Health Literacy: Implications for the Dental Setting Friday, April 5, 2013 9:00-10:00 AM Pacific/12-1 PM Eastern Presented by: Nicole Holland, DDS, MS and Lois Wessel, CFNP Association of Clinicians for the Underserved (ACU) Today s slides and archived presentations from NNOHA s webinar series are available online: http://www.nnoha.org/practicemanagement/webinars.html Disclaimer: This speaker has been engaged for educational purposes only and does necessarily reflect the opinions of NNOHA, its agents or employees, or the organization as a whole. NNOHA does not endorse any specific claim(s) relative to the effectiveness of products or techniques suggested by the speaker and does not accept any liability for actions taken based on the content of this webinar or for any and all consequences resulting from the use of the information. NNOHA does not warrant that this webinar will be presented uninterrupted or error-free, nor that the website or server which make this webinar available are free from viruses or other dangerous conditions. NNOHA does not accept any liability for damage which may ensue as a result of such potentially harmful elements. The viewer and/or any entity using this information assumes all risk associated with its use.
Health Literacy: Implications for the Dental Setting Nicole Holland, DDS, MS and Lois Wessel, CFNP April 5, 2013 NNOHA www.clinicians.org
Objectives Define health literacy and understand its effects on patient outcomes Describe the components of health literate organizations Use universal precautions approach, plain language, and the teach back method to address health literacy in the dental setting Assess office/clinic communication and understand strategies for improvement www.clinicians.org
Oral Health Literacy www.clinicians.org
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
The Invisible Barrier www.clinicians.org
Low Health Literacy: Scope of the Problem www.clinicians.org
Health Literacy 12% 14% 22% Below Basic Basic Intermediate Proficient 53% National Center for Education Statistics, 2006 www.clinicians.org
Health Literacy: A 3-pronged Problem Healthcare System Health literacy Consumer/Patient Provider
Language Access www.clinicians.org
www.clinicians.org
FAMILY BELIEFS AND HISTORY Patients Bring INSURANCE STATUS COMMUNITY VALUES RELIGION AND SPIRITUALITY POLITICAL SITUATION LANGUAGE AND LITERACY ECONOMIC SITUATION HEALTH CARE SYSTEM www.clinicians.org
Media/Marketplace www.clinicians.org
Literacy Demands of the Healthcare System Understand health education materials Read graphs and charts Comprehend drug labels and warnings Fill out health history forms and informed consents Choose between health plans Understand diagnosis and engage in selfcare Ask questions and consider options Read signs and navigate healthcare facilities
Does The Patient Understand The Risks & Benefits? Informed Consent Pharmacotherapy Dosage Medication titration Side effect burden Opioid rotation
Older adults Lower SES People with limited education Minority populations Persons with Limited English Proficiency Who Is At Risk?
Universal Precautions Approach http://www.westernsafety.com/safetec/safetecpg1.html http://wced.wcape.gov.za/branchidc/special_ed/hiv_ai ds/hiv_index.html www.clinicians.org
Health Literacy Red Flags Making excuses Asking friends, family, or others to read written materials aloud Unable to name meds or how to take them No questions OR many questions Perceived resistance Frequently missed appointments Incomplete paperwork/registration forms www.clinicians.org
Possible tasks of a dental visit Pre-Visit Schedule appointment Dental insurance(?) Antibiotic Prophylaxis Transportation/Child Care Visit Fill out consent forms, medical hx, HIPAA, etc. Review findings, treatment plan Receive Rx and/or referral Pay bill Post-Visit Fill Rx and/or follow-up w/ referral Implement home care
CCM PCMH www.clinicians.org
PCMH and Oral Health Literacy www.clinicians.org
So What Can You Do?
Best Practices in the Clinical Setting 1. Shame-free Environment 2. Use of Plain Language 3. Teach-back Method
Best Practice: Shame-free Environment How people feel regarding their limited literacy: Ashamed, embarrassed Less of a person Stupid Angry Anxious, fearful, suspicious Something is wrong with me
Best Practice: Plain Language aka Living Room Language Communication that your audience can understand the first time they read or hear it. Defined by results is it easy to read, understand, and/or use?
Dental Speak Bruxism Calculus Caries Edentulous Extraoral Occlusion Oral-systemic Periodontal disease Pulpitis Recall Xerostomia
Plain Language Principles Message Content Limit need to know information Relevancy Break information into manageable chunks What are the 3-5 main points that you are trying to get across?
Plain and Simple Diagnosis: Deep carious lesion: #14-MO What does the patient need to know/do? Before arriving for appointment During the appointment After/between appointments
Plain Language Principles Visuals - A Picture is worth a thousand words Help people understand and remember Draw added interest Explain concepts that are hard to put into words Demonstrate behaviors http://www.mountsinai.org/patient-care/service-areas/ent/areas-ofcare/head-and-neck-cancer/oral-cancer/hpv/infographics/hpv-oralsex-cancer
Plain Language Principles Use of Visuals Use realistic, uncluttered drawings or photos Use images relevant to your audience Apply labels and arrows Be careful with tables and charts
Plain Language Principles Use everyday conversational language in a friendly, respectful, and positive voice Short, common words Action verbs and active voice Shorter sentences Give concrete examples Define unfamiliar words Give pro-nun-see-ay-shun, if needed Present tense Avoid technical terms, abbreviations, and acronyms Be careful using slang and humor Repeat important information Personal pronouns, such as you Choose positive rather than negative words Headers guide reader to main points Repeat important information
Teach Back Evidence-based Ask the patient to repeat what they need to know or do in their OWN words! You are not testing the patient, but rather how well YOU explained a concept
http://www.emblemhealth.com/newsnotes/spring2011/nn_clin5_spr11.html www.clinicians.org
Next Steps www.clinicians.org
Conduct a Clinic Assessment Physical Space The Written Word Clinic Assessment The Spoken Word Unified Dental Team
Oral Health Literate Organization www.clinicians.org
Clinic assessment: The patient experience Walk-through: The Physical Space Warm, welcoming environment? What is the 1 st impression? Attitude of helpfulness by ALL staff? Can your patient find your practice? Clear signage in your office? Written Materials (including online) What is the 1 st impression? Are you using Plain Language principles? If appropriate, are written materials available in languages other than English?
Appropriate Pt. Ed www.clinicians.org
How to Critically Evaluate Your Current Materials Who is your target audience? Are their interests, needs, and concerns represented in your materials? Use a readability formula Is there unnecessary dental speak? Test with patients Ensure scientific accuracy
Clinic assessment: The patient experience The Spoken Word What is the 1 st impression? Phone Interpersonal (All staff) Are you using Plain Language principles? Is there a need for an interpreter? Unified Dental Team Critical for shame-free environment! Are staff able to identify barriers that may indicate literacy problems?
Readability Formulas Assess the reading grade level at which materials are written Mathematically calculated and expressed as a school grade level Must assess word length and sentence length Assumption: The longer a word or sentence, the harder it is to read
Key Take-aways Universal Precautions Plain Language Review all written materials Unified dental team www.clinicians.org
Association of Clinicians for the Underserved (ACU) www.clinicians.org Lois Wessel, FNP: lwessel@clinicians.org Nicole Holland, DDS, MS: nholland@clinicians.org @ACUnderserved @LoisWessel @pearlywhitesdds www.facebook.com/cliniciansfortheunderserved www.clinicians.org
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Questions? Type your questions into the Chat Box. Who is your question for? Lois Wessel Nicole Holland Maria Smith Today s slides and webinar recording will be available at: http://www.nnoha.org/practicemanagement/webinars.html