STRATEGIES TO IMPROVE COMMUNICATION BETWEEN CAREGIVERS AND DIVERSE PATIENTS. James L. Mason, Ph.D. OCCAT Portland, Oregon March 2016

Transcription

1 STRATEGIES TO IMPROVE COMMUNICATION BETWEEN CAREGIVERS AND DIVERSE PATIENTS James L. Mason, Ph.D. OCCAT Portland, Oregon March 2016

2 CULTURAL COMPETENCE ASSESSMENT QUESTIONS: 1) How well are you able to describe the diverse groups you currently serve? For example, your comforts or discomforts, within group differences, language and communication style, views of illness/health, definitions of credible providers and relevant services. 2) To what extent can you describe cultural, social, environmental or other determinants that impact health awareness, status and outcomes specific to the mentioned groups? 3) To what extent do you have community contacts or cultural key informants that help you understand and ultimately serve diverse communities and clients. 4) Can you share a cross cultural success story, best practice, or practice exemplars re: health literacy that would be useful to colleagues? James L. Mason OCCAT Portland, OR 2011

3 UNIVERSAL PRECAUTION High level education, income, or occupation (i.e., SES) are not assurances of health literacy. Health information is dynamic, medical knowledge is fluid and thing advance almost on a daily basis Health communication is daunting even for high functioning people Important information may be obscured or forgotten if learned in a highly emotional state, provided by someone with whom one is not familiar, or when provided across cultural or linguistic differences.

4 DEFINITION Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Individual and systemic factors might include: Communication skills of the patient and caregiver Lay and professional knowledge of health care topics Culture (of patient, caregiver, organization) Demands and contexts of health care and public health domains (e.g., time, training, priorities, resources, infrastructure, political climate, etc.) Healthy People Washington, DC: U.S. Government Printing Office

5 HEALTH LITERACY ALSO IMPLIES... Operating effectively within a healthcare system, (e.g., identifying a provider, accessing care, completing forms, and complying with preventative measures/treatment plans) and impacts how people: Share personal information, such as health history, with providers Engage in self-care, preventative care, ongoing disease management Understanding mathematical concepts including probability Skills can include calculating lipids and blood sugar levels, meting out medication, understanding food labels; and comprehending prescription coverage and label, and calculating premiums, copays, and deductibles. Healthy People Washington, DC: U.S. Government Printing Office

6 OVERVIEW In this time of increasingly more diverse communities all over the country, all health care groups are now recognizing the importance of cultural and linguistically appropriate services (CLAS) in their specific discipline and context. Thus it may be important for caregivers to pursue cultural competency training ( or variants) and related staff development activities that: 1) promote better understanding of diverse cultures and people, 2) help staff work across various forms of diversity, 3) establish rapport with a wide range of people, and 4) enable caregivers to serve all people and eliminate disparate outcomes.

7 HEALTH LITERACY IN THE US: NAAL RESULTS 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 12% 53% 22% 14% Proficient: Define medical term from complex document, Calculate share of employee s health insurance costs Intermediate: Determine healthy weight from BMI chart, Interpret prescription and over-the-counter drug labels Basic: Understand simple patient education handout Below Basic: Circle date on appointment slip, Understand simple pamphlet about pre-test instructions Kutner et al 2006

8 REFLECTION QUESTION 1) How well are you able to describe the diverse groups you currently serve? For example, your comforts or discomforts, within group differences, language and communication style, views of illness/health, definitions of credible providers and relevant services. 2) To what extent can you describe cultural, social, environmental or other determinants that impact health awareness, status and outcomes specific to the mentioned groups?

9 CULTURAL FACTORS THAT INFLUENCE DIVERSITY AMONG INDIVIDUALS AND GROUPS Internal Factors Cultural/Racial Identity Socioeconomic Status Nationality Language Family History Help-Seeking behavior Generational Status Age & Life Cycle Issues Spatial & Regional Patterns Gender & Sexuality Religion & Spiritual Views Political Orientation James L. Mason OCCAT Portland, OR 2011 External Factors Institutional Biases Community Economics Public Safety & Infrastructure Behavioral Health Geographic/Cultural isolation Intergroup Relations Natural Networks of Support Community History Political Climate Workforce Diversity Community Demographics Modified from James Mason, Ph.D., NCCC Senior Consultant Developed by National Center for Cultural Competence, 2002

10 TYPICAL HIGH RISK GROUPS People: who are elderly from racially and ethnically diverse backgrounds who are Immigrants and refugees in poverty who are homeless who are incarcerated with limited education who are ELL/ESL Universal precaution!!! One never knows

11 FUNCTIONAL LITERACY OF HIGH RISK POPULATIONS Group Low Literacy (%) All 50 Elderly ( 65) 81 Racial/Ethnic group: White 41 Black 77 Hispanic 78 Education level: 0-8 yrs yrs 81 HS/GED 55 Immigrants: 0-8 yrs prior educ yrs prior educ 71 Weiss Adapted from Table 2-1.

12 INDICATORS OF LOW HEALTH LITERACY Excuses: I forgot my glasses. I will look at it when I get home. Previous papers in disarray, unorganized, lost. Apparent, non compliance with recommended exams, appointments, tests, Few or reluctance to ask questions. Might note Questions are basic or irrelevant in nature Difficulty explaining medical concerns or how to take meds Others...? Weiss Katz et al 2007.

13 HEALTH CARE EXPERIENCES Low-literacy patients commonly hide their difficulty Especially those with non-standard dialects or who may be ESL/ELL Many feel ashamed traumatized by systems Avoidant behaviors, easier to delay When do you suspect low literacy? Parikh et al Weiss 2003.

14 CONTEMPORARY CHALLENGES Dynamic and complex health systems, Greater self-care requirements More medications for chronic conditions Formulary and manufacturer changes Medication reconciliation Research and dissemination Most patient instructions are written in English Low-literacy pts have trouble understanding ESL/ELL Verbal instructions Often complex, delivered rapidly, or are easy to forget in stressful situation Others?

15 STRATEGIES TO IMPROVE COMMUNICATION 1. Explain things clearly in plain language 2. Focus on key messages and repeat 3. Use a teach back or show me technique to check understanding 4. Effectively solicit questions 5. Use patient-friendly educational materials to enhance interaction Weiss Kripalani and Weiss 2006.

16 PLAIN LANGUAGE Plain language is communication that users can understand the first time they read or hear it. With reasonable time and effort, a plain language document is one in which people can find what they need, understand what they find, and act appropriately on that understanding. Key elements of plain language include: Organizing information so that the most important points come first Breaking complex information into understandable chunks Using simple language and defining technical terms Using the active voice Language that is plain to one set of readers may not be plain to others. It is critical to know your audience and have them test your materials before, during, and after they are developed. Speaking plainly is just as important as writing plainly. Many plain language techniques apply to verbal messages, such as avoiding jargon and explaining technical or medical terms. Plain Language Action and Information Network. What Is Plain Language? Available atwww.plainlanguage.gov. Accessed on October 21, 2005.

17 PLAIN LANGUAGE TIPS Slow down the pace of your speech, without patronizing Whenever possible use plain, non-medical language build and share your vocabulary Blood pressure pill instead of antihypertensive Pay attention to patient s own terms and use them back Use ethnographic interview strategy Avoid vague terms Take 1 hour before you eat breakfast instead of Take on an empty stomach

18 PLAIN LANGUAGE TIPS: WHAT COULD WE SAY 1. Adverse reaction 2. Hypoglycemia 3. PRN 4. Suppository 5. Topical 6. Other examples 1. Side effect 2. Low sugar 3. When you need it 4. Pill that goes in your bottom/behind 5. On skin 6....?

19 2. FOCUS ON KEY MESSAGES AND REPEAT Limit information: focus on 1-3 key points; note transitions;, and own difficulty in presenting concepts, especially when Develop short explanations for common medical conditions as well as side effects Discuss specific behaviors rather than general concepts, e.g., What the patient needs to do Review each point at the end

20 3. USE A TEACH BACK TO CHECK UNDERSTANDING Schillinger et al 2003

21 PROSPECTIVE TEACH BACK SCRIPTS I want to make sure I explained everything clearly. Might think in terms of explaining this to a nonclinician partner/spouse, child, sibling, etc. Let s review the main side effects of this new medicine. What are the 2 things that I asked you to watch out for? Show me how you would use this inhaler. If you had to explain the important points to me Identify or develop, evaluate and share

22 4. EFFECTIVELY SOLICIT QUESTIONS Don t say: Do you have any questions? Any questions? Do you understand? Instead say: What questions do you have? Develop and model questions they might or should ask, You may have to prime the pump. Remember, no one wants to seem dull or ignorant.

23 5. PATIENT-FRIENDLY MATERIALS Appropriate Content Plain Language Layout Illustrations Seek language/culture specific materials

24 SELF REFLECTION 1) To what extent do you have community contacts or cultural key informants that help you understand and ultimately serve diverse communities and clients. 2) Can you share a cross cultural success story, best practice, or practice exemplars re: health literacy that would be useful to colleagues?

25 NATURAL NETWORKS OF SUPPORT Merchants and businesspeople Unheralded leaders & community elders Faith-based institutions Ethnic media & personalities Advocacy organizations Collateral agencies Social networks Consumer & family member organizations Others? James L. Mason OCCAT Portland, OR 2011

26 CULTURAL COMPETENCE ASSESSMENT QUESTIONS: 1) How well are you able to describe the diverse groups you currently serve? For example, your comforts or discomforts, within group differences, language and communication style, views of illness/health, definitions of credible providers and relevant services. 2) To what extent can you describe cultural, social, environmental or other determinants that impact health awareness, status and outcomes specific to the mentioned groups? 3) To what extent do you have community contacts or cultural key informants that help you understand and ultimately serve diverse communities and clients. 4) Can you share a cross cultural success story, best practice, or practice exemplars re: health literacy that would be useful to colleagues? James L. Mason OCCAT Portland, OR 2011

27 REFERENCES Kirsch I, et al. Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC: National Center for Education Statistics, US Department of Education; September Kripalani S, et al. Predictors of Medication Self-management Skill in a Low-literacy Population. Journal of General Internal Medicine. 2006;21(8): Kripalani S, and Weiss BD. Teaching About Health Literacy and Clear Communication. Journal of General Internal Medicine. 2006;21(8): Kutner M, et al. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NCES ). Washington, DC: U.S. Department of Education, National Center for Education Statistics; Parikh N, et al. Shame and health literacy: the unspoken connection. Patient Education and Counseling. 1995;25: Schillinger D, et al. Closing the Loop: Physician Communication With Diabetic Patients Who Have Low Health Literacy. Arch Intern Med. 2003;163: U.S. Department of Health and Human Services. Healthy People nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November Weiss, BD. Epidemiology of Low Health Literacy. In: Schwartzberg JG, VanGeest JB, Wang CC, eds. Understanding Health Literacy: Implications for Medicine and Public Health. AMA Press; 2005:19. Weiss BD. Health Literacy: A Manual for Clinicians. American Medical Association and American Medical Association Foundation; 2003.

28 ELECTRONIC RESOURCES _22_2012.pdf n.pdf