Health Literacy

Chronic Obstructive Pulmonary Disease Educator Institute (COPDEI)

Margot Malachowski, MLSBaystate Health Sciences Library

Springfield, MA October 2013

Introduction

Outreach LibrarianPatients & their families

Teach how to find reliable websitesLook up information on their behalf

Resource Library for Western New England

The Health Sciences Library at Baystate Medical Center is a Resource Library for the National Network of Libraries of Medicine (NN/LM). Our

mission is to serve the health information needs of unaffiliated health care practitioners, librarians,

educators and consumers in Western New England. We provide free instruction and

assistance to support health literacy.

Health Literacy & Health Numeracy

Basically, understanding words & numbers

Define Health Literacy:

Ability to read +

Understand how the body works +

Understand what causes disease

Define Numeracy:

Understand numbers +Understand prescriptions, test results +Understand insurance deductibles (?!!)

Proficient Health Literacy

12% of US adults

Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

Define Proficient:

Training +

Skill +

Experience

Proficient Health Literacy

12% of US adults

Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

Below Basic Health Literacy

14% of US adults

Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

Define BasicHealth Literacy:

Understand words and numbers enough to have the

ability to achieve goal

(good health)

Below Basic Health Literacy

14% of US adults

Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

Who are the 14%?

51% did not graduate from high school

48% one or more disabilities

36% no medical insurance

35% Hispanic adults

31% over age 65

19% Black adults

Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

Who are the 14%?

51% did not graduate from high school

48% one or more disabilities

36% no medical insurance

35% Hispanic adults

31% over age 65

19% Black adults

Hauser, et al (Eds.). (2005). Measuring Literacy: Performance Levels for Adults, Interim Report. Washington, DC: National Academies Press.

Health Care OutcomesDo not get preventative care

Develop chronic conditions (COPD)Higher rates of hospitalization

Do not feel wellHealth care costs are higher

(more serious situations)Ashamed– lack health and knowledge

Focus: COPD

Reuters: COPD patients with low “health literacy” fare worse, 9/13/12

http://www.reuters.com/article/2012/09/13/us-copd-patients-idUSBRE88C0ST20120913

Journal of General Internal Medicine, 2013

Do not know how to use inhaled medications

Do not recognize need for acute medical attention

Feel helpless to manage own disease

5X more likely to go to the ER

8X more likely to be hospitalized

Omachi TA, Sarkar U, Yelin EH, Blanc PD, Katz PP. Lower health literacy is associated with poorer health status and outcomes in chronic obstructive pulmonary disease. J Gen Intern Med. 2013 Jan;28(1):74-81. doi: 10.1007/s11606-012-2177-3. Epub 2012 Aug 14. PubMed PMID: 22890622; PubMed Central PMCID: PMC3539035.

COPD Helplessness Index

“My breathing problems are controlling my life”“No matter what I do or how hard I try, I just can’t seem to

get relief from my breathing problems”“Too often, my breathing problems just seem to hit me

from out of the blue”“It seems as though fate and other factors beyond my

control affect my breathing problems”

Omachi TA, Katz PP, Yelin EH, Iribarren C, Knight SJ, Blanc PD, Eisner MD. The COPD Helplessness Index: a new tool to measure factors affecting patient self-management. Chest. 2010 Apr;137(4):823-30. doi: 10.1378/chest.09-0764. Epub 2009 Oct 16. PubMed PMID: 19837823; PubMed Central PMCID: PMC2851553.

Identifying Literacy Level

Rapid Estimate of Adult Literacy in Medicine (REALM): patients read lists of words and are scored within minutes

Test of Functional Health Literacy Assessment (TOFHLA): 20-minute test measuring numeracy and reading

comprehension

Identifying Literacy Level

Can the patient name his/her medications?

Does the patient frequently miss appointments?

Does the patient say “I forgot my reading glasses”?

Does the patient use a surrogate reader?

Roberts NJ, Ghiassi R, Partridge MR. Health literacy in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(4):499-507. Review. PubMed PMID: 19281068; PubMed Central PMCID: PMC2650589.

Working with Patients

Relationship-building Open-ended questions

Using Teach Back Pictures/videos

Roberts NJ, Ghiassi R, Partridge MR. Health literacy in COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(4):499-507. Review. PubMed PMID: 19281068; PubMed Central PMCID: PMC2650589.

Conversation

Cultural Competence

The culture of our family

The culture of our jobs

(health care providers)

Define Cultural Competence:

Understand other people’s culture enough to have the

ability to achieve goal

(good health)

Patients sharing their stories

http://www.youtube.com/watch?v=dzpBCymhSp0

Sources of Information

Health Care Providers

Family and Friends

The Internet

Sources of Information

Health Care Providers—70%

http://pewinternet.org/Reports/2013/Health-online.aspx

Sources of Information

Family and Friends (anecdotally, this really means Mom or family member who

is the health care profession)—60%

http://pewinternet.org/Reports/2013/Health-online.aspx

Sources of Information

The Internet—80% of internet users look up health information online

http://pewinternet.org/Reports/2011/HealthTopics.aspx

Sources of Information

Health Care Providers—70%

http://pewinternet.org/Reports/2013/Health-online.aspx

The right to understand

http://www.ted.com/talks/sandra-fisher-martins-the-right-to-understand.html

PlainLanguage.gov

President Obama signed the Plain Writing Act of 2010 on October 13, 2010. The law requires that federal

agencies use "clear Government communication that the public can understand and use." On January 18, 2011, he issued a new Executive Order, "E.O. 13563 -

Improving Regulation and Regulatory Review. " It states that "[our regulatory system] must ensure that regulations

are accessible, consistent, written in plain language, and easy to understand."

Before & After: Losing Weight Safely

Dept. of Health and Human Services

The Dietary Guidelines for Americans recommends a half hour or more of moderate physical activity on most days, preferably every day. The activity can

include brisk walking, calisthenics, home care, gardening, moderate sports exercise, and dancing.

Before & After: Losing Weight Safely

Dept. of Health and Human Services

Do at least 30 minutes of exercise,

like brisk walking, most days of the week.

Before & After: Medicare Fraud Letter

Medicare Beneficiary Services

Investigators at the contractor will review the facts in your case and decide the most appropriate course of

action. The first step taken with most Medicare health care providers is to reeducate them about Medicare

regulations and policies. If the practice continues, the contractor may conduct special audits of the

providers medical records. Often, the contractor recovers overpayments to health care providers…

Before & After: Medicare Fraud Letter

Medicare Beneficiary Services

…this way. If there is sufficient evidence to show that the provider is consistently violating Medicare

policies, the contractor will document the violations and ask the Office of the Inspector General to

prosecute the case. This can lead to expulsion from the Medicare program, civil monetary penalties, and

imprisonment.

Before & After: Medicare Fraud Letter

Medicare Beneficiary Services

We will take two steps to look into this matter: We will find out if it was an error or fraud.

We will let you know the result.

Patient Education Materials

Important points first

Break it down

Use simple language

Give definitions

Ask someone to read it

“Google it”

Best Website (!)

Use medlineplus.gov for:

Learning about how

your body works and

what causes disease.

Define Health Literacy:

Ability to read +

Understand how the body works +

Understand what causes disease

medlineplus.gov

COPD Patient Info

http://www.lung.org/lung-disease/copd/

COPD Patient Info

http://www.copdfoundation.org/

http://www.youtube.com/user/COPDFoundation

Faces of COPD—Robert

Questions?