Literacy Assessment In Health Care Is the Cheese Moving? Terry - - PowerPoint PPT Presentation

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Literacy Assessment In Health Care Is the Cheese Moving? Terry - - PowerPoint PPT Presentation

Apr 07, 2023 134 likes •406 views

Literacy Assessment In Health Care Is the Cheese Moving? Terry Davis, PhD Professor of Medicine and Pediatrics LSUHSC Russ Rothman, MD, MPP Associate Professor of Medicine and Pediatrics Vanderbilt Elizabeth Hahn, MA Associate

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Literacy Assessment In Health Care

“Is the Cheese Moving?”

Terry Davis, PhD

Professor of Medicine and Pediatrics

LSUHSC

Russ Rothman, MD, MPP

Associate Professor of Medicine and Pediatrics

Vanderbilt

Elizabeth Hahn, MA

Associate Professor of Medical Social Sciences

Northwestern

Lauren McCormack, PhD, MSPH

Director, Health Communication

RTI 1

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Measurement

  • Where we have come from
  • Where we are now
  • Numeracy, pediatrics, language
  • Where we are going
  • What we are measuring and why
  • Do we lack conceptual agreement on

health literacy?

  • New modes of data collection
  • Challenges and opportunities

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Standard of Literacy Changes with Demand of Society

  • Signing name (civil war)
  • 3rd, 4th grade education (CCC, WWII)
  • 8th grade education (war on poverty)
  • HS diploma/GED (today’s GI)
  • College or more (emerging global

economy)

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Toward a Literate Society*

Any national program to improve literacy skills needs to be based on the best possible information on the deficits and their severity. 1988 – Congress asked DOE to define literacy and address need for information

  • n the nature and extent of adult literacy.

*1975 Carroll, Chall

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Literacy A National Problem Limiting U.S. Competitiveness

1990 – Governor’s conference set goal By year 2000 every adult American will be literate and possess knowledge and skills to compete in global economy. 1991 – National Literacy Act

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National Literacy Act

“…at a level needed to function on the job and in society to achieve ones goals and develop

  • nes knowledge and potential.”

Literacy

Write Solve Problems Read Speak in English Compute (Math Skills)

1991; 1992 National Adult Literacy Survey; Kirsch, 2001

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National Literacy Assessments

Prevalence of low literacy 13-59% (pre-NALS)

  • Profiles of America’s Young Adults (21-25) 1971-1992 (literacy

lower in 92)

  • English Language Proficiency Study (1980 census)
  • Literacy proficiency in job seekers 1990 (DOL)
  • NAEP. Nation’s report card 1984-2004 (4th, 8th and 12th graders)
  • NALS 1993
  • Adult Literacy in US (4 military, 6 civilian assessments 1917-

1986) (Sticht and Armstrong) 1994

  • NAAL 2003 (H.L. component)
  • HALS 2004 (linked to NALS database)
  • NAAL 2016 (internet component)

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Literacy Rates By State

(National Adult Literacy Survey)

National Institute for Literacy 1998

> 30 % 20 % to 30 % 15% to 20 % < 15% % Adults with Level 1 Literacy Skills

21% U.S. Adults are Level 1

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Literacy Assessment In Healthcare

Where I’ve Come From

1987-2009

I was once “homeless”

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Davis Fam Practice 1990, Davis Fam Med, 1991, 1993, Davis Pediatrics 1994 10

Academic Achievement

  • PIAT-R
  • WRAT-R

Word Recognition

  • SORT-R
  • REALM

Raw scores translate to grade level estimates.

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Test of Functional Health Literacy in Adults (TOFHLA)

  • 3 reading comprehension sections (close

technique) and a numeracy section

  • English and Spanish
  • Long and short versions.
  • Translates into three categories

0-16 Inadequate functional literacy 17-22 Marginal functional literacy 23-36 Adequate functional literacy

Parker J Intern Med 1995, Williams JAMA 1995, Baker Patient Educ Counseling 1999

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Health Literacy is Branded

AMA 1999, NLM 2000 IOM 2004, Healthy People 2010 – “the degree to which individuals have the capacity to obtain, process, & understand basic health information & services needed to make appropriate health decisions.”

HHS, National Institutes of Health, National Library of Medicine (NLM). Health Literacy, January 1990 Through 1999. NLM Pub. 2000, vi.

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Dual Nature of Health Literacy

Literacy and Health in America

  • Conceptualize H.L. framework
  • Looks at populations (vulnerable) and complexity of

material and demand on the individual

  • Linked literacy to disparities in healthcare

Meaning and Measure of HL Healthy People 2010

Objective 11: Improve health communication and literacy

  • Improve health literacy (both individual skills and

materials)

  • Increase research and evaluation in health

communication

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Rudd, 2004, Baker, 2006

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Health Literacy is More Than Individual Ability

14 Ruth Parker

But what are we assessing?

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Literacy Tests Cited In Literature

Test Year Type # Cites WRAT-R3 65, 95 Word recognition >2000 REALM* 91,93 Health word recognition 472 TOFHLA* 95 Comprehension of health materials 393 S-TOFHLA* 99 Comprehension of 2 health forms 249 HALS 04 Use print materials to accomplish health tasks 45 N.V.S. 05 Comprehension, numeracy interpretation food label 95

* Highly predictive of health outcomes.

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Literacy Tests Cited In Literature Literacy Tests Cited In Literature

Test Year Type # Cites

MART 97 Medical word recognition 23 LAD 01 Diabetes word recognition 16 REALM-R 03 Health word recognition (11) 42 REALM-SF 06 Health word recognition (7) 1 REALM-Teen 06 Adolescent health word recognition 18 SAHLSA 07 Spanish word recognition and comprehension 21

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Literacy Tests Cited In Literature “CAGE” questions

3 Screening questions

Year Type # Cites

Williams 95 Self-report Bennett (parents) 03 Self-report 27 Chew 04 Self-report 70

1 question

Wallace 06 Self-report 31 Chew 08 Self-report 70

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Can be given over the phone

Demographics: age, ethnicity, education?

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Assessing HL of Population

2003 NAAL: 1st large scale national literacy assessment to contain a component designed specifically to measure health literacy in US adults

  • 19,000 adults in U.S. households and prisons
  • 152 tasks (28 health related), 40 (8 health) given to each adult
  • Oral reading fluency added to better understand reading

difficulty – 2 passages (3-5th grade and 7th to 8th grade) – Fluency = words read correctly/minute

  • Supplement assessment for adults very low literacy

(navigating/understanding) Vicks 44 + 8 other “stimulus” items – 10 questions asked for each stimulus

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Sheida White

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Several factors affect an individual’s performance on any given task. Key conceptual features continued

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Sheida White

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Hispanic

NAAL Health Literacy Data* NAAL Health Literacy Data*

Basic Below Basic

Proficient

14% 12% 53% 22%

National Assessment of Adult Literacy (NAAL): National Center for Educational Statistics, U.S. Department of Education, 2003.

Intermediate

Average Medicare

20 *Correlation HL & NAAL prose .87

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Current Population Testing Issues

  • FDA requires industry to test consumer understanding
  • f OTC & Rx information – what % sample low literacy?
  • “Mall intercept” is standard. Is it representative?
  • Testing patient literacy level alone will not confirm

ability to navigate, understand and act on health information and manage care.

  • Need studies assessing navigation, comprehension,

self-care and actual use of medication.

  • These can then be correlated with literacy level to give

an estimate of an individual’s OTC (or other domain specific) health literacy.

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Considerations in Testing in Health Care Research

  • Reports in literature
  • Validity/ Reliability
  • Cost
  • Training required
  • Ease and method of administration

(in person, phone, computer)

  • Time required
  • Age, language, cognitive ability of patients
  • Confidentiality

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Cautions

  • All existing tools measure literacy in health context (i.e.

not health literacy).

  • Current tests do not include children or languages other

than English, Spanish

Developers of commonly used tests:*

  • Do not recommend testing patients clinically UNLESS

providers are willing to alter communication.

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*Davis, Parker, Weiss

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The Conundrum of Measuring Health Literacy

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  • Lack of conceptual agreement on

meaning of health literacy

  • Are we only measuring individual

skills?

  • Can health literacy (as we are

measuring it) be improved?

  • What interventions improve scores
  • n health literacy tests?
  • Will higher scores translate to

improved health outcomes?

WHAT IS HEALTH LITERACY?

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Challenges and Opportunities

  • What literacy or HL skills are needed today?

– What skills/demands do we anticipate for tomorrow?

  • Can health literacy of U.S. population be tracked?

– Difficulty in tracking L or HL is that the “cheese moves” and demands become more complex

  • Do literacy or HL include navigating the internet?
  • Can NAAL questions and database be released?

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Is This the Dawning of the Age of Aquarius?

Russell Rothman

  • Numeracy’s emergence
  • Assessing parents/children

Beth Hahn and Lauren McCormack

  • NIH funded development of HL assessments
  • Novel computer based methods of data

collection

  • New psychometric methods

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