Health Literacy: A Crisis In Health Care

1. Health Literacy:A Crisis In Health Care Developed by Stratis Health with the Permission of the American Medical Association Foundation and the American Medical Association

2. Definitions General Literacy: “ An individual’s ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.” National Literacy Act of 1991Health Literacy: “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to makeappropriate health decisions.” Healthy People 2010

3. Self-Assessment

4. Implications of low health literacy on patient care 33% Were unable to read basic health care materials 42% Could not comprehend directions for taking medication on an empty stomach 26% We unable to understand information on an appointment slip 43% Do not understand the rights and responsibilities section of Medicaid application 60% Did not understand a standard informed consent Williams et.al., JAMA 12/6/95

5. Cost of poor health literacy: Estimate >$50 billion annually* We all pay! • 39% paid by Medicare (FICA taxes on workers) • 17% paid by employers • 16% paid by patients, out-of-pocket • 14% paid by Medicaid • 14% from other public and private sources *Estimated by National Academy on an Aging Society using 1998 figures

6. National Adult Literacy Survey (NALS) • Conducted in 1992 • N=26,000 • Most accurate portrait of literacy in the US • Scored on 5 levels • Not accounted for: • Patients who have adequate language skills, but do not have adequate health literacy

7. Results: National Adult Literacy Survey (NALS) Level (Kirsh I, Jungeblut A, 1993)

8. Why are patients at risk? • Reliance on the written word for patient instruction • Increasingly complex healthcare system • More medications • More tests and procedures • Growing self-care requirements • Esoteric language • An aging population • A more culturally diverse patient population

9. Understanding the problem What is it like? • The following passage simulates what a reader with low general literacy sees on the printed page • Read the entire passage out loud • You have 1 minute to read (Hint: The words are written backwards and the first word is “cleaning”)

10. GNINAELC – Ot erussa hgih ecnamrofrep, yllacidoirep naelc eht epat sdaeh dna natspac revenehw uoy eciton na noitalumucca fo tsud dna nworb-der edixo selcitrap. Esu a nottoc baws denetsiom htiw lyporposi lohocla. Eb erus on lohocla sehcuot eht rebbur strap, sa ti sdnet ot yrd dna yllautneve kcarc eht rebbur. Esu a pmad tholc ro egnops ot naelc eht tenibac. A dlim paos, ekil gnihsawhsid tnegreted, lliw pleh evomer esaerg ro lio.

11. What was it like? • How did you feel while reading this passage? • How did you feel when you finished reading the passage? • How do you clean the capstan? • How do you think patients with low health literacy feel?

12. Understanding the problem • View: As Patients See It • Video made by the AMA in 2003 • Real patients and real physicians talking about literacy issues • Task: Note • Barriers to access • Barriers to diagnosis • Barriers to treatment/care

13. Video: The Patient’s Voice Discussion: • What ideas hit home with you? • Did any of the situations seem familiar? • Did anything surprise you?

14. What do we know? • Low Health Literacy (LHL) is prevalent • LHL leads to: • Lower health knowledge and less healthy behaviors • Greater health costs • Poorer health outcomes • Techniques and approaches may be used to address health literacy

15. Strategy: Create a shame-free environment • Recognize red flags • “I forgot my glasses…” • Incomplete forms • Seeking help only when illness is advanced • Convey an attitude of helpfulness, caring and respect (by all staff) • What is it like being a patient in your setting? • Are there forms or instructions that could be confusing?

16. Strategy: improve interpersonal communication • Slow down • Use plain or “living room” language • Focus on key messages (www.askme3.org) • What is my main problem? • What do I need to do? • Why is it important for me to do this? • Use “teach back” techniques

17. Strategy: Develop patient-friendly materials and forms • Keep content concise and focused: • Focus only on key points • Emphasize what the patient should do • Minimize anatomy and physiology to the basics • Tips for easy-to-read materials: • Simple words (1-2 syllables) • Short sentences (4-6 words) • Short paragraphs (2-3 sentences) • Limit medical jargon • Headings, bullets and lots of white space

18. Self-Assessment answers

19. What can you do right away? • Do a ‘walk through’ at your facility and identify barriers • Review registration forms and consider if they could be simplified • Develop a plan to educate all staff about low health literacy

20. What can you do in the future? • Form a team to determine a long-term strategy • Discuss methods for improving communication skills with providers and staff • Incorporate “Ask Me 3” components into patient information

21. “Understanding is a two-way street.” Eleanor Roosevelt

22. For More Information Other resources • www.amafoundation.org • www.askme3.org

23. Brought to you by Stratis Health Minnesota’s Medicare Quality Improvement Organization Stratis Health is a non-profit independent quality improvement organization that collaborates with providers and consumers to improve health care. This presentation was created by Stratis Health under a contract with the Centers for Medicare & Medicaid Services (CMS). The contents do not necessarily reflect CMS policy.