Lecture 9 - Health Literacy and Insurance

What is the WHO definition of health?

A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

What is the Merriam-Webster definition of literacy?

The quality or state of being literate

How does the National Action Plan to Improve Health Literacy define literacy?

A set of reading, writing, basic math, speech, and comprehension skills

What is numeracy?

A component of literacy involving facility with basic probability and numerical concepts

What abilities are included in literacy?

Accessing information, using written or printed material, and participating in society

What are examples of literacy applied to health?

Reading a nutrition label, getting a flu shot, and managing a health condition

What is functional literacy?

The ability to read basic text and write a simple statement about everyday life

How does functional literacy affect participation in society?

It improves economic and social participation and understanding of everyday events

What percentage of people in developed countries are estimated to lack functional literacy skills?

Approximately 7% to 47%

How does functional literacy in developing countries compare with developed countries?

Rates of inadequate functional literacy are higher in developing nations

What is interactive literacy?

A more advanced literacy level involving active participation, deriving meaning from communication, and applying information to changing situations

What is critical literacy?

The most advanced level of literacy involving critical analysis of information and using information to control life events and situations

What is health literacy according to the U.S. Institute of Medicine?

The degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions

What is health literacy according to the WHO?

The cognitive and social skills that determine the motivation and ability to gain access to, understand, and use information in ways that promote and maintain good health

What are the major components of health literacy?

Basic literacy, knowledge, self-awareness, and acquisition of knowledge

What is declarative knowledge in health literacy?

Understanding factual or theoretical information

What is procedural knowledge in health literacy?

Understanding rules that guide choices and actions

What is self-awareness in health literacy?

The ability to assess oneself and take responsibility

What are the three key elements of health literacy?

Knowledge of health and healthcare systems, processing and using information, and self-management with healthcare providers

What areas of knowledge are important for health literacy?

Medicine, health behaviors, healthcare systems, and science

What does medical knowledge include in health literacy?

Knowledge of medications, treatments, and illnesses

What does health knowledge include in health literacy?

Knowledge of behaviors, lifestyle, and public health

What does healthcare system knowledge include in health literacy?

Understanding system structure and available services

What does science knowledge include in health literacy?

Understanding fundamental scientific concepts and scientific arguments

What does processing and using information involve?

Using healthcare information effectively in relation to health and healthcare

What health actions are included in processing and using information?

Knowing when and where to seek information and understanding that information

What is self-efficacy in health literacy?

Self-confidence and accountability in managing health information

What is active engagement in health literacy?

Generating and disseminating health information

What resources support health literacy?

Libraries, online services, family, community organizations, and financial resources

What is self-management in health literacy?

The ability to effectively manage health and illness conditions

What is self-regulation in health literacy?

Awareness of one's situation and preferences, self-analysis, and self-control

What is goal achievement in health literacy?

Setting meaningful health goals

What interpersonal skills are important for health literacy?

Understanding, respecting, listening to, and responding to others

Does increased education always result in adequate health literacy?

No; 45% of high school graduates have limited health literacy

Which groups are disproportionately affected by limited health literacy?

Lower socioeconomic and minority groups

How do reading levels compare between low-income and affluent high school seniors?

Low-income seniors often read at the same level as middle school students from affluent families

How many students drop out of school each day in the United States?

Approximately 7,000 students

How many students drop out of school annually in the United States?

Approximately 1.2 million students

What age group is at increased risk for limited health literacy?

Adults older than 65 years

How do immigration status and health literacy relate?

Recent refugees and immigrants are at increased risk for limited health literacy

How does educational attainment affect health literacy?

Individuals with less than a high school education or GED are at greater risk for limited health literacy

How does income level affect health literacy?

Individuals at or below the poverty level are at increased risk for limited health literacy

How does primary language affect health literacy?

Non-native English speakers are at increased risk for limited health literacy

What percentage of English-speaking adults in the U.S. have proficient health literacy skills?

12%

What is consumer-driven healthcare?

A model in which consumers are primary decision-makers regarding their healthcare

What role do consumers play in consumer-driven healthcare?

Managing their own health through partnership with healthcare providers

What proportion of adults struggle with using everyday health information?

Nine out of ten adults

Where do adults commonly encounter health information they struggle to use?

Healthcare facilities, pharmacies, and media outlets

What are the direct costs associated with limited health literacy?

Hospital visits, hospital admissions, and management of chronic conditions

What are the indirect costs associated with limited health literacy?

Disability from chronic disease, lost wages, and poorer quality of life

What is the estimated annual cost of limited health literacy in the United States?

$106-236 billion annually

What are the estimated future costs of limited health literacy?

$1.6-3.6 trillion

What did the 2003 Healthy People 2010 study report about health literacy?

Only 12% of the population had proficient skills to understand and use printed health materials

What did the 2016 Healthy People 2020 survey report about patient instructions?

69.2% of people reported their healthcare provider always gave easy-to-understand instructions

What is personal health literacy according to Healthy People 2030?

The ability to find, understand, and use information and services to inform health-related decisions and actions for oneself and others

What is organizational health literacy according to Healthy People 2030?

The degree to which organizations enable individuals to find, understand, and use health information and services equitably

What is HC/HIT-01 in Healthy People 2030?

Increase the proportion of adults whose providers ask them to describe how they will follow instructions

What is HC/HIT-02 in Healthy People 2030?

Reduce the proportion of adults reporting poor patient-provider communication

What factors contribute to poor patient-provider communication?

Problems with listening, explanations, respect, and time spent with patients

What is HC/HIT-03 in Healthy People 2030?

Increase the proportion of adults who report being involved in healthcare decisions as much as they desire

What is HC/HIT-D10 in Healthy People 2030?

Increase the proportion of people who find their online medical record easy to understand

What is HC/HIT-D11 in Healthy People 2030?

Increase the percentage of limited-English-proficient adults whose providers explain things in an understandable manner

What is HC/HIT-R01 in Healthy People 2030?

Increase the health literacy of the population

What abilities should be assessed when evaluating health literacy?

Accessing information, differentiating information sources, understanding and personalizing information, and applying information for personal benefit

What does TOFHLA stand for?

Test of Functional Health Literacy in Adults

What does TOFHLA measure?

Health literacy through reading comprehension and numeracy assessment

How long does TOFHLA take to complete?

Approximately 10-20 minutes

How is TOFHLA scored?

Adequate, marginal, or inadequate

What does REALM stand for?

Rapid Estimate of Adult Literacy in Medicine

What type of tool is REALM?

A screening instrument for health literacy

What does REALM assess?

The ability to read common medical words and lay terms for body parts and illnesses

How long does REALM take to complete?

Approximately 2-3 minutes

What does HALS stand for?

Health Activities Literacy Scale

What five domains are assessed by HALS?

Health promotion, health protection, disease prevention, healthcare and maintenance, and systems navigation

How long can HALS take to administer?

Up to 1 hour

How many tasks are included in HALS?

191 tasks

What are the three major areas through which health literacy influences health?

Access to healthcare, patient-provider interaction, and self-care

How does low literacy affect use of health information?

It decreases use of health information

How does low literacy affect comprehension of instructions?

It increases misunderstanding of instructions

How does low literacy affect understanding of nutrition labels?

It leads to poor comprehension of nutrition labels

How does low literacy affect healthcare utilization?

It decreases use of health services

How does low literacy affect management of chronic diseases?

It worsens management of diabetes, hypertension, and asthma

How does low literacy affect health education effectiveness?

Individuals are less responsive to health education

How does low literacy affect preventive healthcare utilization?

It decreases use of preventive services such as mammograms and flu shots

How does low literacy affect disease self-management?

It results in poorer self-management of disease

How does low literacy affect hospital utilization?

It increases preventable hospital visits and admissions

How can low literacy indirectly affect socioeconomic circumstances?

Poor socioeconomic circumstances can contribute to adverse health effects

How does low literacy affect mortality risk?

It is associated with higher mortality risk

How does low literacy affect healthcare utilization indirectly?

It contributes to insufficient or ineffective use of healthcare

How does low literacy affect healthcare costs?

It increases healthcare costs

How does low literacy contribute to health disparities?

It widens health disparities

What psychological costs are associated with low literacy?

A sense of shame and concealment of reading or vocabulary difficulties

Why may healthcare providers be unaware of a patient's literacy struggles?

Patients often hide difficulties with reading and vocabulary

What is the asset model of health literacy?

A model viewing health literacy as an outcome of health and patient education and an asset to be developed

What is the goal of the asset model of health literacy?

To enable individuals to take control of factors influencing health

What is the risk model of health literacy?

A model viewing health literacy as a preexisting status based on literacy and numeracy skills

What is the goal of the risk model of health literacy?

Compliance with recommended care

How are the asset and risk models typically applied?

The asset model has broad application, while the risk model is commonly used in clinical settings

What are the goals of health literacy interventions?

Improve healthcare use, improve outcomes, reduce healthcare costs, and reduce disparities

What information presentation strategy improves health literacy?

Present essential information by itself