lcc session health literacy - macpeds.com · • kickbusch, i. (2009). health literacy: engaging in...

MacPeds LCC 2011-2012 Resident and Facilitator MBL

LCC Session

CanMEDS Competency: Advocacy; Health Literacy

What will happen in this session?

Health Literacy in Pediatrics – Outline

Pre-reading

• OMA Background Paper. (2009) Patient Health Literacy: Implications for Physician Practice and Health System Planning. https://www.oma.org/Resources/Documents/2009OMAHealthLiteracyImplications.pdf

• Kickbusch, I. (2009). Health Literacy: Engaging in a political debate. International Journal of Public Health. 54(3): 131‐2.

Health Literacy Session Requirements

Part One: Review of Evidence(20 min)

Presentation with video clips: • Canadian definition of ‘health literacy’ • Measurement of health literacy • Prevalence of low health literacy • Populations at risk • Outcomes of low health literacy • Contributing factors • The patient’s experience • Health Literacy Universal Precautions

• Large room set up for presentation 1A3

• Laptop with Powerpoint 2007 and Windows Media Player

• Projector, Screen and Speakers

Part Two: Group Activities (40 min)

• Assessing health literacy • Assessing the quality of patient education materials • Writing clear language (optional, take‐home activity)

• Copy of Activity Guide for each participant

References:

Health Literacy in Pediatrics 2012

Lindsay Wizowski, ext 46624

Patient Education Services 1

Health LiteracyI N P E D I A T R I C S

We rely on patients and parents to be partners in care

• Tell us about their health concerns, needs and preferences

• Understand our explanations and instructions

• Ask questions

• Make informed decisions

• Follow treatment protocols and manage their care at home

• Access appropriate services when needed

To actively take part, patients and parents need to be able to use health information

access

understand

evaluate

communicate

apply

This is the foundation of health literacy

Health literacy: a Canadian definition

�as a way to promote, maintain and improve health

�in a variety of settings

�across the life course

The ability to access, understand, evaluate and communicate information:

Canadian Public Health Association www.cpha.ca

Canadian Council on Learning, 2008 www.ccl-cca.ca

Low health literacy:

60% of adults (16+)

88% of seniors (66+)

Low health literacy:

60% of adults (16+)

88% of seniors (66+)

Health literacy of Canadians

Otal, Wizowski, Walton & Fitzgerald. Journal of Pediatric Surgery. Accepted for publication 2012.

Parents withlow health literacy

In the outpatient surgery clinic, 29% of parents had difficulty understanding and using health information.

Health literacy of parents at MCH




Who is most at risk?

• born outside Canada

• limited proficiency in English/French

• low education

• low income, unemployed

• older adults (over 65 yrs)

Canadian Council on Learning, 2008; Rootman & Gordon-El-Bihbety, 2008 Canadian Council on Learning: Health Literacy Map www.ccl-cca.ca

Why does health literacy matter?

• poorer health

• chronic disease

• medication errors

• less preventative care

• more emergency care

• increased hospitalization

• higher mortality (seniors)

AHRQ, 2011; Canadian Council on Learning, 2008

Low health literacy is associated with:

Health literacy impacts

• Access to care

• Patient safety

• Quality of care

• Health outcomes

It’s a ‘silent epidemic’

People with low health literacy:

• Tend not to ask questions

• Rely on other sources of information

• Use effective coping skills

• Don’t want you to know!

Patients who nod and don’t ask questions are being polite.

It doesn’t mean that they understand.

What affects health literacy?

Person Products

Providers Places

Health literacy emerges from the interaction among these factors




How do parents feel?

• anxious

• tired

• stressed

• frustrated

Person How literate are parents?

Statistics Canada (2005) Building on our competencies

Percent of Canadians 16 to 35 years of agewith below proficiency literacy skills

• What is the strongest

personal factor in

predicting higher levels

of health literacy?

Canadian Council on Learning, 2008

Daily reading

That’s good, right?

That’s good, right?

Providers

Common mistakes

Delivering too much information, too fast.

Using jargon and difficult language.

Not checking for understanding.

You have acute sinusitis

You have acute sinusitis

Why, thank you!

Why, thank you!

Products

Health information is everywhere. Much of it is conflicting or confusing.

Say what?

I understand that the rationale for undertaking this procedure includes restoration of biomechanical alignment of affected segments in preparation for continued, and more comfortable, deformity management with othoses.

Over 1000 studies: Mismatch between reading level of materials and reading skills of adults

Print and online information is complex




Most people suffer hearing loss

when naked.

Places Hospital environment

• unfamiliar, scary

• busy, noisy

• distractions, interruptions

• confusing signage

Health care system’s expectations

• informed

• activated

• computer literate

• self-managing

• partners in care

We expect patients and families to be: Person’s capacity

System’s demands

Low health literacy

What can you do?

1. Create a shame-free experience

2. Use clear language

3. Use resources to make teaching more effective

4. Use teach-back to check for understanding

Health Literacy

Universal Precautions

Health Literacy

Universal Precautions

Create a shame-free experience

• Anticipate that patients and parents may have trouble understanding health information.

• Convey an attitude of helpfulness, caring and respect.

• Welcome a support person.

• Encourage questions, listen.

• Provide help with forms.

11




Use clear language

• A way of speaking and writing that is easy for most people to understand.

• Uses familiar, everyday (non-medical) language and a conversational style.

22 Find a simpler way to say it

• per

• onset

• elevated

• hand hygiene

• monitor the site

• practice social distancing

• Blood tests should be drawn 4 hours post injection.

• Surgery may be required after exhausting all non-operative treatments.

• Ensure your child wears appropriate age/activity related protective equipment during physical activities.

Use resources

• A combination of methods makes teaching more effective.

• Choose or develop materials that are easy to read and understand.

• Mark them up! Indicate key points (underline, circle).

33

Individualized and Interactive

Grade 5.7

In the MCH study, parents were satisfied with clear language materials, regardless of their health literacy skills.

Clear language benefits everyone Patient Education Library

Search for clear language materials

Hospital guidelines for developing patient education materials




• The responsibility for communicating clearly is yours.

• How do you know if a patient understands and knows what to do?

Check for understanding44Ineffective Ambiguous OK?

All right?

Less effective

Closed ended

Do you understand?Do you have any questions?Does this make sense?

Effective Open ended

What questions do you have?What parts of this are hard to understand?

Most effective

Teach back To make sure I explained this clearly, could you tell/show me what you are going to do?

Teach back

• Ask patients to repeat in their own words what they need to know or do.

• Not a test of the patient, but of how well YOU explained a concept.

• A chance to check for understanding and, if necessary to re-teach the information in a different way.

One of the top patient safety practices

One of the top patient safety practices

National Quality Forum, 2010

Teach

Check

Clarify

Understanding

Teach back

“Closing the loop”

Schillinger et al, 2003

Americal Academy of Pediatrics Summary

1. Creating a shame free experience

2. Using clear language

3. Using resources to reinforce teaching

4. Using teach back to check for understanding

Any patient or parent in your practice can have difficulty understanding health information.

Low health literacy affects their health and safety, as well as the quality of their care and experience at the hospital.

You can help by:




Lindsay Wizowski BScN MEdPatient Education SpecialistHamilton Health SciencesExt. [email protected]

Activity 1: Assessing health literacy

The Newest Vital Sign is a screening tool to identify patients at risk for low

health literacy. The NVS consists of a nutrition label accompanied by six questions

that assess the patient’s reading and numeracy skills. The tool can be administered

in a clinical setting in just three minutes.

Scoring:

0 to 1 = Low health literacy is likely (greater than 50% chance that patient

has marginal or inadequate health literacy and is at significant risk

for poor health outcomes)

2 to 3 = Low health literacy is possible

4 to 6 = Adequate health literacy

The score provides information about the patient that will allow health care

providers to adapt their communication practices in an effort to achieve better

health outcomes.

1. Simulation: In your group, choose one person to play the role of a parent and

another person to be the pediatric resident. The setting is a hospital pediatric

outpatient clinic. This is the child’s first visit. At this clinic, a health literacy test is

administered to a parent/caregiver as part of the family’s initial assessment.

2. Assess the parent’s health literacy:

The resident gives the parent the nutrition label. The parent can refer to it while

answering questions. It is not necessary to give parents time to review the label

before asking the questions. Rather, they will review the label as they are asked

and answer the questions.

The resident asks the questions and records the patient’s responses on the

scoring sheet, which contains the correct answers. Repeat questions as needed.

Based on the number of correct responses, the physiotherapist estimates the

patient's health literacy level.

3. After the simulated assessment, discuss the experience of “health literacy screening”

from the perspective of the parent and the resident.

4. What health literacy skills does the NVS measure? What health literacy skills are not

measured?

5. Discuss the advantages and disadvantages of assessing patients’ health literacy in

the clinical setting. What is your group’s recommendation regarding routine health

literacy screening?

Newest Vital Sign – Ice cream label

Activity 2: Assessing the quality of patient education materials

The Clear Language Checklist is an abbreviated list of criteria for the quality of

health information. It can be applied to printed information or webpages, to

identify aspects of writing and design that make the material hard to read or

understand. In practice, a checklist can help you determine whether materials are

suitable for patient and family education.

Instructions:

1. Your group is planning education for parents of children having ear surgery

(otoplasty). You want to provide parents with clear post-op instructions.

2. There are two resources to review. Half of your group will review the handout

“Caring for your child after ear surgery” and the other half will review the

webpage “Otoplasty” from www.medicinenet.com

3. Use the “Clear Language Checklist” to assess the writing, design and overall

quality of these resources.

4. Compare the checklist results.

5. Discuss the role of the pediatric resident in selecting or developing “clear

language” patient education materials.

http://www.medicinenet.com/

Clear Language Checklist

Describe the target audience

Yes

No

Not sure

N/A

Wri

tin

g

Is the purpose clearly stated at the start?

Is it written in familiar, everyday language?

Are unfamiliar words & acronyms defined?

Are sentences less than 20 words?

Is it written in active voice?

Is it written in a conversational style?

Is it organized in short sections (paragraphs 6-8 lines)?

Do sections have useful headings or questions?

Is it organized in a logical way and easy to follow?

Does it clearly tell readers what they need to do?

Does it tell readers how to get more information or help?

Yes

No

Not sure

N/A

De

sig

n

Are there only 1 or 2 styles of type (fonts)?

Is the size of the type easy to read?

Are subheadings and headings in larger type?

Are upper and lower case letters used throughout?

Do paragraphs line up at the left margin only?

Does the most important information stand out?

Is there white space at margins and between sections?

Are bullets used to present lists?

Do pictures or colour help find or explain information?

Are pictures realistic and appropriate for the audience?

Very

good Good Fair Poor

Ove

rall

How suitable is the material for the audience?

How likely is the material to achieve its purpose?

How would you rate the quality of the communication?

Sample handout (page 1 of 2)

Caring for your child after ear surgery (Otoplasty)

What happens after surgery?

Your child will go the Post Anesthetic Care Unit (PACU) to be closely

monitored until he or she is fully awake. As soon as possible, the nurse will

bring one parent into the PACU to be with your child.

When your child is fully awake, you and your child will go to the Same Day

Surgery Unit or to the children’s ward, if your child needs to stay in

hospital. The nurses will continue to check your child until you go home.

How do I care for my child after surgery?

Your child’s head will be wrapped in a bulky bandage. The bandage stays on

for 1 to 3 weeks to protect the new shape of the ears and prevent infection.

Do not wash your child’s hair during this time.

The stitches under the dressing will be taken out at your child’s follow-up

appointment.

Pain relief

After surgery, the amount and type of pain is different for each child.

Your child’s ears may throb or ache for a few days.

Your doctor may give you a prescription for pain medication. If you do not

have a prescription, you can give your child acetaminophen (Tylenol ).

Follow the directions on package for your child’s age and weight.

Diet

To prevent nausea and vomiting after surgery, we will start by giving your

child clear fluids (water, apple juice or popsicles). Your child should be able

to eat and drink as usual within 12 hours of surgery.

Please turn over

Caring for your child after ear surgery, page 2 of 2

Activity

Most children are usually up and about within a few hours of surgery.

Your child may return to school after 7 days, if he or she can be careful or

supervised during playground activities.

For 4 weeks after surgery, your child should not go swimming or do any

activity in which the ear might be bent, such as wearing a hat or helmet.

When does my child need a follow-up visit?

Your child needs to see the surgeon in 1 to 2 weeks. Make this appointment

before you go home.

When should I call the doctor?

Call the surgeon if your child has any of the following problems:

your child feels ill or has a fever (temperature higher than 38.5°C (101.3°F)

bleeding or drainage (discharge) through the bandage or dressing

redness or swelling around the incisions

pain that does not go away or seems to be getting worse

unable to eat or drink as usual

nausea or vomiting

Surgeon: _______________________ Phone: _______________________

After hours or on the weekend, call the hospital and ask to speak to the Plastic

Surgeon or the Ear, Nose and Throat (ENT) Surgeon on-call.

If you are not able to reach the doctor, bring your child to the nearest hospital

emergency room.

For questions that are not urgent, please call

your family doctor or pediatrician.

Webpage downloaded from www.medicine.net Dec 22, 2012

http://www.medicine.net/

Text from webpage downloaded from www.medicine.net Dec 22, 2012

What happens after surgery? After surgery, you will be taken to the recovery room where a nurse will monitor you. You will be able to go home the same day as the surgery once you have fully recovered from the anesthetic. This usually takes several hours. You will need a friend or family member to pick you up from the surgical facility and to take you home. He or she should spend the first night after surgery with you. When you arrive home from the surgical facility, you should go to bed and rest with your head elevated on 2-3 pillows. By keeping your head elevated above your heart, you can minimize edema and swelling. You may get out of bed with assistance to use the bathroom. It is best to eat a light, soft, and cool diet as tolerated once you have recovered fully from the anesthetic. Avoid hot liquids for several days. Even though you may be hungry immediately after surgery, it is best to go slowly to prevent postoperative nausea and vomiting. Occasionally, you may vomit one or two times immediately after surgery; if it persists, your doctor may prescribe medication to settle the stomach. It is important to remember that a good overall diet with ample rest promotes healing. You will be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic will also be prescribed (typically hydrocodone/Vicodin), and is to be taken as needed. If you require narcotics you are cautioned not to drive. In some situations your doctor may give you steroids to be taken either preoperatively and/or post-operatively. It is very important that you take this medication as prescribed, and not discontinue it prematurely. If you have nausea or vomiting post-operatively, you may be prescribed medications for nausea (anti-emesis), such as phenergan. If you have any questions or you feel that you are developing a reaction to any of these medications, you should consult your doctor. You should not take any other medication, either prescribed or over-the-counter, unless you have discussed it with your doctor.

http://www.medicine.net/

/script/main/art.asp?articlekey=12699

/script/main/art.asp?articlekey=857

Activity 3: Writing in clear language (optional, take-home assignment)

Clear language:

Is a way of writing that is easy to understand

Uses familiar language and a conversational style to convey information clearly

Makes health information accessible to a wide audience

Is recommended for printed and web-based health information

Instructions

1. Review the sample of health information “What is adolescent medicine?”.

This is an excerpt from a pamphlet that is being developed for teens who are

referred to an adolescent medicine clinic.

2. Consider what information teens need to know, and the language you use with

teens. Revise this part of the pamphlet to make it more suitable for teens.

What is adolescent medicine?

Adolescent medicine physicians are pediatricians with a specialty in working with

and understanding the unique medical needs of teenagers. Adolescence is a transition

period between childhood and adulthood. It is a normal developmental period filled

with major changes in physical maturity and sexuality, cognitive processes (ways of

thinking and thought content), emotions or feelings, and relationships with others.

Adolescence is a special stage of development that requires the support of health

professionals who can assist young people as they gradually accept increasing

responsibility for their own health and transition from childhood to adulthood.

Adolescents require more than routine check ups. They have diverse health needs –

including those related to their physical development, body image, nutrition,

sexuality, mental health, use of substances and other risk behaviours. Difficulties

within the family, school, or peer group often emerge or manifest as health concerns

during the adolescent years. Adolescent medicine physicians provide health

education to ensure understanding and encourage compliance. They provide holistic

medical care and pay particular attention to coordinating medical, mental health,

social and other services. They provide adolescents with confidential care while

encouraging family involvement.

Flesch-Kincaid Grade 14.5

Patient Education Services – Clinical Practice & Education – Dec 2011

Health Literacy in Pediatrics

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