Improving Health Literacy

1

• Improving Health Literacy
• Tools for Taking Action!
• Sandra Williams Hilfiker, M.A.
• Public Health Advisor, ODPHP, HHS
• Joanne Locke, M.A.S.
• Plain Language Advisor, ODPHP, HHS

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Objectives

• At the end of this workshop, you will be able
• to
• Demonstrate a basic understanding of key health
  literacy and plain language concepts.
• Identify specific ways to integrate health
  literacy into your work.

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Agenda

• Defining health literacy
• Strategies for improving health literacy
• Improve usability of health information Plain
  Language
• Developing community partnerships
• Closing and evaluation

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What is health literacy? What does it mean to
you?

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What is health literacy?

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

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What Factors Affect Health Literacy?

• Communication skills of the public and health
  professionals
• Knowledge of health-related topics
• Culture
• Demands of the healthcare and public health
  systems
• Demands of the situation/context

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Health Literacy Affects Peoples Ability To

• Navigate the public health system, including
  locating information and services and filling out
  forms
• Share personal and health information with
  professionals
• Engage in self-care and chronic disease
  management
• Understand medical concepts like probability and
  risk

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The Realities of Limited Health Literacy

• IOM Health Literacy Video

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Healthy People 2010 health literacy objectives

• 11-2. Improve the health literacy of persons
  with inadequate or marginal literacy skills.
• 11-6. Increase the proportion of persons who
  report that their healthcare providers have
  satisfactory communication skills.

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Percentage of Adults in Each Literacy Level 2003
Source National Center for Education Statistics,
Institute for Education Sciences
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Difficulty of Selected Health Literacy Tasks
0

• Circle the date of a medical appointment on a
  hospital appointment slip.
• Give 2 reasons a person should be tested for a
  specific disease, based on information in a
  clearly written pamphlet.
• Determine what time a person can take a
  prescription medication, based on information on
  the drug label that relates the timing of
  medication to eating.
• Calculate an employees share of health
  insurance costs for a year, using a table.

• Below Basic
• Basic
• Intermediate
• Proficient

average
500
Source National Center for Education Statistics,
Institute for Education Sciences
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Percentage of Adults in the Below Basic NAAL
Health Literacy Population
1The Did not obtain health information over the
Internet category does not include prison
inmates because they do not have access to the
Internet. 2Disabilities include vision, hearing,
learning disability, and other health
problems. SOURCE U.S. Department of Education,
Institute of Education Sciences, National Center
for Education Statistics, 2003 National
Assessment of Adult Literacy (NAAL).
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Health Literacy and Health Outcomes

• Persons with limited health literacy skills have
• Higher utilization of treatment services
• Hospitalization
• Emergency services
• Lower utilization of preventive services
• Higher utilization of treatment services results
  in higher healthcare costs.

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Health Literacy Use of Preventive Services

• Persons with limited health literacy skills are
  more likely to skip preventive measures such as
• Mammograms
• Pap smears
• Flu shots

As defined by these studies
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Strategies for Improving Health Literacy

• Improving the usability of health information
• Improving the usability of health services
• Advocating for health literacy improvement

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The HHS Quick Guide to Health Literacy

• Available online
• www.health.gov/communication/literacy

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Improve the Usability of Health Information

• Know the intended users of the health information
  and services.
• Evaluate users understanding before, during, and
  after the intervention.
• Acknowledge and respect cultural differences.
• Use plain language.

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• One should aim not at being possible to
  understand, but at being impossible to
  misunderstand.
• Quintilian
• But in science the credit goes to the man who
  convinces the world, not to the man to whom the
  idea first occurs.
• Sir Francis Darwin

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Using Plain Language

• Key elements of plain language include
• Using simple language and defining technical or
  medical terms
• Using an active voice
• Breaking complex information into understandable
  chunks
• Organizing information so the most important
  points come first
• Overall document design

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Fun with Plain Language!
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Before The Dietary Guidelines for American
recommends a half hour or more of moderate
physical activity on most days, preferably every
day. The activity can include brisk walking,
calisthenics, home care, gardening, moderate
sports exercise, and dancing. After Do at
least 30 minutes of exercise, like brisk walking,
most days of the week.
Source plainlanguage.gov
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Before This is a multipurpose passenger vehicle
which will handle and maneuver differently from
an ordinary passenger car, in driving conditions
which may occur on streets and highways and off
road. As with other vehicles of this type if you
make sharp turns or abrupt maneuvers, the vehicle
may roll over or may go out of control and crash.
You should read driving guidelines and
instructions in the Owners Manual, and WEAR YOUR
SEAT BELTS AT ALL TIMES. After
Source plainlanguage.gov
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Before If the location of the land is in a
state other than the state in which the tribes
reservation is located, the tribes justification
of anticipated benefits from the acquisition will
be subject to greater scrutiny. After If the
land is in a different State than the tribe's
reservation, we will scrutinize the tribe's
justification of anticipated benefits more
thoroughly.
Source plainlanguage.gov
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BeforeWhen the process of freeing a vehicle
that has been stuck results in ruts or holes, the
operator will fill the rut or hole created by
such activity before removing the vehicle from
the immediate area. AfterIf you make a hole
while freeing a stuck vehicle, you must fill the
hole before you drive away.
Source plainlanguage.gov
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Before
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After
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Document Design

• Pay attention to text appearance, layout and
  design.
• Leave plenty of white space
• Do not justify the right margin
• Use at least 12 point font
• Use underline and boldface instead of
  all-capital letter or italics
• Place key information in a text box
• Limit the line length to 40-50 characters
• Use visuals that communicate your message

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Readability

• Readability formulas do not measure how well
  people understand your material.
• Grade level scores for the same text differ
  greatly depending on the formula you use.
• Editing text to reduce the number of syllables
  may not make it easier to read.
• The important thing is that the words are
  familiar, not necessarily shorter.

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Improve Usability of Information on the Internet

• Design Strategies for Low Literacy Users
• Enhance text with video or audio files
• Include interactive features and personalized
  content
• Use uniform navigation
• Organize information to minimize searching and
  scrolling
• Improve search

Source www.usability.gov
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Sources of Health Information
Percentage of adults with Below Basic or Basic
health literacy who get little or no health
information from the following sources
Source National Center for Education Statistics,
Institute for Education Sciences
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Facilitating Healthy Decision-Making through the
Web

• Users want just the basics about a topic.
• Use everyday language and examples.
• Give users positive reasons to change their
  behavior.
• Avoid blanket recommendations be specific.
• Tell users how to do the behavior. Break it down
  into small steps.
• Dont dwell on barriers. Provide tools and
  encouragement.

Source healthfinder.gov prototype studies
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Cut the Clutter Basics, Benefits, Action
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Evaluating Print and Web-based Materials

• Formative evaluation focus groups
• Do the users understand the materials?
• Do the materials reflect the cultural and
  linguistic preferences of the intended users?
• Revise
• Outcome evaluation how will you know if you are
  successful?
• Readability tests (SMOG, Fry) can let you know if
  you are on the right track (aim for a readability
  level of 5th grade), but they cannot predict how
  well your materials will be understood by the
  users.

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2 Ideas

• Jot down 2 ideas from the discussion on improving
  the usability of health information that may work
  at your agency/program.

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Small Group Brainstorm

• Ways to Increase Community Partnerships
• to reach your audience
• How do you currently disseminate your health
  information?
• Who do you currently partner with?
• How can you increase your non-traditional
  partners in the community?

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Conclusions

• Benefits of applying health literacy principles
  to your work

• Enables and empowers people to make informed
  decisions about their health
• Improves health communication ? knowledge and
  beliefs ? behavior change
• Allows health educators to reach a broader
  audience
• Important step toward eliminating health
  disparities

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Thank you!!! Sandy Hilfiker SandraW.Hilfiker_at_hhs
.gov Joanne Locke Joanne.locke_at_hhs.gov