Download Oral Health Literacy and Dental Public Health

Oral Health Literacy and Dental Public Health
Instructor guide
This course presents an overview of the definition of health literacy, the role of oral
health literacy in promoting oral health and access to dental care in both private practice
and in public health settings, ways to improve communication with patients, and oral
health literacy are measured. It includes discussion of how oral health literacy may
influence long-term oral health outcomes, and how literate sensitive communication
approaches can be integrated into private and public health organizations.
The course provides four 1-hour power-point presentations as well as classroom
discussions, classroom activities, test questions and take home activities/assessments.
Depending on the number of activities and classroom discussions, that entire length may
take longer than four hours.
Competency Addressed:
1. Demonstrate the ability to communicate and collaborate with relevant
stakeholders in order to advocate for oral and general health.
The students at the completion of the course will be able to:
1. Define health literacy & oral health literacy for the health care provider and dental
public health professional
2. Understand the individual, community and public health implications of low oral
health literacy
3. Explain the association between health, health literacy, health beliefs and culture
4. Explain strategies to communicate more clearly with patients, the public, or
community
5. Identify aspects of an oral health literate organization and be able to suggest ways to
implement oral health literate best practices
6. Describe ways to identify low health literacy through various measurement strategies
Lecture 1: Health Literacy, Oral Health Literacy and Public Health Literacy
Objective: Define and describe health literacy, oral health literacy, and public health
literacy
The lecture provides an overview on definitions of health literacy, oral health literacy,
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and public health literacy, presents the various domains of health literacy, and how they
function within the health care system.
Classroom discussion: The course opens with a 6-minute video followed by a classroom
discussion about videoed patients talking about the problems they have in getting health
services within the health care system. Lead a discussion on how problems in
understanding one’s care and medications and in how to treat ones’ medical and dental
problems can lead to poor health.
The National Assessment of Adult Literacy (NAAL) is presented as a national survey that
contains a component designed to measure health literacy. Sample NAAL questions are given
that are applicable to health providers, one on understanding a trend graph, and one on a medicine
label dosing.
Possible Classroom activity: Although NAAL survey questions use open-ended format,
possible responses have been provided on the slides and students may be asked to
respond using clickers (if available) to demonstrate that there can be a range of responses,
even among well-educated individuals. Note, one classroom discussion could form
around patients’ understanding of prescription dose instructions.
Demographic results of the NAAL survey are provided.
Classroom discussion: Before showing the slide, ask the students which groups they
think will have lower levels of health literacy. Ask them what percentage of the
population has below basic or basic health literacy.
Lecture 2: Association of low health literacy and health, dental outcomes, health
beliefs and culture
Objectives:
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Understand the individual, community and public health implications of low oral
health literacy
Explain the association between health, health literacy, health beliefs and culture
The associations of low health literacy and systemic and oral health are provided to
encourage discussion about the public health implications of low oral health literacy.
Classroom discussion on Disparities and Clinical implications of Health Literacy:
Individuals with low oral health literacy may have the most need for oral health care and
be the least likely to access it. This has implications for community-based programs such
as dental sealant programs, screening programs, and oral health education programs.
Individuals with low oral health literacy: may not see the benefits of
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participation, may not understand consent forms, may fail to show for appointments.
Discuss the implications of low health literacy and the need to communicate about health
prevention and dental procedures.
A brief overview of the complex relationship between health literacy, health beliefs, and
cultural competency is presented. A wide variety of cultural, ethnic and religious health
beliefs may impact the behavior of an individual and in turn affect personal health
outcomes as well as if and when an individual accesses care.
Classroom Activity:
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Divide students into teams
Each team selects an oral disease (e.g. periodontitis, smoking and oral cancer) and
discusses the implications associated with poor health literacy, culture and health
beliefs and managing the disease. Note: Valerio et al reported on patients’ lack of
understanding of the association between type 2 diabetes and oral health (Diabetes
Research and Clinical Practice 93(2011) 159-165). Macek reported that nearly 1/3
of adults in Baltimore were at the lowest level of oral health knowledge among
questions on smoking and periodontal disease, and oral cancer (JPHD 70(2010)
197-2-4)
Discuss the health communication issues the health care professionals face related
to assuring adequate oral health promotion and disease management to people of
differing health literacy, culture and health beliefs. Consider the risk that a person
will provide inaccurate information on a health history form due to a lack of
understanding about the importance of the association.
Each team will report on their discussion and management strategies for the health
professionals.
Classroom of Home activity:
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Cultural Competency Activity
CALIFORNIA LEGISLATURE— 2013–2014 REGULAR SESSION
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Introduced by Assembly Member Mitchell on February 19, 2013
Title: AB-459 Public contracts: healthy and sustainable food.
“Existing law regulates various aspects of the provision of food and beverages in vending
machines, including requiring a vendor that operates or maintains a vending machine on
designated state property to offer food and beverages in the vending machine that meet
accepted nutritional guidelines, as defined, in accordance with certain content
percentages. “(see complete text at
http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB459 )
Task: Review AB-459 and describe why this is or is not a culturally competent bill that is
presented in literate sensitive language. Consider whether you, as a DPH would advocate
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for or against this Bill.
Lecture 3: Identify aspects of a health literate organization and be able to suggest
ways to implement oral health literate best practices
Objectives:
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Explain and describe strategies to communicate more clearly with patients, the
public or the community
Identify aspects of an oral health literate organization and be able to suggest ways
to implement oral health literate best practices
We now shift our attention to the health care organization and define and provide a
framework for the attributes of a health literate organization.
Describe how private and public health organizations can become more health literate
using the Health Literacy Universal Precautions Toolkit and consider the
recommendations for communication with patients. These guidelines pertain to spoken,
written and verbal communications and highlight the best practices of each.
Consider simple clues that the health care professional can use to identify a person with
potentially low health literacy, for example they may take a longer time than most
patients filling out forms. Present strategies to communicate more effectively, such as
developing forms or other patient educational materials, using symbols and shapes , etc.
Classroom discussions and classroom or home Activities:
1.
Classroom panel discussion: How do private practices and dental public health
providers address oral health literacy?
Invite local dentists, ideally both private practitioners and those providing care in
community clinics, to be a part of the panel discussion. Students would then explore how
organizations address oral health literacy. As you lead the discussion, the following
points should be brought out:
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The comprehensive skills needed to attain good oral health
What sort of literacy ‘tasks’ (prescription management, oral health behaviors,
selection of treatment options like sealants) do patients need to perform in
order to make appropriate oral health decisions?
The importance of good patient-provider communications
How can you improve verbal and non-verbal communications between
patients and staff/providers?
What are important considerations in selecting/creating written materials in
the office?
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How do you know that patients understand your recommendations?
2. The influence of culture on the dental practice-- How does culture influence the adoption
on your recommendations for preventative strategies?
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The people we live and work with often influence our health beliefs and
practices. How do social support networks at the individual and community
levels affect dental practice?
How could an organization identify the barriers to care?
3.
Classroom activity: Practice patient provider communication using the “teachback” or Ask Me 3 methods. Allow 7-10 minutes for activity and 15 minutes for
discussion.
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Have students divide into pairs
One student, the “provider” explains to the other student, “the patient” how
to clean their teeth or the post-operative care following an extraction
The other student is prompted to use their own words to explain what they
have been told, to “teach-back”
The students then reverse roles, with the “provider” explaining postoperative
care following fluoride varnish to the “patient’s parent”
Use open ended questions to facilitate discussion:
 How do you know if patients understand what you are suggesting they
do?
 How do you know if patients will follow your recommendations?
Have the student teams report out to the class.
4.
Classroom or Home Activity: Look at examples of different patient education
systems that have written patient materials (e.g. ADA, CDC, NIDCR) or videos that
describe dental procedures. Talk about how well or poorly the material fits with the
objectives of a health literate or ‘literate sensitive’ education material.
5.
Classroom or Home Activity: Take a school form used in the clinic and assess
how ‘literate sensitive’ the form is and/or measure the reading level. Revise it to be more
compliant, if needed and present this to the school clinic director with your
recommendations.
6.
Classroom or Home Activity: Examine how often patients Fail To Show in the
school dental clinic. Discuss reasons that may result in failing to show for appointments.
Ideas may include: Communication factors, No telephone or computer, Not
understanding the importance of cancelling an appointment, Difficulty managing aspects
of personal life, Cost, Lack of social support or is concerned they may not have resources
for care.
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Lecture 4: Health Literacy Measurement
Objective: Describe ways to identify low health literacy through various measurement
strategies
A variety of health literacy and oral health literacy instruments for individual and
community groups are provided. Instruments can help the DPH professional to
understand the individual’s or the community’s health literacy and whether they have
difficulty understanding health information. Even highly educated people may not have
accurate information about oral health or general health. For example, in the REALM-D,
people with 16+ years of education had near perfect scores on Lists 1 and 2, and for List
3 missed, on average 3 fewer terms than people with 12 years of education or less
(Screening for oral health literacy in an urban dental clinic. Atchison, et al. .JPHD
70(2010)269-275.)
Classroom discussion: Discusses the challenges to understanding one’s patients’ or
community’s health literacy and communication capabilities. As health literacy
competency refers to both the patient and health care provider, health literacy measures
must the address a broad range of skills. The following questions could guide a
discussion about the responsibility of a dentist or DPH professional in understanding the
health literacy of their ‘patient’.
 Why might a dental health care provider want to measure his or her patients’ oral
health literacy?
 How might one act if s/he doesn’t know a patient’s oral health literacy and needs to
give postoperative instructions?
 What other aspects of health literacy are critical in dental care?
 What about the oral health literacy of the dental team, including front desk, chairside
and reception?
 Suggest alternative ways to measure individual health literacy as well as assess the
competencies of the provider or system.
 Describes the associations between low health literacy and oral health outcomes for
the dental health care professional.
Optional exercise for expanded lecture
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2.
Classroom activity: Oral health literacy instruments. Allow 5-7 minutes for
administration and 15 minutes for discussion.
 Have students divide into pairs and test an instrument (NVS, REALMD) The
Newest Vital Sign slides are set up for use of interactive clicker instruments.
Although traditionally provided in open response mode, likely responses are
provided in slides to use for class discussion. Allow students to reverse roles if time
allows.
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What can the instrument inform the clinician about his or her patient’s ability to
take in information or respond to treatment?
Which tests would be practical to use in a clinical setting vs. which tests are more
applicable for research?
How might the instrument help inform a public health needs assessment?
How might this instrument help a community advisory group develop, implement
and/or evaluate a dental program?
How might this instrument assist a dental clinic director or a director overseeing
several clinics to develop an organizational approach to oral health literacy?
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