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Do you know?
Which of the following is the strongest predictors of an individuals health status?
A) Age B) Income C) Literacy skills D) Education level E) Racial or ethnic group F) Average Beer Intake at Metro
Do you know?
Which of the following is the strongest predictors of an individuals health status?
A) Age B) Income C) Literacy skills D) Education level E) Racial or ethnic group F) Average Beer Intake at Metro
Definitions
Illiteracy: total inability to read and write Functional Illiteracy: ability to only read/write/understand below 5th grade level Marginal Literacy: ability to only read/write/understand between the 5th and 8th grade level Literacy: ability to read/write/understand at the 8th grade level and above
Health Literacy
The ability to read, understand, and use healthcare information to make effective healthcare decisions and follow instructions for treatment
half of our adult population has deficiencies in reading or computational skills. (AMA Council on Scientific Affairs, JAMA 1999)
Do your patients understand what you are telling them?
Basic information about a colonoscopy, as perceived by a patient with limited literacy skills
22% of adult Americans are functionally illiterate; an additional 27.5% are marginally literate Therefore, nearly half of American adults (90 million patients) do not have sufficient literacy skills to fully function in society
All segments of the population are affected
Percent of physicians who know about Health Literacy: 33% Percent of physicians who make changes in patient communications after learning about health literacy: 66%
Access to Quality Health Services* Arthritis, Osteoporosis, and Chronic Back Conditions Cancer Chronic Kidney Disease Diabetes Disability and Secondary Conditions Educational and Community-Based Programs Environmental Health* Family Planning Food Safety HEALTH COMMUNICATION Heart Disease and Stroke HIV Immunization and Infectious Diseases*
Injury and Violence Prevention* Maternal, Infant, and Child Health Medical Product Safety Mental Health and Mental Disorders* Nutrition and Overweight* Occupational Safety and Health Oral Health Physical Activities and Fitness* Public Health Infrastructure Respiratory Diseases Sexually Transmitted Diseases* Substance Abuse* Tobacco Use* Vision and Hearing
use bus schedule, find intersection on map read a simple story to a child fill out social security application
RESULT: An excess cost of $50-73 billion per year to the US healthcare system
Trouble understanding:
when next appt was scheduled medical vocabulary (bowel, polyp, colon, etc.) basic disease concepts how to use medical devices (asthma inhaler)
Red Flags
Behaviors
registration forms incomplete or inaccurate frequently missed appointments noncompliance with medication lack of follow-through with tests or referrals eyes wandering over a page very slow to finish sounding out words looking confused
Responses
I forgot my glasses Let me take this home so I can discuss it with my children
may bring decoy reading materials 66-75% of adults in NALS Level 1 say they read well or very well 33.6% of low literacy patients do not admit to having reading trouble
Overview of Implications
Poor Health Outcomes Over-utilization of health services Limited effectiveness of treatment Higher patient dissatisfaction Higher provider frustration
Do social history first in patient evaluation, adding questions about literacy skills in a sensitive manner
How happy are you with the way you read? What do you like to read?
Ask questions in a safe and supportive environment and in a neutral, nonjudgmental fashion Brown-bag medication review
When was the last time you took one of these pills? When was the time before that? Do they read the label or look at the pill?
Remember...
Not stupid All social classes Amazingly able to function
The majority of people with low literacy skills are white, native-born Americans
Health providers should not have racial/ ethnic bias
SOLUTION:
Patient Empowerment
3 Important Questions:
What is my main problem? What do I need to do?
How do I take my medicine? When do I need to be seen again?
AMA-MSS
Health Literacy Subcommittee, Anupama Kathiresan, Chair Community Service Committee, Stephen Patrick, Chair
www.ama-assn.org/go/mss