • Apply a thin layer of antibiotic cream.

  • Cover with the clean bandage.


Use short words sentences l.jpg
Use Short Words & Sentences loss when naked.

  • Return in one week.

  • Bring your insurance card with you.

  • Please sign in.

  • Brush along the gum line.

  • Drink plenty of orange juice.


Rewriting l.jpg
Rewriting loss when naked.

Straight Leg Raise

Lying on your back, bend your opposite knee straight and slowly lift your other leg up approximately 12 in, hold for 3s, and lower slowly.


Sample exercise in rewriting l.jpg
Sample Exercise in Rewriting loss when naked.

Straight Leg Raise

  • Lie on your back

  • Bend left leg

  • Lift right leg 12 inches

  • Hold for 3 seconds

  • Lower slowly

Literacy and the Older Adult, from Topics in Geriatric Rehabilitation, Oct-Dec2005, Vol. 21 Issue 4, p275


Tips for overall appearance l.jpg
Tips for Overall Appearance loss when naked.

  • Make it look easy to read

  • Use lots of white space

    • Aim for “50/50 split”

    • Margins at least one inch wide

  • Use visuals for text (or with text)

    • Place images close to related text

    • Text and pictures must agree

    • Pictographs may be used to represent ideas or actions

  • Avoid “ghosting” visuals

  • Keep visual separation between topics


Easy to read l.jpg
Easy to Read? loss when naked.

What is diabetes? Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn’t good for your health.

How do you get high blood glucose? Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells.


Example visual separation l.jpg
Example: Visual Separation loss when naked.

What is diabetes?

Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn’t good for your health.

How do you get high blood glucose?

Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells.


Visuals should reflect the audience l.jpg
Visuals Should Reflect the Audience loss when naked.

  • Age of reader

  • Consider diversity

  • Use current styles

  • Get user input for color choices

  • Review by target audience


Identify with your audience l.jpg
Identify with Your Audience loss when naked.

Message: Exercise during pregnancy


Message stop smoking l.jpg
Message: Stop Smoking loss when naked.


What about websites l.jpg
What About Websites? loss when naked.

  • Audience

  • Content

  • Organization


Assessment exercise l.jpg
Assessment Exercise loss when naked.


Testing for readability l.jpg
Testing for Readability loss when naked.


Overview l.jpg
Overview loss when naked.

  • Method

    • Word count

    • Syllables

    • Sentence length

  • Readability of Materials

    • Fry

    • SMOG

  • Patient Literacy

    (REALM, TOFHLA, Newest Vital Sign)

  • Computer software


Fry readability test l.jpg
Fry Readability Test loss when naked.

  • Select 3 passages of 100 words each

  • Count the number of sentences

  • Count the number of syllables

  • Find the average number of sentences and syllables

  • Plot the numbers on the graph to determine grade level


Example fry readability test l.jpg
Example: Fry Readability Test loss when naked.

A cold and the flu (also called influenza) are alike in many ways. But the flu can sometimes lead to more serious problems, such as pneumonia. A stuffy nose, sore throat, and sneezing are usually signs of a cold. Tiredness, fever, headache, and major aches and pains probably mean you have the flu. Coughing can be a sign of either a cold or the flu. But a bad cough usually points to the flu.

Know when to call your doctor. You usually do not have to call your doctor right away if you have signs of a cold or flu.


Count sentences l.jpg
Count Sentences loss when naked.

A cold and the flu (also called influenza) are alike in many ways. But the flu can sometimes lead to more serious problems, such as pneumonia. A stuffy nose, sore throat, and sneezing are usually signs of a cold. Tiredness, fever, headache, and major aches and pains probably mean you have the flu. Coughing can be a sign of either a cold or the flu. But a bad cough usually points to the flu.

Know when to call your doctor. You usually do not have to call your doctor right away if you have signs of a cold or flu.

8 sentences


Count syllables l.jpg
Count Syllables loss when naked.

A cold and the flu (al-so called in-flu-en-za) are a-like in m-any ways. But the flu can some-times lead to more se-ri-ousprob-lems, such as pneu-mo-nia. A stuffy nose, sore throat, and sneez-ing are usu-al-ly signs of a cold…

135 syllables


Slide72 l.jpg

6 loss when naked.th grade


Slide73 l.jpg
SMOG loss when naked.

Simple Measure Of Gobbledygook

  • Count off 10 sentences near the beginning, middle and end of text.

  • Circle every word containing 3 or more syllables and total the number of words circled

  • Estimate the square root of the total number of words counted

  • Add three to the square root.

    http://www.harrymclaughlin.com/SMOG.htm


Realm l.jpg
REALM loss when naked.

Rapid Estimate of Adult Literacy in Medicine

  • Asks patients to pronounce 66 words ranging from “fat” to “impetigo”

  • Test provides grade level scores for people who read below a ninth grade level

  • May be better suited for research

  • Realm SF – Form


Tofhla l.jpg
TOFHLA loss when naked.

Test of Functional Health Literacy in Adults

  • Series of health-related reading tasks that measure numeracy and reading comprehension

  • Patients asked to read passages in which every 5th to 7th word has been deleted and to insert the correct word from a choice of four words


Example tofhla l.jpg
Example TOFHLA loss when naked.


The newest vital sign l.jpg
The Newest Vital Sign loss when naked.

  • Screening tool to identify patients with low health literacy

  • English and Spanish

  • From Pfizer Clear Health

    Communication Initiative

  • Based on nutrition label from ice cream

    container

http://community.sw.org/2010/03/decoding-the-nutrition-facts-label/


Computer testing l.jpg
Computer Testing loss when naked.

  • Microsoft Word feature

    • Tools

    • Grammar check

  • Flesch–Kincaid Readability Tests

    • Flesch Reading Ease

    • Flesch–Kincaid Grade Level


Testing things to remember l.jpg
Testing: Things to Remember loss when naked.

  • Don’t write to the formula

  • Formulas do not take into account other factors such as personal relevance

  • Some multisyllable terms are very familiar

    • Operation (4 syllables)

    • Diarrhea (4 syllables)

  • Formatting is not a part of testing


Testing exercise l.jpg
Testing Exercise loss when naked.


Fry readability exercise l.jpg
Fry Readability Exercise loss when naked.

  • Select 3 different passages

  • Count 100 words in each

  • Count the # of sentences in each

  • Count the # of syllables in each

  • Calculate the average # of sentences and syllables

  • Plot the numbers on the graph to determine grade level


In summary or why does it matter l.jpg
In Summary, or . . . loss when naked.Why Does it Matter?

  • “Literacy matters in healthcare because life-threatening or potentially harmful mistakes may happen when people cannot read or understand written information.” *

    *Osborne, Helen. (2005). Health Literacy from A to Z. http://www.healthliteracy.com


Slide83 l.jpg
And… loss when naked.

  • “As clinicians, what we say does not matter unless our patients are able to understand the information we give them well enough to use it to make good health-care decisions. Otherwise, we didn't reach them, and that is the same as if we didn't treat them.“**

    **Benjamin, R. M. (2010). “Surgeon General’s Perspective for Improving Health by Improving Health Literacy.” Public Health Reports.


Thank you l.jpg
Thank You! loss when naked.

Cheryl Rowan, MSLS

Public Health Coordinator

National Network of Libraries of Medicine, South Central Region

http://www.nnlm.gov/scr

cheryl.rowan@exch.library.tmc.edu

713-799-7880/800-338-7657


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