health impact of low literacy & partnering to address solutions paul d. smith, md, associate...
TRANSCRIPT
Health Impact of Low Literacy & Partnering to
Address Solutions
Paul D. Smith, MD, Associate Professor
UW Department of Family Medicine
Topics today
Social determinants of health
Impact of literacy on health and health care
Collaboration in Wisconsin
Policy issues to consider
Social Determinants of Health
Social determinants of health
Impact of literacy on health and health care
Collaboration in Wisconsin
Policy issues to consider
In Their Own Words
Insert video clip here
How Age Effects NALS Data
Adults age 60 and over
Living in households or prisons
68-80% are in Level 1 and 2
More in Level 1 and 2 with advancing age
89-99% Level 1 and 2 age 80 and over
Literacy Levels Change with Age
BUT, they do not recognize their problemAge 60 and older
91% Read well or very well
88% Write well or very well
83% Do arithmetic well or very well
NAAL Health Literacy Assessment
Basic and Below Basic by education level
In High School, GED or HS grad 34-37%
Less than/some High School 76%
NAAL Health Literacy Assessment
Basic and Below Basic by
Self-reported health status
Excellent 25%
Very Good 28%
Good 43%
Fair 63%
Poor 69%
The Impact of Low Literacy on Health
Poorer health knowledge
Poorer health status
Higher mortality
More hospitalizations
Higher health care costs
Poorer Health Knowledge
Understanding prescription labels
395 patients
19% low literacy (6th grade or less)
29% marginal literacy (7-8th grade)
52% adequate literacy (9th grade and over)
5 prescription bottles
Literacy and Misunderstanding Prescription Labels. Davis et al. Ann Intern Med 2006;145:887-894
Poorer Health Knowledge
At least one incorrect
63% low literacy
51% marginal literacy
38% adequate literacy
Literacy and Misunderstanding Prescription Labels. Davis et al. Ann Intern Med 2006;145:887-894
Poorer Health Knowledge
“Take two tablets twice daily”
Stated correctly Demonstrated correctly
71% low literacy 35%
84% marginal literacy 63%
89% adequate literacy 80%
“Show me how many pills you would take in one day.” Counted out 4 tablets-correct
Poorer Health Status
2923 new Medicare enrollees
Inadequate literacy had increased frequency of:
Diabetes
Hypertension
Heart failure
Arthritis
Poorer Health Status
Medical Outcomes Study (SF-36)
Inadequate literacy had
Decreased:
Physical function
Mental health
Increased
Limitations in activity due to physical health
Pain that interferes with normal work activities
Poorer Health Status
Diabetics with retinopathy
0
5
10
15
20
25
30
35
40
%
inadequate adequate
36%
19%
Increased Mortality
Age 70-79
Reading level 8th grade or less
Five Year Prospective Study
Sudore R, et al. Limited Literacy and Mortality in the Elderly. J Gen Intern Med 2006; 21:806-812.
Increased Mortality
Risk of Death Hazard ratio: 1.75
19.7
10.6
0
5
10
15
20
%
Low Literacy Higher Literacy
More Hospitalizations
2 year hospitalization rate for patients visiting ED
0
5
10
15
20
25
30
35
%
low adequate
31%
14%
Increased Health Care Costs
Data
2003 Medical Expenditure Panel Survey
2003 National Assessment of Adult Literacy
Low Health Literacy: Implications for National Health Policy. Vernon, J, Trujillo, A, Rosenbaum, S, DeBuono, B. Oct. 2007
Increased Health Care Costs
Annual cost today:
Future costs based on today’s actions (or lack of action):
Low Health Literacy: Implications for National Health Policy. Vernon, J, Trujillo, A,
Rosenbaum, S, DeBuono, B. Oct. 2007
$106-238 Billion
$1.6-3.6 Trillion
Low Literacy is Overlooked
Patients do not volunteer their literacy problem
Many are ashamed
Some do not recognize their inadequate literacy
Lack of trust
The Big Secret
% of low literate adults that have not told their:
Children 52%
Friends 62%
Spouse 68%
Health care providers 75%
Co-workers 85%
More likely to have Low Literacy
Older
Less education
Non-white
More likely to have Low Literacy
Immigrants
Immigrate after age 12 >50%
NALS Level 1
More likely to have Low Literacy
Low-income
Medical Assistance
Incarceration
You Can’t Tell by Looking
Many Level 1 people don’t fit the stereotypes
75 % born in USA
50% are white
40% hold full or part time jobs
Other Issues Effecting Literacy
Visual Impairments
60 and older 17%
80 and older 36%
Other Issues Effecting Literacy
Cognitive impairment
Learning disability
65 and older
6% severe dementia
10-15 % mild-moderate
Increases with advancing age
Screening for Low Literacy
Upside-down test
Rapid Estimate of Adult Literacy in Medicine
REALM
Test of Functional Health Literacy in Adults
TOFHLA
Newest Vital Sign
NVS
Common Clues of Low Literacy
Patients say things like:
“I lost my glasses”
“I don’t need to read this through now, I’ll read it when I get home”
“I’d like to discuss this with my family”
“I have a headache now and can’t focus
Common Clues of Low Literacy
Medication review
Looking vs reading
Unable to name med
Do not know why taking med
Do not know medication timing
Common Clues of Low Literacy
Non-compliance
Medications
Testing
Consultations
How do we fix this problem?
Universal Design
If it works for people with low literacy or low
English skills, it will work for everyone.
Barriers to Effective Communication
Environmental factors
Noise
Lack of privacy
Distractions
Time constraints
Barriers to Effective Communication
Health care provider factors
Jargon
Lack of rapport
Ambiguous wording
Incomplete message
Too much information
Barriers to Effective Communication
Patient factors
Language
Cultural issues
Lack of trust
Hearing impairment
Visual impairment
Summary
Low literacy is a common problem
Low literacy affects health
Summary
Low literacy is hard to identify
Most of our documents are written
at a reading level that is too high.
Policy Issues to Consider
Healthcare Social Marketing
ABE ELL, family, workforce and corrections
programs.
What can YOU do?
Raise awareness
American Medical Association Foundation
Low Health Literacy: You Can't Tell By Looking
Health Literacy: Help Your Patients Understand
Institute of Medicine
Prescription to End Confusion
What can YOU do?
Be a patient.
Review processes
Review documents
What can YOU do?
Universal Design
Health Literacy Definition
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.
Understandable Consent Forms
A consent process that checks understanding
Documents written at 5th grade reading level
Procedures
Research
Billing/insurance
Informed Consent
Who are We Really Protecting?
Institutions
Researchers
Sponsors
Patients?
Other Consenting Methods
Script with verbal consent
Computer consent
Video/DVD
What can YOU do?
Partner with your local Literacy Council
Connie SolsrudExecutive Director
Marathon County Literacy Council300 N. 1st Street, Wausau
715-261-7292
What can YOU do?
Partner with your local Literacy Council
Jennifer LundDirector
The Neighbors’ Place745 Scott Street, Wausau
715-845-1966
Wisconsin Literacy
Coordinating organization for community-based adult literacy organizations.
52 Organizations scattered around the state.
Four Regional Literacy Consultants.
Wisconsin Literacy
www.wisconsinliteracy.org
Michele Erikson, director
608-257-1655
Health Literacy Regional Meetings
Steering Committee volunteers needed
Sponsors needed
What can YOU do?
Partner with your local
Regional Literacy Consultant
Connie Turbiville
435-2474
Office in Green Bay
Donate
Time
Be a tutor
Donate
Wisconsin Literacy
Your local Literacy Council
“Action expresses priorities.”
“Be the change that you want to see in the world.”
---Mohandas Gandhi
