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Putting Health Literacy into Putting Health Literacy into
Practice: A Pediatric ApproachPractice: A Pediatric ApproachBenard Dreyer, MD, FAAP
Mary Ann Abrams, MD, MPH, FAAP
Connie Arnold, PhD
Norma Kenoyer
May 23, 200711:00 – 12:30 Central Time
(9am PST/ 10am MST/ 12pm EST)
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Web Conference Objectives
• Gain awareness of health literacy, its impact, and relationship to quality care
• Understand the patient and family perspective• Develop skills and techniques to address low
health literacy• Learn principles for selecting or developing plain
language print materials• Identify resources within the AAP for addressing
low health literacy
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“An individual’s ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and develop one’s knowledge and potential.”
National Literacy Act of 1991
General Literacy: Definition
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National Assessment of Adult Literacy (NAAL)*
n = 19,714
● Most up to date portrait of literacy in U.S.
● Scored on 4 levels
● Lowest 2 levels cannot:
◦ Use a bus schedule or bar graph
◦ Explain the difference in two types of employee benefits
◦ Write a simple letter explaining an error on a bill
* National Center for Educational Statistics, U.S. Department of Education
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2003 National Assessment of Adult Literacy
Intermediate
Basic
Below Basic
Proficient
14%
13%
44%
29%
93 Million Adults have Basic or Below Basic Literacy
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Health Literacy: A Definition
Obtain, process, understand basic health information and services
Make appropriate health care decisions (act on information)
Access /navigate healthcare system
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IOM Report on Health Literacy• 90 million adults have trouble
understanding and acting on health information
• Complex text must be simplified and
attention paid to culture and language• Providers need health literacy training
Healthy People 2010• Improve health communication/health literacy
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IOM, 2004: Health Literacy…
“is fundamental to quality care…”
Relates to 3 of the 6 aims in IOM Quality Chasm Report:
• Safety• Patient-centered
care• Equitable
treatment
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Limited Health Literacy: The Problem
A “mismatch” between patients’ capacities and
the demands placed on them by:
• The nature of their illness
• Self-management expectations
• Heath providers
• Health systems
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2003 Health Literacy Assessment
National Assessment of Adult Literacy (NAAL): National Center for Educational Statistics, U.S. Department of Education, 2003.
Basic
Below Basic
Proficient
14%
12%
53%
22%
Intermediate
n=19,000 U.S. Adults
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Health Literacy of America’s Adults• Below Basic: Circle date on doctor’s
appointment slip• Basic: Give 2 reasons a person with no
symptoms should get tested for cancer based on a clearly written pamphlet
• Intermediate: Determine what time to take Rx medicine based on label, use immunization schedule, interpret a growth chart
• Proficient: Calculate employee share of health insurance costs using table
*67% probability individual can perform task
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Low Parental Literacy and Pediatric Asthma
Outcome related
to Asthma
Likelihood compared to children of higher
literacy parents
Hospitalizations 4.6
Emergency Room Visits 1.4
Missed Days of School 2.8
DeWalt et al. Ambulatory Pediatrics 2007;7:25–31
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Pregnant Women: Concern about Effect of Smoking on Baby
40
Arnold, Davis, et al. Preventive Medicine 2001;32(4):313-20
66
37
0
10
20
30
50
60
70
80
90
100
Literate Low Literate
Percent
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Mothers Breastfeed for at least 2 Months
Kaufman et al. Southern Medical Journal 2001;94(3):293-6.
54
23
0
10
20
30
40
50
60
70
80
90
100
Literate Low Literate
Percent
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Mothers Access a Medical Home for Newborn Infant
50
14
0
10
20
30
40
50
60
70
80
90
100
Literate Low Literate
Sanders et al. E-PAS (Pediatric Academic Societies) 2006; 59:4138.1
Percent
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Quality & Safety-related Consequences of Low Health
Literacy
• Excess use of emergency department• Excess hospitalizations• Longer lengths of stay• Decreased adherence• Poorer health outcomes• Increased medication errors
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Amy Tilman
"When I'm confused or worried about my child, I'm not able to read things that I can normally read every day."
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A Demonstration Exercise
• The following paragraph of instructions simulates what a reader with low literacy sees on the printed page
• Read the paragraph out loud.
• You have 15 seconds to read.
• Hint: The words are written backwards and the first word is “cleaning”
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GNINAELC – Ot erussa hgih ecnamrofrep, yllacidoirep naelc eht epat sdaeh dna natspac revenehw uoy eciton na noitalumucca fo tsud dna nworb-der edixo selcitrap. Esu a nottoc baws denetsiom htiw lyporposi lohocla. Eb erus on lohocla sehcuot eht rebbur strap, sa ti sdnet ot yrd dna yllautneve kcarc eht rebbur. Esu a pmad tholc ro egnops ot naelc eht tenibac. A dlim paos, ekil gnihsawhsid tnegreted, lliw pleh evomer esaerg ro lio.
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Test your Comprehension…
You are not alone if…
• You did not get past the first line.
• You were not able to understand the
instructions on how to clean the equipment.
How many of your patients are
struggling just to ‘de-code’ words?
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Cleaning – to assure high performance, periodically clean the tape heads and capstan whenever you notice an accumulation of dust and brown-red oxide particles. Use a cotton swab moistened with isopropyl alcohol. Be sure no alcohol touches the rubber parts as it tends to dry and eventually crack the rubber. Use a damp cloth or sponge to clean the cabinet. A mild soap like dishwasher detergent will help remove grease or oil.