Health Literacy and Plain language: Skills for Clear Health Communication

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Health Literacy and Plain languageSkills for
Clear Health Communication
Sue Stableford, MPH, MSB, Director Health
Literacy Institute University of New
England Portland, Maine With support
from UNE-Maine Geriatric Education Center HRSA
Grant D31HPO8845-03
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Clear communication with diverse public
audiences Key to person-centered care and
community-centered public health
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93 million American adults lack literacy skills
to understand and use health information.
Aging of the population and ? diversity will
continue this trend
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(No Transcript)
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The demands and complexity of our health system
overwhelm younger adults as well.
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Plain language/Clear communication Not a total
solution but critical to success
Also often ignored, overlooked,or put on the
back burner
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Linking up the words and themesMaking the case
for clear communication

• The national call to action
• What do patients understand? Literacy and
  health literacy research
• The communication gap between patients
  providers Impact on safety
• Bridging the gap Plain language and
  Teach-back
• The challenge and the opportunity

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The Institute Of Medicine2004 report
Call to Action
We envisage a society in which people have the
skills that they need to obtain, interpret, and
use health information effectively,
and within which a wide variety of health systems
and institutions take responsibility for
providing clear communication and adequate
support to facilitate health-promoting
actions.p241
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AMA ReportFall 2007
As self-care demands on patients increase, so
does the importance of clear communication
between the health care community and
patients. (p11)
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Patient-centered communication is the linchpin
of patient-centered care. (p 31)
Joint Commission reportFebruary 2007
65 of sentinel events have been found to have
communications failures as the underlying root
cause. (p 48)
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Adults often dont understand and
professionals dont know it.
What do patients understand?

• Barriers
• Shame
• Cultural differences
• Illness/meds
• Time/stress
• Limited literacy
• Others?

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For most adults, health and healthcare are
foreign countries.
The language, geography (anatomy), and systems
are unfamiliar.
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Most adults do not know about their own bodies
and how they work.

• Most have not had
• biology
• anatomy
• physiology

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Most adults dont know healthcare terms.

• Medical terms such as EKG, dialysis,kidney
  function, risk factor
• Cancer terms such as screening, polyp, lesion,
  mammogram, colon, digital rectal examination
• ? Consent form terms such as placebo, randomly,
  efficacy, Institutional Review Board (IRB)

Castro C et al. Am J Health Behav 2007.
31S85-S95 Davis T et al. Cancer Invest 2001.
19193-200
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Most do not know how to navigate the healthcare
system.
They have trouble choosing a health plan, asking
for a 2nd opinion, asking questions about tests
procedures.
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For adults in America, managing health and
healthcare demands significant literacy skills
Literacy The ability to read, write, compute,
understand, and use information
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2003 National Assessment of Adult Literacy
Prose Literacy Skills of American Adults
14 Below Basic 29 Basic 44 Intermediate 13 Pro-ficient
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Adult numeracy skills are even more limited.
Quantitative Literacy Skills of American Adults
28million
71million
47million
71million
22 Below Basic 33 Basic 33 Intermediate 13 Pro-ficient
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Our most vulnerable populations typically have
the most limited literacy skills.

• Elders (age 65)
• Hispanic/Latino populations
• Immigrant groups
• The poor
• Adults with chronic physicalor mental conditions

Avg reading level Grade 5/6
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Limited literacy has many causes. For all
adults, skills decline with lack of use.
Average education level Grade 12 Average reading
level Grade 7/8
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Health literacy using literacy and numeracy
skills to accomplish health-related tasks.

• Health literacy challenges
• Media
• Formats
• Locations
• Topics
• Tasks

Health literacy includes oral skills.
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How might it feel to adults with limited
literacy skills to read medical information?
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 night before the noitanimaxe to clean
out your noloc.
adapted from Weiss, B. Health Literacy, A
Manual for Clinicians.AMA Foundation, 2003, p 19
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2003 NAAL health literacy results12 of adults
have Proficient skills.
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Example Consumer Misunderstanding of Rx Labels
27 of adults with adequateliteracy skills
(reading at grade 9or above) misunderstood
dosage instructions for commonmedications. Tak
e one tablet by mouth twice daily for 7 days.
Wolf et al. Patient Educ Counseling2007.
67293-300
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Despite limited adult literacy skills, most
health information ?10th grade level.
The Communication Gap Between Patients and
Professionals
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500 research studies document high reading
levels in print and on the web.
Consent forms often at college level
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The gap between adult skills and system demands ?
serious risks for patients

• Patients with limited literacy skills have
• Inability to read and use medication
  instructions, appointment slips, consent
  forms
• ? Knowledge and poorer compliance with
  medication and self-care regimens for
  hypertension, diabetes, asthma, HIV/Aids,
  anti-coagulation therapy, weight control
• ? Knowledge and likelihood of getting a
  mammogram or pap smear
• ? Glycemic control and ? rates of retinopathy
  for those with diabetes
• ? Hospitalizations, costs, and deaths

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The gap between adult skills and system demands ?
serious risks to providers

• Increased Provider/System Risk
• Missed appointments
• Cancelled procedures
• Callbacks/Time to repeat instructions
• Medical mistakes
• Malpractice claims
• Unhappy customers

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So, what can we do to ? risk and ? patient and
provider safety satisfaction?

• Joint Commission Recommendations
• Make effective communications an organization
  priority
• Address patients communication needs across the
  continuum of care
• Pursue policy changes that promote improved
  practitioner-patient communications

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Address patients communication needs across the
continuum of care

• 2 Evidence-Based Strategies
• Plain language for all written and verbal
  communication
• Teach back to assure understanding of
  patient teaching

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Plain language writing integrates multiple
elements to increase reading ease.

• ContentLimited, culturally sensitive
• Organization/structureReader-focused
• Writing Clear, using simple terms and proven
  techniques
• DesignLayout and graphics support key messages

From Living With COPDAmerican College of
Physicians
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Plain language works across media and for verbal
communication.
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Attacks on plain language are usually based on
myths and misunderstanding.
The Challenge
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Myth Well dumb everything down.
Fact Our tone determines how we sound.
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Myth Plain language will insult adults.
Fact Most adults want quick, clear help.
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Myth Plain language creates legal risk.
Fact Plain language protects organizations.
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Myth This is mostly a feel good issue.
Fact This is a high priority business issue.
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Myth Plain language is just common sense.
Fact Plain language takes skill and practice.
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May 2010
Quite simply, the responsibility is ours as
health professionals to communicate in plain
languageImproving health literacyis critical
to achieving the objectives set forth in
Healthy People 2020 and, more broadly, key to
the success of our national health
agenda. from the Foreword by Howard Koh, MD,
MPH, Assistant Secretary for Health
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New Joint Commission requirements link patient
safety and effective communication
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We have tools to assess needs and find free
resources.
ahrq.gov/qual/literacy
Hsph.harvard.edu/healthliteracy/curricula.html
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Summing Up the ChallengeDemographic, health
technology, and health delivery trends ? clear
communication need
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The Opportunity

• Align health communications with core national
  health issues
• Reduce health disparities/provide culturally
  sensitive care
• Prevent and manage chronic conditions
• Prepare for and manage disasters
• Improve the safety and quality of care
• Prevent hospital readmissions
• Save time and money
• Enhance consumer/provider andcommunity
  relationships

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Last WordsThe Nations Physician Speaks17th
Surgeon General Richard Carmona,MD
Health literacy can save lives, save money, and
improve the health and well-being of millions of
Americans. All of usgovernment, academia, health
care professionals, corporations, communities,
and consumersworking together can bridge the
gap between what health professionals know and
what patients understand, and thereby improve
the health of all Americans.
www.ahrq.gov/news/press/pr2004/litpr.htm