Transcript 6SOW PRO Presentation

Health Literacy:
A Crisis In Health Care
Developed by Stratis Health with the Permission of
the American Medical Association Foundation and the American Medical Association
Definitions
General Literacy:
“ An individual’s ability to read, write, and speak in English, and
compute and solve problems at levels of proficiency necessary to
function on the job and in society, to achieve one’s goals, and develop
one’s knowledge and potential.”
National Literacy Act of 1991
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.”
Healthy People 2010
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Self-Assessment
Implications of low health
literacy on patient care
33%
42%
26%
43%
60%
Were unable to read basic health care materials
Could not comprehend directions for taking
medication on an empty stomach
We unable to understand information on an
appointment slip
Do not understand the rights and responsibilities
section of Medicaid application
Did not understand a standard informed consent
Williams et.al., JAMA 12/6/95
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Cost of poor health literacy:
Estimate >$50 billion annually*
We all pay!
 39% paid by Medicare (FICA taxes on workers)
 17% paid by employers
 16% paid by patients, out-of-pocket
 14% paid by Medicaid
 14% from other public and private sources
*Estimated by National Academy on an Aging Society using 1998 figures
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National Adult Literacy Survey
(NALS)
 Conducted in 1992
 N=26,000
 Most accurate portrait of literacy in the US
 Scored on 5 levels
 Not accounted for:
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Patients who have adequate language skills, but
do not have adequate health literacy
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Results: National Adult
Literacy Survey (NALS)
35
31.5%
27.5%
30
25
21%
20
16%
15
10
3%
5
0
1
2
3
Level
4
(Kirsh I, Jungeblut A, 1993)
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Why are patients at risk?
 Reliance on the written word for patient
instruction
 Increasingly complex healthcare system
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More medications
More tests and procedures
Growing self-care requirements
Esoteric language
 An aging population
 A more culturally diverse patient population
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Understanding the problem
What is it like?
 The following passage simulates what a reader
with low general literacy sees on the printed
page
 Read the entire passage out loud
 You have 1 minute to read
(Hint: The words are written backwards and the
first word is “cleaning”)
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GNINAELC – Ot erussa hgih ecnamrofrep,
yllacidoirep naelc eht epat sdaeh dna natspac
revenehw uoy eciton na noitalumucca fo tsud
dna nworb-der edixo selcitrap. Esu a nottoc
baws denetsiom htiw lyporposi lohocla. Eb erus
on lohocla sehcuot eht rebbur strap, sa ti sdnet
ot yrd dna yllautneve kcarc eht rebbur. Esu a
pmad tholc ro egnops ot naelc eht tenibac. A
dlim paos, ekil gnihsawhsid tnegreted, lliw pleh
evomer esaerg ro lio.
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What was it like?
How did you feel while reading this
passage?
How did you feel when you finished
reading the passage?
How do you clean the capstan?
How do you think patients with low
health literacy feel?
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Understanding the problem
View: As Patients See It
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Video made by the AMA in 2003
Real patients and real physicians talking
about literacy issues
Task: Note
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Barriers to access
Barriers to diagnosis
Barriers to treatment/care
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Video: The Patient’s Voice
Discussion:
What ideas hit home with you?
Did any of the situations seem
familiar?
Did anything surprise you?
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What do we know?
Low Health Literacy (LHL) is prevalent
LHL leads to:
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Lower health knowledge and less healthy
behaviors
Greater health costs
Poorer health outcomes
Techniques and approaches may be
used to address health literacy
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Strategy: Create a shame-free
environment
 Recognize red flags
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“I forgot my glasses…”
Incomplete forms
Seeking help only when illness is advanced
 Convey an attitude of helpfulness, caring and
respect (by all staff)
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What is it like being a patient in your setting?
Are there forms or instructions that could be
confusing?
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Strategy: improve interpersonal
communication
 Slow down
 Use plain or “living room” language
 Focus on key messages (www.askme3.org)
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What is my main problem?
What do I need to do?
Why is it important for me to do this?
 Use “teach back” techniques
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Strategy: Develop patient-friendly
materials and forms
 Keep content concise and focused:
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Focus only on key points
Emphasize what the patient should do
Minimize anatomy and physiology to the basics
 Tips for easy-to-read materials:
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Simple words (1-2 syllables)
Short sentences (4-6 words)
Short paragraphs (2-3 sentences)
Limit medical jargon
Headings, bullets and lots of white space
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Self-Assessment answers
What can you do right away?
Do a ‘walk through’ at your facility and
identify barriers
Review registration forms and consider
if they could be simplified
Develop a plan to educate all staff
about low health literacy
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What can you do in the future?
Form a team to determine a long-term
strategy
Discuss methods for improving
communication skills with providers and
staff
Incorporate “Ask Me 3” components
into patient information
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“Understanding
is a two-way street.”
Eleanor Roosevelt
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For More Information
Other resources
 www.amafoundation.org
 www.askme3.org
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Brought to you by Stratis Health
Minnesota’s Medicare Quality Improvement Organization
Stratis Health is a non-profit independent quality improvement organization
that collaborates with providers and consumers to improve health care.
This presentation was created by Stratis Health under a contract with
the Centers for Medicare & Medicaid Services (CMS).
The contents do not necessarily reflect CMS policy.
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