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TRANSCRIPT
7/2/2014
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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
7/2/2014
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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: [email protected]
Linda Morgan Davis: [email protected]
Joyce Naseyowma-Chalan: [email protected]
Attaining High Reliability and Safety for Patients –
Collaborating for Change. Patient Safety Collective of the
Southwest (PSCS). March 6-7, 2014; Albuquerque, NM