13/09/2017. Welcome to today s presentation. What we ll talk about today. About us. Activity: Stand up, sit down. What we do. Hello!

Transcription

1 Welcome to today s presentation Hello! Diane Webb, MPH, CHES Health Literacy Program Manager Introduction to health literacy Iowa Family Planning Conference What we ll talk about today About us Introduction HLM and our services What is health literacy and how does it apply to our work? Health literacy strategies to use with patients Nonprofit communications organization founded in 2009 Interdisciplinary team of thought leaders in health literacy Focus on helping partner organizations better communicate with clients What we do Activity: Stand up, sit down Step 1: Everyone stand up Step 2: Keep standing if you know Digital & social media Video creation Do not take what this medicine label if you is trying become to pregnant tell you Plain language Research & testing EOB what the insurance Explanation of benefits letters EOB stand for Health literacy in action Trainings what hospital department Oncology this symbol represents 1

2 What is health literacy? What is health literacy and how does it apply to our work? Success lies at the intersection of social, cultural, built, and natural factors of health Introduction to health literacy Impact of health literacy Barriers to health literacy Healthcare, scientific, environmental, and policy professionals People Healthcare, scientific, environmental, and policy systems Examples of health literacy in action Studies link low health literacy to poor health 50% Understanding and taking medicine on a schedule Explaining a new health diagnosis and care instructions Making intake forms easy to read and fill out Worse overall health status More emergency room visits More hospitalizations Higher mortality Higher rates mortality More hospitalizations rates NAAL, 2003, Griffey et al., 2014, Mitchel et al., 2012 Low health literacy and reproductive health Health literacy barriers for reproductive health Reproductive health knowledge: knowledge of health topics and body functions, understanding of link between lifestyle and health outcomes Health care professionals: competing demands and communication skills Lower use of cancer screenings Trouble making decisions about and using birth control Less likely to identify sexually transmitted infections Social factors: cultural and traditional beliefs, discomfort with health care providers System factors: transportation, location of services, language barriers, policies and funding Mazor et al., 2014; Oldach & Katz, 2014; Yee & Simon, 2014; Rutherford, et al.,

3 Activity: What s going on? Read the scenario and name the possible barriers. Scenario A young woman recently moved to Des Moines from a rural area She is 4 months pregnant and has 4 children, whom she brings to her prenatal visits She is always an hour late for her appointments, and the office policy is that she must wait until everyone else is seen before she can be seen She refuses to fill out her medical history forms and says she asked for her previous records to be transferred Understanding leads to better outcomes Clients use health information better and take medicines as instructed Clients build stronger relationships with providers and improve trust Systems save money and time Vernon et al., 2007 Health literacy is A powerful behavior change tool that can: Improve health Improve public opinions of your organization Save money through prevention Save money through improved service delivery Help with innovation Give your organization a competitive advantage Health literacy framework Universal Precautions for Health Communication: Use clear communication with everyone because you can t tell a person s health literacy level by looking at them Health literacy strategies Health literacy strategies to use with patients Use plain language in spoken and written communication Use Teach-back to check for understanding Build patient-provider relationships 3

4 What is plain language? Communication your audience can understand the first time they read or hear it. Lithodial People who fragments live in glass ought houses not shouldn t to be projected throw stones. by the inhabitants of vitreous abodes. You A can perissodactyl lead a horse ungulate to You Insufficient can t teach instruction an old to may water, be but propelled you can t toward a an dog aged new canine tricks. will not body make of aqueous him drink. fluid, but result in its ability to such ungulate cannot be undertake fresh strategies. compelled or forcibly induced to imbibe such fluid. Plainlanguage.gov, 2016 Avoid jargon or explain it clearly Activity: Replace jargon These are some jargon words in the health care field: Contraception Immunization Reflex Barrier method Contraction Abstinence Distension Incontinent Radiate Vertigo Edema Epidural Culture Numbness Hormonal Family planning Suture Abortion Inflammation Administer Microbicide Stock-outs Unintended Amenorrhea Anemia Endometriosis Miscarriage Look at these words and think about how you might replace them with a more common word. Inception Abstinence Manage Lactation Immunization Administer Start Not having sex Take care of Breastfeed Shot, vaccine Give Activity: Define jargon Focus on the 3 most important points Look at these words and think about how you might define these using simple words. 1. Miscarriage 2. Pre-eclampsia 3. Postpartum 4. Progesterone 5. Viral load Loss of pregnancy High blood pressure or swelling after 20 weeks After pregnancy A hormone made in your ovaries that prepares your body for pregnancy How many copies of HIV are in the blood Prioritize the information you give: Choose 3 important points you want to cover before the visit ends Prioritize need-to-know versus nice-to-know information Example: A patient requesting birth control Need-to-know information is information about an action step, such how birth control works Nice-to-know information is information that won t help the patient take action, such as how many women use birth control in the United States 4

5 Activity: Focus on the 3 most important points Make your content action-oriented 1. Skim the handout 2. Identify the 3 most important points you would focus on with a patient 3. Identify any points that are nice-to-know versus need-to-know information Give clear action steps by organizing the action by: What describe the behavior Why tell the benefits of taking action When and how provide specific action steps WHO, 2016 Health literacy strategies What is Teach-back? Use plain language in spoken and written communication Use Teach-back to check for understanding Teach-back is a method to check that you explained things in a way that your patient understood. Build patient-provider relationships AHRQ Universal Precautions Toolkit, 2016 The Teachback method Explain a new concept Teach-back is not a test of your patient s knowledge Agency for Healthcare Research and Quality, 2016 to you again to you Review any points the patient missed Schillinger et al.,

6 to you to you Create a shame-free environment Make sure your patient knows your goal is to check how well you explained the information, not to test their knowledge Let them know it s okay in fact desirable to have questions We ve covered a lot of information today I want to make sure I explained it clearly. Begin with a question Use open-ended questions or statements These usually start with What How When What questions do you have about you breast feeding? How will you take your birth control? They can t be answered with one word, such as yes or no Weiss, 2007; AHRQ, 2016 Weiss, 2007; AHRQ, 2016 Activity: Ask open-ended questions When we ask people, Do you have any questions? the most common response will be no. Health Literacy in Nursing: Providing Person-Centered Care, Terri Ann Parnell, 2015 Practice asking open-ended questions Rephrase each closed-ended question to an open-ended question or statement. Instead of Do you have any questions? Do you know how to take your medicine? Do you understand? Ask What questions do you have for me? How will you take your medicine? What would you like me to review again? The Teach-back method Explain a new concept Review any points the patient missed to you again to you Explain the content again using a different approach Think of how the patient learns best, or ask how they prefer to learn Re-explain the concepts the patient missed or explained incorrectly I don t think I explained that very well. Let me try again. Review any points the patient missed Schillinger et al.,

7 The Teach-back method to you again Explain a new concept Review any points the patient missed to you concept back to you again After you have explained the concept to your patient: Use open-ended questions to start Teachback again with your patient Continue to review the concept in different ways until the patient understands What Let me questions try to explain do you have this another about what way I said? I How want do to you make plan sure on I doing explained this each it clearly. day? Schillinger et al., 2003 concept back to you again Tips to create a patient-centered Teach-back environment Speak slowly about the pace of an audiobook Sit and make eye contact Use relaxed body language smile, keep your arms and hands loose, sit up straight Speak in a friendly tone of voice Activity: Let s practice! Provider: Explain the concept. Use Teachback to check that the patient understand the key messages Patient: Play the role of María (on the next slide) Observer: Watch and take notes on how the provider uses Teach-back Break into groups of 3: 1 patient, 1 provider, 1 observer Scenario: A patient with type 2 diabetes María has newly diagnosed gestational diabetes and she s having trouble controlling her blood sugar. She just can t seem to get on top of it. When you ask her about her medicine, you learn that she has stopped taking it because she isn t feeling as bad as she used to and is exercising more. Discussion How did you feel using Teach-back? What worked well? What didn t work well? What will you take away from this activity to use in your daily work? 7

8 Why use Teach-back? Health literacy strategies 80% 50% Use plain language in spoken and written communication Use Teach-back to check for understanding Kessels, % of information is forgotten once people leave a doctor s office Only 50% of information that people are able to recall is correct Kessels, 2003 Build patient-provider relationships Why build client-provider relationships? Patients were 19% more likely to not follow treatment recommendations when providers didn t use empathy and ask questions Patients were more than twice as likely to follow Zolnierek & DiMatteo, 2009 treatment recommendations if their provider used empathy or asked questions The truth is, rarely can a response make something better what makes something better is connection. Brene Brown, PhD, Research Professor at the University of Houston Zolnierek & DiMatteo, 2009 The Sacred Moment What is the sacred moment? A practice to put empathy back in caregiving What is your biggest fear or concern about being in the hospital? What was its impact? Reminded staff to pause and be empathetic Patient satisfaction scores increased Didn t cost any money Actively listen to understand the consumer don t just hear Focus your attention on the consumer who is speaking Stop all activities and distractions in front of you Listen to what they are saying Use body language to show your interest, such as leaning toward the consumer, nodding your head, and making eye contact HealthSmart Consumers,

9 Reflect the patient s feelings Example of reflecting To reflect what the patient is feeling: Listen to what the patient is saying Identify the underlying emotion Verbally acknowledge the emotion It sounds like you I m hearing that you re You re feeling I don t want to have a diabetes screening. I don t want to know if I have diabetes. If there s nothing I can do about it, what s the point in knowing? It sounds like the test process may worry you. What worries you the most about it? Example of reflecting All I ever hear when I come for my prenatal appointments is that I m not doing a good enough job taking care of my baby. It s so frustrating! I understand you re feeling frustrated about your prenatal appointments. How can I help make your prenatal visits more helpful? Discussion What are your thoughts about the Sacred Moment? When have you seen the impact of relationship building in your practice? Review Health literacy An intersection of factors that affect health Use plain language in written and spoken communication Avoid jargon, focus on 3 main points, and give clear action steps Use Teach-back Ask open-ended questions to check you explained a concept clearly Build patient-provider relationships Use the Sacred Moment, actively listen, and reflect feelings Get in touch Diane Webb, MPH, CHES dwebb@healthliteracy.media Facebook.com/HealthLiteracyMedia Twitter.com/HealthLitMedia 9