Health Literacy

Question 1

Definition of Health Literacy

Answer 1

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

Question 2

What did the AMA say about health literacy?

Answer 2

Poor health literacy is a “stronger predictor of a person’s health than age, income, employment status, educational level and race.”

Question 3

Is low literacy common in US?

Answer 3

Yes, surprisingly…..

Question 4

What is the average reading level of the US population?

Answer 4

8th grade level

Question 5

Definition of Proficient Literacy

Answer 5

• can calculate share of employee’s health care cost… able to define medical term from complex document

Question 6

Definition of Intermediate Literacy

Answer 6

Able to determine healthy weight from BMI chart, can interpret prescriptions and OTC drug labels

Question 7

Definition of Basic Literacy

Answer 7

Understand simple patient education handouts

Question 8

Definition of BELOW BASIC literacy

Answer 8

Circle date on an appointment slip, unable to understand simple pamphlet about pre-test instructions

Question 9

What % of adults have “Proficient” health literacy?

Answer 9

12

Question 10

What % of adults (how many people) have BELOW BASIC health literacy

Answer 10

14%….30 million people

More likely to lack health insurance (28%) than adults w/ Proficient health literacy

Question 11

Low literacy is an independent risk factor for worse outcomes , including….

Answer 11

Increased mortality
Lower satisfaction w/ care
Lower quality of care
Worse patient safety
Higher health care costs

Question 12

What populations are at risk for low health literacy?

Answer 12

Elderly (age 65+)…….. 81% of patients age 60 and older at a public hospital could not read or understand basic materials such as prescription labels

Minority

Immigrants

Low Income –> approx. 1/2 of medicare/medicaid recipients read below the 5th grade level

Chronic mental and / or physical health conditions

Question 13

Outcomes of low health literacy

Answer 13

Increased Number of preventable hospitalizations

Increased healthcare costs

Higher ER use

More likely to skip preventative screening tests

Unable to manage chronic dz (DM, asthma)

** >50% of patients reading at a sixth grade level or less report they go to the ER when they have an asthma attack

Question 14

When to suspect low literacy

Answer 14

Do not know names of medications or their purpose

Passive during clinical encounters

Have difficulty w/ forms

Have difficulties w/ dx tests, procedures, refills, consultations

Question 15

What are the 5 Tools to Assess Health Literacy?

Answer 15

1. TOFHLA –
   test of functional health literacy in adults
2. S-TOFHLA
   (Test of functional health literacy of adults - SHORTENED)
3. REALM
   (Rapid Estimate of Adult Literacy in Medicine)
4. SAHLSA-50
   (Short assessment of Health Literacy for Spanish adults)
5. NVS (the newest vital sign)

Question 16

TOFHLA

Answer 16

Gold standard, available in English or Spanish

Takes 18-22 minutes

Two parts:

a) Reading comprehension
b) Fill in the blank using word bank

Score 0-100,
75 adequate literacy

*scores

Question 17

S-TOFHLA (shortened TOFHLA)

Answer 17

4 MC numeracy questions… 2 reading questions

7-10 minutes