Oral Health Literacy What s New, What s Hot in Communication Skills Oklahoma Dental Association Annual Meeting Friday, April 25, 2014, 2:00 5:00 Robin Wright, PhD Wright Communications 2410 Thayer Street Evanston, IL 60201 Voice: 847-864-5266 FAX: 847-864-5276 www.greatanswers.com robin@greatanswers.com
Oral Health Literacy What s New, What s Hot in Communication Skills Course Description You know that health literacy is central not only to improving oral health, but to protecting total health. That s why you practice solid patient education every day. But how can you go beyond the basics and be even more effective in helping patients understand dental information and make good treatment decisions? This course reviews the latest research and presents communication skills that will build patient knowledge, bring patients to treatment acceptance, and upgrade your current approach to patient education. Discover the hidden audiences of limited health literacy Go beyond the essential skills to improve oral health literacy Build credibility and patient trust Discuss treatment risks more effectively Help patients do the math to understand treatment outcomes Encourage patients take action on treatment and home care recommendations Get positive messages to deal with the influence of online health information Speaker Biography With an international reputation as a dental communication specialist, Dr. Wright has a proven track record with over 400 audiences since 1985 and is a featured speaker in the ADA Seminar Series. She has spoken at the Yankee, Hinman and ADA annual meetings. Her combination of humor, enthusiasm and expertise make her a powerful speaker. She is the author of more than 50 dental publications including the 1997 book, Tough Questions, Great Answers: Responding to Patient Concerns about Today s Dentistry, through Quintessence Publishing, 800-621-0387, quintpub.com. Dr. Wright is president of Wright Communications and completed her doctorate in healthcare communication at Northwestern University in Evanston, Illinois. Introduction Build Positive Relationships Explain Dental Conditions Promote Treatment Acceptance Bring Patients to Action Course Outline Wright Communications, 2014 robin@greatanswers.com 2
Introduction What is health literacy? The most common definition of health literacy is the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. (National Library of Medicine) Who is affected by health literacy? What factors are related to health literacy? less access to information other than the mass media fewer professional contacts to discuss health issues less knowledge about preventive health services greater reliance on folk medicine lower belief in control over health matters less future-oriented (and thus preventive) health beliefs higher susceptibility to oral disease lower importance placed on oral health greater perceived barriers to care, such as time, cost, fear, pain, lack of access lack of perceived need for dental treatment What are the effects of limited health literacy? Wright Communications, 2014 robin@greatanswers.com 3
What communication skills are dentists using to reach patients of limited literacy? Use easy to understand language Use simple language Speak slowly Draw pictures or use printed illustrations Present only 2 to 3 concepts at a time Ask patients whether they would like a family member or friend in the discussion Use the Teach Back Method Ask patients to repeat back information or instructions Ask patients to tell you what they will do at home to follow instructions Use patient-friendly materials and aids Use models or x-rays to explain Hand out printed materials Use a video or DVD Provide help or assistance in understanding information Underline key points on print materials Read instructions out loud Write or print out instructions Ask staff member to follow up with patients for post-care instructions Follow up with patients by telephone to check understanding and adherence Make practice environment patient-friendly Ask patients how they learn best Refer patients to the Internet or other sources of information Use a translator or interpreter Source: Rozier, R., Horowitz, A., and Podschun, G. Use of Patient Communication Techniques by Dentists in the United States: Results of a National Survey. JADA, 2011. Wright Communications, 2014 robin@greatanswers.com 4
Build Positive Relationships What are the key qualities of rapport? How can we create rapport with our nonverbal skills? How can we create rapport with our verbal skills? Conversation Starters Work School Children Community Interests Referrals Compliment plus Question Forms of Address Directness of Communication Perception of Time Family Relationships Wright Communications, 2014 robin@greatanswers.com 5
Explain Dental Conditions Extended Parallel Process Health Belief Model Target vulnerability I have a dental problem Threat severity The problem is serious Response efficacy The treatment will solve the dental problem Personal efficacy The action is clear and specific I am able to do it Target Vulnerability: Prove the existence of the dental condition Explanation of the Dental Condition Use familiar words and define unfamiliar words Use short sentences Discuss relevance of any symptoms Give reasons for a lack of symptoms Possible Visuals and Support Materials Patient chart Radiographs/digital radiography Study models Intraoral camera Brochures DVDs Educational software Electronic notebooks Threat Severity: Discuss the severity of the problem and the results of no treatment Dental Consequences Health and Lifestyle Consequences The Internet: How Online Information is Affecting Patient Communication and Decisions Wright Communications, 2014 robin@greatanswers.com 6
Promote Treatment Acceptance Extended Parallel Process Health Belief Model Target vulnerability I actually have a dental problem Threat severity The problem is serious Response efficacy The treatment will solve the dental problem Personal efficacy The treatment action is clear and specific I am able to do it How can we present treatment recommendations most effectively? Use of Facts and Examples as Support Gain Frame and Loss Frame Messages Treatment Options and Recommendations How can we discuss treatment risks more effectively? Immediate vs. Long Term Self-controlled vs. Other-controlled Familiar vs. Unfamiliar Natural vs. Manmade Common vs. Sensational How can we help patients do the math to understand treatment outcomes? Do patients see a difference between 1 percent and 1 in 100? Do patients see a difference between relative (1 in 100 US citizens) and absolute (3 million US citizens) risk information? Is 10,000 out of 1,000,000 larger than 1 out of 100? Is a 90% survival rate better than a 10% mortality rate? What else can dental professionals do when the patient doesn t understand? Central vs. Peripheral Thinking Use of Interpreters Wright Communications, 2014 robin@greatanswers.com 7
Dental Amalgam Restoration Treatment Benefit Cheat Sheet Composite Resin Restoration Supports and protects the tooth Protects from future discomfort and infection Affordable Durable and long-lasting Bleaching and Whitening More self-confidence Gives back the brightness of your smile Affordable Easily maintained Inlays Looks very natural; virtually invisible Supports and protects the tooth Protects from future discomfort and infection Preserves tooth structure Durable and long-lasting Bonding Quick and comfortable procedure Change the shape or color of your teeth More self-confidence Looks and feels very natural Fixed Bridge More comfortable when you eat, speak and smile Better function when you speak and chew More stable, not wobbly Feels light, not heavy Food doesn t get caught Looks very natural; virtually invisible Supports and protects the tooth Protects from future discomfort and infection Preserves tooth structure Sealants Protects teeth most at risk for decay Saves dental costs in the near and far future Better dental health in adulthood Comfortable procedure Guaranteed if child has regular visits Laminate Veneers More self-confidence Create a desired tooth shape or close a space Look great at your high school reunion Impress your friends Crowns Durable and long-lasting Supports and protects the tooth Looks and feels very natural Protects from future discomfort and infection More self-confidence Dental Implants Looks and feels more natural Better function when you speak and chew Easier to eat, speak and chew Durable and long-lasting Supports and protects the shape of the face Periodontal Care Keep your teeth a lifetime Protection from future discomfort and infection More affordable dental care Fresher breath Wright Communications, 2014 robin@greatanswers.com 8
Bring Patients to Action Extended Parallel Process Health Belief Model Target vulnerability I actually have a dental problem Threat severity The problem is serious Response efficacy The treatment will solve the dental problem Personal efficacy The treatment action is clear and specific I am able to do it How to Build Personal Efficacy Did you provide a clear series of short-term steps for action? Did you model the action or skills? Can you improve the patient relationship? Did you and the patient decide together on the treatment goals and actions? Did you give positive messages about the outcome of the behavior? Did you tell success stories? Did you suggest ways to make the action easier or overcome the barriers to action? Did you get your foot in the door? Did you make a direct request to try it once? Wright Communications, 2014 robin@greatanswers.com 9
Appendix: Real World Advice for Culturally Diverse Practices Solutions for a Bilingual Practice Response Percent Helping patients to understand dental treatment; providing good information 23 on oral health care; answering all patient questions Communicating well as a team; talking things out; setting aside personal 15 differences Providing written information in Spanish and English 10 Giving patients attention and empathy; accommodating individual needs 9 Helping each other out when needed; making up for different strengths and 9 weaknesses Sharing the same goal of providing the best service to our patients 8 Making patients feel comfortable 7 Offering payment plans; different payment methods; discounts 6 Having Spanish speakers in the office; translating conversations 4 Offering a variety of treatment options 4 Learning about each other s culture 3 Providing a shuttle/transportation service 1 Getting patients in and out in a timely fashion 1 Issues and Concerns for a Bilingual Practice Response Percent Patient low level of oral health literacy; lack of knowledge or negative 22 attitudes about dental care and oral hygiene Not knowing Spanish; not knowing what people are saying; how to 20 pronounce names; being corrected for language mistakes Patients being late or absent 15 Tension between co-workers; coworkers being rude to each other in front of 13 patients Patients who don t speak English expecting staff/doctor to speak Spanish 10 Coworkers being late or absent 8 Patients who don t speak English who don t bring a translator 6 Patients don t get needed treatment due to lack of funds 4 Patients who try to go over (get around) staff by speaking to the doctor 1 Source: Wright Communications Survey, Attendees of Optimize Your Practice Through Powerful Communication, El Paso Dental Society Annual Conference, El Paso, Texas, September 23, 2011. Wright Communications, 2014 robin@greatanswers.com 10