Health Literacy
What’s Done andWhat’s Left to Do
Paul D. Smith, MD, Associate Professor
UW Department of Family Medicine
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Topics today
Literacy VS health literacy
History of health literacy
What’s new
Where are we now?
What’s next
What is Literacy?
Literacy is a combination of skills:
Verbal
Listening
Writing
Reading
What is Health Literacy?
The Institute of Medicine 2004
“The degree to which individuals have the
capacity to obtain, process, and
understand basic information and
services needed to make appropriate
decisions regarding their health.”
Literacy VS Health Literacy
Almost everyone will have difficulty with
health literacy at some point.
Much harder for those that do not:
Read very well.
Speak English as their primary language.
Two Sides to the Equation
It’s all about effective communication
Verbal
Written
Multi-media
It has to be presented in a way that is
understandable to most people.
History - 1974
Health literacy first use in publication
Health Education as Social Policy
Simonds SK. Health education as social policy. Health Educ Monogr 1974;2:1-25.
History - 1990
Health literacy appears in medical literature
Start to see reports of correlation between
literacy and health outcomes
History - 1993
National Adult Literacy Survey (NALS)
First nationwide assessment of adult literacy
History - 1993
Rapid Estimate of Adult Literacy in Medicine
REALM
First tool for assessing health literacy
Davis T, Long S, Jackson R, Mayeaux E, George R, Murphy P, Crouch M. Rapid Estimate of Adult Literacy in Medicine: A Shortened Screening Instrument. Fam Med 1993; 25:391-5.
History - 1996
National Institute for Literacy
Health and Literacy listserv starts
http://www.nifl.gov/mailman/listinfo/Healthliteracy
History - 1999
American Medical Association
Ad Hoc Committee on Health Literacy Report
American Medical Association, Council on Scientific Affairs, Ad Hoc Committee on Health Literacy. Health literacy: report of the Council on Scientific Affairs. JAMA 1999 Feb 10;281(6):552-7.
History - 2000
Department of Health and Human Services
Healthy People 2010
Health literacy definition that is commonly used
U.S. Department of Health and Human Services. (2000). Healthy People 2010 (2nd ed.) [with Understanding and Improving Health (vol. 1) and Objectives for Improving Health (vol. 2)]. Washington, DC: U.S. Government Printing Office.
History - 2003
Paul Smith stumbles on issue
1st attempt at a health literacy grant
1st of many failures
History - 2003
National Assessment of Adult Literacy
2nd adult literacy assessment
National representative sample
Measured health literacy
12% of adults are proficient in health literacy
http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006470 http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483
History - January 2004
Agency for Healthcare Research and Quality
Literacy and Health Outcomes
Comprehensive review of the literature
http://www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacy.pdf
History - April 2004
Institute of Medicine
A Prescription to End Confusion
Comprehensive evaluation and recommendations
http://www.nap.edu/catalog/10883.html
History - July 2004
First Wisconsin Health Literacy Summit
David Kindig, PhD
~50 attendees
Paul Smith’s first health literacy presentation.
History - 2005
Wisconsin Literacy, Inc.
First meeting of Health Literacy Committee
History - 2006
Wisconsin Hospital Association
Webcast presentations
Focus group project funded
American Academy of Family Physicians
Emotional response: stress, shame, fear
History - 2007
Health Literacy Summit 2
220 attendees
3 national speakers
Webcast presentations
Regional Health Literacy Committees created
History - 2008
Regional Initiatives
Needs analysis
Surveys
Brochures, PowerPoint
Wingspread Conference
History - 2009
Health Literacy Summit 3
238 attendees
Andrew Pleasant and other national speakers
Pre-conference meeting of state
representatives
History - 2009
Projects
Nursing health literacy curriculum
Improving Hospital Health Literacy Environment
Ask Me 3
What to do When Your Child is Sick project
History - 2009
Wisconsin Literacy Projects
Incorporate health literacy into tutor training
Reach parent learners with “What to Do..” book
Develop learner resources for medication safety
History - 2009
Joint Commission new regulations
Effective communication
Cultural Competence
Family-Centered care
Approved Requirements to Advance Effective Communication, Cultural Competence, and Patient- and Family-Centered Care Hospital Accreditation Program, The Joint Commission, November, 2009.
What’s new?
www.healthliteracywisconsin.org
Health literacy resources and links
Activities of Regional Health Literacy Committees
Health Literacy curricula
Health care providers
Adult literacy students
What’s new?
www.healthliteracymissouri.org
Health literacy materials library
Searchable database
Easy to read patient education materials
Published articles
Health literacy tools
Agency for Healthcare Research and Quality
Consumer Assessment of Healthcare Providers
and Systems Questions (CAHPS)
Health literacy supplement
www.cahps.ahrq.gov
Agency for Healthcare Research and Quality
Health Literacy Universal Precautions Toolkit
http://www.ahrq.gov/qual/literacy/
Universal precautions VS testing for health literacy
Agency for Healthcare Research and Quality
Informed Consent and Authorization Toolkit for
Minimal Risk Research
http://www.ahrq.gov/fund/informedconsent/
What’s new?
Department of Health and Human Services
Action Plan to Improve Health Literacy
Released May 27, 2010
http://www.health.gov/communication/HLActionPlan/
HHS Action Plan to Improve Health Literacy
Seven goals
1. Develop and disseminate health and
safety information that is accurate,
accessible, and actionable.
HHS Action Plan to Improve Health Literacy
2. Promote changes in the health care
system that improve health information,
communication, informed decision
making, and access to health services.
HHS Action Plan to Improve Health Literacy
3. Incorporate accurate, standards-based,
and developmentally appropriate health
and science information and curricula in
child care and education through the
university level.
HHS Action Plan to Improve Health Literacy
4. Support and expand local efforts to
provide adult education, English language
instruction, and culturally and linguistically
appropriate health information services in
the community.
HHS Action Plan to Improve Health Literacy
5. Build partnerships, develop guidance, and
change policies.
6. Increase basic research and the
development, implementation, and
evaluation of practices and interventions
to improve health literacy.
HHS Action Plan to Improve Health Literacy
7. Increase the dissemination and use of
evidence-based health literacy practices
and interventions.
What’s New?
The Joint Commission
Advancing Effective Communication, Cultural
Competence, and Patient- and Family-Centered
Care – A Roadmap for Hospitals
http://www.jointcommission.org/PatientSafety/HLC/HLC_Develop_Culturally_Competent_Pt_Centered_Stds.htm
What’s New?
Medline Plus website redesign
http://www.nlm.nih.gov/medlineplus/
Easy to read materials
Interactive videos
Where are we now?
Higher level of awareness in WI and nationally
Many projects started around the state
More research being done
Not many definitive answers
Where are we now?
Discussions of:
Health literacy definition
Health literacy measurement
Health professional curricula
National health literacy advocacy organization
Where are we now?
82nd health literacy presentation
What’s Next?
More research and dissemination of results
AHRQ document rating system
More health literacy regional conferences
What’s Next?
Become part of the healthcare reform?
Response to Action Plan?
What’s Next In Wisconsin?
Publication of research results
Collaboration Guide for hospitals and literacy
organizations
Easy-to-Understand Writing Guide
County specific literacy information?
What’s Next In Wisconsin?
Health Literacy Summit IV
April 12 – 13, 2011
Conference grant application
Health materials development workshop
Wingspread Conference follow up
What Can You Do?
Learn more
Continue to raise awareness
Start small
Integrate health literacy into current efforts
Connect with collaborators
Questions?
Comments?