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 of American adults • Limited skills → communication challenge • Addressing the challenge with evidence- ​ based practices – Plain Language – Plain Numbers – Teachback • National support for improvement 2 What is Health Literacy?

Perspective 1 Adult abilities to • Read • Write • Compute • Understand/Evaluate • Communicate • Use ​ health information 3 2003 National Assessment of 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 5 NAAL ​ health literacy results

Only 12% of adults have Proficient ​ skills Sample ​ Proficient task: Calculate an employee’s share of health insurance costs for a year, using ​ a table that shows how the employee’s ​ monthly cost varies depending on income and family size. 6 Most vulnerable

population groups Adults who are: • ​ Older (esp. ages 65+) • Hispanic/Latino • Immigrants • Poor • Managing a chronic physical or mental ​ health condition 7 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

8 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?? 9

How do many (most?) adults respond? 10 ... ​ Health literacy

challenges everyone Limited • knowledge • skills • time • resilience ​ Often, poor • health • vision or hearing • mobility • support system 11

Re-Defining Health Literacy Health Literacy Challenge Complex Health Systems ​ Poor communications Consumer Complex Health knowledge, Systems ​ Poor skills, communications self-efficacy 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” 13 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 14 What works to address the problem? 3 evidence-based solutions Plain language Plain ✓ ​ ✓ numbers ​ ✓ Teachback

15 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 16 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.” 17 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 18 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 20 Do “solutions” work? Evidence says yes...but • ​ Understanding ↑ with ​ better material design • Understanding ↑ with professional support • Reports from health systems mostly positive

21 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 organizational culture • National efforts & trends support this work 22 How will ​ you ​ support evidence-based communication practice? Jot down or share one idea you can try in the ​ next week

23 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. 24