health literacy: help your patients understand · 2018-10-20 · health literacy: help your...
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Michael E. Speer, MD
Professor of Pediatrics and Medical Ethics
Baylor College of Medicine
Health Literacy: Help Your
Patients Understand
Health Literacy & Patient Safety
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Disclaimers:
n “I have no relevant financial relationships with
the manufacturer(s) of any commercial
product(s) and/or provider of commercial
services discussed in this CME activity.”
n I do not intend to discuss an unapproved/
investigative use of a commercial
product/device in my presentation.
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“The single biggest
problem in communication
is the illusion that it has
taken place.”
George Bernard Shaw (1856-1950)
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Research shows that:
nLiteracy is a predictor of health
status
n It is a stronger predictor than age,
income, employment status,
education level, or racial and ethnic
group
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Up to ½ of US population may
be at risk for…
nMedical misunderstandings
nMistakes
nExcess hospitalizations
nPoor health outcomes
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Why?
n Reliance on the written word for patient instruction
n Increasingly complex health systemn More medications
n More tests and procedures
n Growing self-care requirements
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Changes in the health care
system
n 4 - 6 weeks bed restin hospital
n 650
n 3 weeks in hospital2 hours a day of diabetic education classes
n 2-4 days in hospital(M&R Guidelines)
n 10,000 +
n outpatient0-3 hours diabeticeducation classeswritten materialsinternettelemedicine
Treatment of Acute
Myocardial
Infarction
Available Prescription Drugs
Treatment of new onset diabetes
45 Years Ago Today
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“Patients won’t tell you.”
% of patients who have never told:
nSupervisor 91%
nChildren 53%
nSpouse 68%
nAnyone 19%
Parikh N, et al. Patient Educ Couns, 1996.
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Definitions:
General Literacy:
“ An individual’s ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.”
National Literacy Act of 1991
Health Literacy:
“The degree to which individuals have the capacity, to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
Healthy People 2010
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2003 National Adult Literacy
Survey
Health Literacy - 2003
14%
22%
52%
12%
Below Basic
Basic
Intermediate
Proficient
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NALS Level 1
Below Basic (14%)
Able to:n Sign name
n Find a country in an article
n Total a bank deposit entry
Cannot consistently:n Understand the “gist” of an article.
n Use a bus schedule
n Enter information on a SS application
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NALS Level 2
Basic (22%)
Able to:n Find intersection on street map
n Locate information in newspaper article
n Determine difference in price on tickets
Cannot consistently:n Enter information into a vaccination record
n Identify information from a bar graph
n Write a brief letter of complaint
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What is it like?
nThe following passage simulates what a reader with low general literacy sees on the printed page.
nRead both sentences out loud.
nHint: The words are written backwards and the first word is “cleaning”
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GNINAELC – Ot erussa hgih ecnamrofrep,
yllacidoirep naelc eht epat sdaeh dna
natspac revenehw uoy eciton na
noitalumucca fo tsud dna nworb-der edixo
selcitrap. Esu a nottoc baws denetsiom
htiw lyporposi lohocla.
What is it like?
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What is it like?
CLEANING – To assure high performance,
periodically clean the tape heads and
capstan whenever you notice an
accumulation of dust and red-brown oxide
particles. Use a cotton swab moistened
with isopropyl alcohol.
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Many patients struggle with
health reading tasks….
n Take medicine every 6 hours 22%
n Take medicine on empty stomach 42%
n Upper GI instructions (4th grade) 21%
n Medicaid Rights (10th grade) 46%
% Incorrect
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Estimated $106 to $238* billion annual costs of poor health literacy…
We all pay!n 39% paid by Medicare through FICA taxes on
workers
n 17% paid by employers
n 16% paid by patients out-of-pocket
n 14% paid by Medicaid
n The remaining 14% comes from other public and private sources.
*publichealth.gwu.edu Accessed October 6, 2018
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Identifying Red Flags in
Communication
Patients who …
nAre unable to name medications, or explain purpose or timing of administration
nHave difficulty explaining their concerns
nHave no questions
nAct angry, passive, or clown
around
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“Think like a wise man
but communicate in the
language of the people”
William Butler Yeats (1865 - 1939)
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Explain things clearly using
plain language
nSlow down the pace of your speech
nUse analogies
n Arthritis and a creaky hinge on a door
n http://www.altoonafp.org/analogies.htm
nUse plain, non-medical language
n “Keep track of” instead of “monitor”
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Using plain, non-medical
language
nAnti-
inflammatory
nBenign
nChronic
nNormal
nReferral
nPain Killer
nNot cancer (not a
problem)
nHave for many years
nWhat they should be
nSend you to another
doctorhttp://depts.washington.edu/respcare/public/info/Plain_Language_Thesaurus_for_Health_Communications.pdf
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Focus on key messages and
repeat
nLimit information by focusing on 1-3 key
messages per visit
nReview each point and repeat several
times
nHave other staff reinforce key
messages
Vogel, DR et al. In Petterson, R Visuals for Information:
Research and Practice 1989
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Guidelines for creating
patient-friendly materials
nSimple words (1-2 syllables)
nShort sentences (4-6 words)
nShort paragraphs (2-3 sentences)
nNo medical jargon
nHeadings and bullets
nLots of white space
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What not to ask
Do you understand?
Do you have any questions?
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Thank You!