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Presented by Glenda Harbert
 Define
Health Literacy
 Describe:
◦ Strategies for education
◦ Plain Language
◦ Ask Me Three Teach Back Method
◦ Speak Up Campaign

The degree to which individuals have the
capacity to;
◦ obtain,
◦ process, and
◦ understand

basic health information and services needed
to make appropriate health decisions.”
 Healthy People 2010


90 million US adults: literacy skills below high school
level
Adults with limited literacy:
◦ less knowledge of disease management & health promoting
behaviors
◦ report poorer health status
◦ less likely to use preventive services
◦ higher hospitalization rates & emergency service use

>300 studies show health-related materials far exceed
average reading ability of US adults
Health Literacy: A Prescription to End
Confusion. Institute of Medicine, 2004
Proficient,
12
Below
Basic, 14
Intermediate
53
Basic, 22
Percent of Americans
A 2006 study examined
patients’ abilities to
understand five common
instructions on
prescription medications
◦ Both patients with adequate
and low literacy had
difficulty understanding at
least one of the five
instructions.
National Assessment of Adult Literacy
(NAAL): National Center for Educational
Statistics, U.S. Department of
Education, 2003


One out of five
American adults reads
at the 5th grade level or
below
The average American
reads at the 8th to 9th
grade level
Most health care materials
are written above the 10th
grade level

A disproportionate number
of minorities and
immigrants are estimated
to have literacy problems:
• 50% of Hispanics
• 40% of Blacks
• 33% of Asians

More than 66% of US adults
age 60 and over have either
inadequate or marginal
literacy skills.
Functional Literacy
48%
of U.S. adults
cannot read well
enough to use a
bus schedule
The L.A. Workforce Literacy Project, 2004
Compliance
REQUIRES
Understanding
So what’s your point?
If you can’t read a bus schedule or an RX label,
can you understand this?
I understand that there are risks to my health
associated with the hemodialysis treatment,
these include:






High blood
pressure
Significant blood
loss
Air embolisms
Hemolysis
Graft/fistula
infiltrations
Infections







Allergic reactions
Pyrogenic reactions
Hyperkalemia
Hypokalemia
Loss of Amino
Acids/Protein
Chemical imbalances
and metabolic
disorders
Decreased blood flow
to limbs
I understand that there are risks to my health
associated with the CCPD treatment




Infections: risk of
contamination of the abdominal
cavity via catheter or dialysate
fluid with various bacteria or
germs, which can result in
peritonitis (an infection of the
peritoneum).
Peritonitis is potentially serious
and must be treated
immediately.
There is also a risk of infection
at the exit site and also risk of a
tunnel infection with various
bacteria or viruses.
Say What
Language & English Variants
• POS
• Parents over shoulder
• WTMI
• Way too much information
• LMAO
• Laugh my a-- off
• OMG
• Oh my God
Short Message Service (SMS) language or Textese (also known as
chatspeak, txt, txtspk, txtk, texting language or txt talk) - English language
slang used in mobile phone SMS, social networks and instant messaging. This type of language
does not always obey or follow standard English grammar; furthermore, the words used in the
writing system may not be found in standard dictionaries
Keith C. Norris, MD, FASN
 /j
i j u E t/
 / j u w i j E t/
 /j u/
 Did
you eat ?
 Did you eat yet?
 Did you?
Relexification of sentences into a
consonant/vowel vocalic pattern consistent
with the Niger-Congo African syntax
Kifano S, Smith E: Ebonics and education in the context of culture: Meeting the language and
cultural needs of LEP African American students. In: Ebonics: The Urban Education Debate (New
Perspectives on Language and Education), 2nd Ed., edited by Ramirez JD, Wiley TG, de Klerk G, Lee
E, Wright WE, Tonawanda, NY, Multilingual Matters Limited, 2005, pp 62–95
Keith C. Norris, MD, FASN
Not By Looking!
Limited health literacy
 Affects all segments of
society
 Can be well spoken,
completed HS or
college, hold white
collar or even
healthcare jobs
 May & probably will say
they understand
Structure delivery of care
as if every patient may
have limited health
literacy- a practice called
Universal Precautions
Non-adherence with medications
 Asks fewer questions
 Does not follow through on tests or referrals
 States “ I will read this when I get home”
 Don’t seem to pay attention
 Looks confused
 Stare blankly

◦ Language/cultural
barriers
◦ Generational
barriers: younger
& older
patients/staff
Sure! That was
easy.
Thank God those
two are leaving.
I’m going back to
sleep
Do you
understand
everything we
just told you?
◦ Patients nod yes
but may not
understand
Convey
Message
Keith
C. Norris, MD, FASN
Keith C. Norris, MD, FASN
Confirm
Understanding
HOW?

Recommends making plain language a “universal
precaution” in all patient encounters
*Another in the series of Health Care
at the Crossroads reports
What
Why
How
• Plain language is communication that an audience
can understand the first time they read or hear it.
• The concept of using plain language is closely
related to the concept of health literacy.
• Clear communication is critical to successful
health care.
Helps people
understand
information more
rapidly
Makes it easier for the
person giving the
information
The benefit of using plain language is like a two-way street.

Patient-friendly word list-replaces medical jargon and
other difficult terms
◦ Salt instead of sodium
◦ High blood pressure instead of hypertension
◦ Swollen instead of edema

Use examples and/or analogies whenever possible.
Examples-describe:
◦ arthritis by saying it’s like “a creaky hinge on a door”
◦ enlarged heart like an overblown balloon
◦ fluid overload is like drowning in fluid
A plain language thesaurus is online
Be concise. Sentences
should be no more
than 15 words long, on
average.
Paragraphs should
contain only one main
idea.
Get rid of unnecessary
information. Focus only
on what the patient
needs to know.
Simple words (1-2 syllables)
Short sentences (4-6 words)
Short paragraphs (2-3 sentences)
Headings and bullets
Lots of white space
No medical jargon
Your body needs sugar for
energy. It gets sugar from
the food you eat and drink.
The insulin your body
makes helps turn blood
sugar into energy. When
your body does not make
enough insulin, it cannot
get energy from the sugar.
Without insulin, the sugar
stays in your blood. Then
your blood sugar goes too
high and you feel tired.
Normal EducationUnderstanding Diabetes

Where blood sugar comes
from……Blood sugar comes from the
food you eat and drink.

Why insulin is important ……Insulin
turns blood sugar into energy – so
you have more pep and don’t feel
tired all the time.

Why your blood sugar goes high
When you don’t have enough
insulin, the sugar stays in your
blood. Then your blood sugar goes
higher than it should.
Revised
#1. Put the most important
information first.
Emphasize other important
information by:
*bulleting
indenting
using bold or larger font, or
placing the message in a box.
Most patients
forget up to 80%
of what their Dr
tells them as
soon as they
leave
Patients with
low health
literacy are:
less likely
to be
referred
for kidney
transplant
have
worse
control of
chronic
diseases
Have
higher
mortality
Convey
Message
Confirm
Understanding
HOW?
Assess if patient understood
 Do not ask:

◦ “Do you understand?”
◦ “Do you have any questions?”

What percent of the content can they recall
and restate?
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

Ask patients to say back in their own words what
you just taught or explained
Keep the message simple, e.g. 2-3 critical
elements
Ask in a non-shaming way, e.g. “to be sure I/we
did a good job of explaining this, please tell me
what you heard”
◦ I want to make sure I did a good job explaining your
blood pressure medicines, because this can be
confusing. Can you tell me what changes we decided to
make and how you will take the medicine now?
Uses three simple, but essential, questions
and answers for every healthcare interaction:
1. What Is My Main Problem?
2. What Do I Need To Do?
3. Why Is It Important For Me To Do This?

resources at http://www.npsf.org/askme3/
Simple &
Focused
Clear
•Can you tell me the Main Problem we talked about?
•What Do You Think You Need To Do about it?
steps
•Why Is It Important For You To Do This?
WIIFM
We are concerned
about that you are not
being compliant with
your Hemodialysis
treatments. This is
important because your
body accumulates too
much fluid and toxins if
you aren’t complaint
and this may cause you
to have heart failure or
a stroke.
1. What is the main problem?


We are worried that are you are
missing too many treatments. This
is a big problem because it can:
hurt your heart
cause a stroke
2. What do you need to do about
it?


You need to come to every
treatment.
If you can’t get here you need to
call us.
3. Why is it important for you to do
this?


You could die or
You could get kicked out of the
clinic and have no where to get
treatments
We are concerned
about that you are
not being compliant
with your binders.
This is important
because your
phosphorus and
calcium will not be
in balance if you
aren’t compliant
and this may cause
you to have bone
disease.
1. What is the main problem?
 We are worried that are you are not
taking your binder medication enough
(with a picture or actual pill).
 This is a big problem because it can:
hurt your bones and heart
2. What do you need to do about it?
 You need to follow the diet and take XX
pills every time you eat.
3. Why is it important for you to do this?
 Your bones will get weak and may
break
 It will hurt your heart so it can’t work
and
 You could need amputations
 You could die sooner

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Speak up if you have questions or
concerns. If you still don’t understand, ask
again. It’s your body and you have a right to
know.
Pay attention to the care you get. Always
make sure you’re getting the right
treatments and medicines by the right
health care professionals. Don’t assume
anything.
Educate yourself about your illness. Learn
about the medical tests you get, and your
treatment plan.
Ask a trusted family member or friend to be
your advocate (advisor or supporter).
Know what medicines you take and why
you take them. Medicine errors are the
most common health care mistakes.
Use a hospital, clinic, surgery center, or
other type of health care organization that
has been carefully checked out. For
example, The Joint Commission visits
hospitals to see if they are meeting The
Joint Commission’s quality standards.
Participate in all decisions about your
treatment. You are the center of the health
care team.
Before you go to the hospital

As a dialysis patient, you
have a routine. You go to
a dialysis center for
dialysis or perform your
own dialysis at home.
You are actively involved
in the daily care of your
condition. This should
not change when you go
to the hospital. You will
need to work closely with
your hospital caregivers
to get the best care.
Speak up and let your
caregivers know exactly
what you need.

Talk to your kidney doctor and your dialysis
care team. Ask them to send a rounding sheet
to the hospital. The rounding sheet provides
details about your dialysis.

Take the name and phone number of your
dialysis center with you to the hospital.

Find out which hospitals in your area perform
dialysis. If you perform your own dialysis,
make sure the hospital has trained staff to
help with peritoneal dialysis.

Tell your family your wishes for life support.
Ask the dialysis social worker what forms you
need to fill out to make your wishes known.
Take the forms with you to the hospital. Ask
that a copy be put in your chart.

Ask a family member or friend to be your
advocate while you are in the hospital. An
advocate can ask questions that you may not
think about or be able to ask.
Provide Brochure
Patient
admission
packets
 Handbooks
 Education
materials
 Waiting room
 Websites


Speak Up videos can be
shown via closed
circuit TV
Posters
Waiting rooms
Doctors offices
Treatment areas
Adapting for out patient
 Review by PAC
 Campaign to follow
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Health Literacy Toolkit- AHRQ-www.nchealthliteracy.org
Plain language toolkit- printable (PDF) version of this
toolkit contact [email protected]
Ask Me Three- www.npsf.org/askme3/
◦ Includes patient brochures and posters in Spanish, Arabic,
Chinese, French or Russian

Speak Up www.jointcommission.org/speakup/aspx
◦ Includes patient brochures and posters in English and Spanish
◦ Includes videos in English and Spanish