Health Promotion/ Health Literacy Ch. 6

Common health problem faced by immigrants r/t health literacy

Heart attacks Cancer Diabetes HIV/AIDS Strokes

steps of motivational interviewing

Identify patient's own strengths Identify functions to empower to build on own strengths Identify specific goals to carry out change

Health literacy definition

the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

Universal Design (2004 govt mandate)

the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design

Epidemiology

the study of the distribution and the determinants of disease

Health Literacy aspects:

whether individuals are able to comprehend health and self-care information AND whether healthcare institutions are able to provide education that is accessible to everyone

Hmong beliefs about health and obtaining care

will not typically treat an illness/ acute or chronic unless interferes with daily life

Effective Educational material should:

Focus on benefits of changing H. behavior Emphasize conditions that will facilitate change Offer short-term, measurable goals/action plans

TOFHLA - test methods

Full 50 items -25min. - all competencies Brief 2 read/4 num. - 12 min. -math not reliable Short -7 min. - only reading comprehension

TOFHLA (Test of Functional Health Literacy in Adults)

GOLD STANDARD in tools for measuring health literacy - the largest literacy study first conducted in the United States in 1992. English/Spanish/ vision impaired Robert Wood Johnson Foundation

Health literacy: IOM

Health literacy is a shared responsibility; a function of social and individual factors

TOFHLA- measures

Reading Numeracy skills Comprehension

Motivational Interviewing: Role of interviewer

Reflective listener Actively engaged Maintain open-ended dialogue

Document

measures ability to use information from food labels, & noncontinuous texts

TOFHLA: definition of Health literacy

"Ability to perform health-related tasks requiring reading and computation skills" (Speros, 2005)

Methods to assess comprehension

"Show me" "Teach back" Acknowledge success to enhance patient self-efficacy and self-esteem

Canadian expert panel defined Health literacy

"the ability to find, understand, appraise, and communicate information to promote health across the life-course."

Why Latina women not get cervical CA screening

"you go to doctor, if something hurting." otherwise you do go

Why Latina women not get cervical CA screening

"you go to doctor, if something hurting." otherwise you do not go

Issues with Misunderstanding provider instructions

--non-adherence to treatments --no active role in self-care/lack of motivation --medication errors

Lower health literacy has been linked to:

-higher healthcare costs -longer hospital stays/ 2x more likely hospitalized -infrequent use of preventative/primary care -delays in seeking care -higher levels of chronic disease -poor management of chronic disease -ineffective patient-provider communication -more frequent/inefficient use of costly services

TOFHLA - scoring of functional health literacy

0-59 Inadequate 60-74 Marginal 75-100 adequate (Excellent Reliability 0.98; good Validity for criterion and content)

Ways providers can improve health literacy

1. Assess EACH patient's literacy level 2. Assess for readiness to learn 3. Ask what form of material is best for patient 4. Translate written info into pt. primary language 5. Use interactive teaching methods

NAAL (2003) rankings

1. Below basic 2. Basic 3. Intermediate 4. Proficient

Ways to support Health Education in immigrant population

1. Explanatory models of health and illness 2. Use narrative descriptions/visual aids 3. Use primary language 4. Explore if literate family members should be involved in patient's care 5. Inclusion of target audience in design of materials

NAAL (2003) 3- literacy test categories

1. Prose 2. Document 3. Quantitative

2 Tools to measure health literacy Specific to Diabetes

1. SKILLD / Spoken Knowledge in Low Literacy people with Diabetes. SCORES correlate w/ HbA1c results. 2. LAD / Literacy Assessment for Diabetes 3 min. Word recognition/ Pronunciation 4th; 6th; 16th grade reading levels

Optimal manner of providing health content to low literacy population

1. Shame-free environment 2. A few target points per session 3. Emphasize patient's concerns 4. Speak clearly and slowly

What does motivational interviewing cover

1. What health behavior patient wants to change 2. How they wish to begin 3. What they believe is a reasonable goal

Benefits and use of Medical Home

1. consistent H-C providers 2. offer streaming education 3. offer learning kiosks

HALS/Health Activity Literacy Scale evaluates:

1. health promotion & health protection 2. disease prevention 3. health care & maintenance 4. navigation skills (focus on oral communication- 1 hour long)

HALS - identifies ability to:

1. locate information 2. integrate data 3. analyze information 4. calculate responses (correlate findings to demographic variables)

Clues that a person has difficulty with health literacy

1. not being able to name medications or dosages 2. trouble with remembering one's health history 3. frequently making comments about leaving one's glasses at home when being asked to read over healthcare instructions in an office or hospital setting

Benefit to use of Health Museums, exhibits, and theme parks in Health Education

1. participatory in nature 2. greater retain what have seen and experienced 3. unique experience builds on own info base 4. affordable education reaching MANY

Attributes of the healthcare system r/t health literacy

1. rules governing what health plans cover 2. changing formulary coverage 3. physicians who leave the network. 4. short time for patient-provider communication 5. more emphasis on factual/scientific explanation 6. an increase in specialized/fragmented care

Guidelines to improve accessibility of written health information

1. simplified sentence structure 2. active voice 3. shorter words 4. only key content

ALLS - includes

1. sub-scales of literacy 2. document literacy 3. numeracy 4. problem-solving 5. health literacy

Provider factors in patient health literacy

1. unaware of limited literacy 2. frustration with patients unscientific explanations of symptoms 3. Not providing education tailored to needs

NAAL (2003) findings

12% of individuals had proficient health literacy 53% had an intermediate level of health literacy 22% had basic health literacy 14% had below-basic health literacy

WRAT - 2 designs

20-30 minutes 1st level ages 5-11 2nd level 12-64

Percentage of US population functionally illiterate

25% according to National Adult Literacy Survey (NALS)

Grade level for enrollment and consent documents

6th grade

Health and Financial Literacy Instrument measures

9 ques: health insurance, burden of disease, and medication skills 25 ques: financial

Below-basic health literacy level

< than is needed to function in health care setting

patient centered medical home

A model of primary care that provides comprehensive and timely care to patients, while emphasizing teamwork and patient involvement.

Level 3: Critical health literacy

Ability to analyze information & act at individual and community levels by influencing social norms

Level 2: Interactive health literacy

Ability to optimize prevention & self-management; problem-solving; decision-making, applying new information Includes concepts: motivation, personal empowerment for behavior change

Level 1: Functional health literacy

Ability to read, write, and understand factual information about health risks

Proficient health literacy

Able to define medical information from complex document, and synthesize the information to arrive at conclusions

Populations most at risk to suffer poor health r/t health literacy

Age >65 Low SES African American Hispanics Immigrants

REALM scoring

Based on correct pronunciation test-retest reliable & valid for 125 and 66 item tests **Does not measure comprehension

(ECA) Embodied Conversational Agent

Computer interface for health education Showed success with lower health literacy levels

SAHLSA/ Short Assess. Health Literacy Spanish

Developed from REALM Word recognition - term must be associated w/similar word to demonstrate comprehension 3-6 min Good reliability

Types of health literacy

Level 1: Functional Level 2: Interactive Level 3: Critical

How can health education impact health literacy in immigrant populations

Must incorporate 1. cultural beliefs and values 2. culturally sensitive images 3. common healing practices

Health Literacy Manual for clinicians

Offered by AMA to guide providers in their role in improving health literacy

DAISY (Digital Accessible Information SYstem)

Online systems are designed standard so that talking books and print-format documents can be readily adapted to varied learning styles. Tailored to various experience, literacy, and physical ability levels

personal health record (PHR)

pocket-sized record containing the individual's medical history, including diagnoses, symptoms, and medications

Health literacy: Joint Commission

Standard of accreditation: 1. patients must receive oral/written info that is understandable by them 2. Information tailored to patients' health literacy 3. Requires patients to be active participants in their care

Prose

Tests comprehension by reading health brochures and use the information for health decisions

NVS (Newest Vital Sign) assessment measures:

reading and quantitative skills Read & evaluate ICE CREAM Nutrition Label 6 questions Sensitive in assessing Marginal literacy English/Spanish

ALLS testing methods

reading newspapers and bus schedules locating health care facilities calculating medication times providing consent creating exercise regimen

National Assessment of Adult Literacy (NAAL)

The literacy scales used in the 2003 study included prose literacy, document literacy (including health literacy) and quantitative literacy. 28 tasks in each category

WRAT (Wide Range Achievement Test) measures

reading, word recognition, & math --determines grade level reading (Good reliability and validity) ***Not based on HC setting)

fotonovelas

Used by Latinos in Nutrition & HIV education/prevention suspenseful story -involve community in creation of story boards, illustrations of selected health condition

Prophylaxis TB treatment study issue

Vietnamese refused to take treatment 1. side effects "too hot" 2. Asian herbal medicine "benign & cooling"

REALM (Rapid Estimate of Adult Literacy in Medicine) measures:

Word Recognition 125, 66, and 11 item tests 5 minutes - practical for busy h.c. practices English only

motivational interviewing - William Miller 1983

a collaborative, person-centered form of guiding to elicit and strengthen motivation for change Use of non-directive questioning 10-15 min.

Intermediate health literacy

ability to summarize health related content and make inferences

Basic health literacy

can read and understand simple information and complete one-step mathematical calculations

Health literacy predicts health status and outcomes better than:

economic status age ethnic/racial background

ALLS/ Adult Literacy and Life Skills Survey evaluates:

evaluates the same skills as HALS

Health literacy Issues - Children why address in schools

health attitudes/behaviors formed during childhood have direct effect on adult health habits

Health literacy: WHO (2007)

health literacy is "having a central role in determining inequities in health in both rich and poor countries"

DMCAT/ Decision Making Capacity Assess. Tool- measures and for what population

health literacy levels decision-making capacity For ESRD patients to determine understanding of dialysis and kidney transplant

Immigrant Population Health literacy PROBLEM

language barriers and health literacy challenges interfere with obtaining adequate care for disparities that disproportionately affect them

Why health education targeted to both young person and parent/guardian

many parents can NOT calculate Tylenol doses, read immunization schedules & growth charts, or understand food labels and mix formula correctly

Quantitative

measures ability to calculate medication doses and other computations