Download Module 1: Introduction to Health Literacy

In It Together:
National Health
Literacy Project for
Black MSM
Training of Trainers
Module 1: Introduction to Health
Literacy
Welcome
Trainer: Daniel Driffin
Email: [email protected]
Phone: 404.460.4790
This material was produced by John Snow Inc., under
Contract #HHSH25020140037I with the Health Resources
and Services Administration, U.S. Department of Health
and Human Services.
Project overview
 This project is designed to improve the capacity of health
departments and community-based organizations to deliver
health literate HIV services, with a particular focus on health
services provided to Black/African American MSM.
 The purpose of In it Together: National Health Literacy Project
for Black MSM is to provide training-of-trainers (ToT) training to
at least 100 Health Literacy Trainers in 34 communities across
the U.S. that are highly affected by HIV/AIDS.
 Upon completion of this ToT, each trainer will provide health
literacy training to at least 5 health care professionals in his or
her community.
3
Project overview
Upon completion of the Training of Trainers, each trainer will
provide health literacy training to at least 5 health care
professionals in his or her community.
4
Goals of this training module
Trainers will increase their
understanding of:
5

Populations affected by
limited health literacy

Indicators that an
individual may be
experiencing limited
health literacy

The use of the universal
precautions approach to
health literacy
Training objectives
At the end of this training, you will
be able to:
6

Explain the importance of
health literacy

Discuss at least 3 ways in which
limited health literacy results in
poorer health outcomes

List at least 5 indicators that a
patient may have limited
health literacy

Define the universal
precautions approach to health
literacy
What is Health Literacy?
Definition of health literacy
 “The degree to which individuals have the capacity to obtain,
process, and understand basic health information and
services needed to make appropriate health decisions.”1
 “The ability to read and comprehend prescription bottles,
appointment slips, and the other essential health-related
materials required to successfully function as a patient.”2
1 Ratzan
2AMA
8
and Parker, 2000
Council of Scientific Affairs, 2000
Expanded definition of health literacy
 Expanded definitions see health literacy more broadly:
“More than just the ability to read and write, health
literacy includes the ability to listen, follow directions, fill
out forms, calculate using basic math, and interact with
professionals and health care settings. It can also include
making sense of jargon or unfamiliar cultural norms.
Health literacy requires people to apply critical thinking
skills to health-related matters.” 3
 Recognizes health literacy is key to quality, safety, and equity
in health care.
3 http://health.gov/communication/literacy
9
Institute of Medicine’s
Attributes of a Health Literate organization
1. Has leadership that makes health
literacy integral to its mission,
structure, and operations
2. Integrates health literacy into
planning, evaluation measures,
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 needs of populations with a
range of health literacy skills while
avoiding stigmatization
10
6. Uses health literacy strategies in
interpersonal communications and
confirms understanding at all points of
contact
7. Provides easy access to health
information, 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 medicines
10. Communicates clearly what health plans
cover and what individuals will have to
pay for services
Who does limited health
literacy affect?
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Who does limited health literacy affect?
89 million adults, or 36%
of the U.S. adult
population have
limited health literacy
12
Who does limited health literacy affect?
All populations could be affected by limited health literacy
Populations most affected by limited health literacy include:
Elderly
Low Socioeconomic Status (SES)
Unemployed
Did not finish high school
Members of minority groups
People who did not speak English during early childhood
13
Who does limited health literacy affect?
Adult Population Groups with Health Literacy Skills at NAAL "basic" or "below basic"
Group
Below Basic
Basic
Total
%
%
%
Age (years)
19-24
10
21
31
25-39
10
18
28
40-49
11
21
32
50-64
13
21
24
65 and older
29
30
59
Highest Education Level Completed
Less than or some high school
49
27
76
High school graduation (no college study)
15
29
44
High school equivalency diploma
14
30
44
Racial/Ethnic Group
White
9
19
24
Asian/Pacific Islander
13
18
31
Black
24
34
58
Hispanic (all groups)
41
25
66
Health Insurance Status
Employer provided
7
17
24
Privately purchased
13
24
37
Medicare
27
30
57
Medicaid
30
30
60
No insurance
28
25
53
Source: Kutner, M, Greenber E, Jin Y, Paulsen C. The Health Literacy of American's Adults: Reulsts from the 2003 National Assessment of
Adult Literacy. US Department of Education. National Center for Educaiton Statistics. Publication No. 2006-483; September 2006
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How does limited
health literacy
affect people?
15
How does limited health literacy affect people?
 Limited knowledge of the body
U.S. Department of Education National Assessment of Adult Literacy
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How does limited health literacy affect people?
 Limited knowledge of the body
 Difficulty understanding charts or ranges (such as healthy
weight ranges or vaccine charts)
U.S. Department of Education National Assessment of Adult Literacy
17
How does limited health literacy affect people?
 Limited knowledge of the body
 Difficulty understanding charts or ranges (such as healthy
weight ranges or vaccine charts)
 Difficulty understanding when or how to take medication
U.S. Department of Education National Assessment of Adult Literacy
18
How does limited health literacy affect people?
 Limited knowledge of the body
 Difficulty understanding charts or ranges (such as healthy
weight ranges or vaccine charts)
 Difficulty understanding when or how to take medication
 Difficulty using over-the-counter drug labels to identify
potential risks such as side effects
U.S. Department of Education National Assessment of Adult Literacy
19
How does limited health literacy affect people?
 Limited knowledge of the body
 Difficulty understanding charts or ranges (such as healthy
weight ranges or vaccine charts)
 Difficulty understanding when or how to take medication
 Difficulty using over-the-counter drug labels to identify
potential risks such as side effects
 Difficulty filling in health insurance applications
 Unable to evaluate information for determining which legal
document applies to a specific health care situation
U.S. Department of Education National Assessment of Adult Literacy
20
How does limited health literacy affect people?
People with limited health literacy skills often have:
 Limited knowledge of the nature and cause of a disease
Less than 50% of diabetic patients with limited health literacy
knew the symptoms of hypoglycemia
 Trouble understanding and applying health care information
21
How does limited health literacy affect people?
People with limited health literacy skills often have:
 Difficulty interacting with the health care system
86% could not understand Rights and Responsibilities section
of a Medicaid application
26% did not understand when their next appointment was
scheduled
White, S. (2008). Assessing the nation’s health literacy: Key concepts and findings of the National Assessment
of Adult Literacy. American Medical Association Foundation.
22
How does limited health literacy affect people?
People with limited health literacy skills often have:
 Less awareness of preventive health measures
 Less knowledge of their medical conditions and self-care
instructions
42% did not understand instructions to “take medication on an
empty stomach”
(up to) 78% misinterpret warnings on prescription labels
Limited health literacy is associated with increased mortality
and hospitalizations
23
How does limited health literacy affect people?
Those with limited literacy skills:

Report poorer overall health

Have poorer ability to manage
chronic diseases

Have poorer outcomes

Less likely to understand their
diagnosis

Less likely to have screening/
preventive care

Present in later stages of
disease
24
How does limited health literacy affect the health care
system?
 $106-$238 billion in unnecessary costs annually4
 Are more likely to be hospitalized/rehospitalized
Higher costs for emergency room and inpatient care
One study: $2,891 (annual health care cost for Medicaid
enrollee) vs. $10,688 (cost for enrollee with limited health
literacy)5
4
Vernon, University of Connecticut, 2007
Gazmararian J, Parker RM. The impact of low health literacy on the medical costs of
Medicare managed care enrollees. Am J Med. 2005; 118; 371-377.
5Howard DH,
25
26
Relationship between health literacy and health
outcomes
People with limited health literacy are:
Less likely to use of preventive services
27
Relationship between health literacy and health
outcomes
People with limited health literacy are:
Less likely to use of preventive services
Less knowledgeable about medical conditions and treatment
More likely to use emergency services
28
Relationship between health literacy and health
outcomes
People with limited health literacy are:
Less likely to use of preventive services
Less knowledgeable about medical conditions and treatment
More likely to use emergency services
More likely to report their health as “poor”
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Relationship between health literacy and health
outcomes
People with limited health literacy are:
Less likely to use of preventive services
Less knowledgeable about medical conditions and treatment
More likely to use emergency services
More likely to report their health as “poor”
Often ashamed about their literacy skill level
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What is the response?
Recognizing signs of
limited health literacy
Responding to client
needs
Employ the universal
precautions approach
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32
General indications

33
Does not take
medications correctly
General indications
34

Does not take
medications correctly

Frequently misses
appointments

Fails to follow through
on tests or referrals
General indications





35
Does not take
medications correctly
Frequently misses
appointments
Fails to follow through
on tests or referrals
Does not complete
intake forms
Unable to provide a
detailed history of their
illness or treatments
General indications

Does not take medications correctly

Frequently misses appointments

Fails to follow through on tests or referrals

Does not complete intake forms

Unable to provide a detailed history of their
illness or treatments

Does not complete intake forms

Asks few questions

Avoids reading tasks using commonly
accepted reasons (e.g., “I forgot my
glasses.”)

Does not remember information read earlier
36
Indications among people living with HIV/AIDS
 Has a consistently high or unchanged viral load
 Does not take antiretroviral therapies correctly
 Has frequent hospitalizations
 Falls out of care
 Skips important preventive measures
 Can not explain HIV or AIDS
37
38
What is the universal precautions approach?
Universal
precautions refers
to taking specific
actions that
minimize risk for
everyone when it is
unclear which
patients may be
affected.
39
What is the universal precautions approach?

Health literacy universal precautions allow health
professionals to ensure that systems are in place to promote
better understanding for all patients, not just those you think
need extra assistance.

Improving patient understanding is beneficial for both the
patient and health care provider.
40
Premise of the universal precautions approach
 All clients benefit from
easy-to-understand
materials and simple
spoken communication.
 Medical care is
complicated, and many
people struggle with
understanding
medications, self-care,
instructions, and follow-up
plans.
41
How could you implement universal precautions for
health literacy?
Give 3 examples.
42
Considerations when employing the universal
precautions approach
 Cultural, emotional, and situational factors may influence a
client’s ability to process information.
 Clients must feel safe to disclose personal and private
information (judgment-free and confidential) and to ask
questions.
 Points of communication in the patient care process:
scheduling medical visits
reviewing medical history
communicating health information and treatment options
 Each point is an opportunity to improve the clarity and quality
of the exchanges between practice staff and patients of all
literacy levels.
43
Questions?
44
Recap
Today we covered the:
 Importance of health literacy
 Ways in which limited health literacy results in poorer health
outcomes
 Indicators that a patient may have limited health literacy
 Health literacy universal precautions approach
45
Check your knowledge
 Explain the importance of health literacy
 Discuss at least 3 ways in which limited health literacy results
in poorer health outcomes
 List at least 5 indicators that a patient may have limited
health literacy
 Define the universal precautions approach to health literacy
46
Next steps


47
In Module 2, we are going to
explore the cultural,
emotional, and situational
factors that may influence a
client’s ability to process
information, with a focus on
the factors that influence
Black MSM seeking
treatment and care.
In later training modules, we
will look at specific
communication approaches
and tools that can improve
health literacy and increase
your provision of health
literate services.
Take home
Over the next week,
consider what you have
learned. Apply the universal
precautions approach to
health literacy at least 3
times.
Come prepared to share
your experiences.
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Welcome
Trainer: Daniel Driffin
Email: [email protected]
Phone: 404.460.4790
This material was produced by John Snow Inc., under
Contract #HHSH25020140037I with the Health Resources
and Services Administration, U.S. Department of Health
and Human Services.