Transcript Health numeracy powerpoint presentation

Health Numeracy
Strategies for Increasing Comprehension
Kate Murray
University of Minnesota School of Public Health
Intern, Minnesota Health Literacy Partnership
Brought to you by the
Minnesota Health Literacy Partnership
Activity 1: Pop Quiz!
Objectives
 Define health numeracy
 Learn how health numeracy can affect patients and
populations
 Gain understanding of how patients process data
 Learn strategies for using numbers (if at all!) in patient
communication
 Optional: Consider special cases involving numeracy,
such as risk communication and data visualization
What is health numeracy?
“Mathematical literacy as it relates to health.”
“Numeracy is an aspect of health literacy
that includes the quantitative skills
necessary to understand and act on
numerical directions given by health care
providers.”
- Journal of Asthma, “Asthma Numeracy Skill and Health Literacy”
What is health numeracy?
“Health numeracy is
the ability to access,
interpret, and use
quantitative information
to manage one’s
health.”
- Fairview Health Services
What is health numeracy?
Why health numeracy matters
Low numeracy is tied to:
 Shorter life expectancy
 Lower health outcomes overall
 Higher incidence of ER visits
 Higher hospital recidivism
 Poor medication adherence
 Poor chronic disease management
 Higher comorbidity
 Higher body mass index
Why health numeracy matters
 Direct relation to health disparities
 Emphasis on shared decision-making
 More quantitative information than ever
The scope of the problem
• Over half of U.S. adults have only basic or
below-basic number skills
• Math anxiety and health events further diminish
numeracy ability
• Elderly, less-educated, nonEnglish-speaking, and
those of low socioeconomic
status are at greater risk
How Patients Learn
How Patients Learn
Data: Friend or Foe?
Knowing when not to use numbers is just
as important as knowing how to use them
Reduce the cognitive burden
Focus instead on outcomes and actions
How Patients Learn
The “Curse of Knowledge”
Once we know
something, we find
it hard to imagine
what it was like not
knowing it!
How Patients Learn
Fuzzy-Trace Theory
Verbatim thinking – precise details and
facts. Quantitative.
Gist-based thinking – the bottom line.
Relational, categorical, intuitive. Also
subjective/based upon emotion, culture,
education, experience, world view.
How Patients Learn
Focus on bridging information and action
through gist-based messaging first.
If necessary, reinforce the
message carefully with data.
How Patients Learn
“Well Mr. Fischer, your systolic blood pressure is
150 and your diastolic is 95, indicating primary
hypertension. You’ll cut your risk of heart disease
by 50% if you can quit smoking. We could also
get you on 25 milligrams of beta-blockers once a
day. What do you think about that?”
How Patients Learn
“Well Mr. Fischer, your systolic blood pressure is
150 and your diastolic is 95, indicating primary
hypertension. You’ll cut your risk of heart disease
by 50% if you can quit smoking. We could also
get you on 25 milligrams of beta-blockers once a
day. What do you think about that?”
“Mr. Fischer, your blood pressure is high.
[pause] If you quit smoking, you can cut your
risk of heart disease in half. [pause] There are
also medications that can help.” [pause]
How Patients Learn
“Well Mr. Fischer, your systolic blood pressure is
150 and your diastolic is 95, indicating primary
hypertension. You’ll cut your risk of heart disease
by 50% if you can quit smoking. We could also
get you on 25 milligrams of beta-blockers once a
day. What do you think about that?”
“Mr. Fischer, your blood pressure is high. [go to
visual aid] If you quit smoking, you can cut your
risk of heart disease in half. [action plan] There
are also medications that can help.” [decision
aid]
Activity 2: Practicing the gist
Using Numbers with Patients
Using Numbers with Patients
Category
Basic
Examples
• Reading numbers
• Counting
• Telling time
Computational • Arithmetic operations
Analytical
• Ranges
• Frequencies & percentages
• Reading basic tables & graphs
Statistical
• Interpreting risk statements
• Reading complex graphs
• Comparing numbers on different scales
Using Numbers with Patients
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Increase knowledge
Instruct how to
Inform decision-making
Persuade/motivate
Using Numbers with Patients
Order
• Start with the most important information
• Put figures in logical order (such as by date or
alphabetically)
• Consider using descending order when “big”
equals “bad” or is the most important value
Using Numbers with Patients
Less is More
• Unpack complex concepts
• One idea at a time
• Keep pieces logical,
organized
• Underscore the gist of each piece
Using Numbers with Patients
Rounding and Denominators
• Round numbers are easier to understand,
compare, and recall
• Keep denominators consistent
Instead of this…
Use this…
78.64%
79%, or about 80%
1 in 10 vs. 1 in 5
1 in 10 vs. 2 in 10
Using Numbers with Patients
Do the Math
• Do the computations for the patient
• Suggest online tools and calculators
• Mark medicine cups and syringes
• Use pill cards
Using Numbers with Patients
Visual Aids and Cues
• Can clarify, reinforce, reframe
• Helpful for visual learners
• Visual analogies
• Highlight the most
relevant information
Using Numbers with Patients
Visual Aids and Cues
Use caution with
graphs, charts,
icon arrays, and
handouts!
Using Numbers with Patients
Narrative Support
• Context and reframing
• Links abstract to concrete
• Humanizes numbers
Using Numbers with Patients
Consider Cultural Differences
• U.S. Standard or metric
• Meanings and connotations
• Symbols
• Colors
Using Numbers with Patients
Plain Language
• Always advisable in health communication!
• Avoid technical and medical terminology
• Background information on a need-to-know
basis
plain
Using Numbers with Patients
Teach-back & Open-ended Questions
• Have them teach it back in their own words
• What will they tell their spouse/partner/etc.?
• Emphasize that this testing your abilities, not
theirs
• Avoid yes-or-no questions, especially, “Do you
understand?”
Activity 3: How should this
information be presented?
Visualizing Health Information
Visualizing Health Information
True or False?
Images like infographics are easier to understand
than a paragraph of plain text because pictures
don’t require literacy skills.
Visualizing Health Information
True or False?
Images like infographics are easier to understand
than a paragraph of plain text because pictures
don’t require literacy skills.
Visualizing Health Information
Document literacy: the ability to search,
comprehend, and use non-continuous texts
Reading a table requires:
• Understanding rows and column headings
• Selecting the right row + column of interest
• Locating the cell at that intersection
• Scanning up and down and back and forth
repeatedly
Visualizing Health Information
Simplify
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One message per graph
Fewer categories
Downplay the noise
White space is your friend!
Avoid embellishments
Visualizing Health Information
Clarify
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•
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Audience-appropriate
Order
Intuitive, consistent
Able to stand alone
Underscore the gist
Highlight or circle
Visualizing Health Information
Text
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Right-justify numbers
in tables
10-14 point fonts
Simple, no-frills font
Clear and concise
labels and legends
Title (who, what,
when)
Visualizing Health Information
Color
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White or subdued
background
Adequate contrast
Printer-friendly
Color-blind safe
Action colors
Visualizing Health Information
Choosing a Display Type
• Remember the “why”
• Underscore the gist!
• Use as a supplement
Visualizing Health Information
Pie and Donut Charts
• Displays related parts of
a whole (proportions)
• Good for highlighting
smallest/largest piece
• Adds up to 100%
• Variation: donut chart
Visualizing Health Information
Pie and Donut Charts
Do:
• Point the largest slice
at 12 o’clock
• Use short labels or a
legend
• Slices in clockwisedescending order
Don’t:
• Show >6 slices
Visualizing Health Information
Bar Graphs
• Show relative
differences/patterns
• Vertical: emphasize rise
and fall
• Horizontal: allows for
longer labels; may be
more intuitive
Visualizing Health Information
Bar Graphs
Do:
• Use 6 or fewer bars
• Select intervals, and
beginning/ending
values carefully
Don’t:
• Use overlays or
stacked bars
Visualizing Health Information
Line Graphs
• Great for showing trends
over time
• Effective for before and
after differences
• Obvious rising, falling,
and stasis of data
Visualizing Health Information
Line Graphs
Do:
• Use indicators to highlight
key events
• Use intervals and
beginning/ending values
that make sense
Don’t:
• Use >4 trend lines
• Add too much text/data
Visualizing Health Information
Icon Arrays (Pictographs)
• Great for probability data (absolute risk)
• Units can be counted, making them
easier to understand
• Shows parts-to-whole relationship
without percentages
• Can also use height cue
Visualizing Health Information
Icon Arrays (Pictographs)
Visualizing Health Information
Icon Arrays (Pictographs)
Do:
• Consider using people-shaped icons to
humanize the data
• Highlight the numerator
• Place icons adjacently
• Keep common denominators
between arrays
Visualizing Health Information
Icon Arrays (Pictographs)
Don’t:
• Use too many
colors or symbols
within one array
•
Crowd with text or
numbers
Activity 4: Which Graphic Is
Best?
Risk Communication
Risk Communication
• Eliminate all but the key information
• Round to whole numbers
• Start with the gist, then qualify with numbers
Risk Communication
• Use frequencies instead of percentages
• Keep denominators constant
• Use large denominators for small risks
Risk Communication
• Provide both positive and negative frames
• Keep timeframes constant
• Compare against a clear baseline
Risk Communication
Absolute or Relative Risk?
Relative risk:
“This treatment will reduce your
symptoms but it doubles the risk of
cancer.”
Risk Communication
Absolute or Relative Risk?
Relative risk:
“This treatment will reduce your
symptoms but it doubles the risk of
cancer.”
Absolute risk:
“With this treatment, your risk of cancer
will go from 1% to 2%.”
Risk Communication
• Dr. Brain J. Zikmund-Fisher
• Risk communication framework
• Possibility statements vs.
Probability statements
• “The right tool at the right time”
Risk Communication
If your goal is to:
Avoid surprise or regret for the patient
Decision example:
Seeking informed consent for a treatment with rare
complications
The patient will need a:
Possibility statement (instead of probability/stats)
Narrative Example:
“There is a small risk of hives with this medicine.”
Risk Communication
If your goal is to:
Emphasize a better treatment option or rank a set of
potential risks
Decision Example:
Choosing between medications of the same class
The patient will need a:
Relative possibility statement comparing options
Narrative Example:
“This birth control pill is as effective as the older
formula but has fewer side effects.”
Risk Communication
If your goal is to:
Motivate the patient to act or not act
Decision Example:
Categorical risk calculators
The patient will need a:
Possibility statement (not probability/stats) involving
categories or descriptors
Narrative Example:
“Robert is at above-average risk for diabetes.”
Risk Communication
If your goal is to:
Inform the patient of potentially high risks
Decision Example:
Treatment options based on patient’s preferences
The patient will need a:
Comparative possibility and/or probability statements
Narrative Example:
“The surgery has higher risk of complications, with
35% of patients experiencing erectile dysfunction.”
Risk Communication
If your goal is to:
Help the patient decide between treatments with
varying risks of serious outcomes
Decision Example:
Risk-reducing and secondary treatments
The patient will need a:
Compare precise or incremental probabilities
Narrative Example:
“If you follow this round of radiation with chemo, your
risk of the cancer spreading will go from 20% to
12%.”
Risk Communication
• Patients may have all of these needs at
different points in time
• It’s the communicator’s responsibility to
adjust their strategy
• Consider what the patient wants to know
• Less is more!
Questions? Comments?
Additional Resources
NIH Making Data Talk: A Workbook:
Key concepts, practical suggestions, and examples on
communicating health-related data to the public, policy
makers, and the media
cancer.gov/publications/health-communication
Minnesota Health Literacy Partnership:
Free resources to help educate individuals and health care
professionals about the importance of health literacy
healthliteracymn.org
Additional Resources
Health Literacy Out Loud:
Podcasts and articles about health literacy
healthliteracyoutloud.com
Centers for Disease Control and Prevention:
Toolkits and courses from the CDC and beyond
www.cdc.gov/healthliteracy/gettraining.html
Additional Resources
Federal plain language guidelines:
plainlanguage.gov
UnitedHealth Group:
Plain language glossaries in English and Spanish
justplainclear.com
Additional Resources
University of Michigan Risk Science Center:
Explore and make your own data visualizations
iconarray.com
vizhealth.org
Tools for selecting color schemes for graphics:
color-blindness.com (simulator)
colorbrewer2.org
Acknowledgements
Minnesota Health Literacy Partnership
healthliteracymn.org
Minnesota Literacy Council
mnliteracy.org
Minnesota Hospital Association
Patient and Family Advisory Council
mnhospitals.org
Acknowledgements
Community Health Initiative | U of M
diversity.umn.edu/bced/chi
Made possible by a grant from
Medica
Very special thanks to
Alisha Ellwood Odhiambo
Chairperson, MHLP
Thank you!
Kate Murray
University of Minnesota School of Public Health
Intern, Minnesota Health Literacy Partnership
Brought to you by the
Minnesota Health Literacy Partnership