1. Health Disparities & Health Literacy Your Place of Worship Your Name Date Health Disparities & Health Literacy: a customizable introduction from NN/LM (2013)

2. Agenda Introductions Health Disparities Determinants of Health Literacy Health Literacy Tools to Increase Health Literacy Community Outreach Resources Questions/Discussion

3. Definition of Health Disparities Preventable “population-specific differences in the presence of disease, health outcomes, or access to health care.” ~ Health Resources and Services Administration (HRSA, DHHS) More information on Health Disparities: www.unnaturalcauses.org http://www.cdc.gov/omhd/Highlights/Highlight.htm#DISPARITIES0

4. Diabetes in U.S. Ethnic Populations Diabetes in U.S. Ethnic Populations 7.1 11.8 12.6 16.1 0 2 4 6 8 10 12 14 16 Non-Hispanic Whites Hispanic/Latino Americans Non-Hispanic African-Americans Native Americans/ Alaska Natives Prevalence (%) CDC. National Diabetes Fact Sheet. 2011 (survey 2009) 8.4 Asian Americans

5. Health Disparities Many factors contribute to racial/ethnic health disparities: o Socioeconomic status Education, employment, income o Lifestyle Behavior Physical activity and alcohol intake o Social Environment Educational and economic opportunities, racial/ethnic discrimination, neighborhood and work conditions o Access to Preventive Care Cancer Screening and vaccination http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a1.htm

6. What does this mean for Minorities? Minorities are likely to receive poorer quality health care than Caucasians. Minorities are more likely to die from all types of cancers than Caucasians. Minority infant death rates are significantly higher than those for Caucasian infants. The incidence of stroke for minorities is far more frequent than compared to Caucasians. AHRQ, National Healthcare Disparities Report 2009: http://www.ahrq.gov/qual/nhdr09/nhdr09.pdf http://www.ahrq.gov/qual/nhdr09/nhdr09.pdf

7. Determinants of Health Age Income Literacy Skills Employment Status Education Level Race or Ethnic Group

8. Literacy Literacy in Context Time & Place Circumstances Background Speaker/Writer Listener/Reader Culture Speaker/Writer Listener/Reader 5 Core Skills Reading Prose Documents Writing Numeracy Speaking Listening The Oral Exchange Shared with permission from Dr. Rima Rudd, Harvard School of Public Health www.hsph.harvard.edu/healthliteracy

9. Created by Kay Hogan Smith, University of Alabama, Birmingham NAAL ( 2003) : http://nces.ed.gov/naal/http://nces.ed.gov/naal/

10. What is Health Literacy? “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health care decisions” Healthy People 2010 “…understand and act on health information” Pfizer Clear Health Communication, 2012

11. Two Sides to the Story At first, health literacy was considered to be a characteristic of the individual. Increasingly, researchers and practitioners are looking at both sides of the coin: Shared with permission from Dr. Rima Rudd, Harvard School of Public Health www.hsph.harvard.edu/healthliteracy graphic by Dalen Gilbrech

12. AMA 'Help Patients Understand' Video http://www.youtube.com/watch?v=cGtTZ_vxjyA http://www.youtube.com/watch?v=cGtTZ_vxjyA

13. Do You Understand? “Transverse and longitudinal response functions have been extracted for 3 He, 12 C, 40 Ca, 48 Ca, and 56 Fe up to a momentum transfer of 550. The quenching of the longitudinal response function in the quasi- elastic region is significant and might be a signature of modification of the intrinsic properties of the nucleon in nuclear matter.” --Zein-Eddine Meziani. Transverse and longitudinal response functions in quasielastic electron scattering from nuclei. Nuclear Physics A Volume 446, Issues 1-2, 16 December 1985, Pages 113-122 [Created by Michael Villaire of IHA]

14. Health Literacy Matters To fill out a patient information form To follow discharge instructions To manage medications To care for a loved one’s health To keep appointments To understand insurance To identify signs To research health information To sign consent forms

15. Directional Signs Ambulatory Entrance Hospital XYZ Some people become confused about whether this entry was intended for ambulances or for patients Ambulatory Entrance The use of visuals clarify the message Contrast in color makes it easy to read Try to be consistent when hanging signs Created by Kay Hogan Smith, University of Alabama, Birmingham

16. Symbols and Drug Labels What’s “plenty”of water? “Medicine will make you feel dizzy” “Don’t take medicine if you’ve been in the sun too long.”

18. Low Health Literacy Leads to… Underutilization of services Increased medication errors Poor understanding of health Increased hospitalizations Poor health outcomes Increased healthcare costs

19. What Can We Do? Dr. Rima Rudd Harvard School of Public Health www.hsph.harvard.edu/healthliteracy Change the Skill Side: Improve literacy skills of the public Improve communication skills of professionals Change the Demand Side: Recalibrate the norm and identify literacy barriers Lower Demands Remove Barriers

20. Communication Tools Use Teach-Back technique Encourage questions & self advocacy Use plain language o “Keeps bones strong” vs. “Prevents osteoporosis” o “Chest pain” vs. “Angina” o “The heart is a pump.” Provide easy-to-understand materials Combine tools

21. Teach-Back Technique I want to be sure I went over everything. Tell me how you will take this medicine. Just to check if I’ve covered everything: Tell me what you will say to your wife when you return home. Just to be sure I was clear: Show me how you will use this peak flow meter.

22. Teach-Back Technique Patients can also initiate this technique: Let me make sure I understand – Each morning, I should…… So, what you’re telling me is…… Is that right?

23. Encourage Self Advocacy Partnership for Clear Health Communication Ask-Me-3 Initiative: http://www.npsf.org/askme3/ 1.What is my main problem? 2.What do I need to do? 3.Why is it important for me to do this? Patient can initiate Teach-Back “Let me make sure I understand: I should…”

24. Encourage Self Advocacy: Websites http://nihseniorhealth.gov medlineplus.gov http://www.healthyroadsmedia.org

25. Plain English/Plain Language http://www.plainlanguage.gov Promote the use of plain language for all government communications Examples, word suggestions, thesaurus Separate section for health literacy http://www.lib.umich.edu/plain-language-dictionary Plain Language Widget and App

26. Visual Tools: Story Cards http://healthysmilesforautism.org/

27. Visual Tools: Videos & Tutorials Medlineplus.gov

28. Easy-to-Understand Materials

29. Tips for Message Content Be clear about targeted audience. Be sensitive to cultural differences – word choice, graphics, customs & beliefs. Tell readers what they will gain from reading your material – “Tips for a Healthier You!” Limit the number of messages.

30. Tips (cont.) Use visuals for text (or with text)  Place images close to related text.  Text and pictures must agree.  Pictographs may be used to represent ideas or actions. Keep visual separation between topics Test for Readability – pg. 27 in Simply Put manual http://www.cdc.gov/healthliteracy/pdf/simply_put.pdf

31. Text & White Space 12 point or larger font size - not ALL CAPS, no “effects” Use common fonts such as Arial or Tahoma; avoid script Eat fruits and vegetables. Use boldface type and underlining to cue readers to important text Use white space o Aim for “50/50 split”

32. Present Tense & Active Voice 1.Wrap the cut in a clean cloth. 2.Keep it dry. Use: Consider Pay Concerns Avoid: Give consideration to Make payment Is concerned with

33. Common Terms Accordingly Afford an opportunity At a later date Close proximity In the event that Incumbent upon Utilize So Allow Later Near If Must Use AvoidUse

34. Physician Cardiac Medical Terms

35. Hazardous Radiology Medical Terms

36. Visuals Should Reflect the Audience Age of reader Consider diversity Use current styles Get user input for color choices

37. Rewriting Straight Leg Raise Lying on your back, bend your opposite knee straightand slowly lift your other leg up approximately 12 in, hold for 3s, and lower slowly.

38. Rewriting Straight Leg Raise Lie on your back Bend left leg Lift right leg 12 inches Hold for 3 seconds Lower slowly Literacy and the Older Adult, from Topics in Geriatric Rehabilitation, Oct-Dec2005, Vol. 21 Issue 4, p275

39. Letter to Parents of New Baby Before and After *Examples from: Iowa Department of Public Health: http://www.idph.state.ia.us/health_literacy/examples.as p http://www.idph.state.ia.us/health_literacy/examples.as p Before and After Examples

40. Community Outreach Public Libraries and Community Partners: Working together to provide health information - http://nnlm.gov/outreach/community - A guide to encourage health information partnerships between public libraries, the National Network of Libraries of Medicine, and local health or community-based organizations.http://nnlm.gov/outreach/community Community Tool Box - http://ctb.ku.edu - Community Tool Box (CTB) provides over 6,000 pages of practical information to support your work in promoting community health and development.http://ctb.ku.edu Healthy People Library Project - http://ehrweb01.aaas.org/science-insidehttp://ehrweb01.aaas.org/science-inside /projects/healthy-people//projects/healthy-people/ - Healthy People Library Project is designed to provide minority groups and other consumers easy access to current, reliable information on selected health topics at their local libraries. THRIVE - http://www.preventioninstitute.org/thrive/index.php - THRIVE is a tool to help you understand and prioritize the factors within your own community that can help improve health and safety. (THRIVE - Tools for Health and Resilience in Vulnerable Environments.)http://www.preventioninstitute.org/thrive/index.php

41. Outreach & Evaluation Guides http://nnlm.gov/evaluation/guide/

42. National Network of Libraries of Medicine WE OFFER: Free Training – For a list of classes see our website: http://nnlm.gov/sea/training http://nnlm.gov/sea/training Funding – For projects to promote health information in your community: http://nnlm.gov/sea/funding Advocacy – Check out our blog for the latest information on health information issues in the Southeastern/ Atlantic Region: http://nnlm.gov/sea/newsletter http://nnlm.gov/sea/newsletter Join the network or find local resources by calling us at 1-800-338-7657. The NN/LM's goal is to enhance access to quality health information and enable people to make informed decisions about their health.

43. Thank You! Questions/Comments? Your Name Contact Information