Health Literacy: Helping Patients Get the Message

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Health LiteracyHelping Patients Get the Message

• Pamela Zarkowski, JD, MPH, BSDH, FACD, FACLM
• North Dakota Dental Hygienists Association
• September 18, 2015

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Misunderstood

• Take two tablets on an empty stomach
• Take a tablet by mouth twice each day
• Two tablets twice daily- (two tablets a day)

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Health Literacy

• Health literacy is dependent on individual and
  systemic factors
• Communication skills of lay persons and
  professionals
• Lay and professional knowledge of health topics
• Culture
• Demands of the healthcare and public health
  systems
• Demands of the situation/context

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Clear Communication

• We must not blame the individual for not
  understanding information that has not been made
  clear to him or her.
• Everyone, no matter how educated, is at risk for
  misunderstanding health information if the issue
  is emotionally charged or complex.
• In almost all cases, physicians and other health
  professionals, try to and believe they are,
  communicating accurate information.
• In some cases, patients may believe they have
  understood directions, but may be embarrassed to
  ask questions to confirm their understanding.

• It is increasingly difficult for people to
  separate evidence based information, especially
  online, from misleading ads and gimmicks.
• The communication of risk in an effective and
  fair way continues to be a challenge for both the
  provider and the patient.
• There are additional challenges in understanding
  how to select insurance plans and benefits,
  especially for those who have not previously been
  insured.
• http//www.nih.gov/clearcommunication/healthlitera
  cy.htm

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Consider Literacy

• Context
• Time and Place
• Background
• Speaker/writer
• Listener/reader
• Culture
• Speaker/writer
• Listener/reader

• 5 Core Skills of
• Literacy
• Reading
• Prose
• Documents
• Writing
• Numeracy

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Literacy Skills for the 21st Century

• Literacy influences ones ability to access
  information and to navigate the highly literate
  environments of modern society.

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Epidemiology

• Most health care materials are written at a
  10th-grade level or higher.
• Most adults read between the eighth and ninth
  grade level.
• Approximately one half of adults are unable to
  understand printed health care material, and
  approximately 90 million adults have fair to poor
  literacy.
• Twenty-one to 23 percent of adults read at the
  lowest reading level, approximately fifth-grade
  or lower.

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Epidemiology

• For patients whose primary language is not
  English, the problem is compounded.
• A survey of patients at two hospitals revealed
  that 35 percent of English-speaking patients and
  62 percent of Spanish-speaking patients had fair
  to poor health literacy.
• Study of patients 65 and older found that those
  who couldnt understand basic written medical
  instructions were much more likely to die within
  six years than those who had no problems grasping
  the information.

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Changing Concept

• At first, health literacy was considered to be a
  characteristic of the individual. Increasingly,
  researchers and practitioners are looking at both
  sides of the coin
• Health literacy is a shared function of social
  and individual factors.
• Health and Human Services, Communicating Health,
  2003. Institute of Medicine Health Literacy A
  Prescription to End Confusion, 2004
• Health Literacy is an interaction
• Institute of Medicine Health Literacy A
  Prescription to End Confusion, 2004

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What Can we Do?

• Change the Skill Side
• Improve literacy skills of the public
• Improve communication skills of professionals
• Change the Demand Side
• Recalibrate the norm and identify literacy
  barriers
• Lower demands
• Remove barriers

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Professional Concern

• Health Literacy in Dentistry
• Strategic Action Plan
• 2010-2015
• Vision
• The Council and its ad hoc advisory committee on
  health literacy in dentistry share a vision that
  dentists and dental team members, and the ADA and
  related health organizations, will use and
  promote clear, accurate and interactive
  communication with colleagues, patients and
  policy makers to achieve optimal oral health for
  all. This vision may be realized when the
  following promising and best practices are used.
• American Dental Association (ADA), Council on
  Prevention and Interdisciplinary Relations

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Health Literacy

• Create a respectful and shame-free environment
  and use a universal standards approach, where all
  patients are offered assistance to better
  understand and use printed and written
  communications.
• Periodically assess office/clinic for ways to
  improve communication.
• Use clear and plain language in talking and
  writing.
• Encourage question-asking and dialogue.
• Use teach-back or teach-to-goal method to
  check on successful communication by asking
  patients to repeat their interpretation of
  instructions and other information that has been
  provided.
• Offer take-home tools designed for easy use with
  clear directions.
• American Dental Association, Council on
  Prevention and Interdisciplinary Relations

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Health Literacy

• The degree to which individuals have the capacity
  to obtain, process, and understand basic health
  information and services needed to make
  appropriate health decisions.
• Health People 2010, http//www.healthypeople.gov/
  Document/pdf/uih/2010uih.pdf
• The capacity of an individual to obtain,
  interpret, and understand basic health
  information and services and the competence to
  use such information and services in ways which
  are health-enhancing.
• Health Education Standards

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Health Literacy

• Patients are often faced with complex information
  and treatment decisions. Some of the specific
  tasks patients are required to carry out may
  include
• evaluating information for credibility and
  quality,
• analyzing relative risks and benefits,
• calculating dosages,
• interpreting test results, or
• locating health information.

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Health Literacy

• In order to accomplish these tasks, individuals
  may need to be
• visually literate (able to understand graphs or
  other visual information),
• computer literate (able to operate a computer),
• information literate (able to obtain and apply
  relevant information), and
• numerically or computationally literate (able to
  calculate or reason numerically).

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Health Literacy Affects Everyone

• Even people who read well and are comfortable
  using numbers can face health literacy issues
  when
• They arent familiar with medical terms or how
  their bodies work.
• They have to interpret statistics and evaluate
  risks and benefits that affect their health and
  safety.
• They are diagnosed with a serious illness and are
  scared and confused.
• They have health conditions that require
  complicated self-care.
• They are voting on an issue affecting the
  communitys health and relying on unfamiliar
  technical information.

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Health Literacy and Patient Safety

• https//youtu.be/cGtTZ_vxjyA

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Health Literacy
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At Risk Vulnerable Populations

• Minority populations
• Immigrant populations
• Low income - Approximately half of
  Medicare/Medicaid recipients read below the
  fifth-grade level http//www.medicarerights.org/ma
  incontentstatsdemographics.html)
• People with chronic mental and/or physical health
  conditions

• Vulnerable populations include
• Elderly (age 65)
• Two thirds of U.S. adults age 60 and over have
  inadequate or marginal literacy skills, and 81
  of patients age 60 and older at a public hospital
  could not read or understand basic materials such
  as prescription labels (Williams, MV. JAMA,
  December 6, 1995).

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Influencing Factors

• Cultural, social, and family influences shape
  attitudes and beliefs and therefore influence
  health literacy.

• Lack of educational opportunity - people with a
  high school education or lower.
• Learning disabilities.
• Cognitive declines in older adults.
• Use it or lose it
• Reading abilities are typically three to five
  grade levels below the last year of school
  completed. Therefore, people with a high school
  diploma, typically read at a seventh or eighth
  grade reading level.

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Influencing Factors

• Native language, socioeconomic status, gender,
  race, and ethnicity along with mass culture as
  represented by news publishing, advertising,
  marketing, and the plethora of health information
  sources available through electronic channels are
  also integral to the socialcultural landscape of
  health literacy.

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Health Literacy and Health Outcomes

• Health status
• Report their health as poor
• Healthcare costs
• Use services to treat disease complications more
  less use of services to prevent complications,
• Stigma and shame
• Psychological effects

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Health Literacy and Health Outcomes

• Use of preventive services more likely to skip
  important preventive measures, e.g. Pap smear and
  flu shots.
• Knowledge about medical conditions and treatment
  more likely to have chronic conditions.
• Rates of hospitalization higher rates of
  hospitalization and use of emergency services.

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Literacy NVS-Ice Cream Label

• If you eat the entire container, how many
  calories will you eat?
• If you are allowed to eat 60 g of carbohydrates
  as a snack, how much ice cream could you have?
• Your doctor advises you to reduce the amount of
  saturated fat in your diet. You usually have 42 g
  of saturated fat each day, which includes 1
  serving of ice cream. If you stop eating ice
  cream, how many grams of saturated fat would you
  be consuming each day?
• If you usually eat 2500 calories in a day, what
  percentage of your daily value of calories will
  you be eating if you eat one serving?
• Pretend that you are allergic to the following
  substances Penicillin, peanuts, latex gloves,
  and bee stings. Is it safe to eat this ice cream?
  Why or why not?

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Answers

• 1,000 calories
• 1 cup, or half the container
• 33 grams
• 10 percent
• No, because it has peanut oil

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Behaviors Indicating Low Literacy

• Patient registration forms that are incomplete or
  inaccurate.
• Asking staff for help.
• Bringing someone who can read.
• Inability to keep appointments.
• Making excuses- I forgot my glasses.
• Noncompliance with medication.

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Confusion in Labeling

• Costco
• Warning 1 "If you drink alcohol, discuss the
  safe use of alcohol while taking this this
  medication with your healthcare professional
• NOTE This warning appears inconsistent with the
  approved FDA prescriber information that states
  "Avoid alcohol consumption."
• Warning 2 "Do not take aspirin products without
  doctor approval. Continue taking low-dose aspirin
  to prevent heart attack/stroke unless doctor
  tells you to stop"

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Behaviors Indicating Low Literacy

• Poor adherence to recommended interventions
  (e.g., changes to decrease acid reflux, such as
  elevating the head of the bed).
• Postponing decision making (May I take the
  instructions home? or Ill read through this
  when I get home.)
• Watching others (mimicking behavior).
• Lack of follow-through with laboratory tests,
  imaging tests, or referrals to consultants.
• Patients say they are taking their medication,
  but laboratory tests or physiological parameters
  do not change in the expected fashion.

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What is feels like..

• 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 thgin erofeb the noitanimaxe to naelc
  out your noloc.

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Tools to Evaluate Low Literacy

• REALD-99 after REALM, where words on the
  instrument are ranked in order of increasing
  difficulty and the score is based on the number
  of words the subject pronounces correctly.

• REALM Rapid Estimate of Adult Literacy in
  Medicine
• REALD Rapid Estimate of Adult Literacy in
  Dentistry
• TAFHLAL Test of Functional Health Literacy in
  Adults

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Tools to Evaluate Health Literacy

• TOFHLA Used to measure functional health
  literacy both numeracy and reading
  comprehension.
• Developed at Georgia State University in 1995
• Lets take a TOFHLA Reading Comprehension
  Evaluation

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Cultural and Linguistic Competency

• Culture affects how people communicate,
  understand, and respond to health information.
• Cultural and linguistic competency of health
  professionals can contribute to health literacy.

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Cultural and Linguistic Competency

• Cultural competence is the ability of health
  organizations and practitioners to recognize the
  cultural beliefs, values, attitudes, traditions,
  language preferences, and health practices of
  diverse populations, and to apply that knowledge
  to produce a positive health outcome.
• Competency includes communicating in a manner
  that is linguistically and culturally
  appropriate.

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Influencing Factors Cultural Competence

• Cultural awareness A deliberate, cognitive
  process in which health-care providers become
  appreciative and sensitive to values, beliefs,
  lifestyles, practices, and problem-solving
  strategies of clients cultures.
• Cultural knowledge The process of seeking and
  obtaining a sound educational foundation
  concerning worldviews of various cultures goal
  is to understand clients world views, or the way
  individuals or groups of people view the universe
  to form values about their lives and the world
  around them.
• Speaking of Health (IOM 2002)

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Cultural Competence

• Cultural skill The ability to collect relevant
  cultural data regarding clients health histories
  and presenting problems, as well as accurately
  perform culturally sensitive physical histories.
• Cultural encounter A process that encourages
  health-care providers to engage directly in
  cross-cultural interactions with clients from
  culturally diverse backgrounds (IOM, 2002).

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Acknowledge cultural differences and practicing
respect

• Cultural factors include race, ethnicity,
  language, nationality, religion, age, gender,
  sexual orientation, income level, and occupation.
  Some examples of attitudes and values that are
  interrelated with culture include
• Accepted roles of men and women
• Value of traditional medicine vs. Western
  medicine
• Favorite and forbidden foods
• Manner of dress
• Body language, particularly whether touching or
  proximity is permitted in specific situations
• Ensure that health information is relevant to the
  intended users' social and cultural contexts.

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Case Study

• Patient presents to your office. The case is
  complicated and involves a four-unit bridge, the
  possibility of failed endo resulting in a future
  extraction and implant. The case will also
  involve 2-3 appointments of periodontal
  treatment. Patient does not speak English.
  Daughter explains everything to her mother.
  However, you give a long explanation of what the
  issues are and the daughter says about two
  sentences to the mother that you do not
  understand. Daughter than tells you to proceed.
• How do you deal with this situation?

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Cultural Competence Sensitivity

• Health care provider much be culturally competent
  sensitive
• Work force patient population is diverse
  including gender, racial, ethnic, and religious
  background
• Awareness knowledge influence colleague
  patient interaction

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Cultural Competence SensitivityAn Introduction

• Awareness and knowledge influences patient
  assessment, treatment, communication and
  follow-up
• Cross cultural dental hygiene effective
  integration of the clients socio-ethnocultural
  background into dental hygiene care. Includes
  social, political, ethnic, religious, and
  economic religious and economic realities
• Dental hygiene care is based on Western practices
  research, although most of the world is
  non-Western

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Concepts

• Cultural competence a process for effectively
  working within the cultural context of an
  individual or community from a diverse cultural
  or ethnic background

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Culture

• Sum total of human behavior or social
  characteristics peculiar to a specific group and
  passed from generation to generation or from one
  another within the group
• Common pattern of communication
• Similarities in dietary preferences
• Community patterns of dress
• Predictable relationship and socialization
  patterns
• Common set of shared values and beliefs

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Concepts

• Ethnicity a sense of identity an individual has
  based on common ancestry and national, religious,
  tribal, linguistic or cultural origins. It is
  generally implied that there are shared values,
  lifestyles, beliefs and norms among those
  claiming affiliation to a specific ethnic group.

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Concepts

• Race one of three classifications based on
  physical characteristics ignores issues of
  genetics which is concerned with heredity and
  biological variation preference for terms such
  as ethnic, multicultural, and culturally diverse.

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Concepts

• Acculturation degree to which an individual
  from a culture has given up the traits of that
  culture and adopted the traits of the dominant
  culture in which he or she now resides.
• Assimilation related to acculturation and is
  viewed as the social, economic and political
  integration of a cultural group into mainstream
  society to which it may have emigrated or
  otherwise been drawn.
• Ethnocentrism assumption an individual makes
  that his or her way of believing and behaving is
  the most preferable and correct one.

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Common Beliefs and Cultural Practice

• Eritreans believe in the healing powers of roots
• Therapeutic burning (moxbustion)
• Evil eye (mal de ojo) appears in several Hispanic
  cultures
• Native Americans turn to sweat lodge
• herbal medicine

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Common Beliefs and Cultural Practice

• Chinese and Cambodian medicine classifies food,
  illness and medications according to perceived
  effects on the body as hot or cold.
• Moral retribution
• Cup, pinch, coin or rub an ill persons skin
• Storytelling

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Rapport Patient-Centered

• Communication
• Verbal
• Nonverbal
• Written

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Rapport Patient Centered

• Communication
• Enhances relationships
• Reduces total time with patient
• Reduces legal problems and malpractice claims
• Increase patient compliance
• Reduces stress

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Rapport Patient-Centered

• Non-verbal communication
• Set the scene first impressions important
• Take a seat
• Respect cultural differences
• Smile important
• Eye contact and facial expressions
• Hands and feet
• Distracting habits
• Gender differences

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Rapport Patient-Centered

• Challenges to communication in healthcare
• Literacy
• Slang
• Humor
• Lay vs. dental/medical terminology
• Dialects/Accents
• Family Roles
• Gender Roles
• Speed
• Accents

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Rapport Patient Centered

• Clinicians Perspective
• Explain symptoms
• Interpret data
• Adequately explain and advise
• Offer treatment
• Understand patients perspective

• Patients Perspective
• Describe concerns
• Clarify information
• Obtain adequate explanation
• Obtain treatment
• Develop a relationship

Ctr for Health Professions UCSF
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Rapport Patient Centered

• Culture in Health, Illness and Healing
• Various dimensions of cultural beliefs
• Different explanatory models of illness
• Complementary and alternative medicine
• Stereotypes and generalizations

Ctr for Health Professions - UCSF
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Rapport Patient Centered

• Dimensions of Cultural Beliefs
• Decision-making styles
• Healing traditions
• Spirituality
• Privacy Disclosures
• Status/Hierarchy
• Communication
• Socioeconomic status
• Immigration status
• Kagawa-Singer, JAMA 2001

• Gender
• Poverty
• Gender identity
• Disability/Ability
• Professional training

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Think-Pair-Share

• Identify a tradition or belief in your personal
  experiences that focused on health or health
  behaviors?
• Describe an instance when a patient and you had
  differing beliefs about oral or general health
  that may have been based on culture or their
  personal experiences or practices.

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Rapport Patient-Centered

• Cultural Symbolism of Teeth
• Toothache biting the forbidden fruit
• Broken teeth loss of power
• Pulling teeth Freudian interpretation
• Tooth filing Coming of age
• Coloring teeth social status
• The magic and meaning of the Tooth Fairy

Ctr for Health Professions - UCSF
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Rapport Patient Centered

• Models of Illness
• Upset in body balance
• Soul loss/theft
• Spirit possession
• Breach of taboo

Ctr for Health Professions - UCSF
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4000 years of medicine

• I have a headache
• 2000 BCE Here, eat this root.
• 1000 AD That root is heathen! Here say this
  prayer
• 1850 AD The prayer is superstitious!
  Here drink this potion
• 1940 The potion is snake oil! Here take
  this pill
• 1985 The pill is ineffective! Here take this
  antibiotic
• 2011 The antibiotic artificial! Here take
  this root

http//www.metafilter.com/104583/Here-eat-this-roo
t
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Rapport Patient Centered

• CAM Complementary Alternative Medicine
• Patients are looking to
• Improve their health and well being
• Relieve symptoms
• Eliminate side effects of traditional treatments
• Fin a modality aligned with their health beliefs

Ctr for Health Professions - UCSF
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Rapport Patient Centered

• CAM in United States
• Only 10-30 of medical problems are brought to
  the attention of a clinician
• 36 of adults have used some form of CAM therapy
  in the past 12 months including natural
  products, deep breathing exercises, yoga, massage
  and diet based therapies
• M Loustaunau, et al. The Culture of Health
  Illness and Medicine
• CDC Complementary and Alternative Medicine in
  Adults, 2004

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Rapport Patient Centered

• Stereotypes
• Assigns a person to a category based on what we
  believe
• Based on limited knowledge or experience
• No attempt to confirm
• Stereotype linked bias may occur without
  prejudicial intent
• Occurs during stress
• Order of stereotyping RaceGenderAge

Ctr for Health Professions - UCSF
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Rapport Patient Centered

• Generalization
• Summary of common trends in beliefs and behaviors
  of a group
• Can be inaccurate when applied to individuals
• Further information needed

Ctr for Health Professions - UCSF
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Rapport Patient Centered

• LEARN Model
• Listen with sympathy
• Explain your perceptions
• Acknowledge differences
• Recommend treatment
• Negotiate an agreement

L-E-A-R-N Model of Cross Cultural Encounter
Guidelines for Health Practitioners
Http//www.diversityrx.org/HTML/MOCPT2.htm
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Culturally Competent Clinical Practice

• Explanation
• Treatments
• Healers
• Negotiate
• Intervention
• Collaboration

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Rapport Patient Centered

• Strategies
• Awareness and sensitivity
• Staff education and training

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Reading Level A Test

• Count the number of polysyllabic (three syllables
  or more) words in a chain of 10 sentences.
  Multiply by three. Find the approximate grade
  level on the SMOG conversion table.
• Practice!

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How to Count Syllables

• Method 1
• Say the word.
• How many times do you hear "A, E, I, O, U" as a
  separate sound?
• Method 2
• Put your hand under your chin.
• Say the word.
• How many times does your chin touch your hand?

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Reading Level
Total polysyllabic word counts Approximate grade level (/- 1.5 grades)
0-2 4
3-6 5
7-12 6
13-20 7
21-30 8
31-42 9
43-56 10
57-72 11
73-90 12
91-110 13
111-132 14
133-156 15
157-182 16
183-210 17
211-240 18
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Think Pair-Share

• Discuss the reading level of the pamphlet that
  you evaluated?
• Did you find the outcome surprising?
• Would some patients in your practice find the
  pamphlet to hard to understand? Or too
  simplistic?
• Best practices How might you work with those
  patients to either explain concepts or educate
  them at a more advanced level

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Six Steps to Enhance Understanding Among
Patients with Low Health Literacy

• Slow down, and take time to assess the patients
  health literacy skills.
• Use living room language instead of medical
  terminology.
• Show or draw pictures to enhance understanding
  and subsequent recall.
• Limit information given at each interaction, and
  repeat instructions.
• Use a teach back or show me approach to
  confirm understanding. This approach involves
  having the provider take responsibility for
  adequate teaching by asking patients to
  demonstrate what they have been told (e.g.,
  repeat how to take their medication) to ensure
  that education has been adequate.
• Be respectful, caring, and sensitive, thereby
  empowering patients to participate in their own
  health care.

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Additional FactorLEP Limited English
Proficiency

• Limited English Proficient (LEP) patients are
  faced with language barriers that undermine their
  ability to understand information given by
  healthcare providers as well as instructions on
  prescriptions and medication bottles, appointment
  slips, medical education brochures, doctors
  directions, and consent
• forms. They experience more difficulty (than
  other patients) processing information necessary
  to care for themselves and others.

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Are you speaking clearly and listening carefully?

• Ask open ended questions
• Check for understanding
• Summarize what you want the patient to do.
• Check for understanding I want to be sure I
  didnt leave anything out out that I should have
  told you. Would you tell me what you are to do so
  that I can be sure you know what is important?
• Source Doak CC, Doak LG, Root JH 1996 Teaching
  Patients with Low Literacy

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Use Plain Language

• Plain language is a strategy for making written
  and oral information easier to understand. It is
  one important tool for improving health literacy.
• Plain language is communication that users can
  understand the first time they read or hear it.
  With reasonable time and effort, a plain language
  document is one in which people can find what
  they need, understand what they find, and act
  appropriately on that understanding.

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Improve the Usability of Health Information

• Limit the number of messages, use plain language
  and focus on action.
• Supplement instruction with visuals
• Make written communication look easy to read.
• Improve the usability of information on the
  Internet.

• Identify the intended users of the health
  information and services
• Evaluate users understanding before, during and
  after the introduction of the information and
  services
• Acknowledge cultural differences and practice
  respect
• Accepted roles of men and women
• Tradition medicine vs. Western medicine
• Favorite and forbidden foods
• Manner of dress
• Body language

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Example Treating Strep Throat

• Take your pills 2 times each day (once in the
• morning and once in the evening).
• Take the medicine every day for 10 dayseven if
  you feel better before then.
• Stopping the pills before 10 days can result in
• serious heart problems.
• (43 words 6th-grade reading level)

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Words/Phrases

• Keep metaphors to a minimum, for example the
  phrase "Make like a tree and leave" is understood
  as (an attempt) at a pun by native
  English-language speakers.
• Examples
• My dogs are killing me
• That smarts
• It went up in smoke

• Current communication techniques eg. Texting
• Inappropriate language/phrases/slang
• Some phrases can be confusing
• For instance, when you say "I give up," you mean
  "I surrender," "I quit," or "I yield." But the
  newcomer to the English language may be puzzled.
  What does it mean to make a gift in an upward
  direction?
• Idiomatic expressions
• Whats up?
• Can you work the graveyard shift?

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Teach Back Method

• The teach-back method enhances communication.
  The person receiving the health information is
  asked to restate it in their own wordsnot just
  repeat itto ensure that the message is
  understood and remembered. When understanding is
  not accurate or complete, the sender repeats the
  process until the receiver is able to restate the
  information needed. Consumers also can be asked
  to act out a medication regimen.

• I want to be sure I went over everything. Tell me
  how you will take this medicine.
• Just to check if Ive covered everything Tell me
  what you will say to your wife when you return
  home.
• Just to be sure I was clear Show me how you will
  use this peak flow meter.

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Usability of Health Forms and Instructions

• Revise forms to ensure clarity and simplicity
• Test forms with intended users and revise as
  needed.
• Provide plain language and in multiple languages
• Provide clear information for assistance
• Train staff to give assistance in completing
  forms.

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eHealth

• eHealth - the use of interactive technologies to
  improve health behavior and disease management
• Examples
• http//www.colgateprofessional.com/patienteducatio
  n

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Resources

• Office of Minority Health
• http//www.omhrc.gov/
• Pfizer Clear Health Communication Initiative
• http//www.pfizerhealthliteracy.com/
• National Institute for Literacy
• http//www.nifl.gov/
• Health Literacy AMA
• http//www.ama-assn.org/ama/pub/about-ama/ama-foun
  dation/our-programs/public-health/health-literacy-
  program.shtml

• Ask Me 3
• http//www.npsf.org/askme3/
• Sponsored by the Partnership for Clear Health
  Communication at the National Patient Safety
  Foundation.
• Ask Me 3 promotes three simple but essential
  questions that patients should ask their
  providers in every health care interaction
• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?

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Resources

• Plainlanguage.gov
• Designed to improve communication from the
  Federal Government to the public, this Web site
  contains excellent tools and examples of plain
  language.
• Visit http//www.plainlanguage.gov
• Health Literacy A Prescription to End Confusion
• Released in 2004 by the Institute of Medicine
  (IOM), this report examines the body of knowledge
  that applies to the field of health literacy and
  recommends actions to promote a health-literate
  society.
• Available at www.iom.edu/report.asp?id19723

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Online Resources

• http//www.cdc.gov/healthliteracy/ResearchEvaluate
  /index.html
• CDC Health Literacy for Public Health
  Professionals. Available at www2a.cdc.gov/TCEOnlin
  e/registration/detailpage.asp?res_id2074
• Improving Health Literacy Training Resources.
  University of Michigan Library. Available at
  guides.lib.umich.edu/healthliteracyU.S.
  Department of Health and Human Services, Office
  of Disease Prevention and Health Promotion.
  Health Literacy online A guide to writing and
  designing easy to-use health Websites. Washing,
  D.C. Available at www.health.gov/healthliteracyo
  nline/index.htm

88
Online Resources

• http//www.nih.gov/clearcommunication/healthlitera
  cy.htm

89
References

• Atchison, K.A. et al., Screening for oral health
  literacy in an urban dental clinic. J. Public
  Health Dent. Fall 2010, 70(4) 269-275

90
Thank you!

• W 313.993.1585
• pamela.zarkowski_at_udmercy.edu