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Sabrina KurtzSabrina Kurtz--Rossi, M.Ed.Rossi, M.Ed. Health Literacy ConsultantHealth Literacy Consultant
KurtzKurtz--Rossi & AssociatesRossi & Associates
[email protected]@comcast.net
Member Clear Language GroupMember Clear Language Group
www.clearlanguagegroup.comwww.clearlanguagegroup.com
Eighty-three year old Virgil Heidbrink has found
what he thinks is the perfect place to retire. He’s met
interesting people there. They share their life stories
and favorite jokes. And he’s convinced that the new
social connections are keeping him young in spirit.
Case Example
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Bob Moos, The Dallas Morning News Oct 12, 2009
Bob Moos, The Dallas Morning News Oct 12, 2009
Mr. Heidbrink spends 3 – 4 hours a
day on the Internet where he writes his
blog and answers email. A computer
coach helped the resident at the
Edgemere retirement community in
Dallas build and maintain his website.
www.virgilsviews.com
Case Example
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Objectives – Workshop
Discuss the opportunities and challenges of the Internet for older adults
Apply strategies to improve the health information literacy skills of seniors and their caregivers
Review teaching resources to support seniors and caregivers use the Internet to find health information
Identify features that improve the usability of health information websites for seniors
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What are the Challenges?
Health literacy among older adults
Readability of health information
Access to computers and the Internet
Accuracy and reliability of information
Health information literacy skills
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Health Literacy in the U.S.
Over 75 million adults have Basic and Below Basic health literacy
Seniors have the lowest health literacy
Only 12% total (3% seniors) have proficient health literacy
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Number & Percent of Adults in Each Health Literacy Level
Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp
Readability of Health Information
Numerous studies show the mismatch between patient skills and the readability of health materials (Meade 1989, Davis 1990, Dollahite 1995, Stevens 2007, Vallance 2008, Bergman 2010 )
More recent studies look at the readability and usability of health information on the Internet (Berland 2001, D’Allesandro 2001, Fogel 2003, Birru 2004, Leroy 2008, McInnes 2011)
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Medicare Website
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www.medicare.gov
Activity
Use www.Medicare.gov to find the following:
Tips for how to prevent fraud
Medicare & You Handbook in Spanish
Eligibility criteria for home health care services
List of Medicare Health Plans with drug coverage in your area
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Medicare Website Usability Study
69% could not determine eligibility for home health care services
80% could not find their local agency
57% could not make decision about Medicare Part D
72% could not follow the steps needed to select a plan
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Source: Czaja, S. et al. (2008) Usability of Medicare Health Web Site. JAMA. 300(7):790-792. Available at: http://jama.ama-assn.org/cgi/content/full/300/7/790-a
The Fastest Growing Online Population – Seniors!
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2004 2005 2006 2011
22%
29% 34%
42%
Internet Use by Seniors Age 65 and Older Over Time Percent
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Source: Fox, S. (2004). Older Americans and the Internet; Fox, S. (2006). Online Health Searches; Usage Over Time. Pew Internet and American Life Project. Available at: http://www.pewinternet.org
Year
Seniors Online
42% of adults age 65 and older are online
Seniors with higher incomes more likely to be online
Seniors with higher education more likely to be online
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Source: Kaiser Family Foundation (2005). E-Health and the Elderly: How Seniors Use the Internet For Health Information. Available at: www.kff.org
Seniors Off-line
Majority of non-users are age 65 and older
“Truly Unconnected” tend to be even older
Concerned about content and safety
Too expensive, don’t have the time
Don’t need it, and don’t want it
Too complicated and hard to use
Don’t have a computer or Internet access
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Source: Lenhart, A. (2003). The Ever-Shifting Internet Population. Pew Internet and American Life Project. Washington, DC. Available at: www.pewinternet.org/pdfs/PIP_Shifting_Net_Pop_Report.pdf
Health Information and the Internet
80% of Internet users search for health information
86% do not seek advice about which websites to use
72% express trust in most or all information found online
75% rarely or never check for source and date
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Source: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC: Pew Internet & American Life Project. Available at: http://www.pewinternet.org/PPF/c/5/topics.asp
42% of adults age 65 and older are online
Caregivers Online
Half of health searches are for someone else
Among e-caregivers (those who help others)
36% found health care advice
34% found health care services
26% found information to compare options
58% said the Internet was their most important resource
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Source: Fox, S. (2006). Online Health Searches 2006. Pew Internet and American Life Project. Washington, DC. Available at: www.pewinternet.org
Affects on Health
58% said the Internet affected a decision they made about treatment
55% changed their approach to maintaining their health
44% changed the way they think about diet, exercise, or stress
39% changed how they cope with chronic disease or chronic pain
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Source: Fox, S. (2006). Online Health Searches 2006. Pew Internet and American Life Project. Washington, DC. Available at: http://www.pewinternet.org
A real drug. A real disorder. A spoof
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Focused Outreach Health Information Literacy
National Network of Libraries of Medicine – New England Region (NN/LM NER) http://nnlm.gov/ner/
Program Goals
Increase access health information for communities experiencing health disparities
Collect formative and summative evaluation data for program improvement
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Three Phases, Two Communities
1. Community Assessment Key informant interviews
2. Focused Outreach Implementation Tailored efforts based on assessment findings
Community-based partnerships
3. Evaluation Outcome measures: pre-post training evaluations,
follow-up assessment
Process measures: story-based evaluation, community partner exit interviews
*
1. Western Maine (rural)
* *
*
2. Providence, RI (Latino)
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Community Assessment Western Maine, Rural Seniors
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Findings (n=9)
Rural with growing senior population
Growing African immigrant community
Healthy communities coalitions as partners
Strong school health program
Broadband is limited
Libraries offer public access
Focused Outreach Implementation Western Maine, Rural Seniors
Tailored Approach
Core outreach activities (professional trainings, consumer education, and materials) targeted to the needs of seniors
Established partnerships with healthy communities coalitions and provided stipends for outreach activities
Promoted NLM resources (MedlinePlus, NIHSeniorHealth) via trainings, exhibits, libraries, senior services, etc.
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Evaluation Results Western Maine – Rural Seniors
Outputs
Consumers reached (n=154)
Consumer pre-/post-training evaluations (n=85)
Consumer follow-up (n=13 )
Service providers trained (n=98)
Service provider pre-/post-training evaluations (n=82)
Service provider follow-up (n=28 )
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Consumer Pre-training: Age of Respondents
0.0% 3.7%
7.3%
31.7%
57.3%
18 - 24 years old
25 - 34 years old
35 - 49 years old
50 - 64 years old
Over 64 year old
N=82
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Consumer Pre-training: Use of the Internet
Never 34.9%
Sometimes 27.7%
Every day 36.1%
Never Sometimes Every day
N=83
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Consumer Pre-training: Where Respondents Access the Internet
52.1%
0.0%
5.6%
14.1%
36.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Home School Work Library I don't use the Internet
N=71
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Consumer Pre/Post-training: Ever Used NLM Resources
2% 1%
39%
29%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
MedlinePlus NIHSeniorHealth
Pre-Training
Post-Training
Pre N=82
Post N=62
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Consumer Pre/Post-training: Confidence in Ability to Find Health Information Using the Internet
33%
16%
51%
79%
17%
46%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Confident Not Sure Not Confident
Pre-training
Post-training
Pre N=81
Post N=65
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Consumer Post-training: Likely to Use MedlinePlus in the Future
Likely 67.7%
Not sure 16.1%
Not likely 16.2%
Likely
Not sure
Not likely
N=62
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Consumer Post-training: Likely to Use NIHSeniorHealth in the Future
Likely 66.1%
Not sure 15.4%
Not likely 18.4% Likely
Not sure
Not likely
N=65
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Consumer Follow-up: Used NLM Resources
46%
23%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
MedlinePlus NIHSeniorHealth
N=15
Evaluation Results Western Maine – Rural Seniors
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N=13
Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Service Provider Post-training: Likely to Use NIHSeniorHealth in their Work
Likely 83%
Not Sure 14%
Not Likely 3%
Likely
Not Sure
Not Likely
N=87
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Service Provider Follow-up: Used NLM Resources
82%
41%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
MedlinePlus NIHSeniorHealth
N=27
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Service Provider Follow-up: Shared NLM Resources with Others
N=27 69%
56%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Co-worker / other service provider
Client / other community member
Evaluation Results Western Maine – Rural Seniors
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Funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract #N01-LM-6-3508 with the University of Massachusetts Medical School
Teaching Observations
Seniors are hungry for health information
Seniors are eager to learn
Learning a new technology is very stressful to some
Very few seniors are “truly unconnected”
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Auburn Public Library Computer Training Class
NIHSeniorHealth: Helping Older Adults Search for Health Information Online: A Toolkit for Trainers
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Teaching Resources
http://nihseniorhealth.gov/toolkit/toolkit.html
Health Information Literacy
Health information literacy is the ability to:
Recognize a health information need
Identify sources and use them to find health information
Assess the quality of the information and its usefulness
Understand and use the information to make informed health care decisions
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Definition of Health Information Literacy Medical Library Association (MLA) Task Force, 2003
Core Content
How do you know if the information you find on the Internet is accurate (correct) and reliable (trustworthy)?
Who developed the website? Do you trust them?
When was it last updated? Is it current?
What is the purpose? Is it biased in anyway?
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Source: Kurtz-Rossi S, Duguay P. (2010). Health Information Literacy Outreach: Improving Health Literacy and Access to Reliable Health Information in Rural Oxford County Maine. Journal of Consumer Health on the Internet. 14:4, 325-340. http://www.pewinternet.org
Teaching Tips
Provide hands-on practice
Repetition, go slow
Use health topics of interest
Provide access to computers
Teach small groups
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Usability Issues
Vision: non-text, color, small print, PDF files
Hearing: audio files, video, tutorials
Motor: key board, small links
Cognition: complex content or navigation
Literacy: technical language, too much information
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Universal Design
Section 508 Standards
Federal requirements for technology accessibility
Online tools to test 508 accessibility
http://www.cynthiasays.com/
http://wave.webaim.org
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Source: Eichner, J. Accessible Health Information Technology (IT) for Populations with Limited Literacy. AHRQ, US DHHS. (2007). Available at: http://www.heatlhlit.ahrq.gov
Plain Language 2.0
Text
Use “living room” language
Speak in active voice
Provide glossary
Use headers
Chunk information
Avoid acronyms
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Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at: http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf
Plain Language 2.0
Design
Use larger (12 or 14 point) sans serif font
Limit use of bold, italics and other font features
Leave plenty of white space
Use upper and lower case letters
Be careful with colors
Include text with icons
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Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at: http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf
Plain Language 2.0
Navigation
Minimize scrolling
Step by step navigation, show “breadcrumbs”
Consistent layout
Include non web-based contact information
Make buttons large and easy to use
Provide search function
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Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at: http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf
Plain Language 2.0
Multi-Media
Use short segment to reduce download time
Provide text alternative (e.g. open caption or print version) for all animation, video, audio
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Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Health literacy online: A guide to writing and designing easy-to-use health Web sites. Washington, DC. Available at: http://www.health.gov/healthliteracyonline/Web_Guide_Health_Lit_Online.pdf
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NIHSeniorHealth.gov
46
NIHSeniorHealth.gov
47
NIHSeniorHealth Videos
NIHSeniorHealth.gov
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MedlinePlus.gov
MedlinePlus.gov 49
Healthfinder.gov 50
Healthfinder.gov 51
Recommend Websites
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MedlinePlus.gov
NIHSeniorHealth.gov
Healthfinder.gov
cdc.gov/aging
Recommended Resources
NIHSeniorHealth Toolkit http://nihseniorhealth.gov/toolkit/toolkint.html
Health literacy online: A guide to writing and designing easy-to-use health Web sites http://www.health.gov/healthliteracyonline/ Web_Guide_Health_Lit_Online.pdf
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Questions and Comments
Sabrina Kurtz-Rossi Health Literacy Consultant
Kurtz-Rossi & Associates
Phone: 781-835-6488; Fax 781-391-4409
Member Clear Language Group
www.clearnlanguagegroup.com
Thank you
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