Transcript Examining the Factors that Impact Health Literacy in an Urban

Examining the Factors
that Impact Health Literacy
in an Urban Community
Presentation for the 12th Annual State of the State Conference
Cleveland, OH; March 15 – 16, 2007
Lucinda M. Deason, Ph.D.
Associate Professor
The University of Akron
[email protected]
Background
• Approximately 90 million American adults
have problems with understanding and
acting upon health information.
• In April of 2004, the Institute of Medicine
(IOM) released a report entitled, “Health
Literacy: A Prescription to End
Confusion.”
Background Cont’d
• The IOM’s report on health literacy found
that low health literacy adds as much as
$58 billion a year to health care and people
of all ages, ethnicities, income levels, and
educational levels are challenged by low
health literacy.
Health Literacy Definition
• Health literacy is a constellation of skills,
including the ability to perform basic
reading and numerical tasks required to
function in the health care environment.
• In various settings, patients with adequate
health literacy can read, understand and act
on health care information (Bresolin,
1999).
Health Literacy Definition Cont’d
• More specifically, 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 (National Library of Medicine,
2000).
Health Literacy Definition Cont’d
• There are numerous factors that influence
health literacy skills.
Health Literacy and
Health Behaviors
• Low health literacy has been linked with:
• Patients’ adherence to medical regimens
• Utilization of potentially life-saving
screenings,
• Poor patient-physician communication,
• Ability to understand prescriptions,
instructions, and consent forms,
• Participation in health promotion and disease
prevention activities
Health Literacy and
Health Behaviors Cont’d
• Ability to understand and use information on
food labels, and
• Self-management of chronic diseases.
Purpose of the Study
• The purpose of this study was to assess
health and social service professionals’
perceptions of the scope and nature of the
health literacy problems in an urban
community.
Methodology
• A total of 13 health and social service
professionals participated in 2 focus group
sessions.
• At the beginning of each focus group, the
facilitator, provided the participants with
the definition of health literacy provided in
a previous section of this presentation.
Methodology Cont’d
• After the definition of health literacy was
discussed, the facilitator then began posing
questions about the participants’ perceptions of
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The magnitude of low health literacy problems
among the clients/patients they served,
Encounters they had with clients/patients with low
health literacy skills,
How they determined if a client/patient had low
health literacy skills,
The types of issues that arose when a client had low
health literacy skills,
Methodology Cont’d
• What can be done to address the issues in
order to improve their clients’/patients’ health
literacy skills, and
• Whether or not there were some cultural
issues that facilitated or impeded helping to
improve their clients’/patients’ health literacy
skills.
Demographic Results
• The focus group participants represented forprofit, not-for-profit, public, medical, social
service and the faith-based organizations.
• Their respective organizations provided services
to 250 to well over hundreds of thousands of
clients/patients from ethnically diverse
backgrounds, including African Americans,
European Americans, Latino/Hispanic
Americans, and Middle Eastern/Arabic
Immigrants.
Results Cont’d
• Perceptions of the Magnitude of the Health
Literacy Problems
• The participants’ perceptions of the
magnitude of the health literacy problem in
this urban setting ranged from 30 – 80
percent of the clients/patients they served.
Results Cont’d
• Methods Used to Assess Low Health Literacy
Skills included:
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Asking clients/patients to identify the times for
taking their medications,
Asking clients/patients to restate the instructions that
were provided to them,
Being aware of when patients ask for information to
be read to them,
Patients failing to act on the information that was
provided to them, and
Patients’ inability to speak English.
Results Cont’d
• Encounters when Working with Individuals with
Low Health Literacy Skills included:
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Clients/patients trying to hide their low literacy skills,
Clients/patients wanting you to read things to them,
Depression and anxiety making it difficult for
clients/patients to understand health information and
comply with medication regimens.
Results Cont’d
• Issues that Arise when Working with Individuals
with Low Health Literacy Skills included:
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Accessing health insurance and medications,
Receiving poor health information,
Engaging in poor patient-physician communication,
Having a poor understanding of medication
interactions,
Not complying with medication regimens, and
Patients and providers lacking trust.
Results Cont’d
• Addressing Issues and Improving
Clients’/Patients’ Health Literacy Skills included:
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Work with clients/patients, physicians, health educators, and
community health workers,
Address issues related to the health care system,
“Empower them to change their position, find out what they
already know and give them information any way you can
(written, verbal, pictures, etc.)”,
“Go with clients/patients to their office visits and model
behavior that will empower them and improve their health
literacy skills”,
Build trust among clients/patients and providers, and
Train providers about health literacy issues.
Results Cont’d
• Barriers Preventing Improving Clients’/Patients’
Health Literacy Skills included:
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Physicians’ prejudices, biases, assumptions, stigmas,
stereotypes, and inflexibility,
Access to insurance and community programs,
Access to transportation,
Low income, and
Culture.
Results Cont’d
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Factors Facilitating Improving Clients’/Patients’ Health Literacy
Skills included:
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Establishing better communication between providers and patients,
Providing transportation,
Following up with clients/patients,
Involving the community,
Improving the referral system,
Making it mandatory for providers to speak fluent English,
Assisting in finding low cost healthy foods,
Teaching clients how to prepare healthy ethnic meals,
Teaching physicians how to listen to their patients, and
Allowing community health workers to advocate for their patients
at their doctor visits.
Results Cont’d
• Cultural Issues that Facilitate and Impede
Clients’/Patients’ Health Literacy Skills
included:
• “Cultural and linguistic competence are an
integral component for improving health
literacy…” and
• “Everyone should take time to try to
understand each other.”
Conclusion
• Based on the results of the two focus groups
facilitated in this urban setting, it is obvious that
low health literacy is a major issue.
• Many of the results of this study were consistent
with the literature.
• There are numerous issues that influence
clients’/patients’ health literacy skills.
• There are also some barriers and solutions that
should be considered when attempting to improve
health literacy skills.