Health and Literacy Crouse Nurse Practice Council Marsha L. Tait, National Coalition for Literacy Donna Valerino, Literacy Volunteers of Greater Syracuse.

Health and LiteracyHealth and LiteracyCrouse Nurse Practice Crouse Nurse Practice

CouncilCouncilMarsha L. Tait, National Coalition for Marsha L. Tait, National Coalition for

LiteracyLiteracyDonna Valerino, Literacy Volunteers of Donna Valerino, Literacy Volunteers of

Greater SyracuseGreater Syracuse

PresentationPresentation HighlightsHighlights

The Scope of Adult Literacy Globally and in the US

The 2003 National Assessment of Adult Literacy

The NAAL Health Literacy Report

Tips and Techniques for Health Care Providers

Resources

Global Adult Global Adult LiteracyLiteracy

The UN defines illiteracy as:

Having no reading and writing skills at all

UNESCO estimates more than 770 million adults are illiterate

Two-thirds of illiterate adults are women

UN Decade of Literacy: Cut illiteracy in half by 2015

The 2003 National Assessment of Adult Literacy (NAAL) was the first examination of the literacy skills of America’s adults in more than a decade

A nationally representative household survey of more than 19,000 adults, including adults in prison

NAAL: What is Adult NAAL: What is Adult Literacy in the US? Literacy in the US?

Definition: using printed and written information to function in society, to achieve goals, and to develop knowledge and potential.

2003 NAAL Key 2003 NAAL Key FindingsFindings

11 million adults are Non-literate in English

30 million adults have Below Basic Literacy skills

63 million adults have Basic Literacy skills

Why Should You Why Should You Care?Care?

Poor Health Outcomes: Poor Health Knowledge Less Frequent Screening and Preventive

Care Increased Use of Emergency Rooms Increased Hospitalization Higher Rates of Disease and Mortality

Baker et al, 1997

Patient InterviewsPatient Interviews

Special NAAL Report: Special NAAL Report: Health LiteracyHealth Literacy

Definition: The degree to which individuals have the capacity to obtain, process, and understand basic health literacy information and services needed to make appropriate health decisions.

?

AMA Definition of AMA Definition of Health LiteracyHealth Literacy

Definition: the ability to read and comprehend prescription bottles, appointment slips and other essential health-related materials required to successfully function as a patient.

NAAL Estimate ofNAAL Estimate ofHealth Literacy Health Literacy

SkillsSkills

Who needs help Who needs help with health with health

literacy?literacy?"We are your family-members; "We are your family-members;

we are your neighbors; we are we are your neighbors; we are your co-workers. We are small-your co-workers. We are small-business owners; we are first-business owners; we are first-responders. We are among the responders. We are among the working poor; we are working poor; we are millionaires. Few ever know our millionaires. Few ever know our truth. Because of shame and truth. Because of shame and stigma, we keep it hidden."stigma, we keep it hidden."

Characteristics of Characteristics of Population Population

with Low Health with Low Health LiteracyLiteracy

GenderGender More men (16%) than women (12%) had

Below Basic or Basic Literacy Skills

Less men (51%) than women (55%) had Intermediate literacy skills

Men had lower average health literacy scores (242) than women (248)

Older AmericansOlder Americans

Adults aged 65+ had the lowest average health literacy scores

More Americans aged 65+ had Below Basic or Basic Skills than any other age group (29 + 30%)

Adults with Medicare and Medicaid or no health insurance had the lowest average health literacy scores

Health Condition Self-Health Condition Self-AssessmentAssessment

Sources of Health Sources of Health InformationInformation

Information from Information from ProfessionalsProfessionals

36

29

17

18

37

33

19

11

34

37

21

8

30

39

23

8

0%

20%

40%

60%

80%

100%

BelowBasic

Intermediate

Health Care Professionals

None

A little

Some

A lot

Information From Other Information From Other PeoplePeople

Information From PrintInformation From Print

12

29

22

37

15

35

27

24

14

36

31

19

10

32

38

20

0%

20%

40%

60%

80%

100%

BelowBasic

Intermediate

Newspapers

None

A little

Some

A lot

Information From The Information From The InternetInternet

775

80

14

16

12

58

21

27

19

33

26

37

22

15

0%

20%

40%

60%

80%

100%

BelowBasic

Intermediate

Internet

None

A little

Some

A lot

Where are they Where are they getting it?getting it?

A higher percent of adults with Below Basic or Basic literacy skills cited radio and television as their primary source of health information.

Factors Affecting Factors Affecting Patient Provider Patient Provider CommunicationCommunication

Additional factors that may hinder understanding:

Intimidation, fear, vulnerability Shock upon hearing a diagnosis Extenuating stress within the patient's

family Multiple health conditions to understand

and treat

Make Effective Communications an Organizational Priority

Address Patients’ Communication Needs Across the Continuum of Care

Pursue Policy Changes that Promote Improved Provider-Patient Communications

SignageSignage

1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

What Can You Do?What Can You Do?

Create a safe environment where patients feel comfortable talking openly with you

Use plain language instead of technical language or medical jargon

Sit down (instead of standing) to achieve eye level with your patient

Use visual models to illustrate a procedure or condition

Ask patients to "teach back" the care instructions you give to them

From “Askme3.org

Avoid JargonAvoid Jargon “Hypertension” vs “High Blood

Pressure”

“Fatigued” vs “Tired”

“Acetaminophen” vs “Tylenol”

“Febrile” vs “Feverish”

“Myopathy” vs “Muscle Aches”

NYS Patients’ NYS Patients’ RightsRights

““Advance directives are verbal or written Advance directives are verbal or written instructions made by you before an instructions made by you before an incapacitating illness or injury… incapacitating illness or injury… Advance directives communicate that Advance directives communicate that your wishes about your treatment be your wishes about your treatment be followed if you are too sick or unable to followed if you are too sick or unable to make decisions about your care. make decisions about your care. Advance directives include but are not Advance directives include but are not limited to a health care proxy, a consent limited to a health care proxy, a consent to a do-not-resuscitate (DNR) order to a do-not-resuscitate (DNR) order recorded in your medical record, and a recorded in your medical record, and a living will.”living will.”

Simplify, Simplify, Simplify, Simplify, Simplify!Simplify!

Wikipedia

Colonoscopy is the endoscopic Colonoscopy is the endoscopic examination of the large colon and examination of the large colon and the distal part of the small bowel the distal part of the small bowel with a CCD camera or a fiber optic with a CCD camera or a fiber optic camera on a flexible tube passed camera on a flexible tube passed through the anus. It may provide a through the anus. It may provide a visual diagnosis (e.g. ulceration, visual diagnosis (e.g. ulceration, polyps) and grants the opportunity polyps) and grants the opportunity for biopsy or removal of suspected for biopsy or removal of suspected lesions.lesions.

Is Consent Is Consent Informed?Informed?

AdvocacyAdvocacy

Americans Americans are are

anticipated anticipated to spend to spend

$45.5 Billion $45.5 Billion

on their on their pets in pets in 2009!2009!

American Pet Products Association

Health Literacy Health Literacy ResourcesResources

www.askme3.org

www.cdc.gov/az/a.html

www.healthliteracy.worlded.org/index

www.hsph.harvard.edu/healthliteracy/

www.lvgs.org

www.jointcommission.org

www.national-coalition-literacy.org

www.proliteracy.org

www.rwjf.org

Clear Clear CommunicationCommunication

“What is clear to you is clear to you. Every patient should be a full partner in his or her medical decisions. This requires crystal-clear communication that is done with compassion and mutual respect.”

~~ Toni Cordell, former adult literacy student and health literacy advocate

And Remember…And Remember…

Marsha L. Tait [email protected] Valerino [email protected]