Why should I care about health literacy 2013
Why should I care about health literacy? 2013 CCMI
Video Test Bobby Mc. Ferrin’s Pentatonic Scale: https: //youtu. be/ne 6 t. B 2 Ki. Zuk 2013 CCMI
Devon Poznanski dpoznanski@bccancer. bc. ca November 23, 2019 Health Literacy www. centre. CMI. ca 2013 CCMI January 2017 © 2013
Learning objectives 1. Define health literacy 2. Describe who is affected by low health literacy 3. Describe the impact of low health literacy 4. Identify and practice skills to address low health literacy 2013 CCMI
Agenda 1. What is health literacy and why does it matter? 2. Skills to address low health literacy: a. Universal precautions b. Plain Language c. Chunk and Check d. Teach-back e. Ask-Tell-Ask 2013 CCMI
INTRO Why health literacy? What is health literacy about? Definitions & Evidence 2013 CCMI
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How do you clean the capstan? 2013 CCMI
What is literacy? “a person’s knowledge of a particular A person’s ability to read or write? subject or field. ” 〉 But also includes things like computer literacy and financial literacy Dictionary. com 2013 CCMI
Health literacy is … “… the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. ” The Patient Protection and Affordable Care Act of 2010, Title V 2013 CCMI
Health literacy is … “…the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course. ” Rootman and Gordon-El-Bihbety, 2008 2013 CCMI
Health Literacy is also. . . “. . . the ability of professionals and institutions to communicate effectively so that community members can make informed decisions and take appropriate actions to protect and promote their health. ” Adapted from Rootman and Gordon-El-Bihbety, 2008 2013 CCMI
Health Literacy Includes: Oral/Written • • Appointments After Visit Summary Phone Advice Pill Bottles 2013 CCMI Numeracy • • • Risk Numbers Medication directions Weight calculations E-Health • • • Computer literacy Use of IT and mobile apps Reputable sites
Health Literacy: Balancing Demands and Skills Based on Graphic by Dalen Gilbrecht 2013 CCMI Health Literacy
Why is health literacy important? 1. Numbers 2. Effect on health 3. Chronic disease 4. Cost 5. Complex health information 6. Fairness Courtesy of Dr Irv Rootman 2013 CCMI
1. Numbers (Canada) 〉 60% of Canadians (almost 15 million people) 〉Almost 90% of older adults Canadian Council on Learning, 2008 2013 CCMI
1. Numbers (US) 77 million at basic or below basic health literacy. US Department of Human Services 2013 CCMI
2. Effect on Health Low Health Literacy may lead to: 〉 Longer hospitalizations (Baker et al. , 1997, 2002) 〉 Chronic Disease (CCL, 2008) 〉 Earlier Death (Baker et al. , 2007; Sudore, 2006) 2013 CCMI
3. Chronic Disease 〉Increasingly common (Anderson and Horvath, 2004: CIHI, 2009) 〉Low health literacy is a barrier to effective self-management (Johnston et al. , 2006) 2013 CCMI
4. Cost 〉 Limited health literacy increases total health costs by 3 to 5% of the total health cost per year Hudson et al 2018 2013 CCMI
5. Complex Health Information 〉 There is a mismatch between reading levels of health education materials and the reading skills of the audience. 19% (Rudd, 2007) 〉 The same is true for health information websites. 81 (Petch 2004) 〉 Jargon is also often used in health care. Jargon No Jargon (Castro et al, 2007) 2013 CCMI 5
6. Fairness Certain groups experience lower levels of health literacy, including: 〉 Older adults 〉 Immigrants 〉 People with less education 〉 People whose mother tongue is neither English nor French 〉 People who receive social assistance 〉 Residents of particular geographic regions (Rootman and Gordon-El-Bihbety, 2008) 2013 CCMI 5
Health Literacy and the Triple Aim Population Health Happy People! Experience of Care www. ihi. org Healthy People! And we can afford it! Per Capita Cost 6
ATTITUDE Universal Precautions 2013 CCMI 11
What affects health literacy? Personal Factors Health Literacy System factors Interaction of the person and the health care context 2013 CCMI 13
Personal Factors 〉 LIFE! › › 〉 Physical and emotional health: pain, fatigue, anxiety, lack of sleep Cultural beliefs about health Experience with the condition and the healthcare system Motivation and self-confidence Social determinants of health › › 2013 CCMI Money Education Access Environment 13
System Factors Providers • Communication skills • Use of Health Literacy Universal Precautions Patient Education • Complexity and design of information Materials (PEM) • Translation service/availability Places • Nature of the environment 14
Imbalance Person’s capacity Person 2013 CCMI System demands Providers Education Materials Places 14
Red flags: Signs of Literacy Issues 〉 Copying 〉 Mixing things up 〉 Saving it for later 〉 Missing appointments 〉 Handing it off 〉 Waiting to get help 〉 Making excuses 〉 Not acting on 〉 Withdrawing or information avoiding 2013 CCMI 15
Screening for Health Literacy? Which Should we use one? Cost Individual Health Time Literacy Screening? Reliability 2013 CCMI Training and competency 15
Screening for Low Health Literacy Alternative to screening…. . Universal Precautions 2013 CCMI 16
Health Literacy Universal Precautions Structuring the delivery of care in the practice as if every patient may have limited health literacy 〉 You can’t tell by looking 〉 Higher literacy skills ≠ understanding 〉 Health literacy is a state not a trait 〉 Everyone benefits from clear communication http: //ahrq. gov/qual/literacy 2013 CCMI 14
Tips from Universal Precautions 1 Create a welcoming environment 2 Use Plain Language 3 Chunk and Check information 4 Use Teach-Back to check understanding 2013 CCMI 16
Top Tip: Create a Welcoming Environment 1 2013 CCMI 17
Setting Time to respond What would a Supports welcoming environment look and feel like? Instructions Body language and tone 2013 CCMI Privacy Encourage questions Introduce self 17
SKILLS Plain Language Chunk and Check Teach-Back Ask-Tell-Ask 2013 CCMI 19
What does plain language mean to you? 2013 CCMI 21
Plain language “Communication your audience can understand the first time they read or hear it. ” Materials that are in plain language help people to 〉 “Find what they need 〉 Understand what they find 〉 use what they find to meet their needs” What is plain language? plainlanguage. gov 2013 CCMI 21
Plain Language: Fact or Fiction? Fiction It limits the information that can be provided. . Fiction It insults adults. Fiction It creates legal risk. Fiction It is just common sense. 2013 CCMI 21
3 Top Tip: Use Plain Language Plain language is: 〉 user-oriented materials – print, audio, visual, online, multi-media, presentations. 〉 driven by, tested by and succeeds through contributions from your audience. 〉 about accessibility, credibility and usability. Plain language is a process! 2013 CCMI 21
Plain Language 2013 CCMI
Plain Language 2013 CCMI
Sample Consent Form This is to certify that the surgical procedure known as ______ (name of operation), the reason why it is considered necessary, its advantages and possible complications, as well as possible alternative methods of treatment have been explained to me by_____(name of Physician or Surgeon), and in light of the information the anesthetic deemed advisable, the operation stated above and also to perform such additional procedures as may be held to be therapeutically necessary on the basis of findings in the course of the operation. Any tissues surgically removed may be disposed of by the surgeon or the hospital in accordance with their accustomed practice. Literacy Partners of Manitoba 2013 CCMI 22
Plain Language Consent Form I give permission for the surgeon, Dr. _____, to operate on me. During the operation, he/she 〉 may perform any other surgery that may be necessary, 〉 may use any anesthetic that may be necessary, 〉 may dispose of any tissue that is cut out. Literacy Partners of Manitoba 2013 CCMI 22
Turning Our Words Into Living Room Language Medical Term 2013 CCMI Living Room Language
Make it Simple! Difficult Early Detection Cardiovascular Nephrologist Smoking cessation Influenza. . . 2013 CCMI Simple 23
Speak in Your Client’s Language 〉 Plain language is a process – involving the person listening, watching or reading from start to finish. 〉 Use plain language to connect. 〉 Look for ways to communicate information in their language. 2013 CCMI 24
What if you do not speak the same language? 〉 Work with those you serve to address the need in the way that makes sense to them. 〉 Use pictures whenever possible. 〉 Provide the information the way they want it provided. 〉 Translate written materials when possible and useful. 〉 Let front-line workers know what resources are available. 2013 CCMI 24
3 Chunk and Check Information 〉 Write short, manageable paragraphs and sections that answer common questions. (1 -3 sentences: 6 -8 lines) › Words with less syllables › Short sentences 〉 Use lists and bullet points This also applies to speaking. 2013 CCMI 24
Video This is Bad Enough: https: //youtu. be/R 3 t. J-MXq. Pmk 2013 CCMI
Teach-Back 4 A method to check that information has been communicated clearly 〉 Is a test of the person giving information, not the one receiving it 〉 Is the best way to help someone understand information American Medical Association and the AHRQ Universal Precautions Health Literacy Toolkit 2013 CCMI 30
Teach-Back TELL ASK LISTEN UNDERSTANDING? Based on the work of Darren De. Walt, MD NO YES 30
Teach-Back After you give information or instruction, say: “Could you tell me back what we just talked about to see if I was able to make it clear? ” OR “After you leave this appointment a family member or friend might ask you what happened today. What are you going to tell them about what you are going to do? ” If teaching a skill, use “Show me. ” “Show me how you are going to do this at home so I know if I was clear. ” American Medical Association and the AHRQ Universal Precautions Health Literacy Toolkit 2013 CCMI 30
Using teach-back has been shown to… 〉 Improve blood sugar control for people with diabetes (Schillinger, 2003) 〉 Decrease time it takes to get people taking warfarin (medication to prevent blood clots) to the right dose (Schillinger, 2007) 〉 Other publications show effectiveness for asthma patients and people with chronic heart failure titrating their own diuretic medication. (Paasche-Orlow, 2005; De. Walt, 2006) 2013 CCMI 31
Working with an Interpreter 〉 Pre-visit › Time › Brief the interpreter › Ask permission › Review confidentiality › Arrange seating › Interpret everything and explain cultural adaptations needed 2013 CCMI 〉 During the visit › Look at the person › Provide full explanations › One question at a time › Speak slow and pause › Clarify as needed › Encourage questions › Summarize › Use teach-back. 32
Teach-Back Example https: //www. youtube. com/watch? v=e 5 jxe. ZWM 3 tw&feature=youtu. be 2013 CCMI
Try using teach-back now 〉 〉 〉 Turn to someone seated next to you that you do not know Tell them how to get from your house to the post office (coffee shop, gym, etc. ) Ask them a teach-back question “Can you tell me how to get to the ___ so I know if I was clear? ” Repeat as needed Switch 2013 CCMI Danby Wiske UK, by C Davis
Teach-Back Practice PARTNER A PARTNER B Tell your partner how to get from your house to the post office (coffee shop, gym, etc. ) Listen to the description. Ask the teach-back question: “Can you tell me how to get from my house to ____ so I know if I was clear? ” Respond to their question honestly. Repeat instructions as needed. Switch. You will have about 5 minutes for each turn. 2013 CCMI Switch. You will have about 5 minutes for each turn.
Partner A Partner B Observer Tell your partner how to get from Listen to the description. your house to the post office (coffee shop, gym, etc. ) Ask the teach-back question: “Can you tell me how to get from my house to ____ so I know if I was clear? ” Respond to their question honestly. Follow-along on the teach-back checklist. Switch. You will have about 5 minutes for each turn. Review what you observed on the checklist. Switch. You will have about 5 minutes for each turn. Repeat instructions as needed. Switch. You will have about 5 minutes for each turn. 2013 CCMI
Teach-Back Observation Tool 〉 Key aspects of teach- back 2013 CCMI
Jennifer Deering talks about Universal Precautions https: //www. youtube. com/watch? v=Sze. D_xuf. Tj. M&feature=youtu. be 2013 CCMI
How to Give Information and Advice ASK (elicit) 1. 2. Permission to give information or advice OR What they already know or want to know TELL (provide) limited amount of information in clear language ASK (elicit) 1. 2. 2013 CCMI What do they think of what you said OR Teach back to check for understanding Miller W, Rollnick S. Motivational Interviewing: Helping people change. 3 rd ed. New York: Guilford Press; 2012. 33
Ask-Tell-Ask: What does it look like? Test Results https: //vimeo. com/85555368 2013 CCMI
Step Options and Tips ASK #1 1) for Permission Option 1: Permission to give information and advice: � “Is it ok if we talk about. . . ? ” � “Would you like to know more about. . . ? ” OR Option 2: What they already know or want to know: � “What do you know about. . . ? ” OR � “There are several things we could talk about, where should we start? ” 2) what they know � “What information can I help you with? ” or want to know � “You already know a lot about. . . , but are there any questions you still have? ” 2013 CCMI 33
Step Options and Tips 1. 2. TELL information respectfully, clearly, and in small amounts 2013 CCMI 3. 4. 5. 6. Make sure the information fits the person and is focused on the present. � “You said that. . . is on your mind right now. ” Provide the information in a neutral way. The purpose is to give information, not change their minds. � “Sometimes people in this situation. . . ” � “Let’s look at the (questionnaire/survey/screening) results together. . . ” Focus on one or two key messages that the person wants to know. � “There are two things to think about right now. . . ” Use plain language (short sentences and familiar words). Use pictures and handouts when they are helpful. Emphasize choice and options by avoiding words like “can’t, ” “must, ” or “have to. ” � “There are three choices about where to go from here. . . ” 33
Step Options and Tips ASK #2 1) what they thought OR 2) use teach-back to make sure there is understanding 2013 CCMI Option 1: What they thought: � “What do you think about that? ” � “I wonder what this all means to you? ” � “I wonder how you think we might best proceed? ” OR Option 2: Use teach-back to make sure there is understanding: � “I’d like to make sure I did a good job explaining. Could you say it back to me so I know I was clear? ” � “If someone asked you what we talked about today, what would you tell them? ” � “Can you show me how you are going to (use this equipment/complete this form/…. ) so I know that I explained it well. 33
Special case: A rule or a professional or legal obligation 〉 A rule 〉 A professional obligation 〉 A topic you must discuss 〉 A reporting requirement 2013 CCMI 34
Special Case: They ask me to tell them what to do! 〉 Emphasize choice 〉 Offer a menu of choices (behavioral menu) 2013 CCMI 34
Activity: Ask-Tell-Ask Key Learner Listening Listen to the description. Respond as you think the person would respond. Guide Observer Describe what information you often give and to which key learner. Use Ask-Tell-Ask to give your information or advice. Watch for the Spirit of MI. Follow along on the skills checklist. Remember it may be Ask-Tell-Ask-Tell Debrief using the checklist. 2013 CCMI Switch
Ask-Tell-Ask Skills Checklist 2013 CCMI 35
Questions? 2013 CCMI
BC Cancer Patient Education POD page 2013 CCMI
2013 CCMI
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