Health Literacy Matters:Strategies for Improving Communication

and Health OutcomesDaniela B. Friedman, PhD

Professor & Chair, Department of Health Promotion, Education, and BehaviorSam Noblet, MPH

Project Coordinator, South Carolina Cancer Prevention and Control Research Network

“TO BE A PERSON IS TO HAVE A STORY TO TELL.” –ISAK DINESEN

Effective Communication?

Session Objectives

• Increase awareness about the state of health literacy and the impact of literacy on health outcomes.

• Provide information and skills for how to communicate plain language health information.

• Share ideas for how to make communication a focus area for clinics and health centers through a new statewide initiative.

Newest Vital Sign• 6 questions• Score of 0-1 suggests high likelihood (50% or

more) of limited health literacy.• Score of 2-3 indicates the possibility of limited

health literacy.• Score of 4-6 almost always indicates adequate

health literacy.

• “ability to read and comprehend prescription bottles, appointment slips, and other essential health-related materials”

• (Ad Hoc Committee on Health Literacy, 1999)

• “cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health”

• (Nutbeam and Kickbush, 1998)

Defining Health Literacy

National Assessment of Adult Literacy

• Only 12% of US adults have proficient health literacy skills

• South Carolina has 13th highest rate of functional illiteracy

Health Literacy is CriticalHealth literacy skills can be a stronger predictor of an individual’s health status than age, income, employment status, education level, and race.

Limited Health LiteracyHealthcare Costs

Hospitalization Rates

Later Stage Diagnoses & Poor Health Outcomes

Factors Affecting Understanding• Intimidation, fear, vulnerability • Shock upon hearing a diagnosis • Extenuating stress within the individual's family • Multiple health conditions to understand and treat• Complicated information

• NIH Plain language training: http://www.nih.gov/clearcommunication/plainlanguage/gettingstarted/

Conceptualization of Health Literacy as Risk

Conceptualization of Health Literacy as Asset

What is Health Communication?

• “study and use of communication strategies to inform and influence individual and community decisions that enhance health” (Healthy People)

• Way we seek, process, and share health information• Crucial element in disease prevention and in health promotion

campaigns• “Where good health promotion and good communication

practice meet.”• From: Rootman, I., & Hershfield, L. (1994). “Health Communication Research:

Broadening the Scope” Health Communication, 6(1), 69-72.

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Health/Risk Communication17

Importance of Health Communication

• Success of health care encounters• Source of self-confidence • Potential to reduce health care costs• Helps in operation of health organizations• Informs public about health• Contributes to decision making for voluntary behavior change

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Risk Communication

Best Practice Communication Styles

• Simplicity• Language, graphics, handouts (PRE-TEST)

• Avoid humor• Take every statement from the public seriously• No “lecturing”

• Listen first; acknowledge concerns; build trust• No faking; admit unknowns• Be professional in action and appearance• Give people things to DO

• Mobilize; Sense of control

Plain Language• Embodies clear communication• NOT ‘‘dumbing things down’’ BUT communications that engage and

are accessible to the intended audience• Also used to describe process of developing such communications,

as in the phrase ‘‘using a plain language approach’’• For text-based information, it means using evidence-based

standards in structuring, writing, and designing to create reading ease

• Resulting texts described as easy to read, user-friendly, or reader-focused

Plain Language: It's the law!HTTP://WWW.PLAINLANGUAGE.GOV/PLLAW/INDEX.CFM

• President Obama signed the Plain Writing Act of 2010 on October 13, 2010.

• The law requires that federal agencies use "clear Government communication that the public can understand and use.

• " On January 18, 2011, he issued a new Executive Order, "E.O. 13563 - Improving Regulation and Regulatory Review." It states that "[our regulatory system] must ensure that regulations are accessible, consistent, written in plain language, and easy to understand."

Gobbledygook vs. Clarity• Original:In order to be responsive to Member problems and concerns

about HMO policies, programs, procedures, personnel, or benefits and services (their coverage, provision, or omission), the following grievance procedures have been established.

• Plain language rewrite:If you have a problem or complaint, here’s what to do.

Gobbledygook vs. Clarity• Original:

Is there help for caregivers? Most often, spouses or other familymembers provide the day-to-day care for people with AD. As the disease gets worse, people often need more and more care. This can be hard for caregivers and can affect their physical and mental health, family life, job, and finances.

• Plain language Rewrite:Is there help for caregivers? Yes. If you are caring for someone with Alzheimer’s disease, you may feel overwhelmed. It can take all your time and energy. There is help for you. Learn about support groups, adult day-care programs, home healthcare services and other helpful resources. You need to take care of yourself in order to take care of someone with Alzheimer’s disease.

Hands-On Practice in Revising Social Media Content

• Too Much Jargon -- Facebook Post:Prevent squamous cell carcinomas by seeking midday shade, avoiding tanning booths, wearing sunscreen every day, and wearing protective clothing. While many squamous cell carcinomas can be treated with simple excision or Mohs surgery, sun-cautious behavior can prevent them before they begin.

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• Flat, boring Facebook post:Has anyone ever told you that your heart stops when you sneeze? Is this true or false? Let us know what you think here. Then learn more. Read our Fun Medical Facts for Kids.

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• Tweet is too long:Waterproof sunscreen lasts twice as long as water-repellent, but both kinds need to be reapplied if you use a towel to dry off after a swim.

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• Impersonal Tweet:Good Food 4Baby, an online program, teaches mothers how to feed toddlers a healthy diet so they maintain a healthy weight. go.usa.gov/XYZ

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• Text Message without call to action:High Blood Pressure—Almost 75M Americans (about 1 in 3 adults) have high blood pressure (HBP) & greater risk of heart disease or stroke. Many people don’t realize they have it!

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COMMUNITY HEALTH INTERVENTION PROGRAM (CHIP) MINI GRANTS

Do graphics/art always work? It depends.

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Enhancing Quality of Care through Improved Health Literacy

Daniela B. Friedman, PhD, University of South CarolinaHeather M. Brandt, PhD, University of South Carolina

Michelle Arent, MPH, University of South CarolinaWilliam D. Isenhower, MD, Self Regional HealthcareDiana Zona, BS, South Carolina Hospital AssociationDelores Fedrick, BS, Chester County Literacy Council

Abraham Wandersman, PhD, Wandersman CenterLarisa Bruner, PhD, University of South Carolina

Chester County Literacy Council

accesshealth sc

Grant #: 6816-SP

Proposed Program

Phase 1: Assess Clinical Readiness (YR 1)

Phase 2: Intervention Implementation (YR 2 & 3)

Phase 2: Intervention Implementation

1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?

This will be the first systematic statewide initiative to …

1. Understand clinic readiness for implementing a health literacy initiative

2. Implement systematically a health literacy initiative in clinics statewide

3. Increase clinic/health center staff team awareness about health literacy and improve communication

4. Improve patient and family participation and health literacy

Clinic Diagnostic Tool

What we plan to do … Please join us!

• Evaluate patient communication needs across SC• Increase health care teams’ awareness of health literacy

disparities• Encourage dialogue to improve health care staff communication,

and patient understanding and participation in care

Think about your daily communication at work:• WHO delivers information?• WHO receives information? Who is your audience(s)?• What are the KEY messages you are communicating? • What type of facts do you need deliver your messages?• What communication strategies are you using to reach

your audience(s)?

Table of Strategies… Do you use words that are easy to understand? Examples?Do you use real world examples to help individuals and families understand what you were saying?Do you explain things in a way that others can understand?Do you use pictures, charts, or drawings to explain the information?

Do you give people a chance to ask all the questions they have?

Do you encourage people to be involved in their decision making?Do you check that people understand the things they need to do to take care of their health?Do you help people deal with feelings of worry about their health?

THANK YOU!Daniela B. Friedman, MSc, PhD

Department of Health Promotion, Education, and Behavior

Arnold School of Public Health University of South Carolina

Tel: 803.576.5815Email: dbfriedman@sc.edu

Sam Noblet, MPH

Prevention Research Center

Arnold School of Public Health University of South Carolina

Tel: 803.777.5887Email: noblet@mailbox.sc.edu

QUESTIONS?

Clinic Diagnostic Survey