Transcript 2012_Oct_ Health Literacy_final_10-18-12

The Importance of Health Literacy:
What Can You Do?
Facilitator:
Barbara Boshard, MS, RN, NQC Consultant
Presenters:
Lucy Graham, St. Mary's Family Medicine, Grand Junction, CO
Eileen Sheridan Malone & Altricia Belk,
John Hopkins Medical Center High Risk OB Clinic
Evelyn Bradley, DrPH, BCDH, Baltimore, MD, NQC Fellow
Thursday, October 18, 2012
Funded by HRSA
HIV/AIDS Bureau
Welcome, Participation Guidelines &
Overview
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[email protected]
Funded by HRSA
HIV/AIDS Bureau
Welcome, Participation Guidelines &
Overview
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HIV/AIDS Bureau
Learning Objectives
• Define health literacy
• Discuss health literacy alignment with national health
trends and Ryan White core values
• Identify key components and tools of a health literacy
environment assessment
• Share a simple health literacy assessment tool
• Share information on health literacy tools for
medication adherence
• Introduce multi-media programs as patient education
tools
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National Quality Center (NQC)
Agenda – October 18, 2012
3:00 – 4:30 p.m. EDT
3:00
3:05
3:15
3:25
3:35
3:50
4:15
4:25
4:30
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Welcome and Introductions
Health Literacy (HL), National Trends, Core Values
What is a Health Literacy Environment Assessment?
Using a Simple Health Literacy Assessment Tool - Lucy
Graham
Sharing our Experiences with the “Taking Medicine on Time
Tool” – Eileen Sheridan Malone &/or Altricia Belk
Using Multimedia Programs to Improve Health Literacy Evelyn Bradley
Discussion, Q&A
Evaluation
Adjourn
National Quality Center (NQC)
Health Literacy Broadly Defined
• Health literacy is the ability to obtain, process,
and understand health information to make
informed decisions about health care
(BJ’s Mnemonic – Oh!PU!)
http://nnlm.gov/outreach/consumer/hlthlit.html
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National Quality Center (NQC)
What are Components of Health Literacy?
Getting to the Specifics
• Health literacy includes the ability to
understand instructions on prescription drug
bottles, appointment slips, medical education
brochures, doctor's directions and consent
forms, and the ability to negotiate complex
health care systems. Health literacy is not
simply the ability to read. It requires a
complex group of reading, listening,
analytical, and decision-making skills, and the
ability to apply these skills to health
situations.
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•
http://nnlm.gov/outreach/consumer/hlthlit.html
National Quality Center (NQC)
Intersection of Health Literacy
and Cultural Competency
• Cultural competency is the ability of health
organizations and practitioners to recognize
the cultural beliefs, values, attitudes,
traditions, language preferences, and health
practices of diverse populations, and to apply
that knowledge to produce a positive health
outcome. Competency includes
communicating in a manner that is
linguistically and culturally appropriate.
http://www.health.gov/communication/literacy/guickquide/factsbasic
.htm
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National Quality Center (NQC)
Extent of the Problem
• Nearly 9 out of 10 adults have difficulty using
the everyday health information that is
routinely available
• Most at risk
 Older adults
 Racial/ethnic minorities
 People with less than high school education
 People with low income levels
 Non-native speakers
 People with compromised health status
http://www.cdc.gov/healthliteracy/Learn/index.html
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National Quality Center (NQC)
Health Literacy - Improved Outcomes
•
•
•
•
Increase preventive screenings
Improve management of chronic disease
Improve health status self-report
Decrease health care costs
 Decrease hospitalizations & ER use
• Decrease stigma and shame
http://www.health.gov/communication/literacy/quickguide/factslitera
cy.htm
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National Quality Center (NQC)
Drivers of Health Literacy Focus
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National Quality Center (NQC)
Patient Protection and Affordable Care
Act 2010
• The degree to which an individual has the
capacity to
 obtain,
 communicate,
 process, and;
 understand basic health information and services,
• to make appropriate health decisions.
http://www.cdc.gov/healthliteracy/Learn/index.html
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National Quality Center (NQC)
Ryan White Care Act – PL 111-87
• Identify individuals with HIV/AIDS who do not
know their status
• Help them seek medical services
• Reduce barriers to routine testing
• Reduce disparities in access to services for
minorities and underserved communities
• Promote consumer involvement
• Ensure access to effective care
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National Quality Center (NQC)
National HIV/AIDS Strategy
• Reduce the number of people who become
infected with HIV
• Increase access to care and improve
outcomes for PLWHA
• Reduce HIV-related disparities
http://hab.hrsa.gov/newspublications/careaction
newsletter/may2012careaction.pdf
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National Quality Center (NQC)
Healthy People 2020
 Improve the health literacy of the population
 Increase the proportion of persons who report that
their health care providers have satisfactory
communication skills
 Increase the proportion of persons who report that
their health care providers always involved them in
decisions about their health care as much as they
wanted
http://healthypeople.gov/2020/topicsobjectives2020/objectivesli
st.aspx?topicId=18
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National Quality Center (NQC)
FFATA - P.L. 110-252
• The Federal Funding Accountability and
Transparency Act (FFATA) was signed on
September 26, 2006. The intent is to
empower every American with the ability to
hold the government accountable for each
spending decision. The end result is to
reduce wasteful spending in the government.
https://www.fsrs.gov/
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National Quality Center (NQC)
Other National Trends Impacting HL
• Patient Centered Medical Home
• American Medical Association Foundation
 It is a patient right to understand their disease.
 “Health Literacy and Patient Safety: Help Patients Understand –
Manual for Clinicians.” Barry Weiss, MD, University of Arizona,
College of Medicine.
• Joint Commission Public Policy Initiative
 “What did the Doctor say?”
 E.g. “Make effective communication an organizational priority.”
• Public Law 102-73 – The National Literacy Act of 1991
• Plain Writing Act of 2010 - http://www.plainlanguage.gov/plLaw/index.cfm
• National Action Plan on Health Literacy 2010 http://www.health.gov/communication/hlactionplan/pdf/Health_Lit_Action_Plan_Summary.pdf
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National Quality Center (NQC)
LOOKING AT HEALTH LITERACY IN
A BROADER CONTEXT
Environment
Program
Patient
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National Quality Center (NQC)
Health Literacy Environment
The health literacy environment of a healthcare
organization is the extent to which
communication structures and processes
facilitate access to the information patients
need to manage and make decisions about
their health.”
-Evelyn Bradley, DrPH, BCDH
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National Quality Center (NQC)
Health Literacy Environment:
A Summary of findings by Rima Rudd and
Jennie Anderson
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National Quality Center (NQC)
Components of the Health Literacy Environment
1.
2.
3.
4.
5.
Navigation
Print Communication
Oral Exchange
Technology
Policies and Protocols
Rudd RE, Anderson JE. 2007. The Health Literacy Environment of Hospitals and Health Centers. Partners for Action: Making
Your Healthcare Facility Literacy-Friendly. Cambridge MA: National Center for the Study of Adult Learning and
Literacy. Also on line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p. i., p.7.
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National Quality Center (NQC)
Navigation
1. Navigation
• Telephone system
• Entrance
• Lobby
• Staff Assistance
• Hallways: Navigation Ease
• Services and Specialty Areas (Medical Records,
Pharmacy, MRI, etc.).
Rudd RE, Anderson JE. 2007. The Health Literacy Environment of Hospitals and Health Centers. Partners for Action: Making Your
Healthcare Facility Literacy-Friendly. Cambridge MA: National Center for the Study of Adult Learning and Literacy. Also on line at:
www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p.9-12.
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National Quality Center (NQC)
Print Communication
2. Print Communication
• Community relations
• Notifications (i.e. follow up)
• Patient/client orientation
• Patient education materials
• Patient forms
• Legal Materials
• Discharge preparation
Rudd RE, Anderson JE. 2007. The Health Literacy Environment of Hospitals and Health Centers. Partners for Action: Making
Your Healthcare Facility Literacy-Friendly. Cambridge MA: National Center for the Study of Adult Learning and
Literacy. Also on line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p.13-16.
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National Quality Center (NQC)
Print Communication cont’d.
• Materials assessed for:
• Writing Style
• Organization and Design
• Type style, Size of Print, and Contrast with Paper
• Photographs, Illustrations, Symbols and Diversity
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National Quality Center (NQC)
Oral Exchange & Technology
3. Oral Exchange
•
•
staff communication
multilingual providers/translation services
4. Technology
•
•
•
•
Televisions
Telephones
Computers
Kiosks
Rudd RE, Anderson JE. 2007. The Health Literacy Environment of Hospitals and Health Centers. Partners for
Action: Making Your Healthcare Facility Literacy-Friendly. Cambridge MA: National Center for the Study
of Adult Learning and Literacy. Also on line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net.
p.17-20.
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National Quality Center (NQC)
Policies & Protocols
5. Policies & Protocols
•
Use of Print
• Oral Exchange
• Staff Orientation
• Staff Skills Building (print communication and oral
exchange)
Rudd RE, Anderson JE. 2007. The Health Literacy Environment of Hospitals and Health Centers. Partners for Action:
Making Your Healthcare Facility Literacy-Friendly. Cambridge MA: National Center for the Study of Adult Learning
and Literacy. Also on line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p.21-24.
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National Quality Center (NQC)
How do we assess the health care
program for Health Literacy?
SCREENING
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National Quality Center (NQC)
Screening Tool
• Rudd & Anderson’s “The Health Literacy Environment of Hospitals
and Health Centers”
 Section II: “The Health Literacy Environment Review”
• Provides rating system for various components of health care
environment, as well as a score calculator and ways to
interpret score
• Appropriate organizational assessment tool questions
 Appendix II: Needs Assessment Tools
• Activities to sensitize health care workers to literacy related
barriers (i.e.- telephone assessment, walking interview,
materials assessment tools)
• Appropriate as a “self-assessment” tool
http://www.hsph.harvard.edu/healthliteracy/files/healthliteracyenvironment.pdf
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National Quality Center (NQC)
Rating Scale Example: Oral Exchange
Rudd RE, Anderson JE. 2007. The Health Literacy Environment of Hospitals and Health Centers. Partners for Action: Making
Your Healthcare Facility Literacy-Friendly. Cambridge MA: National Center for the Study of Adult Learning and Literacy. Also on
line at: www.hsph.harvard.edu/healthliteracy and www.ncsall.net. p.17-18.
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National Quality Center (NQC)
Example - Results and Follow-Up
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National Quality Center (NQC)
Lucy Graham – St. Mary's Family Medicine, Grand Junction, CO
I SCREAM, YOU SCREAM, WE
ALL SCREAM FOR ICE CREAM
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National Quality Center (NQC)
Why read an ice cream label?
Lucy Graham, RN, MPH, St. Mary’s Family Medicine, Grand Junction, Colorado
• 3 minutes to administer
• Easy to document
• Validated tool in English and
Spanish
• Assesses
 Prose literacy
 Numeracy
 Document literacy
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National Quality Center (NQC)
The Newest Vital Sign (Pfizer, Inc)
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National Quality Center (NQC)
Score Sheet for the Newest Vital Sign
Questions and Answers READ TO SUBJECT: This information is on the back of a container of a pint
of ice cream.
1. If you eat the entire container, how many calories will you eat?
Answer: 1,000 is the only correct answer
2. If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice cream could you have?
Answer: Any of the following is correct: 1 cup (or any amount up to 1 cup), half the container. Note: If patient answers “two
servings,” ask “How much ice cream would that be if you were to measure it into a bowl?”
3. Your doctor advises you to reduce the amount of saturated fat in your diet. You usually have 42 g of saturated fat each day,
which includes one serving of ice cream. If you stop eating ice cream, how many grams of saturated fat would you be
consuming each day?
Answer: 33 is the only correct answer
4. If you usually eat 2,500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one
serving?
Answer: 10% is the only correct answer
READ TO SUBJECT: Pretend that you are allergic to the following substances: penicillin, peanuts, latex gloves, and
bee stings.
5. Is it safe for you to eat this ice cream?
Answer: No
6. (Ask only if the patient responds “no” to question 5): Why not?
Answer: Because it has peanut oil.
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National Quality Center (NQC)
Interpretation
• Number of correct answers: Tally up ‘Yes’
answers
 Score of 0-1 suggests high likelihood (50% or
more) of limited literacy.
 Score of 2-3 indicates the possibility of limited
literacy.
 Score of 4-6 almost always indicates adequate
literacy.
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National Quality Center (NQC)
How St. Mary’s HIV Clinic Uses Results
• Health literacy assessed
once ever.
• Score of <=3, patient to
receive intervention.
• Intervention = Teach back.
Goal is teach back done at
end of each medical
appointment.
• Started using teach back
consistently in August 2011.
2012 will be first full year of
data for complete HIVQUAL
health literacy measure.
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National Quality Center (NQC)
Ice Cream Tool Discussion Questions
• How do you feel about this tool?
• How easy would it be to incorporate this tool
into your clinic?
• How likely is it that you would use this tool?
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National Quality Center (NQC)
Eileen Sheridan Malone
&
Altricia Belk
John Hopkins Medical Center High Risk OB Clinic
USING A SIMPLE HEALTH LITERACY
TOOL FOR TAKING MEDICATIONS ON
TIME
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National Quality Center (NQC)
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
•Lack of adherence has grave consequences for pregnant women
with HIV and their babies.
•Working with Evelyn as part of an NQC Fellowship, we participated in
a quality assurance pilot to increase adherence by:
•Communicating the importance of adherence using a graphic and plain
language educational tool “Take Your HIV Medicine On Time Every
Day--original source, Lidia Barakat, MD
•Showing clients their progress using a CD4/Viral Load Chart—source,
Queen Anne’s County Health Department
•Providing a pill card showing exactly which medications should be
taken…when and how-- original source, AHRQ Health Literacy Tool Kit
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National Quality Center (NQC)
The CD4 T cells in your body are like a factory, making
things that protect you from infection.
CD4-T
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But HIV is a clever virus.
HIV
CD4-T
It hijacks your good CD4 T cells, and turns them into an HIV factory.
Then you get a lot of HIV (a big Viral Load).
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Your HIV medicine stops that HIV factory!
HIV
HIV Medicine
CD4T
When you swallow HIV pills, they go from your mouth to
your stomach, then into your blood to defend your CD4-T
cells. Your HIV medicine protect your CD4 cells from
HIV…like an umbrella protects you from the rain.
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If you take your medicine ON TIME and EVERY DAY, you
keep enough medicine in your blood to defend you, and you will
usually feel better.
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But if you don’t take your HIV medicine ON TIME and
EVERY DAY, there is not enough medicine in your blood.
The HIV gets around the medicine.
HIV
Medicine
CD4-T
The HIV factory starts up again.
Your HIV is now resistant to your medicines, and your doctor
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will look for other medicines.
The new medicines may
be hard on you,
And you and your doctor may
run out of medicines that work.
?
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Also, your baby may be born with HIV.
A lot of sickness comes with HIV.
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Sample Pill Card—site for template:
http://www.ahrq.gov/qual/pillcard/pillcard.htm
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
ASSESSING IMPACT
•For each of the adherence interventions we had data collection tools,
asking a few brief questions before and after exposure to interventions.
•The data collection tools also support “teach-back.” For example, we
asked five questions before and after showing Take Your HIV Med…:
•Can you think of two reasons why it is important for you health for you to
take your HIV medicine on time and every day?
•Can you tell me in your own words what a CD4 T-cell is?
•Is it better to have more CD4 cells or fewer CD4 cells?
•Can you tell me in your own words what viral load means?
•Is it better to have a higher viral load or a lower one?
•Following the post- questions, we went over any errors.
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National Quality Center (NQC)
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
PROCESS
•The adherence tools were worked in with other components of
our adherence program: 1) identifying barriers to adherence, 2)
setting up cell phone reminders, 3) phone calls, 4) home visits.
•We work as a team, with one person responsible for note
taking and preparing materials, the other presenting the
materials.
•The patients have our undivided attention…a quiet, private,
neat room, with flowers and no distractions…time for
questions.
•At the client’s first visit we 1) ask pre-questions, 2) show Take
Your HIV Medicine…, and 3) ask post-questions, 4) send home
a copy of Take Your HIV Medicine…
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National Quality Center (NQC)
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
PROCESS (CONT)
•At the second visit, we ask follow-up questions (Did you
review the materials we sent home with you? Have you been
adherent?) and introduce the CD4/VL chart. By then we have
two CD4 and VL data points to show progress.
•We found that covering the 2 interventions (Take Your HIV
Medicine… and the CD4/VL chart) including the data
collection/teach-back takes 10-15 minutes.
•Although we liked the pill card and had hoped to pilot it, due
to staffing and patient visit time, we did not. It takes time to
prepare the card for each client, and we did not want to
overwhelm clients with TMI.
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National Quality Center (NQC)
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
Observations
•Many clients did not know all of the basic information included in
Take Your HIV Medicine on time and Every Day (e.g. CD4 and VL).
•The cartoons and simple words in that presentation were an
effective way to communicate basic information.
•Clients needed to understand WHY it is so important to take HIV
medicine every day and on time.
•Clients like to watch their VL values drop.
•Clients appreciate the materials. For many it seems to be new
knowledge (e.g. keeping medication blood level even).
•Clients are very excited when they see (on the CD4/VL chart) that
their lab values are improving.
•Follow-up needed…are adherence results temporary, reflecting
concern for baby? Will they continue?
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National Quality Center (NQC)
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
RESULTS OF HEALTH LITERACY TOOL PILOT – PART 1
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
Pre-test and Post-test-teach-back questions. For fourteen (14) clients,
there are both pre- and post- exposure responses to questions about
messages in “Take Your HIV Medicine on Time and Every Day.” There
were 6 possible responses per client.
• Pre-exposure, clients provided 71 out of 84 possible correct answers.
• Post-exposure, clients provided 82 out of 84 correct answers.
Case Manager Observations:
Pre-exposure responses are frequently correct, which does not expose the
depth of some client’s pre-exposure misunderstanding of basic HIV
knowledge (e.g. mix up CD4 and Viral Load), nor lack of understanding
about WHY it is important to take medicine on-time and every day.
Case Managers will continue to use post-exposure questions for
discussion with the client, even after the pilot is over, to ensure that the
client really understands the material.
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National Quality Center (NQC)
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
RESULTS OF HEALTH LITERACY TOOL PILOT – PART 2
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
Data Part 2: Changes in lab values pre- to post-exposure.
“Most recent” lab values are
generally very recent (August or September of 2012). “Months elapsed” are between exposure to the
presentation (Take Your HIV Medicine on Time and Every Day) and the most recent labs.
Pre-exposure CD4* Most Recent CD4 Pre-exposure VL*
Most Recent VL
Months elapsed
600 807
U** U
2
525 614
1,000 U
5
700 793
U U
4
375 544
U U
1
50 528
50,000 U
6
428 437
U U
3
625 856
4,000 183
6
650 683
U U
3
475 654
4,000 U
1
575 662
2,000 67
2
650 662
30,000 21,296
1
600 718
400 227
1
*Pre-exposure numbers are approximate as they were taken from the CD4/VL chart. Post-exposure
numbers are from lab reports ** U=Undetectable
Case Manager Observations:

The interventions contributed to improvements in clients’ attentiveness to their medications.
Other factors contributing to improved lab values include: 1) several clients started ARVs after
they entered the HIV-OB clinic, and 2) clients’ concern for their unborn children influenced them
to be more adherent.
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National Quality Center (NQC)
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
RESULTS OF HEALTH LITERACY TOOL PILOT
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
Client Observations
• All but one client exposed to the two
interventions found them to be informative. Most
took a compressed version of the presentation, and
their individual CD4/VL chart home with them, and
many reported reviewing them at home. Almost all
reported no missed doses at their next visit.
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National Quality Center (NQC)
PILOT—PLAIN LANGUAGE ADHERENCE TOOLS
Eileen Sheridan-Malone and Altricia Belk, Johns Hopkins Medical Center High-Risk OB Clinic
Recommendations:
•The tools are valuable assets to clients’ understanding HIV and
subsequent adherence. We recommend their use.
•Obtain date of diagnosis…we saw that a number of people had
been HIV+ for quite a while, but still did not have even basic
understanding of HIV—for example of the difference between a
CD4 and Viral Load.
•It would be good to track clients’ results (CD4/VL) over a longer
time frame. We see them for a maximum of 9 months, as they
leave our clinic once they deliver.
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National Quality Center (NQC)
Evelyn Bradley – Baltimore City Health Department
USING MULTIMEDIA TO
IMPROVE HEALTH LITERACY
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National Quality Center (NQC)
MULTIMEDIA EDUCATION TOOLS FOR SELF-MANAGEMENT
Evelyn Bradley, Baltimore City Health Department
•Multimedia education programs (MMEP) use a variety of media to
communicate educational information
•Live actors
•Pictures
•Text
•Sound
•Animation
•Teach-back questions
•MMEPs are effective health education tools…for people with
varied literacy skill levels.
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National Quality Center (NQC)
MULTIMEDIA EDUCATION TOOLS FOR SELF-MANAGEMENT
Evelyn Bradley, Baltimore City Health Department
•Research showed that exposure to a plain language diabetes
MMEP increased patients’ understanding of diabetes…no matter
what their literacy competence.
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National Quality Center (NQC)
Knowledge improvement based on
exposure to diabetes MMEP
Questions
answered
correctly
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12.6
14
12
10
7.5
10
6.5
8
Before
After
4.3
6
2.6
4
2
0
Inadequate Literacy
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Marginal Literacy
Adequate Literacy
National Quality Center (NQC)
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MULTIMEDIA EDUCATION TOOLS FOR SELF-MANAGEMENT
Evelyn Bradley, Baltimore City Health Department
•As part of a NQC Fellowship, I looked for a comparable HIV MMEP.
•I found some materials, but not an HIV MMEP that had it all!
•Plain language
•Effective media per message
•Teach-back
•Navigation for “just in time” learning
•Brief (maximum 5-7 minutes)
•Comprehensive
•So I started to design an MMEP for HIV.
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National Quality Center (NQC)
MULTIMEDIA EDUCATION TOOLS FOR SELF-MANAGEMENT
Evelyn Bradley, Baltimore City Health Department
•The diabetes researchers started by identifying 17 key messages
people needed to understand the disease. I read HIV health
education materials, and identified 400 messages given to PLWH/A.
•A dozen motivated experts convened in February…PLWH/A, HIV
PMC providers, educators, health literacy professors, and media
experts, who provided feedback on:
•Key HIV messages
•The most effective media
•To explain the HIV MMEP to prospective funders, I developed
storyboards: graphic illustrations of proposed content.
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National Quality Center (NQC)
MULTIMEDIA EDUCATION TOOLS FOR SELF-MANAGEMENT
Evelyn Bradley, Baltimore City Health Department
HIV MMEP Structure—10 Segments or “clips”
HIV and Me*
New to HIV*
HIV-Positive*
•How People Get HIV*
•HIV in the Body*
•How HIV Medication Works*
•Managing HIV*
•HIV and Real Life*
*Starred segments have storyboards
•Untreated HIV
•HIV Disclosure
Index—list of clips, with links
Resources—list of resources, with links
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National Quality Center (NQC)
SAMPLE: HOW HIV MEDICATION WORKS
Your blood has many tiny cells. Cells have different
jobs. Most cells build things your body needs.
Immune system cells defend your body. They destroy
invaders. CD4-T cells are immune system cells.
Animation:
•Human body
•Zoom in on bloodstream with red and white blood cells
•Zoom in on one CD4 cell
HIV Clip List—
Resources
• The short story is that
•First the HIV virus invades the CD4-T cell.
• Then HIV takes over the CD4-T cell.
• Next HIV uses the CD4-T cell to make HIV
copies.
• HIV copies itself in four steps
• Finally, HIV kills the CD4/T cell.
•Lets see how
HIV Virus
1
“Attack the
virus”
messages
First step…HIV breaks into the CD4-T cell, using a chemical key.
2
“Attack the
virus”
messages
Second step…HIV uses a chemical disguise to look like a friend, so
the cell’s workshop…like a kitchen…lets it in.
3
“Attack the
virus”
messages
Third step. HIV uses the cell’s kitchen to make more HIV. HIV uses a
chemical helper.
4
Fourth step…HIV uses a chemical packager so new HIV cells
are ready to go out and make more copies.
Then HIV kills the CD4-T cell
Human
Immunodeficiency
Virus
That’s why this virus is called the Human Immunodeficiency Virus-HIV. It’s a Virus that destroys Humans’ Immune systems.
• It’s bad if HIV is not controlled by medication. HIV uses your
CD4/T defenders to make copies of itself, then kills them
• Soon your defender army is defeated
• You are defenseless against other invaders like:
• Cancers
• Other viruses
• Fungus
• Pneumonia
Animation:
• Zoom out to the blood stream, again
• Lots of HIV is attacking and destroying CD4 –T cells
• Animations of OI’s show as they are named
• Zoom out further to show person lying in bed looking really
sick.
•Good news. There is medication that helps.
Animation:
• Zoom in past the blood stream to the CD4-T cell level
1
When HIV tries to breaks into the CD4/T cell using a chemical key,
some HIV medications change the lock so HIV can’t get in.
2
When HIV uses a chemical to look like a friend, some HIV medications tear
off the disguise. The door stays closed
3
When HIV tries uses the cell’s kitchen to copy itself, some HIV
medications destroy the chemical helper
4
When HIV tries to package the HIV cells, some HIV medications stop
the packager.
Medication combos work best. They stop several steps. They are called
HAART. “HAART” stands for:
Highly
Active
AntiRetroviral
Therapy
HAART
HAART medications use several ways to stop HIV.
Take your medication ON TIME and EVERY DAY!
Keep enough medication in your blood all the time.
You will feel better.
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medication
CD4-T
HIV
What if you don’t take your HIV medication ON TIME and EVERY DAY?
There is not enough medication in your blood. The HIV can resist your
medication—the medication stops working. The HIV makes more copies.
Your doctor has to look for other HIV medication.
82
?
The new medications may be
hard on you.
You and your doctor may run out
of medications that work.
83
If your HIV medication makes you feel sick, go to the doctor. There may be
medication for the sick feeling. Or a different HIV medication may work
better.
What if you take too much HIV medication? You can feel sick
from too much medication. And it doesn’t work any better!
85
Unless you and your doctor keep the HIV under control, it
destroys your body’s defenders. Cancers, pneumonias,
fungus, and even common flu can knock you out.
MULTIMEDIA EDUCATION TOOLS FOR SELF-MANAGEMENT
Evelyn Bradley, Baltimore City Health Department
•Do you think a MMEP will help your clients?
•Suggestions?
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National Quality Center (NQC)
MULTIMEDIA EDUCATION TOOLS FOR SELF-MANAGEMENT
Evelyn Bradley, Baltimore City Health Department
•The article on the diabetes study can be found here:
Kanula, Namratha et al, The relationship between health literacy and
knowledge improvement after a multimedia type 2 diabetes education
program, Patient Education and Counseling, 75 (2009), 321-327
•The diabetes MMEP can be found here:
http://cch.northwestern.edu/edtools/
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National Quality Center (NQC)
Final Discussion/Q&A?
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National Quality Center (NQC)
References
• Agency for Health Care Research and Quality (AHRQ):
Health Literacy Universal Precautions Toolkit, April 2010
Health Literacy Assessment Questions:
http://www.nchealthliteracy.org/toolkit/tool2A.doc
• Rudd RE, Anderson JE. 2007. The Health Literacy
Environment of Hospitals and Health Centers. Partners for
Action: Making Your Healthcare Facility Literacy-Friendly.
Cambridge MA: National Center for the Study of Adult
Learning and Literacy. Also on line at:
www.hsph.harvard.edu/healthliteracy and www.ncsall.net
• Quick Guide to Health Literacy:
http://www.health.gov/communication/literacy/quickguide/factslit
eracy.htm
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National Quality Center (NQC)
Additional Resources
• Previous NQC TA Calls
www.NationalQualityCenter.org/TACalls
• NQC Quality Academy
 Tutorial 23: Understanding & Addressing Health Literacy
 Tutorial 24: Cultural Competence as a Quality Issue
http://www.nationalqualitycenter.org/index.cfm/5847/8860
• AETC National Resource Center website http://www.aidsetc.org/
• TARGET Center website http://careacttarget.org/
Several slides used in this presentation were part of previous HL presentations
developed by NYSDOH AI interns, guests, and consultants
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National Quality Center (NQC)
Contact Information
• Barbara Boshard, [email protected]
• Lucy Graham, St. Mary’s Family Health Center, Grand
Junction, CO, [email protected], (t)970-2981735
• Eileen Sheridan Malone, [email protected] & Altricia
Belk, [email protected], John Hopkins Health Center,
High Risk OB Clinic
• Evelyn Bradley, DrPH, NQC Fellow, Baltimore City
Health Department, [email protected]
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National Quality Center (NQC)
National Quality Center (NQC)
212-417-4730
NationalQualityCenter.org
[email protected]
Funded by HRSA
HIV/AIDS Bureau