Transcript Health Literacy

What the Heck is
Health Literacy?
Emily Beauregard, MPH
Health Planning Coordinator
Family Health Centers, Inc
Mary Beth Wright, RN, BSN
Patient/Family Nurse Clinician
Kosair Children’s Hospital
Objectives
• Define Health Literacy
• Discuss the Impact of Poor Health Literacy
• Discuss implementing best practice
methods for Health Literacy
– Teach Back/Show Back Method
• Discuss Health Literacy Kentucky
Do You Know What Critical
Public Health Issue…
• Can hit any population segment,
regardless or age, race, education or
income?
• Costs between $106 billion to $238 billion
of the U.S. personal health care
expenditures?
• Can’t be diagnosed by any new medical
technology and is not visible to the eye?
(3.)
The Answer
What is Health Literacy?
• The ability to read, understand, and act on
health information.
• It’s communication between patient and
provider.
• Not just how well a person can read.
Will Your Patient/Family Understand?
• When you are in respiratory distress or
have an asthma exacerbation, take two
inhalations of your bronchodilator (beta
agonist) immediately and if you don’t
improve call your physician or go to the
nearest emergency room.
Who is at Risk?
• Anyone regardless of age, race, education,
income or social class can be at risk for low
HEALTH literacy.
• Almost 9 out of 10 adults lack the skills needed
to manage their health and prevent disease.
• Some groups have a higher risk
(1)
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Ethnic minority groups
Older patients
Recent immigrants
People with chronic diseases
Low socioeconomic status
American Medical Association
Health Literacy Video
• http://www.youtube.com/watch?v=BgTuD7l7LG8&featur
e=related
Universal Precautions
• Just as clinicians should assume everyone
has an infectious disease, health care
providers should assume everyone has
difficulty processing and understanding
basic health information.
• In the Joint Commission’s sentinel event
database, 65% of the identified adverse
events have been found to have
communication failures as the underlying
root cause. How much of this was health
literacy problems?
Impact of Low Health Literacy
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Poor health outcomes
Needless patient suffering
Under-utilization of preventive services
Over-utilization of health services
Unnecessary health care cost
Limited effectiveness of treatment
Higher patient dissatisfaction
Higher provider frustration
To the Non-Health Care Professional
Outer Space
Same words – Different meaning
• What’s the color of your stools?
• The doctor did not see any growth on your
vocal cords. (Are they too small?)
• If you have an acute (a cute) attack take
your rescue medicine. (I don’t think attacks
are cute.)
• You have to be in Contact Isolation.
(Contacts are for eyes???)
• There is a disconnect between the
patient/family and the provider.
• What we think we are saying or asking is
not what they are understanding.
Start With What You Can Improve
• Do a Health Literacy Check on yourself.
• Are you using Plain Everyday Language?
• Are you providing easy to understand
written and verbal medical information?
• Are you allowing your patients/families to
have open an “ask me questions”
environment?
• Are you allowing a “Shame Free”
environment?
• INVOLVE THE PERSON
– Assess their needs – knowledge level, readiness to
learn, how they best learn
• Have the person work with you in the learning
process
– Each time you do the procedure, give the medicine,
go into the room – describe to the patient what you
are doing, explain all the steps.
– Keep these words in your mind –
• What does this patient/family need to know
• What does this patient/family need to do
• Stop asking – Do you understand?
• Instead ask –
– Tell me what you know about…. TEACH
BACK
– Show me how to do…. SHOW BACK
– Tell me what you are going to watch for…..
– Tell me what you are going to do when you go
home about …
• Stop asking – Do you have questions?
• Instead ask:
What questions do you have?
What are your concerns?
What do you want to go over together
again?
Improvements You Can Make
• Limit the use of medical language and define medical
language that is needed.
• Remember that even well educated people do not
understand the medical language.
• Keep it short and simple.
• Involve as many of the senses as possible.
– Use discussion
– Use written materials
– Use hands on as much as possible
– Use visuals – realistic medical equipment, charts,
graphs, dolls
Active Learning – Involve Person
Interesting statistics about retention of
learning. People usually remember:
• 10% of what we read
• 20% of what we hear
• 30% of what we see
• 50% of what we see and hear
• 70% of what we say
• 90% of what we say as we do
Best Way to Learn
Only Way to Evaluate
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Hands on doing the task/teaching yourself.
TEACH BACK and SHOW BACK.
Provide the education and then ask them to teach back.
Let them know you want them to TEACH BACK and/or
SHOW BACK to you to make sure you gave them the
best information to care for themselves at home.
• DO not place blame if they did not understand.
Rephrase your teaching and evaluate again.
Six steps to improve patient understanding
from the American Medical Assoc. (AMA)
• Limit the amount of information you give at one
time
• Slow down
• Avoid medical jargon
• Use pictures or models to explain important
concepts
• Check understanding with the “teach-back”show-back” technique
• Encourage patients/family to ask questions
Do A Health Literacy Check
On Your Work Place
• Think Plain Everyday Language
– Signage
– Forms
– Patient/Family education sheets
• Guidelines from American Medical Association say
written materials should be at 6th grade reading
level or below.
• Use simple non-medical language and define any
medical or technical terms you used
• Put most important points first
• Bulleted list are prefer over paragraphs
• Use headings and subheadings to separate text
• Use universal symbols and clear signage
• Use simple sentence structure
• Use active voice
• Use one or two syllable words
• Have good amount of empty or white space
• Use 12 font or larger
What Can We Improve With Good
Health Literacy?
• Patients who understand health care
information may
– Be more compliant with instructions including
medications
– Call back less often
– Visit the HCP less often
– Have fewer hospitalizations
– Have better health outcomes
– Have increased patient satisfaction
Best Practices at Family Health Centers
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Patient-approved handouts (6th grade level)
Health Literacy Committee
Monthly emails
Health literacy month
Best Practices at Kosair Children’s Hospital
Norton Healthcare
• Health Literacy taught in System Orientation
• Web Based Training on Medication Teaching
EVERY DOSE, EVERY TIME
• Education Response of TEACH BACK and/or
SHOW BACK on every patient teaching record
• Family Advisory Council
• Written materials approved using Health Literacy
Guidelines
Best Practices at Kosair Children’s Hospital
Best Practices at Kosair Children’s Hospital
What Can We Do To Improve
Health Literacy and Improve
Communication
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Increase awareness
Health Literacy KY Summit
Health Literacy KY Partnership
Talk the Talk where ever you go
Make good health communication a part of
your communication style
• Go Patient/Family Friendly- INVOLVE the
person
Useful Resources
• Health Literacy KY Partnership
• http://healthliteracyky.org/resources.htm
• Medline Plus
• http://www.nlm.nih.gov/medlineplus/
Good Health Literacy Saves Lives
It is the right thing to do!!!
Make sure your client understands what
you think
you told them
TEACH BACK/SHOW BACK
References
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Kutner M., Greenberg E., LJin Y and Paulsen C. The Health Literacy of American’s Adults: Results from 2003
National Assessment of Adult Literacy. U.S. Department of Education. Washington, DC: National Center for
Education Statistics. 2006
Williams MV, Parker RM, Baker DW, et al. Inadequate Functional Health Literacy Among Patients
at Two Public Hospitals. JAMA 1995 Dec 6; 274(21):1,677–82
Low Health Literacy: Implication for National Health Policy
Kirsch et al., “A First Look at the Results of the National Adult Literacy Survey” Nat’l Center for Education Statistics,
1993
Stedman L, Kaestle C. Literacy and Reading Performance in the US From 1880 to Present. In: Kaestle C, Editor.
Literacy in the US: Readers and Reading Since 1880. New Haven (CT): Yale University Press; 1991. P. 75–
128
Partnership for Clear Health Communication
Ask Me 3 Intervention – What is my main problem? What do I need to do? Why is it important for me to do this?
“What Did the Doctor Say?:” Improving Health Literacy to Protect Patient Safety – The Joint Commission White Paper
American Medical Association – Health Literacy