August 6, 2015 I have high blood pressure, not hypertension How health literacy affects what you do every day Steve Sparks Health Literacy Director Wisconsin Health Literacy Division of Wisconsin Literacy 76 member literacy agencies 18,000 adult learners; 3300 volunteer tutors Statewide Training, Consultation and Outreach on Health Literacy Community Health Projects WisconsinHealthLiteracy.org Which of the following is the single strongest predictor of an individual s health status? 1. Age 2. Income 3. Literacy Skills 4. Employment status 5. Education Level 6. Racial or ethnic group 1
Newest Vital Sign Adult Literacy Levels 60% 50% 40% 34-55% of adults are at below basic and basic literacy levels 30% 20% 10% 0% 55% 43% 34% Prose Document Quantitative Literacy in Wisconsin 1,500,000 Wisconsin adults need literacy services 2
A silent problem Percent who never told: Parikh, N.S., et al. Patient Educ Couns, 1996. What is Health Literacy? What is Health Literacy? The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health. -The Institute of Medicine 2004 3
Day-to-day problems associated with health literacy: Understanding common words: Stool Bowel Colon Lesion Growth Polyp Rectum Screening Day-to-Day Problems associated with health literacy: Those who didn t understand: When next appointment scheduled Take on empty stomach instructions Warnings on prescription labels Rights/responsibilities in Medicaid application A real life example An 89-year-old man with dementia is diagnosed with an ear infection and is prescribed an oral liquid antibiotic: one teaspoon twice a day. -Parker, R. et al. J Health Comm, 2003. 4
Day-to-day problems associated with health literacy: Clients/patients less likely to know: How to use inhaler Symptoms of hypoglycemia That weight loss & exercise lower blood pressure What foods are good to eat How to understand direct-to-consumer ads Literacy Vs. Health Literacy Almost everyone will have difficulty with health literacy at some point. Much harder for those that do not: Read very well. Speak English as their primary language. Health literacy of U.S. Adults 12% 14% 52% 22% (NAAL, 2003) Below Basic Basic Intermediate Proficient 5
The Impact of low Health Literacy Poorer health knowledge Higher mortality Increased hospital use Increased emergency department use Increased health care costs Who is at-risk? Ethnic populations Poor health status Low education level Limited English proficiency Low income Seniors and Persons with Disabilities Seniors and Health Literacy Proficient Intermediate Basic or Below Basic 75+ 1% 29% 70% 65+ 3% 38% 59% All Adults 12% 53% 36% 6
How can you tell? They may have difficulty: Locating services Filling out complex health forms Sharing medical history Understanding risk Managing chronic health conditions Understanding directions on medicine I forgot my glasses. I ll read when I get home. Why are seniors at high risk? High users of medical services 65+: twice as many office visits as 45-64 More medications 5+ meds: 50% greater chance of ADEs Decreased reading skills 45% read at lowest level Other issues affecting seniors health literacy Physical Changes (hearing, vision) Psychological Changes (depression, anxiety) Intellectual Ability (change) Short-term Memory 7
Age & medication use Multiple medications- risk of interactions Complicated dosage schedules Difficulty of reading medication labels You may be thinking.. Adopt Universal Precautions Since you can t always tell by looking. Take actions that minimize risk for everyone Use plain language with every patient 8
6 steps to better communication 1. Create shame-free environment 2. Practice plain, simple language 3. Show or draw pictures 4. Slow down 5. Limit amount of information provided 6. Verify understanding Create Shame-Free Environment Even highly educated people prefer simple, understandable health information. Practice plain, simple language 20% of American adults read at or below the 5th grade level. Most health care materials are written above the 10th grade level. 9
Avoid health care jargon (And we have plenty of it!) Doctor: Your foot infection is so severe that we will not be able to treat it locally. Patient: I hope I don t have to travel far, doctor. I don t like to drive out of town. Avoid Jargon What do these mean? ACA CDC HIPAA EHR SNF FDA FAQ LOL Use Plain Language Prevents osteoporosis Keeps bones strong 10
What is a way to say each of these words in plain language? Adverse Anti inflammatory Intermittent Angina Depression What is a way to say each of these words in plain language? Medical Term Another way to say Adverse Anti inflammatory Intermittent Angina Depression Bad Helps swelling and irritation go away Off and on Chest pain Feeling sad or down What about seniors and the web? More seniors are using the web. But those with difficulty navigating or understanding are not. 2013: 59% of adults 65+ on-line Use of Internet for health information: 3 of 10 older adults with adequate health literacy 1 of 10 with low health literacy Health Literacy and the Digital Divide among Older Americans, J Gen Intern Med, Nov. 2014 11
Show or draw pictures Slow down Speak clearly and at a moderate pace. sorrymyemaillookslikethisbutmycomputerdroppedandmyspacebarbroke Limit amount of information provided Only need to know concepts 12
Verify understanding using Teach Back Ask to demonstrate understanding We have gone over a lot of information today. What will you tell your wife about your diabetes? I want to be sure I explained everything clearly, so can you please show me how you will use your asthma medication when you get home? Do not ask: Do you understand? Which question would be most effective to ask at the end of a visit? 1. Is there something else you want to address in the visit today? 2. Is there anything else you want to address in the visit today? If you only remember three things: 1. Practice plain language 2. Slow down 3. Teach back-confirm understanding (3 Best Practices: DeWalt et al, 2010) 13
Questions? Steve Sparks Health Literacy Director steve@wisconsinliteracy.org 14