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Health Literacy. Asilomar 2009 September 13 – 16, 2009 Mary Annese, M.P.A. Adapted in part from: Advancing Clear Health Communication to Positively Impact Health Outcomes ( . Learning Goals. Define health literacy

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Health literacy
Health Literacy

Asilomar 2009

September 13 – 16, 2009

Mary Annese, M.P.A.

Adapted in part from: Advancing Clear HealthCommunicationto Positively Impact Health Outcomes (

Learning goals
Learning Goals

  • Define health literacy

  • Discuss impact of low literacy on health outcomes

  • Identify health literacy needs in own setting

  • Develop a plan to address health literacy needs in own setting

Presentation sections
Presentation Sections

  • Definition of Health Literacy

  • Low Health Literacy

  • Finding a Solution

  • Clear Communication and Clinical Practice

What critical public health issue
What Critical Public Health Issue

  • Impacts 1:3 people living in the U.S.?

  • Does not discriminate?

  • Costs $58 billion a year?

  • Can’t be diagnosed or observed?

The answer
The Answer!

Low Health Literacy


Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Preamble to the Constitution of the World Health Organization (1948)


Literacy is the ability to read, speak, write, and use math skills that enable one to successfully function at certain levels of society.

Functional illiteracy
Functional Illiteracy

Functional illiteracy is the inability of an individual to use reading, speaking, writing, and math skills to effectively perform fundamental tasks in everyday life situations - even in his own cultural and linguistic environment.

Effects of functional illiteracy
Effects of Functional Illiteracy

  • People who are functionally illiterate are subjected to:

    • Social intimidation

      • Health risks

        • Stress

          • Low income

This big
This Big!

  • 40 – 44 million adults are functionally illiterate

  • 50 million adults are marginally illiterate

  • Average reading skills of adults are between 8th and 9th grade levels

The problem low health literacy

The Problem:Low Health Literacy

Scope and Impact

What is health literacy
What is Health Literacy?

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

Nac stneitap dnatsrednu
Nac Stneitap Dnatsrednu?

Can patients understand the materials and information needed for their health?

90 Million U.S. Adults Have Problems

High risk for low health literacy
High Risk for Low Health Literacy

  • Elderly

  • Racial/ethnic minority populations

  • Arriving in the United States after Age 12

  • Unemployed and Underemployed

  • Less than a high school education

Largest study to date found
Largest Study to Date Found:

33% Were unable to read basic health care materials

42% Could not comprehend directions for taking medication on an empty stomach

26% Were unable to understand information on an appointment slip

43% Did not understand the rights and responsibilities section of a Medicaid application

60% Did not understand a standard informed consent

Health literacy 1316539

Low Health Literacy Results In:

  • Less compliance

  • Lowered adherence

  • Increased medication errors

  • More and longer hospitalizations

  • Less preventive care

  • Inability to negotiate the healthcare system

Effects of low health literacy
Effects of Low Health Literacy

  • Poor health outcomes

  • Underutilization of prevention services

  • Overutilization of emergency services

  • Unnecessary healthcare expenditures

  • Limited treatment effectiveness

  • Needless patient suffering

Health literacy 1316539

The Practical Solution:

Clear Health Communication

Literacy and provider communication
Literacy and Provider Communication

Health providers sometimes or never listen carefully, explain things, show respect, or spend enough time if:

  • You are

    • Asian

    • American Indian

    • Hispanic (regardless of race)

  • Have a family income less than 400% FPL

  • Have a chronic disease

2005 National Healthcare Disparities Report, Agency for Healthcare Research and Quality

For patients
For Patients

  • Health information can be confusing at times

  • Everyone wants help with health information

  • Asking questions helps patients understand how to prevent or manage illness

Patients Should Not Be Anxious About Asking Their Health Care Provider Questions!

For providers
For Providers

Health Care Providers Want Patients to Know:

  • All they can about their condition/medication

  • Why this advice/treatment is important for good health

  • Steps to take to prevent a condition or keep it under control



Ask me 3 creates shared responsibility for clear health communication

Ask Me 3 – Creates Shared Responsibility for Clear Health Communication



De-stigmatize andReduce Embarrassmentof Low Health Literacy

RecognizePatient Coping Mechanisms

What is ask me 3

Promotes three simple, but essential, questions and answers for every healthcare interaction:

What Is My Main Problem?

  • Why Is It Important for Me to Do This?

What Do I Need to Do?




What Is Ask Me 3

Clear health communication we can all be a part of the solution

Even if you are not in a position to directly answer the three questions, keep clear health communicationin mind and in your dialogue when communicating with patients

Many people have trouble understanding medical terms. Often, these terms are better understood when explained with common words, an example or visual interpretation

Clear Health Communication– We Can All Be a Part of the Solution

What can providers do

Six steps to improving patient understanding

Limit the amount of information provided at each visit

Slow down

Avoid medical jargon

Use pictures or models to explain important concepts

Assure understanding with the “show-me” technique

Encourage patients to ask questions

What Can Providers Do?

What else can providers do
What Else Can Providers Do?

People Have Difficulty Making Appointments

Appointment InstructionsAlso see: Urgent Care (if you are too sick to wait for an appointment)Making a medical appointment for the first time, it is straightforward: You call 555-2222 and make a appointment at XYZ Health Services just like you would at any doctor's office.

You can request a specific clinician if you have someone in mind, or you can explain your need or problem to the appointment counselor, and he or she will schedule you with an appropriate clinician at the earliest possible date. At your first appointment you will receive a medical record card -- often referred to as your "gold card" -- which you will keep and use as your XYZ Health Services identification. 

If you are unsure about whether you should make an appointment, you may call the Advice Nurse at 666-7777. Also, in advance of your first appointment, be sure to read "How to Make the Most of Your XYZ Visit."

Please call 643-7177 to make an appointment in the Specialty Clinics, including Allergy & Travel. Specialty appointments require a referral.

You may also drop by the Appointment Office to make a medical appointment. The Appointment Office is located on the first floor in Room 1111. You may also make an appointment in the Specialty Clinics by going to the Specialty Clinic reception desk, located behind the elevators on the first floor.

If you need to cancel an appointment, please call our 24-hour cancellation line at 643-7033. Please note that you will be billed for a broken appointment fee if you do not show up for your appointment and have not called to cancel it.

  • When making an appointment, provide people with simple options and clear facts

Your Name

Your Appointment Date



Our Telephone Number:

Do not eat or drink for 6 hours before the day and time on this card.

What else can providers do1
What Else Can Providers Do?

People Have Trouble Understanding Phone Recordings

  • Phone answered by a tape recording. Speaking quickly, the caller is offered numerous options and alternatives

  • Speak slowly and clearly

  • Provide an easy way to connect with a live person

  • Provide options in other languages

What else can you do

Ambulatory Entrance

Ambulatory Entrance

Hospital XYZ

What Else Can You Do?

People Have Trouble Reading Signs

  • Some people become confused about whether this entry was intended for ambulances or for patients

  • The use of visuals clarify the message

  • Contrast in color makes it easy to read

  • Try to be consistent when hanging signs

What can providers do1
What Can Providers Do?

People Have Trouble Understanding Maps

Maps are usually hard to follow:

  • Too complicated

  • Codes are hard to understand

  • Names and directions not always match

  • Small fonts

To make maps easier to follow:

  • Match the color in the map with the paint color on walls or floors

  • Match the names in the map to the names on the signs

  • Use 14 point font size or larger

How can enhanced communication with patients benefit provider practice

Patients who understand health care information may:

Be more compliant with instructions and medications

Call back less often

Visit less often

Have fewer hospitalizations

Have better health outcomes

Have increased patient satisfaction

How Can Enhanced Communication With Patients Benefit Provider Practice?

Greater Provider Satisfaction


National Assessment of Adult Literacy

Agency for Healthcare Research and Quality

American Medical Association Health Literacy Program

HP2010 – Health Communication Objective

(Goal 11.0, Objectives 11.1 – 11.6)


Resources continued
Resources (continued)

U.S. DHHS/Office of Disease Prevention and Health Promotion: Health Literacy Improvement

AMA/Health Literacy Resources

Health Literacy Kit $35.00

AMA Bookstore On-line

Join the Partnership for Clear Health Communication. Sign up as a member at Adopt the Action Agenda within your own work