9/15/2014. Health Literacy and Clear Communication: Moving Towards Understanding. Carol Howe, PhD, RN, CDE

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Welcome to the COPE Webinar Series for Health Professionals!

Moving Towards Understanding Time: 12 noon 1 PM EDT Moderator: Rebecca

Prevention & Education Handouts of the slides are posted at: www.villanova.

Goals Provide Continuing Education Partner with agencies and organizations

Communication: Moving Towards Understanding Carol Howe, PhD, RN, CDE

Describe the prevalence of low health literacy and its association with

Describe the health communication mismatch between patients and providers

webinar provides 1 contact hour for nurses, 1 CPEU for dietitians and 1

Suggested CDR Learning Need Code: 4000, 6010; Level 2.

accredited provider of nursing education by the American Nurses

1 Welcome to the COPE Webinar Series for Health Professionals! September 16 th 2014 webinar: Health Literacy and Clear Communication: Moving Towards Understanding Time: 12 noon 1 PM EDT Moderator: Rebecca Shenkman, MPH, RDN, LDN Program Manager MacDonald Center for Obesity Prevention & Education Handouts of the slides are posted at: MacDonald Center for Obesity Prevention and Education (COPE) Goals Provide Continuing Education Partner with agencies and organizations Participate in Research Enhance Education Health Literacy and Clear Communication: Moving Towards Understanding Carol Howe, PhD, RN, CDE Objectives: The learner will be able to: 1. Describe the prevalence of low health literacy and its association with health outcomes 2. Describe the health communication mismatch between patients and providers 3. Discuss effective communication strategies Credits: Notice: This webinar provides 1 contact hour for nurses, 1 CPEU for dietitians and 1 CEC for sports medicine and exercise professionals. Suggested CDR Learning Need Code: 4000, 6010; Level 2. Villanova University College of Nursing Continuing Education is an accredited provider of nursing education by the American Nurses Credentialing Center. Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration and an Approved Provider with the American College of Sports Medicine. 1

DISCLOSURE Accredited status does not imply endorsement by Villanova University, COPE or the American

Health Literacy and Clear Communication: Moving Towards Understanding Carol J.

Literacy The degree to which individuals have the capacity to obtain, process, and understand basic health

2 DISCLOSURE Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products displayed in conjunction with an activity. Health Literacy and Clear Communication: Moving Towards Understanding Carol J. Howe, PhD, RN, CDE Texas Christian University Harris College of Nursing and Health Sciences 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 (Nielsen-Bohlman, 2004; Parker & Ratzan, 2010). Print literacy Numeracy Oral literacy 2

3 What ratio of your patients can you expect to have low health literacy? a) 1 in 10 patients b) 1 in 3 patients c) 1 in 50 patients d) 1 in 6 patients Prevalence of Low Health Literacy 1 in 3 adults with low health literacy National Assessment of Adult Literacy Survey, in 4 parents with low health literacy Yin, et al Who s at Risk for Low Health Literacy? Older adults ESL patients Adults who did not compete high school read 3-5 grade levels below the last grade in school Minority patients Low income patients 3

Impact of Low Health literacy Disparities in health outcomes Less knowledge Poorer self-care Increased complications $106-$238 billion annually $143-$7,798

4 Impact of Low Health literacy Disparities in health outcomes Less knowledge Poorer self-care Increased complications $106-$238 billion annually $143-$7,798 per person/year Rise to $1.6-$3.6 trillion (Vernon, 2007) AMA Health Literacy Video Assessing Health Literacy 4

TOFHLA (Test of Functional HL Adults) Numeracy Normal blood sugar is 60-150 Your blood sugar today is 160 Question: if this were your score, would your

5 TOFHLA (Test of Functional HL Adults) Numeracy Normal blood sugar is Your blood sugar today is 160 Question: if this were your score, would your blood sugar be normal today? Prose Literacy The doctor has sent you to have a x-ray. a.stomach b.diabetes c. stitches d.germs REALM Newest Vital Sign 5

6 Brief HL Screening Tool How often do you have someone help you read hospital materials? How confident are you filling out medical forms by yourself? How often do you have problems learning about your medical condition because of difficulty understanding written information? Chew et. Al (2009) Assess health literacy - what s your opinion? a) Assess HL in all patients to determine best interventions b) Assess HL for research purposes only c) Assess HL in patients you think are at risk d) Do not assess HL, it further labels patients IOM Health Literacy Framework 6

Demands of Health Care Environment Synthesize complex information Analyze risks and benefits Calculate doses Interpret and understand test results What we bring to the table Our education and

7 Demands of Health Care Environment Synthesize complex information Analyze risks and benefits Calculate doses Interpret and understand test results What we bring to the table Our education and experience Culture of medicine Medical jargon ( 4/visit) Talk fast, move quickly Tend to not check comprehension Cannot tell who has low health literacy The Right to Understand Right to understand health information. Health information in clear terms Listenability Healthy People 2020 ; National Action Plan to Improve Health Literacy 7

8 Benefits of Communication Improved self-care Adherence Health outcomes Patient satisfaction Patient safety Beckett et al., 2009 Barriers to Effective Communication Minority race Low income Low education level Low health literacy Patients with Low Health Literacy 6 times more likely to not understand words we use 5 times more likely to not understand explanations Ask fewer and different types of questions Participate less in decision making Schillinger, et al. 2004; DeWalt, et al

Castro, et al. (2007) Clear Communication Health Literacy Universal Toolkit http://www.

9 Medical Jargon Disconnect Audio recorded diabetes visits Analyzed transcripts for jargon 18 jargon terms Telephone interviews with patients > 60% did not understand jargon and could not describe Castro, et al. (2007) Clear Communication Health Literacy Universal Toolkit PowerPoint presentations Videos Handouts Links to internet resources DeWalt et al. for AHQR,

Tips for Communication Use plain language Slow down Prioritize & emphasize 1 to 3 key points Check understanding with teach-back Kripalani and Weiss, 2006.

10 Tips for Communication Use plain language Slow down Prioritize & emphasize 1 to 3 key points Check understanding with teach-back Kripalani and Weiss, Sick Days and Diabetes Being sick and having diabetes Learn how to take care of your diabetes when you are sick. This means managing your blood sugars, any ketones, and keeping hydrated. Be prepared for when you get sick. 3 Key Points- Chunk & Check Check Inject Drink 10

11 Teach back Method What is it? Why do I use it? How do I use it? When do I use it? Kripalani and Weiss, 2006 Teach-back is Asking patients to repeat in their own words what they need to know or do, in a nonshaming way. NOT a test of the patient or family, but of how well you explained a concept. A chance to check for understanding and, if necessary, re-teach the information. 11

Teach-back is supported by research Less than ½ patients could report diagnosis or medications Parents recalled 2/7 recommendations from diabetes visit Patients whose MD used teach back were 9 times

12 Teach-back is supported by research Less than ½ patients could report diagnosis or medications Parents recalled 2/7 recommendations from diabetes visit Patients whose MD used teach back were 9 times more likely to have A1C below group mean (8.6%) Makaryus & Friedman, 2005 Ask patients to demonstrate understanding, using their own words: I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did? What will you tell your husband about the changes we made today? We ve gone over a lot of things you can do to deal with blood sugars and exercise. In your own words, please review what we talked about. How will you make this work? Avoid Yes/No Questions Do you understand? Am I clear? Do you have any questions? 12

13 Teach back Reveals Misunderstanding Creates an opportunity for dialogue. Re-phrase information. Ask the patient to teach back the information again, using their own words If they still do not understand, consider other strategies. Teach-back Using it Well Responsibility is on the provider. Use a caring tone of voice & attitude. Start with your last patient of the day Document use of & response to teach-back. Integrating Teach Back into Your Practice What are specific topics you discuss with your patients? How could you use teach-back? 13

14 Putting it all together Think of a patient teaching scenario Jot down what you usually teach Prioritize and select 3 key points (Chunk complex info) Think about how to phrase your teach back question References Beckett, M. K., Elliott, M. N., Richardson, A., & Mangione Smith, R. (2009). Outpatient satisfaction: The role of nominal versus perceived communication. Health Services Research, 44(5p1), Castro, C. M., Wilson, C., Wang, F., & Schillinger, D. (2007). Babel babble: Physicians' use of unclarified medical jargon with patients. American Journal of Health Behavior, 31(Supplement 1), S85-S95. Chew, L. D., Griffin, J. M., Partin, M. R., Noorbaloochi, S., Grill, J. P., Snyder, A.,... VanRyn, M. (2008). Validation of screening questions for limited health literacy in a large VA outpatient population. Journal of General Internal Medicine, 23(5), DeWalt, D. A., & Hink, A. (2009). Health literacy and child health outcomes: A systematic review of the literature. Pediatrics, 124(Supplement 3), S265. Kripalani, S., & Weiss, B. D. (2006). Teaching about health literacy and clear communication. Journal of General Internal Medicine, 21(8), Kutner, M., Greenberg, E., Jin, Y., & and Paulsen, C. (2006). The health literacy of America s adults: Results from the 2003 national assessment of adult literacy. U.S. department of education. Washington, DC: National center for education statistics. Makaryus, A. N., & Friedman, E. A. (2005). Patients' understanding of their treatment plans and diagnosis at discharge. Paper presented at the Mayo Clinic Proceedings,, 80(8) Schillinger, D., Bindman, A., Wang, F., Stewart, A., & Piette, J. (2004). Functional health literacy and the quality of physicianpatient communication among diabetes patients. Patient Education and Counseling, 52(3), Vernon, J. A. (2007). Low health literacy: Implications for national health policy University of Connecticut, Department of Finance. 14

Thank you Evaluations and CE Certificates Everyone who has completed the webinar will be emailed a link to the evaluation.

The evaluation does expire after 3 weeks. Once expired, you cannot obtain a certificate.

15 Thank you Evaluations and CE Certificates Everyone who has completed the webinar will be ed a link to the evaluation. The will be sent to the address that you used to register for the webinar. Please complete the evaluation soon after you receive the . The evaluation does expire after 3 weeks. Once expired, you cannot obtain a certificate. Once the evaluation is completed, the CE certificate will be ed separately within 2 business days. COPE s October Professional Webinar Mary Ellen Posthauer, RDN, LD, CD The Impact of Sarcopenic Obesity on our Aging Population Date: Time: CE Credit: Wednesday October 29 th 12:00PM 1:00PM EDT 1.0 contact hour, 1.0 CPEU To register, go to villanova.edu/cope and click on Webinar Series 15

16 Questions and Answers! Moderator: Rebecca Shenkman, MPH, RDN, LDN Web site: villanova.edu/cope To receive monthly s on upcoming COPE events, please join COPE s Contacts on the web site. Thank you for your time and interest. 16

3/2/2015. Welcome to the COPE Webinar Series for Health Professionals! Motivational Interviewing: Overcoming Client Resistance to Change

3/2/2015. Welcome to the COPE Webinar Series for Health Professionals! Motivational Interviewing: Overcoming Client Resistance to Change Welcome to the COPE Webinar Series for Health Professionals! March 11 2015 webinar Motivational Interviewing: Overcoming Client Resistance to Change Time: Moderator: 12 noon 1 PM EST Rebecca Shenkman,