Health Literacy & Health Literate Care September 12, 2014 Presented by Jennifer Pearce, MPAHealth Literacy Program Manager Sutter Center for Integrated Care, Sutter Health
Presentation Objectives • Define health literacy and understand prevalence of low health literacy among adults • Understand relationship between health literacy and patient engagement • Identify interventions to reduce health system demand/complexity and increase patient skills/ability
Wall Street Journal December 5, 2006 PATIENT SKILLS: College educated Health care experience Prepared for medical appointments Had support system SYSTEM BARRIERS: Multiple providers (12) Had Medicaid, then uninsured Miscommunication led to lack of follow-up care Didn‘t understand options • Nikki didn’t die from lupus, Nikki died of complications of the failing health care system. • Dr. Amylyn Crawford PBS Frontline, Sick Around America
How Is “Health Literacy” Different From “Literacy”? Source: Weiss B. Epidemiology of Low Health Literacy. Understanding Health Literacy: Implications for Medicine and Public Health
Health Literacy Includes One’s Ability To Perform Multiple Tasks Source: IOM. 2004. Health Literacy: A Prescription to End Confusion Source: Schwartzberg, J. 2005. Understanding Health Literacy: Implications for Medicine and Public Health
Health system demand/complexity Mismatch Leads to Harm Source: Parker, R. and Ratzan, S. 2010. “Health Literacy: A Second Decade of Distinction for Americans', Journal of Health Communication” 15: S2, 20 — 33 Health literacy Patientskills/ability
Patient Skills: Prevalence Of Low Health Literacy Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy
Adult health literacy by highest level of education Only 1/3 of those with a graduate degree have the skills to effectively manage a chronic illness Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy
NAAL (2003) Adult health literacy by age Only 3% of those age 65+ have the skills to effectively manage a chronic illness Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy
Program for the International Assessment of Adult Competencies (PIAAC) 2012“Using digital technology, communication tools, and networks to acquire and evaluate information, communicate with others, and perform practical tasks.”
Health literate tools + training promote shared decision making Patient competencies Provider competencies Improved satisfaction, better outcomes Source: E. Bernabeo and E. Holmboe (2013). Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care. Health Affairs 32, No. 2: 250-258
Is our health care workforce prepared to engage patients? • 5 of 35 recent grads said they received no training on health literacy during medical school. • Dr. Cliff Colemanet al, 2013 Journal of Health Communication Consensus Study - “curricula needed to produce a health care workforce which is not only aware of the issues around low health literacy, but is also preparedto address them.” Echoed by 2010 National Action Plan to Improve Health Literacy – workforce objectives. Journal of Health Communication, 18:82-102,2013.
Examples of Health Literacy Competencies Knowledge • Knows that educational attainment is an inadequatemarkerfor health literacy skills. • Knows that the average US adult reads at an 8th-9th grade level. • Knows that patients learn best when a limitednumber of new concepts are presented at any given time. Journal of Health Communication, 18:82-102,2013.
Examples of Health Literacy Competencies Skills • Demonstates ability to recognize, avoid and/or constructively correct the use of medical jargon. • Demonstrates ability to recognize plain language principles in written materials. • Demonstrates effective use of teach back technique for assessing patient understanding. Journal of Health Communication, 18:82-102,2013.
Examples of Health Literacy Competencies Attitudes • Expresses the attitude that effective communication is essential to the delivery of safe, high quality health care. • Expresses the attitude that it is a responsibility of the health care sector to address the mismatch between patients’ and health care providers’ communication skills. Journal of Health Communication, 18:82-102,2013.
How do you do it? Health Literate Care Delivery
Single Item Health Literacy Screener “How confident are you at filling out medical forms by yourself?” • Extremely • Quite a bit • Somewhat (cut point) • A little bit • Not at all Source: Stagliano V, Wallace LS. Brief health literacy screening items predict newest vital sign scores. J Am Board Fam Med 2013;26(5):558-565.
Distinct health literacy tasksPotential navigation pitfalls 15 Source: DeWalt, D. A., and J. McNeill. 2013. Integrating health literacy with health care performance measurement. Discussion Paper, Institute of Medicine, Washington, DC. http://www.iom.edu/linktoyourpaper.
Best Practice – Universal Precaution Approach to Health Literacy Source: Smith, Sandra A. (2001). Patient Education and Literacy in Labus, A. & Lauber, A. (Eds.) Preventive Medicine and Patient Education. Philadelphia: WB Saunders, 266-290.
Evidence: Easy-to-read is Preferred! College educated readers’ response to health information written at 5th grade level: Recall of key messages Satisfaction Source: Smith SA. Information giving: Effects on birth outcomes and patient satisfaction. Int Electronic J Health Educ 1998:;3:135-145.
Where will you hitch your health literacy wagon? Health Literate Care Promotes IOM Aims
Health Literate Care Resources http://www.health.gov/communication/interactiveHLCM/#resources When a health care organization adopts the Health Literate Care Model, health literacy becomes an organizational value infused into all aspects of planning and operations. Health Aff February 2013 vol. 32 no. 2 357-367
Jennifer Pearce, MPAHealth Literacy Program Manager Sutter Center for Integrated Care Sutter Health Contact: firstname.lastname@example.org www.suttercenterforintegratedcare.org