The Health Information Literacy Curriculum Sponsored by the Medical Library Association Funded by the National Library of Medicine Contract Number HHSN /NO1-LM

Learning Objectives Recognize the impact low health literacy has on patient care Name five strategies and resources to improve health literacy Describe the health literacy services offered by the library

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 decisions. Healthy People 2010

What factors affect Health Literacy? Health literacy is dependent on individual and system factors Communication skills Information and knowledge Culture and language Demands of the system

Why is Health Literacy Important? Low health literacy is linked to… Under-utilization of services Increased medication errors Poor knowledge about health Increased hospitalizations Poor health outcomes Increased healthcare costs

Health Literacy and Cancer Screening Women with low health literacy are less likely to have had a mammogram or Pap test than women with higher health literacy skills Source: Davis, et al (1996). Caner. Lindau, et al (2002). Am J Obstet Gynecol.

Health Literacy and HIV / AIDS Knowledge Source: Kalichman, et al (2000). Am J Prev Med.

Health Literacy and Diabetes Management Percent of patients with diabetes correctly answering questions according to literacy level (low, moderate, high) Need to Know: symptoms of low blood sugar (hypoglycemia) Need to Do: correct action for hypoglycemic symptoms Low Moderate High Low Moderate High Source: Williams, et al (1998). Arch Int Med.

Health Literacy and Healthcare Costs $2,891 $10,688 Annual Healthcare Costs of Medicaid Enrollees Source: Weiss, et al (2004). J Am Board Fam Pract. (<3 rd -grade reading level)(>4 th -grade reading level)

How is Information Critical to Health Literacy? Health information is key to: Patient and provider communication Shared health care decision making Understanding and following directions Recognizing when to seek care Learning and adopting healthy behaviors

What are the Challenges? Health literacy in the U.S. Readability of health materials Health information and the Internet

Health Literacy in the U.S. Intermediate Basi c Below Basic Proficient 13% 12% 53 % 22% 77 million adults have basic or below health literacy skills Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics (2006). Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics (2006).

Readability of Health Information Over 300 studies show health-related materials far exceed the reading ability of U.S. adults Increasing number of studies show similar results when looking at the readability of online health information Source: NLM BibliographyUnderstanding Health Literacy and Its Barriers (2004).

Health Information and the Internet 80% of Internet users search for health information 75% rarely or never check the source and date 72% express trust in most or all information found online Source: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC:Pew Internet & American Life Project. Source: Fox, S. Vital Decisions (2003). Online Health Search (2006). Washington, DC: Pew Internet & American Life Project.

Health Literacy From the Patients Perspective Source: Help Your Patients Understand. AMA Foundation Health Literacy. category/9913.html category/9913.htmlwww.ama-assn.org/ama/pub/ category/9913.html Mrs. Cordell Mr. Bell

Strategies to Improve Health Literacy Use living room language Limit information (3-5 key points) Use easy-to-read print materials Practice teach-back Use Information Rx Address culture and language needs

Living Room Language Name common terms for… Hypertension Insomnia Benign Hazardous Disorder Option Poultry Routinely

Ask Me 3 – National Patient Safety Foundation

Teach-Back Method Source: Help Your Patients Understand. AMA Foundation Health Literacy. Source: Help Your Patients Understand. AMA Foundation Health Literacy. assn.org/ama/pub/category/9913.htmlwww.ama- assn.org/ama/pub/category/9913.html

Easy-to-Read Materials Deciphering Medspeak Brochures HIV Cancer Diabetes Other

Information Rx

Interactive Health Tutorials

Top 10 Most Useful Consumer Health Websites Cancer.gov * CDC.gov * Familydoctor.org * Healthfinder.gov * HIVInsite.ucsf.edu * * Available in Spanish KidsHealth.org * Mayoclinic.com Medem.com MedlinePlus.gov * Noah-health.org * Source: Medical Library Association.

How Can Librarians Help? Free access to the Internet Information Rx Program Patient information packets Consumer health collection Native language resources Teaching and training Virtual chat / assistance Health literacy workgroup

Why Now? Why Hospitals? The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care. The Joint Commission Source: What did the Doctor Say?: Improving Health Literacy To Protect Patient Safety. The Joint Commission (2007).

Take Home Points Accurate and reliable health information is critical to health literacy Use Information Rx to refer patients to reliable health information and to the library for help Librarians are available to address the health literacy needs of patients and providers

Thank You! Questions? Comments?

References AHRQ ReportLiteracy and Health Outcomes (2004) AMA Foundation Health Literacy groups/ama-foundation/our-programs/public-health/health- literacy-program.shtml AMA Foundation Health Literacy groups/ama-foundation/our-programs/public-health/health- literacy-program.shtml groups/ama-foundation/our-programs/public-health/health- literacy-program.shtml groups/ama-foundation/our-programs/public-health/health- literacy-program.shtml Fox, S. & Fallows, D. (2003) Internet Health Resources. Washington, DC:Pew Internet & American Life Project Fox, S. & Fallows, D. (2003) Internet Health Resources. Washington, DC: Pew Internet & American Life Project Resources.aspx Resources.aspx Healthy People 2010, Health Communication, Objective IOM ReportHealth Literacy: A Prescription To End Confusion (2004)

References NLM BibliographyUnderstanding Health Literacy and Its Barriers (2004) The Health Literacy of Americas Adults: Results from the 2003 National Assessment of Adult Literacy (2007) The Health Literacy of Americas Adults: Results from the 2003 National Assessment of Adult Literacy (2007) The Joint Commission Report: What did the Doctor Say?: Improving Health Literacy To Protect Patient Safety (2007) The Joint Commission Report: What did the Doctor Say?: Improving Health Literacy To Protect Patient Safety (2007) Medical Library Association Top 10 Most Useful Consumer Health Websites Medical Library Association Top 10 Most Useful Consumer Health Websites

Pilot Site Librarians Martha Prescott, Berkshire Medical Center Health Sciences Library Tori Koch and Kim Hart, Billings Clinic Medical Library Andrea Harrow, Good Samaritan Hospital Health Sciences Library Holly Kimborowicz, Lake Hospital System Medical Library Jeff Mason and Mary Chipanshi, Regina General Hospital Health Sciences Library Julie Smith, St. Joseph Hospital Burlew Library Denise Rumschlag and Carolyn Martin, St. Vincent Hospital Library Lenora Kinzie, Stormont-Vail Healthcare Stauffer Health Sciences Library, and Scarlett Fisher-Herreman, Topeka & Shawnee County Public Library Geneva Bush Staggs and Beverly Rossini, University of South Alabama Biomedical Library Acknowledgements

Project Advisors Elliot Siegel, Robert Logan, Angela Ruffin, Lisa Boyd, Susan Barns, Cindy Olney, Kathy Schilling, Marge Kars, Terry Jankowski, Barbara Bibel, and Cathy Boss Health Information Literacy Research Project Sabrina Kurtz-Rossi, Project Coordinator Jean P. Shipman, Co-Principal Investigator Carla J. Funk, Co-Principal Investigator Acknowledgements