Health Literacy An Opportunity to Advance the Adult Literacy Agenda

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Health Literacy An Opportunity to Advance the
Adult Literacy Agenda

• Paul D. Smith, MD
• University of Wisconsin
• Department of Family Medicine
• Paul.Smith_at_fammed.wisc.edu

Michele Erikson Executive Director Wisconsin
Literacy, Inc. Michele_at_wisconsinliteracy.org
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Topics today

• General health literacy information
• Why it matters
• Health literacy projects
• How you can get started collaborating

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What is Literacy?

• Literacy is a combination of skills
• Verbal
• Listening
• Writing
• Reading

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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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Literacy VS Health Literacy

• Almost everyone will have difficulty with health
  literacy at some point.
• Much harder for those that do not
• Read very well.
• Speak English as their primary language.

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Two Sides to the Equation

• Its all about effective communication
• Verbal
• Written
• Multi-media
• It has to be presented in a way that is
  understandable to most people.

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In Their Own Words

• Insert video clip here

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2003 National Assessment of Adult Literacy

• Data released 12/05
• 17,000 people participated
• Over age 15
• Living in households and prisons

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2003 National Assessment of Adult Literacy

• 4 categories of literacy
• Below basic
• Basic
• Intermediate
• Proficient

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2003 National Assessment of Adult Literacy
34-55 of adults are at below basic and basic
literacy levels
55
43
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2003 National Assessment of Adult Literacy

• NAAL health literacy assessment
• 28 questions specifically related to health
• 3 clinical
• 14 prevention
• 11 system navigation

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NAAL Health Literacy Assessment

• Entire population
• Proficient 12
• Intermediate 53
• Basic 22
• Below basic 14

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NAAL Health Literacy Assessment

• Basic and Below Basic Health Literacy
• Entire population 36
• White 28
• Native Americans 48
• Blacks 58
• Hispanics 66

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NAAL Health Literacy Assessment

• Basic and Below Basic Health Literacy
• Age16-64 28-34
• Age 65 59

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NAAL Health Literacy Assessment

• Basic and Below Basic by education level
• In High School, GED or HS grad 34-37
• Less than/some High School 76

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NAAL Health Literacy Assessment

• Basic and Below Basic by Self-reported health
  status
• Excellent 25
• Very Good 28
• Good 43
• Fair 63
• Poor 69

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Determinants of Health

• Gender
• Age
• Race/ethnicity
• Co-morbidities

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Determinants of Health

• Employment status
• Income level
• Health insurance status
• Marital status

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Determinants of Health

• Education level
• High school diploma or equivalent
• But, almost 20 of high school grads are at below
  basic literacy level
• Literacy level

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

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
Diabetics with retinopathy
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Increased Mortality

• Age 70-79
• Reading level 8th grade or less
• Five Year Prospective Study

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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Mortality Study
Fully adjusted Cox Model
Age 1.10 Male gender 1.29 Black
race 1.07 Income lt10K 1.04
Literacy level 1.75 Cardiac disease 1.40 Diabetes
1.52 Current smoker 3.09
Sudore R, et al. Limited Literacy and Mortality
in the Elderly. J Gen Intern Med 2006 21806-812.
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More Hospitalizations
2 year hospitalization rate for patients visiting
ED
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Increased Health Care Costs

• Data
• 2003 Medical Expenditure Panel Survey
• 2003 National Assessment of Adult Literacy
• Low Health Literacy Implications for National
  Health Policy. Vernon, J, Trujillo, A, Rosenbaum,
  S, DeBuono, B. Oct. 2007

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Increased Health Care Costs

• Annual cost today
• Future costs based on todays actions
• (or lack of action)
• Low Health Literacy Implications for National
  Health Policy. Vernon, J, Trujillo, A, Rosenbaum,
  S, DeBuono, B. Oct. 2007

106-238 Billion
1.6-3.6 Trillion
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Hospital Health Literacy Project

• Sue Gaard, RN, BSN, MS
• Founder, Confident Conversations, LLC
• Oscar Mireles, Executive Director
• Omega School
• Chris Baker, RN, PhD and Matt Albert
• St. Marys Hospital
• Michele Erikson
• Executive Director, Wisconsin Literacy, Inc.

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Hospital Health Literacy Project

• GED students trained consultants
• Navigation exercise and document review
• Student and hospital teams
• Joint meetings to discuss results and solutions
• Next steps
• Develop solutions
• Test with students before implementation

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Wisconsin Literacy, Inc.

• A nonprofit coalition of 60 adult, family, and
  workplace literacy providers
• Vision to strengthen Wisconsins workforce,
  families, and communities through literacy

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our health literacy journey
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getting started

• A voice in the wilderness or a champion?
• Dr. Paul Smith joins WL Board of Directors
• 2003

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in the beginning..

• First statewide health literacy summit
• 50 attendees in 2004
• First attempt to develop collaborative project
  linking adult learners with health care providers
• Statewide funding unsuccessful-2004-2005-2007

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the spread of a good idea

• Wisconsin Hospital Association hosts webcast of
  Dr. Smiths Health Literacy presentation to all
  member hospitals.
• WL made over 60 Health Literacy Awareness
  presentations in 15 months.

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putting a good idea to work

• Smaller grant proposals funded for Focus Group
  research on literacy barriers in health care -
  2006
• Promotion of HL initiatives among member agencies
  2008-2010
• connect to local hospital foundations
• health literacy seminar for healthcare
  professions
• Incorporate health literacy curricula for
  students

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two way street

• Raising awareness among your healthcare community
• Building capacity of local literacy agencies to
  incorporate health literacy into program

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moving beyond awareness

• Starting small
• health literacy curriculum for nursing students,
  practicing nurses and other health professions
• Improving the health literacy environment of
  hospitals using a collaborative model
• Next step is to replicate statewide

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funding

• 2009 funding for local literacy programs
• incorporate health literacy into tutor training
• 2) reach parent learners with What to Do..
  book
• 3) develop learner resources for medication
  safety

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funding

• Funding sources that denied previous requests
• were funded for health literacy component
• Focus on health literacy content in curricula
• opened up new funding sources

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regional activity

• On-line Health Literacy Survey for physicians and
  patients to assess their understanding of health
  literacy
• Informational materials developed to meet demand
  for increased presentations
• Joint Commission presents at a regional Health
  Literacy Conference and 07 and 09 Summits
• Model Wisconsin hospital integrates health
  literacy overhaul throughout all levels of
  personnel, add HL website, HL personnel committee
  

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learn from others

• NIFL Health Literacy Discussion List
• (http//www.nifl.gov/mailman/listinfo/healthlitera
  cy)
• Adult Learners
• Other States and Other Communities
• National Plan to Improve Health Literacy

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collaborative partners

• State level partners
• Medical Society
• Hospital Association
• Department of Public Health
• Department of Health Services
• 2020 State Health Plan
• Public Health Association
• Association of Health Underwriters
• Nursing Association
• Pharmacy Society
• Dental Association
• Mental Health Association

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local and regional partners

• Local Hospitals and Clinics
• Libraries and Medical Libraries
• Health Care Quality Organizations
• Corporations with Literacy Focus
• University and Community/Technical Colleges
• Area Health Education Centers
• Local Newspaper - Tell your Learner Stories
  related to Health
• AARP
• Rotary and Other Service Organizations
• Local pharmacies

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target your market

• Patient Education Writers
• Risk Managers
• Quality Improvement Directors
• Patient Safety Directors
• Human Relations Directors
• Language Services Professionals
• Health Educators
• Administrators
• Physicians
• Nurses
• Pharmacists

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money matters

• Wisconsin 3.4-7.6 billion
• County data for state legislators with local
  health literacy story
• Vernon, J. et al, University of Connecticut, Feb.
  2009

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The Joint Commission

• Standard PC.02.01.0X The hospital effectively
  communicates with patients when providing care,
  treatment, and services.
• Source Approved Requirements to Advance
  Effective Communication, Cultural Competence, and
  Patient- and Family-Centered Care Hospital
  Accreditation Program, The Joint Commission,
  November, 2009.

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The Joint Commission

• EP 1 The hospital identifies the patient's oral
  and written communication needs, including the
  patient's preferred language for discussing
  health care.

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The Joint Commission

• Note Examples of communication
• needs include the need for personal devices
  such as hearing aids or glasses, language
  interpreters, communication boards, and
  translated or plain language materials.

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The Joint Commission

• Determine whether the patient needs assistance
  completing admission forms

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The Joint Commission

• How can we determine whether the patient has
  difficulty understanding health information?
• Ask the patient Do you often need help
  understanding health care information?
• Use methods such as teach back

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The Joint Commission

• Refrain from asking the patient Do you
  understand?
• Ask the patient about preferred way of receiving
  information (e.g. using written, oral or visual
  communication
• Include interpreters in patient rounds

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The Joint Commission

• Use plain language instead of technical
  terminology or medical jargon
• Use visual models to illustrate a procedure or
  condition

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getting started

• Contact partners tell the stories
• Add health literacy resources to your Website
• Show the AMA video
• Relay The Joint Commissions requirements on
  language, literacy, culture and patient safety

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More Resources

• www.wisconsinliteracy.org
• www.healthliteracywisconsin.org

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• Questions?
• Comments?

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Want a copy?

• Presentation
• Health literacy resources list
• Paul.Smith_at_fammed.wisc.edu
• Michele_at_wisconsinliteracy.org

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