Plain Language on the Plains: Introduction to Health Literacy in Nebraska

Susan Bockrath, MPH, CHESSteering Committee Chair, Health Literacy Nebraska

Health Literacy Nebraska

Scottsbluff

Kearney

Adults with Below Basic Literacy

Low Literacy0

102030405060708090

100

NebraskaSarpyLancasterColfaxCaliforniaNorth Dakota

Percent (%) across Nebraska

Proficient (12%): Define medical terms from complex document, calculate share of employee health insurance. Intermediate (53%): Determine healthy weight from body mass index (BMI) chart, interpret prescription and over-the-counter drug labels.Basic (22%): Understand simple patient education handout.Below Basic (14%): Circle date on appointment slip. Understand simple pamphlet about pre-test instructions.

Health Literacy in America (NAAL 2003 Data)

(Kutner, Greenberg, Jin, & Paulsen, 2006 )

Health Literacy Nebraska

Health Literacy Literacy Demands

Systems & Organizatio

ns

Provider Skills &

Experience

Patient Skills &

Experience

“Health literacy allows the public and personnel working in all health-related contexts to

• find,

• understand,

• evaluate,

• communicate, and

• use information.”

(Calgary Charter, 2008)

11

Demands of providers and

systems

Skills of patients, clients,

communities

Health Literacy

Demands of providers and

systems

Skills of patients, clients,

communities

etHhla ityeLrac

How much does Health Literacy matter?

• Limited literacy and health literacy are associated with negative health outcomes, less knowledge of medical conditions, less use of preventive services, poor disease self management, treatment mistakes, increased hospitalization and hospital readmissions, and death.(DeWalt, Berkman, Sheridan, Lohr, Pignone, 2004)

Predictors of Health Status

Literacy Skills

• Age

• Income

• Employment Status

• Education Level

• Racial or Ethnic Group

14

Strong Associations BetweenHealth Literacy and…

15

Lower educational attainment

Limited exposure to higher-level language

Limited baseline knowledge

Racial or ethnic minority

Consistent with other health disparities

Older ageDiminished cognitive

functionIncreased medical

encounters as one agesDifferent expectations

related to patient/provider roles

Not attending to Health Literacy Costs Money

Estimated annual health care costs for people with low literacy are 4 times higher than for those with higher literacy skills.

(Weiss, 1999) Comparative Costs

Low Liter-acyHigher Literacy

16

5060

7080

9010

0P

erce

nt A

live

0 20 40 60 80Months

AdequateMarginalInadequate

Adjusted HR 1.52 (95% CI 1.26 -1.83)

Inadequate vs Adequate

Not Attending to Health Literacy Costs Lives

17

(Baker, Wolf, Feinglass, Thompson, Gazmararian, Huang, 2007)

Health Literate Strategies• Plain Language• Easy-to-Read• Examples & Visuals• Brown Bag Checks• Teach Back• Ask Me 3• Interpreters

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Literacy Demands

Systems & Organizati

ons

Provider Skills &

Experience

Patient Skills &

Experience

Health Literate Strategies

Literacy Demands

Systems & Organizati

ons

Provider Skills &

Experience

Patient Skills &

Experience

• Plain Language• Easy-to-Read• Examples & Visuals• Brown Bag Checks• Teach Back• Ask Me 3• Interpreters

19

Work to Date• 230 local and tribal health department staff participated in a baseline

survey assessing their perceptions related to the health literacy.

• Project staff visited 19 sites where over 144 staff took part in on-site trainings introducing health literacy and in focus groups and interviews.

OPIHL project staff established a Health Literacy Listserv for collaboration specific to health literacy

Project staff has provided Health Literate Writers’ Workshops in 4 communities across the state. More than 100 health department staff and community partners participated in these workshops between May 1 and August 1, 2013. A fifth workshop is scheduled in September 2013.

All participating health departments have been trained in and have at least one license to use Health Literacy Advisor software

www.nalhd.org

MissionTo connect and coordinate health literacy

projects and expertise in Nebraska.

Who is ? • Partnership of:

• Medical providers• Pharmacists• Public Health practitioners• Librarians• Educators • Interpreters• Students• Consumers

What do we do?Connect Nebraskans interested in improving health literacy

• Bi-annual Summit

• Multi-disciplinary work groups

• Health literacy training

• Including health literacy items on Behavioral Risk Factor Surveillance Survey (BRFSS)

More of what ht does…• Nebraska-focused training opportunities…..

• Quarterly newsletter coming soon.

• Developing state-level data:

• With partners, ensuring that 2013-2014 Behavioral Risk Factor Surveillance Survey (BRFSS) in Nebraska includes 3 questions about health literacy.

• Completed a provider survey in 2012 asking about health literacy perceptions.

Why Join ?

• Be connected to this exciting work!

• Value priced• $20 annually for individual• $100 annually for organization

www.healthliteracyne.org

Resources

Find information and links to health literacy resources at…

www.healthliteracyne.org

www.nalhd.org/healthliteracy