Literacy and Health: The Patient's Point of View

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Literacy and Health The Patient's Point of View

• Paul D. Smith, MD, Associate Professor
• UW Department of Family Medicine
• Paul.Smith_at_fammed.wisc.edu

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Welcome

• Health Care Organizations
• Community-Based Literacy Organizations
• Technical Colleges
• Public Health

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Thanks

• Sponsors
• Michele Erikson
• Georgia Weier
• Many others

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Topics today

• Research about literacy and health
• Focus group results
• What can we do?

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Literacy skills
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What is Literacy?

• National Assessment of Adult Literacy (NAAL 2003)
• Using printed and written information to
  function in society, to achieve one's goals, and
  to develop one's knowledge and potential.

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More than just reading grade level

• Prose Literacy
• Written text like instructions or newspaper
  article
• Document literacy
• Short forms or graphically displayed information
  found in everyday life
• Quantitative Literacy
• Arithmetic using numbers imbedded in print

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Reading Levels

• 20 of American adults read at or below the 5th
  grade level.
• Most health care materials are written above the
  10th grade level.

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2004 Comprehensive Reports

• Agency for Healthcare Research and Quality (AHRQ)
• Literacy and Health Outcomes
• The Institute of Medicine
• The IOM report Health Literacy
• A Prescription to End Confusion

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What is Health Literacy?

• The Institute of Medicine 2004
• The degree to which individuals have the
  capacity to obtain, process, and understand basic
  information and services needed to make
  appropriate decisions regarding their health.

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What is Health Literacy?

• The Institute of Medicine 2004
• The degree to which individuals have the
  capacity to obtain, process, and understand basic
  information and services needed to make
  appropriate decisions regarding their health.

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What is Health Literacy?

• The Institute of Medicine 2004
• The degree to which individuals have the
  capacity to obtain, process, and understand basic
  information and services needed to make
  appropriate decisions regarding their health.

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In Their Own Words

• Insert video clip here

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The Impact of Low Literacy on Health

• Poorer health knowledge
• Poorer health status
• Higher mortality
• More hospitalizations
• Higher health care costs

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Poorer Health Knowledge

• Understanding prescription labels
• 5 prescription bottles
• 395 patients
• 19 low literacy (6th grade or less)
• 29 marginal literacy (7-8th grade)
• 52 adequate literacy (9th grade and over)

Literacy and Misunderstanding Prescription
Labels. Davis et al. Ann Intern Med
2006145887-894
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Poorer Health Knowledge

• At least one incorrect
• 63 low literacy
• 51 marginal literacy
• 38 adequate literacy

Literacy and Misunderstanding Prescription
Labels. Davis et al. Ann Intern Med
2006145887-894
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Poorer Health Knowledge

• Take two tablets twice daily
• Stated correctly Demonstrated
  correctly
• 71 low literacy 35
• 84 marginal literacy 63
• 89 adequate literacy 80

Show me how many pills you would take in one
day. Counted out 4 tablets-correct
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Poorer Health Status

• 2923 new Medicare enrollees
• Inadequate literacy had increased frequency of
• Diabetes
• Hypertension
• Heart failure
• Arthritis

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Poorer Health Status

• Medical Outcomes Study (SF-36)
• Inadequate literacy had
• Decreased
• Physical function
• Mental health
• Increased
• Limitations in activity due to physical health
• Pain that interferes with normal work activities

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Poorer Health Status
Diabetics with retinopathy
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Increased Mortality

• Five Year Prospective Study
• 2512 people age 70-79
• Reading level 8th grade or less

Sudore R, et al. Limited Literacy and Mortality
in the Elderly. J Gen Intern Med 2006 21806-812.
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Increased Mortality

• Risk of Death Hazard ratio 1.75

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More Hospitalizations
2 year hospitalization rate for patients visiting
ED
31
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Increased Health Care Costs
Based on 1992 National Adult Literacy Survey
data Majority from increased hospitalizations
1998 - 73 Billion
Other private,
3.2
Other public,
7.6
Medicare, 28.3
Medicaid, 10.3
Patients, 11.5
Employers,
12.1
Friedland R. New Estimates of the high cost of
inadequate health literacy. In Pfizer Inc.
Proceedings Report from Promoting Health
Literacy A Call to Action. New York City,
October 7-8, 19986-10.
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Low Literacy is Overlooked

• Patients do not volunteer their literacy problem
• Many are ashamed
• Some do not recognize their inadequate literacy
• Lack of trust

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The Big Secret

• of low literate adults that have not told their

Children 52
Friends 62
Spouse 68
Health care providers 75
Co-workers 85
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Non-Compliance has a New Cause

• Medications
• Testing
• Consultations

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In Their Own Words

• Six focus groups
• Racine
• Madison
• Osh Kosh

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In Their Own Words

• Adult basic education (ABE)
• English language learners (ELL)
• English as a second language (ESL)

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Main Themes

• Translators
• Understanding
• Emotional cost

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Translators

• Generally OK at hospitals.
• Only Spanish, if at all, at doctors offices.
• Should be available for all languages.

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Translators

• Pride in not needing a translator.
• Females reluctant to discuss personal problems
  with male translator.
• Confidentiality not mentioned.

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Understanding

• Length
• Short questions
• Short answers
• Short words

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Understanding

• Speed
• Speaking too fast
• Takes time to formulate answers

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Understanding

• Easier written materials
• Shorter sentences 10-15 words
• Shorter words
• Explain big words
• Consents

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Emotional Cost

• Shame common with ABE
• Significant anxiety
• Asking for help
• Uncertainty about understanding

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Focus Group Summary

• No single solution to address all issues.
• ABE and ELL have some similar and some different
  issues.
• There is a significant emotional impact.

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How do we fix this problem?

• Education

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How do we fix this problem?

• Universal Design
• If it works for people with low literacy or
• low English skills, it will work for everyone.

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Where do we start?

• Be a catalyst for change

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Where do we start?

• Raise Awareness
• Your organization
• Leadership
• Staff
• Statewide organizations
• Legislators

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Where do we start?

• Regional breakout groups
• Regional follow up meetings
• Steering Committee volunteers needed
• Sponsors needed

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Where do we start?

• Local collaborative projects
• Walking Interview
• Test written materials
• Funding

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Where do we start?

• Health Literacy Curriculum
• Redesign and share documents
• Medical consent forms

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Where do we start?

• Universal Design
• Health Literacy Definition
• The degree to which individuals have the capacity
  to obtain, process, and understand basic
  information and services needed to make
  appropriate decisions regarding their health.

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Summary

• Low literacy affects health
• Most of our documents are written
• at a reading level that is too high.

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Summary

• Raising awareness is the first step
• Whats next is up to YOU.

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• Action expresses priorities.
• ---Mohandas Gandhi
  

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