Health Literacy and Occupational Therapy

What do patients have the right to understand?

Patients have the right to understand health care information that is necessary for them to safely care for themselves

What do patients have the right to choose?

Patients have the right to choose among available alternatives

What do health care providers have a duty to provide?

Information in simple, clear, and plain language

What do health care providers have a duty to check before ending the conversation?

That patients have understood the information

As allied health professionals, what do occupational therapist's have the responsibility to ensure?

Highest quality of care for all patients

True or False: Each practice area is unique and each physical facility presents its own distinct barriers and limitations to health literacy.

True

What term can be defined as the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment?

Health literacy

Health Literacy

Ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions and follow instructions for treatment

2 Types of Health Literacy

1. Personal

2. Organizational

What type of health literacy can be defined as the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others; personal and organizational?

Personal health literacy

Personal Health Literacy

The degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others

What type of health literacy can be defined as the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others; personal and organizational?

Organizational health literacy

Organizational Health Literacy

The degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others

Where does the disconnect in health literacy lie?

Patient ability and health care communication

What is the average reading level?

8th grade

What does poor health literacy lead to?

Confusion and a feeling of helplessness

What impact does poor health literacy have on healthcare?

Use services more

Increase healthcare costs

How can clinicians create a shame-free environment?

Adopt an attitude of helpfulness

Convey a safe, nonjudgement environment

Be alert to clues (e.g. incomplete forms)

Develop forms that screen for health literacy

Review patient medications with them (e.g. brown bag test)

Engage entire staff

How can clinicians mitigate the barriers and limitations of poor health literacy?

Create a shame-free environment

Improving communication skills

How can clinicians improve their communication skills?

Slow down

Convey most important concepts

Use living room/plain language that anyone can understand

Explain through examples and visual aids

Involve family members

Do not ask them if they understand

Employ the teach-back method

According to the 2003 National Assessment of Adult Literacy, what percent of Americans can not read or understand complicated and complex information including health and medication information?

14%

What 3 types of health literacy were surveyed in the 2003 National Assessment of Adult Literacy?

1. Prose (e.g. editorials, news stories, brochures)

2. Document (e.g. job applications, maps)

3. Quantitative (e.g. measurement, percentages, graphs)

Results of the 2003 National Assessment of Adult Literacy

Proficient - 13% (e.g. read, and understand all text)

Intermediate - 44% (e.g. reading/understanding is challenging)

Basic - 29% (e.g. everyday reading, basic pamphlets)

Below Basic - 14% (e.g. read short set of instructions)

Program for the International Assessment of Adult Competencies (PIAAC)

A program designed to assess and compare adults' skills in participating countries over a broad range of abilities, from reading simple passages to complex problem-solving skills, and to collect information on an individual's skill use and background

National Healthcare Initiatives for Health Literacy

Institute of Medicine ("A Prescription to End Confusion")

Healthy People 2010, 2020, 2030

National Action Plan to Improve Health Literacy 2010

Affordable Care Act, 2010

What 4 skills are included in health literacy?

1. Reading

2. Verbal comprehension

3. Numeracy

4. Analyzing information

Are health literacy skills static or dynamic?

Dynamic

Health literacy skills change depending on what 5 factors?

1. Age

2. Health

3. Education

4. Previous experiences

5. Culture

What is an important part of an occupational therapist's job?

To ensure the patient has understood their role in the rehabilitation process

How can occupational therapist's ensure the patient has understood their role in the rehabilitation process?

By matching written materials and verbal communication to the patient's level of comprehension

When is the self-management of healthcare possible?

Once the patient is offered information that is clear and appropriate for their level of understanding

What do therapists routinely issue to their patient? Why?

Written information to support their home programs

What does the patient's ability to benefit from the written information provided to them from their therapist depend on?

Their level of understanding

What does the degree of basic literacy skills affect?

The extent of their comprehension

How can occupational therapists promote health and contribute to efforts to create a more health-literate society?

Through the development and use of health education approaches and materials that are understandable, accessible, and usable by the full spectrum of consumers

What does health literacy affect?

Individuals' ability to make health decisions and actively participate in health-related activities

What does the definition of health literacy include?

Gather, interpret, and use information to make health decisions

Individual ability and professional communication skills

Context/environment in which information is being presented

What does health literacy promote when all aspects are considered?

Participation

Empowerment

Control over daily life

What is low health literacy a strong predictor of?

Health status

Specific Issues Related to Low Health Literacy

Less awareness of preventative health measures

Less knowledge of medical condition and self-care

Less healthy behaviors

Poorer health status, worse health outcomes

Increased costs for health care system

What populations are most commonly affected by low health literacy?

Older adults

Low income

Did not finish high school

Those whose first language is not English

Individuals living in poverty

Can a therapist tell if a person has low health literacy by looking at them; yes or no?

No

What are 3 quick screening tools used to inform a therapist about a patient who may have low health literacy?

1. Word recognition

2. Reading

3. Numeracy

Health Literacy Assessments

Rapid Estimate of Adult Literacy in Medicine (REALM)

Test of Functional Health Literacy (TOFHLA)

Self-Report Question

Newest Vital Signs (NVS)

Short Assessment of Health Literacy (SAHL)

CHEW Self-Report Questionnaire

BRIEF Health Literacy Screening Tool

Short-Form Health Literacy

Organization Health Literacy Assessments

Health Literacy Environment of Hospitals and Health Centers

Building Health Literate Organizations

Health Literacy Environment Activity Packet

Health Literacy Environment of Hospitals and Health Centers

An assessment tool for identifying facilitating factors and barriers to information, care, and services

Building Health Literate Organizations

An assessment tool that evaluates a patients capacity for achieving change

Health Literacy Environment Activity Packet

An assessment tool based on first impressions from when patients first walk-in the clinic

Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit

A toolkit used to help primary care practices reduce complex health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels

What does the Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit address?

Path to improvement

Spoken communication

Written communication

Self-management and empowerment

Supportive systems

Why do patients find it hard to communicate in healthcare?

Fear and intimidation

Embarrassment out of not understanding diagnosis

Not feeling well

What should the therapist do if the patient is not feeling well enough to participate in therapy?

Continue treatment at another time

Provide them with contact if questions arise

How many aspects of their diagnosis should a therapist discuss with the patient if time permits during the treatment session?

1-3 main aspects (and how they will manage the diagnosis)

What should the therapist discuss with friends or family members of the patient with their permission?

Health information (using the patient's native language)

Red Flags Indicating Low Health Literacy

Reports that they don't have their glasses to read the handout

Can only identify pills by color/shape, not label information

Not compliant with medication directions (e.g. crushing pills)

Can not complete registration forms

Miss numerous appointments or may come on the wrong day

Can not explain diagnosis, prognosis, or reason for surgery

Can not demonstrate their exercises as instructed

Trouble accurately reporting medical history

What should therapists encourage their patients to do?

Ask questions

How can therapists encourage their patients to ask questions?

Provide pen and paper to write questions down

Note patient responses during appointments (e.g. confusion)

Inform them that there are not any bad or stupid questions

Follow methods for better communication (e.g. pictures)

Do not use medical jargon (e.g. plain language is better)

Explain terminology if using medical jargon

Limit talking points (keep discussion brief)

Discuss the 3 most important things first

How can a therapist be sure that their patient understands what they are trying to teach them?

By using the teach-back technique

Teach-Back Technique

An approach to determine what the patient understands and what questions or concerns they may have about the information shared

What does the teach-back technique allow?

Interactive communication loop

Interactive Communication Loop

A process in which participants alternate positions as sender and receiver in order to ensure the message has been received

10 Teach-Back Techniques

1. Have a caring tone (no shame)

2. Always make eye contact

3. Use plain language

4. Ask the patient to explain or repeat back

5. Confirm comprehension (use open-ended questions)

6. Do not use questions that can be answered with "yes" or "no"

7. Assure the responsibility to explain clearly is on the therapist

8. Explain AGAIN if the patient can not teach-back correctly

9. Printed materials should be easy to read and understand

10. Include patient response to teach-back in notes

What has research shown a discrepancy between?

Written patient education and their health literacy level

Are informational materials, including internet information, written above or below the reading level of most patients?

Above

How can therapist's be sure that their informational material is appropriate for their patient?

By checking the reading level of their informational material using a formula for reading levels (e.g. Flesch-Kincaid Readability Tool)

Should therapists write at a higher or lower grade level to improve written communication for patients?

Lower

Should written material being shared with the patient be published in small or large font?

Large font

At what grade level should written text be prepared at or below?

6th grade level

Resources for Communication Information

CDC Clear Communication Index

Federal Plain Language Guidelines

Simply Put (e.g. guide for creating easy-to-read materials)

Suggestions to Prepare Clear Language Text

Use plain language

Prepare text at or below 6th-grade reading level

Use large serif/times roman font, at least a 14 point

Incorporate white space in document

Use pictures or drawings to demonstrate information

Always prepare content in the spoken language of the patient

Consider patient’s culture and social norms

Include reputable resources for additional information

Include chunks of material, do not exceed 3 key points

Use short sentences and short paragraphs

Use headings to divide material

Simple charts or bulleted lists are easier to read than lines

In addition to pamphlets and handouts, patients use of what for medical information has increased?

Internet

What are the majority of internet searches for?

Medical conditions

What is our responsibility as therapist's in the use of the internet?

To guide patients to reputable, trusted websites for valid information

Digital Health Literacy

The ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem

National Institute of Health (NIH) Recommendations for Evaluating Health Information

Content:

Is the content serious?

Who is the author?

Is the site connected to an organization?

Updated:

Is this internet site updated regularly?

When was it created?

Does it offer links to other current webpages?

Accuracy:

Is the page edited?

Does the site reference other resources?

Is a bibliography included?

Fact-Based:

Is the information factual?

Is it straightforward and without advertising?

What is the purpose of the site?

Is it population, clinical, or scholarly?

10 Attributes/Building Blocks of a Health Literate Organization

1. Leadership/management must make health literacy a priority

2. Conduct assessments to best meet patient needs

3. Train the staff in techniques to address health literacy

4. Seek input from patients and consumers to identify barriers

5. Practice universal precautions (e.g. allocate resources)

6. Use specific strategies for verbal and written communication

7. Design systems to be accessible to all patients (e.g. website)

8. Create all informational material in an easy to read style

9. Address medications and patient self-management

10. Clearly explain costs and charges for services