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Health Literacy and Reliability

Barbara Balik, Linda Morgan Davis and Joyce Naseyowma-Chalan

Health Literacy: Strategies for Care Communication Reliability

Concurrent Session 1B // March 6, 2014 // 4:00-5:00 pm

Attaining High Reliability and Safety for Patients –

Collaborating for Change. Patient Safety Collective of the

Southwest (PSCS). March 6-7, 2014; Albuquerque, NM

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CE Disclosure

In compliance with the ACCME/NMMS Standards for Commercial Support of CME:

Barbara Balik, RN, EdD

Linda Morgan Davis, MLS, MBA

Joyce Naseyowma-Chalan MPH

have been has asked to advise the audience that each has no relevant financial relationships to disclose or does have relevant financial relationships to disclose which they will disclose here.

Attaining High Reliability and Safety for Patients –

Collaborating for Change. Patient Safety Collective of the

Southwest (PSCS). March 6-7, 2014; Albuquerque, NM

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Health Literacy: Strategies for Care Communication Reliability

Barbara Balik, RN, EdD, Co-founder // Aefina Partners

Linda Morgan Davis, MLS, MBA, Assistant Director Collections & Community // Albuquerque Bernalillo County Library

Joyce Naseyowma-Chalan, MPH, Manager, Native American Affairs // UNM Sandoval Regional Medical Center

Objectives Participants will understand and be equipped to: Apply core components and tools of Health

Literacy and their value in healthcare settings

Identify two community resources and available tools to aid Health Literacy

Understand unique aspects of Health Literacy in Native Americans

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What is Health Literacy?

Health literacy is the ability to obtain, process, and understand health information to make informed decisions about health care - for both patients and practitioners

Why Care? According to a national survey, over one-third of the adult

population has limited health literacy, meaning that they have basic or below basic health literacy levels

Limited health literacy is associated with medication errors, increased health care costs, and inadequate knowledge and care for chronic health conditions

It’s not just those who “look” like they have trouble reading

It is all of us – under stress or with poor interpersonal connections, our understanding goes down

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Health Literacy = Mutual

Understanding and Respect Reliability in healthcare is impossible without mutual

understanding and respect!

Promoting health, seeking medical care, taking medications correctly, and following prescribed treatments requires that people understand how to access and apply health information.

It also requires health care practitioners listen to and honor patient and family perspectives and choices.

Patient and family knowledge, values, beliefs and cultural backgrounds are incorporated into the planning and delivery of care.

Modified from: IPFCC.org

Link to High Reliability

Preoccupation with failure

Patients often know where the gaps are

Sensitivity to operations

Patients/Families know the whole journey

Reluctance to simplify

Mutual understanding and respect gives a full picture

Commitment to resilience

Ideas from Patients/Families

Deference to expertise

Patients/Families bring their wisdom and knowledge – a source of ideas

http://high-reliability.org/pages/Weick-Sutcliffe

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Some Examples Patients with Below Basic Health Literacy cannot:

Use the dosage chart on over-the-counter medicine

From a pamphlet, give 2 reasons why screening is important

Patients with Basic Health Literacy cannot:

Use an immunization schedule

Follow a prescription to “take medicine on an empty stomach”

Health Literacy Benefits

Everyone! Adult Learners’ Statement About Literacy Testing in Health Settings:

“A doctor’s office is no place for a reading test.”

Improving patient understanding is beneficial for the patient and health care provider Research: clear communication practices and

removing literacy-related barriers will improve care for all patients regardless of their level of health literacy From: AHRQ Health Literacy Universal Precautions Toolkit:

http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html

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Steps for Mutual Understanding

1. Create a respectful patient-/person-

centered environment.

2. Improve interpersonal communication

with patients.

3. Create and use patient-friendly written

materials.

Respectful Patient Centered Environment

Environments where patients feel comfortable: Saying : I don’t understand” Asking questions Talking openly about their health and concerns

Remember: asking healthcare practitioners questions can be intimidating: Fear of sounding stupid Fear of ridicule or of being “difficult” Fear of upsetting or bothering a busy

practitioner

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Possible Signals

Incomplete registration forms

Frequently missed appointments

Skipped tests and referrals

Trouble following through with medication plans

Excuses:

“I forgot my glasses…”

“I’ll look at this at home…”

“I’ll show it to my daughter…”

Unable to name medications, or explain purpose or timing of administration

Difficulty explaining medical concerns

No questions

Steps for Mutual Understanding

1. Create a respectful patient-/person-centered environment.

2. Improve interpersonal communication with patients.

3. Create and use patient-friendly

written materials.

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Steps to Use with Everyone

Plain “living-room” language

Slow down

Break it down, short statements

Organize into 2-3 concepts then check for understanding

Chunk and check

Teach-back

Plain Language

Clinical Language Plain Language

Benign

Contraception

Hypertension

Oral

Anti-inflammatory

Incontinence

Abdomen

Twice daily

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Chunk and Check The patient is newly diagnosed with

diabetes

What are the 2-3 main concepts they need to know?

1. Concept #1 2. Concept #2 3. Concept #3

Does everyone in the clinic/hospital use the same main concepts?

Teach Back

Respectfully ask patients to demonstrate understanding, using their own words:

“What will you tell your husband about what to do when Erin’s asthma gets worse?”

“I want to be sure I explained everything clearly, so could you say it back to me so I can be sure I did?”

“We’ve gone over a lot of information; can we talk about things you might do to get more exercise in your day? How might you make it work at home? What might get in the way?”

www.teachbacktraining.com

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Steps for Mutual Understanding

1. Create a respectful patient-/person-centered environment.

2. Improve interpersonal communication with patients.

3. Create and use patient-friendly written materials.

Patient Friendly Written

Materials

Chunk – key content “Just because you know it doesn’t mean they

need to hear it”

Readability http://www.readabilityformulas.com/free-

readability-formula-tests.php

Plain language http://www.nih.gov/clearcommunication/plai

nlanguage/gettingstarted/index.htm

Patients co-develop and review The Red Pencil exercise

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Partnerships

Reliable Partners

Public Library

Health Groups American Heart Association, American

Cancer Society…

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Why the Public Library? Trusted community resource

Educated staff

Diversity of materials

Anonymity

Hours of operation

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Library Resources

Public access computers

Health databases

Medline Plus

Gale - Health Reference Center

EBSCO – Health Source Plus

Library’s website - Libguide

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Why Health Groups

Reliability of Information

Focused Information

Support Groups or Other Services

Native American Health

Literacy Considerations

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NMDOH American Indian Health Disparities

Report Card

• Deaths related to alcohol*

• Deaths due to diabetes*

• Homicide*

• Late or no prenatal care*

• Motor vehicle deaths*

• Youth obesity*

• Pneumonia and influenza deaths

• Youth suicide

• Adults (age 65 +) not receiving a pneumonia

vaccination

*Indicators for which rates of American Indians are two or more

times higher than the rates of the group with the best rates

Health Systems

Native American

Model: Holistic

Medicine: Spiritual

Health: Balance

Focus: Promote health

Goal: Community health

Values:

Family/Community

participation

Western/Medical

Model: Allopathic

Medicine: Physical

Health: No Disease

Focus: Treat disease

Goal: Cure/control

individual disease

Values:

Confidentiality

Warne, D (2005). Traditional perspectives on child and family health. Pediatric Child Health,

10(9), 542-544.

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How did we get here?

100 Years of Policy

Health Disparities

and Policy

Snyder Act of 1921 Forced Removal of Indians - 1830

Indian Self-Determination and

Education Assistance Act (PL 93-638) 1975

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Compassion

Patience

Belief

Hope

Mind

Heart

Spirit

Body

Abeita-Sanchez, Leah. 2011, Pueblo Health Presentation Pueblo Convocation , Leadership Institute.

Free online resources

AHRQ Health Literacy Universal Precautions Toolkit: http://www.ahrq.gov/professionals/quality-patient-safety/quality-

resources/tools/literacy-toolkit/index.html

http://www.readabilityformulas.com/free-readability-formula-

tests.php

www.teachbacktraining.com

Examples of practitioners interacting with patients http://www.youtube.com/watch?v=cGtTZ_vxjyA

6-minute health literacy video:

http://www.acponline.org/multimedia/?bclid=782539368001&b

ctid=790962260001

http://www.ama-assn.org/ama/pub/about-ama/ama-

foundation/our-programs/public-health/health-literacy-

program/health-literacy-video.page

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Free online resources

Medline Plus : www.medlineplus.gov

Albuquerque/Bernalillo County Library – website:

abclibrary.org

Questions?

Barbara Balik: balik.barbara@gmail.com

Linda Morgan Davis: ldavis@cabq.gov

Joyce Naseyowma-Chalan: JNaseyowma@salud.unm.edu

Attaining High Reliability and Safety for Patients –

Collaborating for Change. Patient Safety Collective of the

Southwest (PSCS). March 6-7, 2014; Albuquerque, NM