Transcript Developing Easy-to-Read Patient Education Materials

Health Literacy and the Provider/System
Role in Improving Communication and
Reducing Bias
Jonathan B. VanGeest, PhD
Department of Health Policy and Management
College of Public Health
Kent State University
Diversity Rx Eighth National Conference on Quality Health Care for Culturally Diverse Populations
Health Literacy Is…
“The degree to which individuals have the capacity to obtain,
process, and understand basic health information and services
needed to make appropriate health decisions.”
Not simply a patient problem
– One with implications for quality shared by the provider, healthcare
system, and community in partnership with the patient
– Implications for treatment as well as disease prevention/health
promotion
A Crosscutting Factor Impacting the
Delivery of Health Care
• Access to care
– Preventive service use, participation
in medical decision-making, reduced
adherence
• Worse health outcomes
– Self reported health status/QOL, risk
behaviors, mortality, poor health
outcomes (multiple indicators), risk of
medical error, etc.
– A stronger predictor of health than
age, SES, education level, and race
(Weiss, 2007)
Addressing Health Literacy
• Risk populations:
– Racial and ethnic minorities, the elderly, immigrant populations, poor
• Health communication occurs in a social context
• Provider-patient interaction shaped by their differing social
roles and their different needs
• Power differential – Expert Authority/Patient vulnerability
• Physician power and patient weakness make the physicianpatient relationship necessarily a fiduciary one
– Greater burden on the clinician to improve communication and
ensure patient understanding (Lee, Arozullah & Cho, 2003)
Challenges
•
•
Most patient instructions are written
Verbal instructions
– Often complex, delivered rapidly
– Easy to forget in stressful situation
•
Increasingly complex health system
– More medications, tests and procedures
– Greater self-care requirements
– Participatory/informed decision-making
•
Disease prevention/health promotion messages
• Clinicians often unaware of patient’s health literacy
• Unable to tailor the clinical encounter to the needs of patients
• Initially identified solely as a patient deficit/education issue
Universal Precautions
• Use simple, everyday language
• Stick to a 2-3 key points
• Draw pictures, write down key instructions
for patients to take home
• Effectively solicit questions:
“What questions do you have?”
• Ask patients to “teach-back” the main points
to confirm understanding
Contrasted with more targeted
interventions to improve health
communication
http://ahrq.gov/qual/literacy
Applications of Best Practices
• Recommended strategies to
improve communication
have been tried by
physicians, nurses, and
pharmacists, but are not
yet routinely incorporated
into clinical practice
(Schwartzburg, Cowett, VanGeest, & Wolf, 2007)
Clinician Role
• Identifying patients at risk due to low health literacy is
productive
– Health behaviors such as correct medication use and preventive
measures (e.g., exercise, smoking cessation) are improved when
patients with LHL were given visual aids, easy readability
brochures or videotapes
– Teach back validated as a technique to improve communication
• Practical assessment tools now available that can be
completed in the clinical setting
– Tailoring communication to meet the needs of at-risk patients
– Improved application of established best practices
• Patient Centered Care
– Improved quality and reduction of disparities
System Role
• A health literate organization makes it easier for people to
navigate, understand, and use information and services to
take care of their health (Brach et al. 2012)
– Most HL research has focused on characterizing patients’ deficits,
how best to measure a patient’s health literacy, and on clarifying
relationships between a limited health literacy and outcomes
– Growing appreciation that health literacy represents a balance
between individuals' health literacy skill and the demands and
attributes of the healthcare system
– Interest and commitment from multiple stakeholders to address
system-level factors contributing to the high literacy demands of
the healthcare system
Health Literacy Policy Roundtable
http://iom.edu/~/media/Files/PerspectivesFiles/2012/DiscussionPapers/BPH_Ten_HLit_Attributes.pdf
Slide: Schillinger, 2012
CDC Health Literacy Planning Tool
Tool available from CDC’s health
literacy site
Slide: Schillinger, 2012
Pharmacy HL Assessment Tool
Available from the AHRQ
Pharmacy Health Literacy Center
Slide: Schillinger, 2012
Goals
• The Institute of Medicine states that "efforts to improve
quality, reduce costs, and reduce disparities cannot
succeed without simultaneous improvements in health
literacy" (IOM, 2004)
–
An "under-recognized silent epidemic to an issue of health policy
and reform"
• Not just clinicians – Receptionists should teach back
appointment times, billing clerks should break down the
steps patients have to take to be reimbursed by insurers,
etc.
• Patient Empowerment – the second half of the HL
definition
Reducing Health Literacy Demands
References
Brach, C., Dreyer, B., Schyve, P., et al. (2012). Attributes of a Health Literate Organization. Washington,
D.C.: The National Academies Press. Retrieved from http://www.iom.edu/~/media/Files/PerspectivesFiles/2012/Discussion-Papers/BPH_HLit_Attributes.pdf.
Lee, S.Y., Arozullah, A.M., & Cho, Y.I. (2004). Health literacy, social support, and health: A research
agenda. Social Science and Medicine, 58, (7):1309-1321.
Nielsen-Bohlman, L., Panzer, A.M., & Kindig, D.A. (Eds). (2004). Health Literacy: A Prescription to End
Confusion. Washington, D.C.: The National Academies Press.
Schillinger, D. (2012). The other side of the coin: 10 attributes of “health literate” healthcare
organizations. San Francisco, CA: Presentation at the 2012 Annual Meeting of the American Public
Health Association.
Schwartzberg, J.G., Cowett, A., VanGeest, J., & Wolf, M.S. (2007). Communication techniques for patients
with low health literacy: A survey of physicians, nurses and pharmacists. American Journal of Health
Behavior, 31 (Suppl 1), S96-104.
Weiss, B.D. (2007). Health Literacy and Patient Safety: Help Patients Understand (2nd edition). Chicago,
IL: AMA Foundation. Retrieved from http://www.amaassn.org/ama1/pub/upload/mm/367/healthlitclinicians.pdf