Health Literacy and

Cultural Competency

Sabrina Kurtz-Rossi, MEd, Assistant Professor, Tufts

University School of Medicine, Health Literacy Consultant

Julie McKinney, MS, Moderator of the Health Literacy

Discussion List, Health Literacy Consultant

CNYCC Webinar

February 27, 2015

What We Will Talk About

•Link health literacy and cultural competency

•Define health literacy and who is at risk

•Consider evidence-based interventions

•Facilitate discussion

What are the literacy and language

demands in health and healthcare?

What is your role?

Clinician

Administrator

Public Health Professional

Educator

Care coordinator

Community Based Organization

Other

Poll: Please click on the choice that’s closest to what you do

What kind of facility are you from?

Hospital or Medical Center

FQHC or other health center

Private or group practice

Public Health Department

Health Home/Nursing Home/Assisted Living Facility

Specialty Care Treatment Center (Behavioral health,

dental, substance abuse, etc.)

Other

Poll: Please click on the choice that’s closest

How much does your workplace address…

Health Literacy

None

A little

A lot

Cultural Competency

None

A little

A lot

“Culture and health literacy both influence the content and outcome of health care encounters.”

“This intersection between culture and health literacy is recognized in the DHHS OMH National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care.”

Source: Institute of Medicine Committee on Health Literacy. Health Literacy: A Prescription to End Confusion. Nielsen-Bohlman L,

Panzer AM, Kindig DA, eds. Washington, DC: The National Academies Press; 2004.

Culturally and Linguistically Appropriate

Services (CLAS) Standards

• National standards developed by DHHS Office of Minority Health

• Provide common understanding of culturally and linguistically appropriate services

• Offer framework for services and structure to respond to cultural and linguistic differences

Source: U.S. DHHS OMH (2001). National Standards for Culturally and Linguistically Appropriate Services in Health care.

Federal Register 65(247):80865-79.

Enhanced - Culturally and Linguistically

Appropriate Services (CLAS)

• Principle Standard (Standard 1)

Provide effective, equitable, understandable and

respectful quality care and services that are responsive

to diverse cultural health beliefs and practices,

preferred languages, health literacy and other

communication needs.

Source: U.S. Department of Health and Human Services Office of Minority Health. National Standards for Culturally and

Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and

Practice. U.S. DHHS. Washington, DC: 2013.

Calgary Charter, 2008

“Health literacy allows the public and personnel working in all

health-related contexts to find, understand, evaluate, communicate,

and use information.”

http://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_

Charter_2011.pdf

What is Health Literacy?

http://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_Charter_2011.pdfhttp://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_Charter_2011.pdf

Health Literacy Includes

• Finding health information

• Understanding it

• Evaluating it

• Communicating it

• Using it…acting on it…to live longer and better!

Health Literacy: A Two-way Street

http://www.google.com/imgres?imgurl=http://www.sipmoc.com/images/w17ra25_img.jpg&imgrefurl=http://www.sipmoc.com/warning_signs.html&usg=__7ipshnvVEj8paW2ed5A5p1R7HRQ=&h=141&w=141&sz=28&hl=en&start=107&zoom=0&tbnid=I3PME0mnwbVmcM:&tbnh=94&tbnw=94&ei=w5t_Tfq3EcXJgQeLl7yTCA&prev=/images?q=double+arrow+two-way+street&hl=en&sa=G&biw=1088&bih=741&gbv=2&tbs=isch:1&itbs=1

Health literacy of U.S. Adults

12% 14%

22%

52%

Below Basic

Basic

Intermediate

Proficient

(NAAL, 2003)

88% of U.S. Adults below Proficient level That is nearly 9 out of every 10 adults!

~ Andrew Pleasant, Canyon Ranch Institute

Why Does Low Health Literacy Contribute to Health

Disparities?

Who has the lowest skills? (Basic and Below Basic )

• 58% of Blacks

• 66% of Hispanics

• 76% of high school dropouts

• 28% of whites

• 36% of total population

Low Health Literacy is Linked to …

• Under-use of primary care services

• Overuse of EDs

• Increased hospitalizations

• Increased medication errors

• Poor health knowledge

• Poor health outcomes

• Increased healthcare costs

Source: Berkman N, Sheridan S, Donahue K, et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence Report/Technical Assessment No. 199. Prepared by RTI International-University of North Carolina Evidence-based Practice Center under

contract No. 290-2007-10056-1. AHRQ Publication Number 11-E006. Rockville, MD. Agency for Healthcare Research and Quality. 2011.

What does health literacy have to do with it?

The People:

• Poor health literacy skills

The Health System:

• Poor health literacy skills

• Too complex

• Intimidating

People can’t meet their health

needs

Build Health Literate Organizations

Source: Institute of Medicine Roundtable on Health Literacy. Attributes of a Health Literate Organization

http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf

http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf

Attributes of Health Literate Organizations

Source: Institute of Medicine Roundtable on Health Literacy. Attributes of a Health Literate Organization

http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf

A Health Literate Organization 1. Has Leadership that makes health literacy integral to its mission structure and operation

2. Integrates health literacy into planning, evaluation, patient safety and quality improvement

3. Prepares the workforce to be health literate and monitors progress

4. Includes populations served in the design, implementation and evaluation of health information and services

5. Meets need of populations with a range of health literacy skills while avoiding stigmatization

6. Uses health literacy strategies in interpersonal communication and confirms understanding at all points of contact

7. Provide easy access to health information and services and navigation assistance.

8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on

9. Addresses health literacy in high-risk situations, including care transitions and communications about medicine

10. Communicates clearly what health plans cover and what individuals with have to pay for services.

http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdfhttp://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf

Evidence-based Cultural Competency

Interventions

• Cultural competency training

• Racial and ethnic concordance

• Language access services –

interpreters and translators

• Community health workers

Source: Fortier, JP, Bishop D. Setting the Agenda for Research on Cultural Competence in Health Care. Brach C.

editor. OMH and AHRQ. (Publication No. 474). 2004.

Evidence-based Health Literacy

Interventions

•Health literacy training

•Plain language

•Teach-back technique

• Teaching health literacy in

adult education programs

Source: Berkman N, Sheridan S, Donahue K, et al. Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evidence

Report/Technical Assessment No. 199. Prepared by RTI International-University of North Carolina Evidence-based Practice Center under

contract No. 290-2007-10056-1. AHRQ Publication Number 11-E006. Rockville, MD. Agency for Healthcare Research and Quality. 2011.

English for speakers of other languages students working

on the HEAL health literacy curriculum

Online Training for Health Professionals

• Module 1: Introduction to

Health Communication

• Module 2: Health Literacy

• Module 3: Cultural

Competency

• Module 4: Limited English

Proficiency

http://www.hrsa.gov/publichealth/healthliteracy/

Competencies for Health Professionals

• Awareness

• Attitudes, skills and beliefs

• Communication skills

• Plain language skills (written and oral)

Diagnosis……………..

Anti-inflammatory…….

Nasal congestion……..

Lesion………….…….

Risk factor……………..

Cause of your illness

Lowers fever and swelling

Stuffy nose

Cut, wound, sore

Will increase your chance of getting…

Avoid Medical Jargon

Use Living Room Language

Practice Teach-back

Source: American Medical Association Foundation and American Medical Association. Health Literacy and Patient Safety: Help Patients Understand. Chicago, IL: American Medical Association; 2007.

Do you have any

questions?

•Check for understanding

Working with Interpreters and Translators

Source: Andrulis DP, Brach C. Integrating Literacy, Culture, and Language to Improve Health Care Quality for

Diverse Populations. Am J Health Behav. 2007;31(Suppl 1):S122-133.

• Interpreting

• Translating

Birth control methods brochures in five

languages. Action for Boston Community

Development (ABCD)

Communicating Effectively Through an

Interpreter. Kaiser Permanente.

RECOMMENDED REGARDING WRITING

IN TERMS OF ITS RECEPTION

IT IS NOT INAPPROPRIATE , WHEN USING PRINT MEDIA TO

IMPART MATERIAL OF A FACTUAL OR INTERPRETIVE NATURE

WHICH HOLDS THE INTENTION OF CONVEYING CRITICAL

INFORMATION TO AND/OR INCLUDING A CRITICAL ACTION BY

ITS PROSPECTIVE RECIPIENTS, TO EMPLOY RELATIVELY

NONCOMPLEX VERBIAGE SO AS TO MAXIMIZE

COMRPEHENSION IN THE AFOREMENTIONED POPULATION.

Source: Lessons in Plain Language 1992, PLAN, Inc.

The Role of Cultural Brokers and

Community Health Workers

Source: Communicating Effectively Through an Interpreter. Kaiser Permanente.

Video Clip:

Working Effectively

With an Interpreter

Downloaded From: HRSA (2007). Unified Health Communication 101: Addressing Health Literacy, Cultural

Competency, and Limited English Proficiency. http://www.hrsa.gov/healthliteracy/training.htm

http://www.hrsa.gov/healthliteracy/training.htm

Cultural humility is a lifelong commitment to self-evaluation and self-critique, and developing beneficial and non-paternalistic relationships.

Cultural Humility vs Cultural Competency

Source: http://healthresearch.berkeley.edu/disparities/docs/CulturalHumility.pdf)

Source: Dr. Bankole presentation Tufts University School of Medicine, January 2015

How do we improve health literacy?

People must…

• Improve skills

• Gain confidence

• Learn the system

• Engage in the system

appropriately

Systems and Providers must…

• Improve skills

• Lower barriers

• Revise policies

Community Education

• Basic literacy skills

• Health literacy skills

• How to use the healthcare system

• Confidence and trust in health

system

• How to take care of your own

health: preventive care and chronic

disease management

“Building Bridges” in NYC

Example of two-way learning experience

• Partnership between Harlem Hospital and adult literacy program • Students toured the local hospital

• Intro talk from each department • Students felt more comfortable going there for care

https://www.youtube.com/watch?v=uPM3kSb2Cfw

https://www.youtube.com/watch?v=uPM3kSb2Cfwhttps://www.youtube.com/watch?v=uPM3kSb2Cfw

Summary of Key Points

• Low health literacy is linked to poor health outcomes

and health disparities

• Health literacy and cultural competency initiatives need to address system challenges and engage the community

• Education/training needs to happen for both sides: the public and the health systems/providers.

Sabrina Kurtz-Rossi, MEd

Assistant Professor, Tufts University School of Medicine, Health Literacy Consultant

sabrina_kurtz-rossi@comcast.net

Julie McKinney, MS

Moderator of the Health Literacy Discussion List, Health Literacy Consultant

jmckinney11@gmail.com

Thank You!

mailto:sabrina_kurtz-rossi@comcast.netmailto:sabrina_kurtz-rossi@comcast.netmailto:sabrina_kurtz-rossi@comcast.netmailto:jmckinney11@gmail.com