May 23, 2007 11:00 – 12:30 Central Time (9am PST/ 10am MST/ 12pm EST) Putting Health Literacy into Practice: A Pediatric Approach Benard Dreyer, MD, FAAP Mary Ann Abrams, MD, MPH, FAAP Connie Arnold, PhD Norma Kenoyer
Web Conference Objectives • Gain awareness of health literacy, its impact, and relationship to quality care • Understand the patient and family perspective • Develop skills and techniques to address low health literacy • Learn principles for selecting or developing plain language print materials • Identify resources within the AAP for addressing low health literacy
General Literacy: Definition “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 1991
National Assessment of Adult Literacy (NAAL)* n = 19,714 ● Most up to date portrait of literacy in U.S. ● Scored on 4 levels ● Lowest 2 levels cannot: ◦ Use a bus schedule or bar graph ◦ Explain the difference in two types of employee benefits ◦ Write a simple letter explaining an error on a bill * National Center for Educational Statistics, U.S. Department of Education
13% Proficient 14% Below Basic 44% Intermediate Basic 29% 2003 National Assessment of Adult Literacy 93 Million Adults have Basic or Below Basic Literacy
Health Literacy: A Definition • Obtain, process, understand basic health information and services • Make appropriate health care decisions (act on information) • Access /navigate healthcare system
IOM Report on Health Literacy • 90 million adults have trouble understanding and acting on health information • Complex text must be simplified and attention paid to culture and language • Providers need health literacy training Healthy People 2010 • Improve health communication/health literacy
IOM, 2004: Health Literacy… • “is fundamental to quality care…” • Relatesto 3 of the 6 aims in IOM Quality Chasm Report: • Safety • Patient-centered care • Equitable treatment
Limited Health Literacy: The Problem A “mismatch” between patients’ capacities and the demands placed on them by: • The nature of their illness • Self-management expectations • Heath providers • Health systems
12% Proficient 14% 53% Intermediate Below Basic Basic 22% 2003 Health Literacy Assessment n=19,000 U.S. Adults National Assessment of Adult Literacy (NAAL): National Center for Educational Statistics, U.S. Department of Education, 2003.
Health Literacy of America’s Adults • Below Basic: Circle date on doctor’s appointment slip • Basic: Give 2 reasons a person with no symptoms should get tested for cancer based on a clearly written pamphlet • Intermediate: Determine what time to take Rx medicine based on label, use immunization schedule, interpret a growth chart • Proficient: Calculate employee share of health insurance costs using table *67% probability individual can perform task
Low Parental Literacy and Pediatric Asthma DeWalt et al. Ambulatory Pediatrics 2007;7:25–31
100 90 80 66 70 60 Percent 50 37 30 20 10 0 Literate Low Literate Pregnant Women: Concern about Effect of Smoking on Baby 40 Arnold, Davis, et al. Preventive Medicine 2001;32(4):313-20
100 90 80 70 54 60 50 Percent 40 23 30 20 10 0 Literate Low Literate Mothers Breastfeed for at least 2 Months Kaufman et al. Southern Medical Journal 2001;94(3):293-6.
Mothers Access a Medical Home for Newborn Infant Percent Sanders et al. E-PAS (Pediatric Academic Societies) 2006; 59:4138.1
Quality & Safety-related Consequences of Low Health Literacy • Excess use of emergency department • Excess hospitalizations • Longer lengths of stay • Decreased adherence • Poorer health outcomes • Increased medication errors
"When I'm confused or worried about my child, I'm not able to read things that I can normally read every day." Amy Tilman
A Demonstration Exercise • The following paragraph of instructions simulates what a reader with low literacy sees on the printed page • Read the paragraph out loud. • You have 15 seconds to read. • Hint: The words are written backwards and the first word is “cleaning”
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.
Test your Comprehension… You are not alone if… • You did not get past the first line. • You were not able to understand the instructions on how to clean the equipment. How many of your patients are struggling just to ‘de-code’ words?
Cleaning – to assure high performance, periodically clean the tape heads and capstan whenever you notice an accumulation of dust and brown-red oxide particles. Use a cotton swab moistened with isopropyl alcohol. Be sure no alcohol touches the rubber parts as it tends to dry and eventually crack the rubber. Use a damp cloth or sponge to clean the cabinet. A mild soap like dishwasher detergent will help remove grease or oil.