Health Literacy:A Crisis In Health Care

Developed by Stratis Health with the Permission of

the American Medical Association Foundation and the American Medical Association

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Definitions

General Literacy:

“ An individual’s ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.”

National Literacy Act of 1991Health Literacy:“The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

Healthy People 2010

Self-Assessment

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Implications of low health literacy on patient care

33% Were unable to read basic health care materials

42% Could not comprehend directions for taking medication on an empty stomach

26% We unable to understand information on an appointment slip

43% Do not understand the rights and responsibilities section of Medicaid application

60% Did not understand a standard informed consent

Williams et.al., JAMA 12/6/95

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Cost of poor health literacy: Estimate >$50 billion annually*

We all pay! 39% paid by Medicare (FICA taxes on workers)

17% paid by employers

16% paid by patients, out-of-pocket

14% paid by Medicaid

14% from other public and private sources *Estimated by National Academy on an Aging Society using 1998 figures

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National Adult Literacy Survey (NALS)

Conducted in 1992 N=26,000 Most accurate portrait of literacy in the US Scored on 5 levels Not accounted for:

Patients who have adequate language skills, but do not have adequate health literacy

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Results: National Adult Literacy Survey (NALS)

21%

27.5%

31.5%

16%

3%

0

5

10

15

20

25

30

35

1 2 3 4 5

(Kirsh I, Jungeblut A, 1993)

Level

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Why are patients at risk?

Reliance on the written word for patient instruction Increasingly complex healthcare system

More medications More tests and procedures Growing self-care requirements Esoteric language

An aging population A more culturally diverse patient population

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Understanding the problem

What is it like? The following passage simulates what a reader

with low general literacy sees on the printed page

Read the entire passage out loud You have 1 minute to read

(Hint: The words are written backwards and the first word is “cleaning”)

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GNINAELC – Ot erussa hgih ecnamrofrep, yllacidoirep naelc eht epat sdaeh dna natspac revenehw uoy eciton na noitalumucca fo tsud dna nworb-der edixo selcitrap. Esu a nottoc baws denetsiom htiw lyporposi lohocla. Eb erus on lohocla sehcuot eht rebbur strap, sa ti sdnet ot yrd dna yllautneve kcarc eht rebbur. Esu a pmad tholc ro egnops ot naelc eht tenibac. A dlim paos, ekil gnihsawhsid tnegreted, lliw pleh evomer esaerg ro lio.

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What was it like?

How did you feel while reading this passage?

How did you feel when you finished reading the passage?

How do you clean the capstan?How do you think patients with low

health literacy feel?

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Understanding the problem

View: As Patients See It Video made by the AMA in 2003 Real patients and real physicians talking

about literacy issues

Task: Note Barriers to access Barriers to diagnosis Barriers to treatment/care

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Video: The Patient’s Voice

Discussion:

What ideas hit home with you?

Did any of the situations seem familiar?

Did anything surprise you?

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What do we know?

Low Health Literacy (LHL) is prevalentLHL leads to:

Lower health knowledge and less healthy behaviors

Greater health costs Poorer health outcomes

Techniques and approaches may be used to address health literacy

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Strategy: Create a shame-free environment

Recognize red flags “I forgot my glasses…” Incomplete forms Seeking help only when illness is advanced

Convey an attitude of helpfulness, caring and respect (by all staff) What is it like being a patient in your setting? Are there forms or instructions that could be

confusing?

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Strategy: improve interpersonal communication

Slow down Use plain or “living room” language Focus on key messages (www.askme3.org)

What is my main problem? What do I need to do? Why is it important for me to do this?

Use “teach back” techniques

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Strategy: Develop patient-friendly materials and forms

Keep content concise and focused: Focus only on key points Emphasize what the patient should do Minimize anatomy and physiology to the basics

Tips for easy-to-read materials: Simple words (1-2 syllables) Short sentences (4-6 words) Short paragraphs (2-3 sentences) Limit medical jargon Headings, bullets and lots of white space

Self-Assessment answers

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What can you do right away?

Do a ‘walk through’ at your facility and identify barriers

Review registration forms and consider if they could be simplified

Develop a plan to educate all staff about low health literacy

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What can you do in the future?

Form a team to determine a long-term strategy

Discuss methods for improving communication skills with providers and staff

Incorporate “Ask Me 3” components into patient information

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“Understanding is a two-way street.”

Eleanor Roosevelt

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For More Information

Other resources www.amafoundation.org

www.askme3.org

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Brought to you by Stratis HealthMinnesota’s Medicare Quality Improvement Organization

Stratis Health is a non-profit independent quality improvement organizationthat collaborates with providers and consumers to improve health care.

This presentation was created by Stratis Health under a contract with the Centers for Medicare & Medicaid Services (CMS).

The contents do not necessarily reflect CMS policy.