Health Literacy, Plain Language, and Clear Health Communication Sue - - PDF document

Health Literacy, Plain Language, and Clear Health Communication

Sue Stableford, MPH, MSB ​Aging ME GWEP Consultant & Trainer Health Literacy, Plain Language, ​and Clear Health Communication

Slide references and notes are in a separate Word document Funding attribution is on the final slide

Where We’re Going

• Literacy and health literacy skills
• f American adults
• Limited skills → communication

challenge

• Addressing the challenge with

evidence- ​based practices

– Plain Language – Plain Numbers – Teachback

• National support for improvement

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What is Health Literacy?

Perspective 1

Adult abilities to

• Read
• Write
• Compute
• Understand/Evaluate
• Communicate
• Use ​health information

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2003 National Assessment

• f Adult Literacy ​[NAAL]

Prose ​Literacy Skills of American Adults

30 million 14% ​Below Basic 63 95 28 million million million 29% ​Basic

4 ​44% ​Intermediate

13% ​Pro- ficient

More NAAL Results

Quantitative ​Literacy Skills of American Adults

47 71

71 28 million million million million 22% 33% 33% 13% ​Below Basic Intermediate Pro- ​Basic ficient

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NAAL ​health literacy results

Only 12% of adults have Proficient ​skills

Sample ​Proficient task: Calculate an employee’s share

• f health insurance costs for a

year, using ​a table that shows how the employee’s ​monthly cost varies depending on income and family size.

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Most vulnerable

population groups

Adults who are:

• ​Older (esp. ages 65+)
• Hispanic/Latino
• Immigrants
• Poor
• Managing a chronic physical or

mental ​health condition

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2012 PIAAC similar to

2003 NAAL Results

International survey: Scores in 5 levels (500 points)

– In U.S., representative sample of 5000+ adults ages 16-65 – Overall, U.S. did poorly compared to other countries Higher levels = better scores

• ​Literacy​: 48% at levels 3,4,5
• ​Numeracy​: 36% at levels 3,4,5

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What do care systems and public health demand? ​Adults expected to

manage:

– Insurance and bills – Acute and chronic conditions – Preventive care – Treatment regimens – Health habits – Behavioral health – Care coordination – Quality surveys – And??

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How do many (most?) adults respond?

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... ​Health

literacy

challenges

everyone

Limited

• knowledge
• skills
• time
• resilience ​Often, poor
• health
• vision or hearing
• mobility
• support system

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Re-Defining Health Literacy

Consumer knowledge, skills, self-efficacy Health Literacy Challenge Complex Health Systems ​Poor communications Complex Health Systems ​Poor communications Strong Emotions

Adapted from IOM conceptual framework in ​“​Health Literacy: A Prescription to End Confusion​”, 2003 ​12

The Communication “Gap” Consumer Skills vs System Demands

Average literacy skills about

grade 8/9 Most health information at reading level 10 + Verbal teaching too fast in a “foreign language”

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Impact: Serious for patients and systems

Increased Consumer Risk

• ​Low understanding of ​health

information

• ​↓ Knowledge and uneven

adherence in managing chronic conditions → poor outcomes

• ​↓ Knowledge and likelihood ​of

getting preventive care

• ​↑ Hospitalizations, costs, ​and

deaths

Increased System Risk

• Suboptimal patient ​experience

lower CAHPS scores

• ​Suboptimal outcomes
• Increased costs and ​potential for

malpractice claims

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What works to address the problem?

3 evidence-based solutions ✓ Plain language ​✓ Plain numbers ​✓ Teachback

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Plain language: More than words

Using plain language means paying attention to:

• ​Content ​Limited and focused
• ​Organization/structure ​Key

messages up front, small information chunks

• ​Writing ​Clear, using familiar terms

and proven techniques

• ​Design ​Visually supports key

messages: ‘skim and scan’

• ​Culture ​Sensitivity and inclusion

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Formal Definition of Plain Language

3 professional plain language groups agree on ​this definition: “A communication is in plain language if its wording,

structure, and design are so clear that the intended readers can easily ​find ​what they need, understand ​what they find, and use ​that information.”

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Plain Numbers ​(Public Materials) ​“Use plain

numbers” means:

• Use whole numbers as much as

possible, ​not decimals, fractions, or percentages

• Don’t expect consumers to do math
• Do it for them
• Provide context or ‘gist’ so

consumers understand what ​the numbers mean ​for them

• Write numbers as digits, not words

(write 8, not eight)

• Be aware of unfamiliar

measurement units such as ​mmHg, and decide if just numbers meet needs

• Keep charts, graphs, and tables

simple

• Use consistent denominators and

icons to explain risk

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Teachback

Assures understanding of verbal teaching

• Educator teaches
• Person tells or shows back ​in own

words

• Educator re-teaches as needed

An invitation, not “grilling” a learner​19

A Larger View: Policies and Programs Driving Change

• 1. Patient experience, patient

engagement 2. Patient safety ​3. Legal and fiscal considerations

• 4. Federal efforts ​5. Affordable

Care Act payment reforms ​6.

Academic/professional practice standards 7. Hospital accreditation standards

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Do “solutions” work?

Evidence says yes...but

• ​Understanding ↑ with ​better

material design

• Understanding ↑ with

professional support

• Reports from health systems

mostly positive

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Summing Up

• We are all challenged by our

complex and demanding care systems, especially when sick.

• Only 12% have ​proficient

health literacy skills.

• We can help by using proven

techniques: plain language, plain numbers, and teachback

• Effective communication builds

patient trust ​and loyalty, meets regulatory requirements, and helps build healthy

• rganizational culture
• National efforts & trends

support this work

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How will ​you ​support evidence-based communication practice?

Jot down or share one idea you can try in the ​next week

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Funding Attribution

This project is supported by the Health Resources and ​Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1QHP33080-01-00, Geriatrics Workforce Enhancement ​Program, Year One-total award amount $749,999.00.

This ​information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS or the U.S. Government.

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