Transcript ppt - The Health Literacy Place

Health literacy: Making It easy
Angela Shepherd
NES Nursing & Midwifery Practice
Educator
Functional Literacy
The basic skills of reading, writing
and numeracy taking context into
account
Low Literacy – not confined to
developing countries
1 in 5 adults in Scotland
could not locate the
page for plumbers in the
Yellow Pages directory
Literacy Levels In Scotland
Results of International Adult Literacy Survey (Scotland)
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23%
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32%
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45%
Very poor skills. May not be
able to determine the amount
of medicine to take
Weak skills. Can only deal with
well laid out simple material
and tasks that are not complex
Skills at or above level required
for coping with demands of
everyday life
Consequences of low literacy
Higher unemployment
• Low skill jobs
• Social exclusion
• More likely to live in areas of deprivation
• Women more likely to be teenage mothers
• Increased health problems and disabilities
• Higher rates of depression
• Higher proportions self-reporting poor health
• Less physical activity
• Higher smoking rates
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Medicines/Health Screening
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Trouble adhering to medication regimes
Poor understanding of labelling
3-4 times more likely to misinterpret
prescription labels
43% working age adults – unable to
calculate childhood Paracetamol dose
49% unable to understand instructions for
using the National Bowel Cancer screening
kit
Low literacy can hamper
self-care activities
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Information leaflets difficult to read, often discarded
Medication instructions - too much text, writing too
small
Dosage - frequency not understood
Difficulties buying OTC medicines
I don’t know what I’m buying normally, do you know if
it’s got Calpol on it, then I’m like that ‘That’s Calpol,
that’s fine’…. but then if it’s Cal.. is it Calbrufen? I’m not
allowed that, because I’ve got asthma so (son)’s not
allowed that…..So you have to watch the colours of the
packets and stuff … to tell the difference
Self Management
People with low literacy more likely to be more
unwell, have lower knowledge, not use inhalers
properly and more likely to go to an emergency
department
(Williams, MV et al. Arch Int Med 1998;158:166-172)
Less diabetes knowledge, less likely to understand
and act on diabetes monitoring, less likely to control
their blood glucose and more likely to have eye
problems
(Schillinger, D et al. JAMA 2002;288:475-482)
Stigma
Research participants anticipated that disclosure
would not change clinical treatment but staff would
judge them, be patronising, think badly of them, look
down on them, compromising relationships with
healthcare staff
...... they speak to you like you’re three.
Then they wouldn’t leave you alone and
then they’re kinda like as if you can’t do
nothing for yourself (Katy, female, 20s)
People with low literacy who had
attended clinics said that they…
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Hid their literacy problems
Pretended to understand
Did not ask questions
Did not ask for help
.... they never explain anything properly. It’s
always their own big words and I just say, uh
hmm, yeah, okay and I go home and I’m like, ‘I
don’t know what that meant.’
(Megan, female, teens)
Red Flags for Low/Poor Literacy
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Frequently missed appointments
Incomplete forms
Non-compliance with medication
Unable to name medications, explain purpose
or dosing
• Identifies pills by looking at them, not reading
label
• Unable to give coherent, sequential history
• Asks fewer questions
• Lack of follow-through on tests or referrals
Recommendations from people
with low literacy
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Don’t assume that people can read or write
Use a variety of media to share information
Oral explanation in simple terms
Keep forms simple and explain them
Offer to help without labelling
Don’t put people on the spot
Send forms out before appointments
Health Literacy
“Health literacy is based on general literacy and entails
people’s knowledge, motivation and competences to
access, understand, appraise and apply
health information to make judgments and take decisions
in terms of healthcare, disease prevention and health
promotion to maintain and improve quality of life
throughout the life course”
(HLS-EU Project - the European Health Literacy Project)
“The term ‘health literacy’ refers to people having the
appropriate skills, knowledge, understanding and
confidence to access, understand, evaluate, use and
navigate health and social care information and services”
(Making it Easy, NHS Scotland, 2014)
Findings from various surveys
Recent UK study- estimated 33%of people
aged over 52 have limited health literacy
Survey of 8 European countries - 47%
estimated to have inadequate health
literacy
The Scale of Limited Health
Literacy
42% working age individuals – unable to
understand & make use of everyday health
information
61% find health materials too complex to
understand
43% - unable to calculate childhood
Paracetamol dose
(Improving Health Literacy to Reduce Health Inequalities: Public Health England, 2015)
People with Low Health Literacy:
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1.5 - 3 times more likely to experience increased hospitalisation or death
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More likely to have depression
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More likely to struggle with managing their and their family’s health and wellbeing
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Increased risk of developing multiple health problems
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Use fewer preventive and health promotion services, such as cancer screening and flu vaccinations
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Have less recall and adherence to medical instructions and healthcare regimes
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Find it more difficult to access appropriate health services
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Make more use of accident and emergency services and have longer in-patient stays
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Have less effective communication with health and social care practitioners
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Less likely to engage in active discussions about their health options, potentially leading to their
health needs being hidden
(Improving Health Literacy to Reduce Health Inequalities: Public Health England, 2015)
Improving Health Literacy
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Increases health knowledge
Builds resilience
Encourages positive lifestyle change
Empowers people to manage long-term
health conditions
• Reduces the burden on health and social
care services
Low Health literacy:
not just a problem for patients with limited education or
reading ability - can also be found in individuals who may
be highly literate in other areas but have difficulty
understanding medical terminology and jargon.
Patients may be embarrassed to admit their lack of
understanding and sometimes matters can be further
complicated by anxiety or confusion associated with pain
or drug treatments.
The use of Teach Back will ensure that patients understand what is
being explained to them.
Teach-Back
A way to confirm that you have explained to
the patient what they need to know in a
manner that the patient understands
Teach-Back is Supported by Research
“Asking that patients recall and restate what they
have been told” is one of 11 top patient safety
practices based on the strength of scientific
evidence.”
AHRQ, 2001 Report, Making Health Care Safer
“Physicians’ application of interactive
communication to assess recall or
comprehension was associated with better
glycemic control for diabetic patients.”
Schillinger, Arch Intern Med/Vol 163, Jan 13, 2003, “Closing the Loop”
Teach-Back
•Not a test of the patient’s knowledge
•A test of how well you have explained the concept
•Should be used by everyone with everyone
•Avoids use of ‘closed’ questions
•Takes time to learn, requires practice
•Can save time in the long run
•Person centred approach
•Can improve patient safety and patient outcomes
Laws of Remembering
• Recently
• Frequently
• Impact
• Application
Listening Dilemma
• We speak at a rate of about 150 words per
minute (wpm)
• But we can hear at a rate of about 1,000 wpm
• This gives us a lot of extra time!
• What do we do with this time?
(Gaber, 2008)
Listening Exercise
Hearing is a passive process, like breathing.
We do it without thinking.
Listening, however, is a learnt skill and an
active process. Our brains have to work
harder to process the information
that we hear and see
in order to understand the meaning of the
message.
Understanding is the goal of listening.
Talking with Patients & Families
Always:
Use Plain Language.
Slow down.
Break it down into short statements.
Focus on the 2 or 3 most important concepts.
Check for understanding using teach-back
Teach-Back
Asking patients to demonstrate understanding using their own words:
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“I want to be sure I explained everything clearly. Can
you please explain it back to me so I can be sure I
did?”
“What will you tell your husband about the changes
we made to your blood pressure medicines today?”
“We’ve gone over a lot of information about your
diabetes tablets, In your own words, can you tell me
what we talked about?”
From Health Literacy: Universal Precautions Toolkit (AHRQ)
http://www.nchealthliteracy.org/toolkit/Toolkit.pdf
Teach-back…
Creates an opportunity for dialogue in which the provider
gives information, then asks the patient to respond and
confirm understanding before adding any new information
•Re-phrase if a patient is not able to repeat the information
accurately
•Ask the patient to teach back the information again, using
their own words, until you are comfortable they really
understand it
•If they still do not understand, consider other strategies
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Questions to Consider
• What are specific topics or directions you
commonly discuss with your patients that you
can use the teach-back method with?
Ideas: Insulin injections, inhalers, medication changes, chronic disease
self-care, colonoscopy prep
• How can you phrase your teach-back questions?
New Online Resource Developed
www.thehealthliteracyplace.org.uk
Thank You