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b2 > L1-2: Health Literacy > Flashcards

L1-2: Health Literacy Flashcards

1
Q

Health Literacy Definition

A

The ability to access, understand and act on info for health

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2
Q

How many levels of health literacy

A

5

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3
Q

What is the % of health literacy in Canada

A

60% of Canadians of Canadians lack the skills to manage their health care needs
Assuming level 3 is minimum required

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4
Q

What are some high risk groups when it comes to health literacy (7)

A 
● Seniors
● Minorities
● Immigrants
● Unemployed
● Non-official Language
● Prisoners
● Persons with limited education

These groups are not related to health literacy by causality but by correlation

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5
Q

Level 1 Health Literacy

A

Level 1—Very poor literacy skills. An individual may, for
example, be unable to determine from a package
label the correct amount of medicine to give a child.

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6
Q

Level 2 Health Literacy

A

Level 2—A capacity to deal only with simple, clear

material involving uncomplicated tasks. People at this level may develop everyday coping skills

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7
Q

Level 3 Health Literacy

A

Level 3—Adequate to cope with the demands of everyday life and work in an advanced society. It roughly denotes the skill level required for successful high-school completion and college entry.

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8
Q

Level 4/5 Health Literacy

A

Levels 4 and 5—Strong skills. An individual at these levels can process information of a complex and demanding nature.

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9
Q

Recall the Avg health literacy scores for the high risk groups and some ranges of literacy

A
  • Age 26-35 high level 2 ~ 275. BEST
  • Age 16-25 high level 2 ~ 270.
  • Employed high level 2 ~ 265.
  • Immigrant, non-official language low level 2 ~ 225.
  • Aboriginal mid level 2 ~ 245.
  • French minority high level 2
  • Not Employed low level 2 ~ 235.
  • 66+ level 1 ~ 210. (lowest)

Age is related to education levels that lead to health literacy
Language can be a barrier for health literacy scores

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10
Q

When do you suspect low literacy?

A

● Low-literacy patients commonly hide their difficulty
● Many feel ashamed
● Avoidant behaviors

Identified by a gut feeling, based on patients’ nonverbal and verbal communication
Other patient characteristics such as hearing disabilities and mental health problems as indicators
“You can tell by the things they say. These patients look lost”
Recognized non-verbal signals, nervousness, looking lost

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11
Q

What are possible indicators of low health literacy?

A

● Excuses: “I forgot my glasses.”
● Lots of papers folded up in purse/pocket
● Lack of follow-through with tests/appts.
● Seldom ask questions
● Questions are basic in nature
● Difficulty explaining medical concerns or how
to take meds

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12
Q

Informal Assessments for identifying low health lit (2)

A
  • common signs

- med review

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13
Q

Formal Measures for identifying low health lit (2)

A
  • Single Item Questions
  • Multiple Item Measures (9 listed most not practical for
    practice)
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14
Q

What are 2 One-time measures for determining health literacy?

A

“How confident are you filling out medical forms by
yourself?” (0, extremely; 1, quite a bit; 2,
somewhat; 3, a little bit; 4, not at all)
“How often do you have someone help you read
hospital material?” (0, none of the time; 1, a little of
the time; 2, some of the time; 3, most of the time;
4, all of the time)

positve answers: some, most, all of the time

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15
Q

3 Universal Precautions (not too sure what this means)

A

● Can’t tell (identify) by looking
● Communicate clearly with everyone
● Confirm understanding with everyone

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16
Q

Why does Health Literacy Matter?

A

up to 2.5x the odds of having fair or poor health, being on income support and not participating in community activities for level 1

  • 2.5 times poorer health if you have a level 1-2 health literacy
  • Less have poor health if you have a level 4, 5 health literacy
  • More on income support (2.5x more likely) with level 1-2
  • More people not participating in community activities with level 1-2
  • Controlled age, gender, education, language, immigration, Indigenous status
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17
Q

Misinterpretation of Warning Labels Table

A

Review common misconceptions like nursing infants

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18
Q

3 criteria used in the Sri Lankan paper for rating patient’s ability to read and understand dosing instructions

A

Instructions: Completeness, readability, comprehensibility

Comprehensibility is understanding and acting on health info which is health literacy

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19
Q

Medication errors: Original statement: Take two tablets by mouth twice daily. How would you revise?

A

Take 2 pills by mouth at 8am and 2 pills at 6pm. Is this better? The first one can mean 2/day or 2/day twice?

creating a visual schedule
Larger text for increased readability
Colour-coded icons for times of day

20
Q

5 things that make a good instruction label

A
  1. Clear refill details make re-ordering a snap
  2. Simplified dosage schedule for clearer directions
  3. Color-coded icons for times of day
  4. Larger text for increased readability
  5. Easy to find prescription info
21
Q

What makes giving clear dosing instructions challenging? (3)

A 
● Increasingly complex health system 
- Greater self-care requirements
- Increased medications for chronic conditions 
- Formulary and manufacturer changes 
- Medication reconciliation 
● Most patient instructions are written 
- Low-literacy pts have trouble understanding 
● Verbal instructions 
- Often complex 
- Delivered rapidly 
- Easy to forget in stressful situation
22
Q

6 Recommended Strategies to Improve Communication

A
  1. Explain things clearly in plain language
  2. Focus on key messages and repeat
  3. Use a “teach back” or “show me” technique to
    check understanding
  4. Effectively solicit questions
  5. Use patient-friendly educational materials to
    enhance interaction
  6. Communicate numbers effectively
23
Q

Describe: 1. Explain things clearly in plain language

A

● Slow down the pace of your speech
● Use plain, nonmedical language
- “Blood pressure pill” instead of “antihypertensive”
- Pay attention to patient’s own terms and use them back
● Avoid vague terms
- “Take 1 hour before you eat breakfast” instead of “Take on an empty stomach”
- Be specific when explaining

24
Q 
What could we say instead of... 
side effect? 
hypoglycemia? 
PRN? 
For external use only?
Inhale? 
Discontinue? 
Inflammation?
A 
rxn to a med
low blood sugar
when you need it
use only on skin
breathe in; take a breath
stop 
swelling
25
Q

What is the readability test and avg grade of reading level?

A

Flesch Kincaid test, avg Gr 6
Lexi-comp has a good reading level for patients
Micromedex, Drugs.com, Medline Plus too high

26
Q

What is SMOG?

A

Simple Measure of Gobbledygook… simple tool that provides some info about the potential literacy difficulty of written health info

27
Q

What 3 things influence reading level? (Flesch tools and SMOG)

A

● document(layout, color, font, spacing, legibility, and grammar);
● person (education, comprehension, health literacy, motivation, prior knowledge, information needs, anxiety levels); and
● style of writing (cultural sensitivity, context, comprehensiveness, and
appropriateness).

28
Q

What is important to consider for Plain Language - Audience?

A

● Everyone benefits
● Know your audience and purpose
● What is my message? How urgent?
● Organize your content

29
Q

What is important to consider for Plain Language - Writing?

A 
● Use personal pronouns when appropriate
● Use common everyday words
● Use active voice.
● Keep it short, simple, and direct.
● Use positive language - Don’t forget to refill your pills. vs Refill your pills.
30
Q

What is important to consider for Plain Language - Presentation?

A

● Put your main message at the top
● Include only the details your reader needs
● Only use technical words if needed. Define them.
● Consider readability, but clarity is more important.

31
Q

What is important to consider for Plain Language - Visual Clarity?

A

● Using headings and lists
● Use infographics and tables
● Organize your material. Break into chunks
● Use a clear and readable font. Avoid all caps
● Use left justification
● Leave white space around lists and margins

32
Q

Describe: 2. Focus on Key Messages and Repeat

A

● Limit information (if appropriate)
- Focus on 1-3 key points
● Develop short explanations for common medical conditions and side effects
● Discuss specific behaviors rather than general
concepts
- What the patient needs to do
● Review each point at the end

33
Q

Describe: 3. Use a “Teach Back” to Check Understanding

A

Refer to nice figure on slide 66… Clinician explains concept-clinician assesses patient recall and comprehension-> clinician clarifies and tailors explanation -> clinician reassesses patient recall and comprehension-patient recalls and comprehends -> leads to adherence

34
Q

Examples of Teach Back scripts?

A

● I want to make sure I explained everything clearly. If
you were trying to explain to your partner how to take
this medicine, what would you say?
● Let’s review the main side effects of this new medicine. What are the 2 things that I asked you to watch out for?
● Show me how you would use this inhaler.
● Can you tell me what you will do when you get home?

35
Q

Describe: 4. Effectively Solicit Questions

A
  • “any” is associated with “none”, as in, “I don’t have any bananas.”
  • When patients hear “Do you have any questions?,” it may subconsciously trigger a blocking mechanism.
  • Instead of perceiving an invitation to share
    information, patients may perceive this phrase
    as a signal that the conversation is done.
    So Don’t say:
    -Do you have any questions?
  • Any questions?
    Instead say:
    -What questions do you have?
36
Q

Describe: 5. Patient-Friendly Materials

A 
● Appropriate Content
● Plain Language
● Layout
● Illustrations
There is inconsistent laeblling, drug sheets are not always included, warnings not the same
37
Q

what is the relation with healthy literacy and diabetes and medication management?

A

Level 3 is adequate health literacy
Diabetes goes down by 50% from level 2 to level 3
Low literacy leads to less knowledge and decrease in good medication management
Effect on adherence is varied
94% of those with adequate health literacy knew the symptoms of hypoglycemia compared with only 50% of inadequate health literacy

38
Q

how can health literacy lead to decreased Knowledge and Understanding

A
  • Pt with limited health literacy have less knowledge about their disease and how to manage it
  • persons with limited health literacy did not know about factors that could lower blood pressure such as weight loss and exercise
  • Decreased understanding of appropriate medication use
  • Misunderstanding label instructions
  • Warning labels may not be useful for patients with limited health literacy
39
Q

how can health literacy lead to decreased Ability for Medication Management

A
  • the correct identification of medications, opening the appropriate containers, proper selection of the correct dose, and timing of administration,54 as well as appropriate use of containers such as MDIs, nasal sprays, and eye drops
  • only 40.5% of patients with inadequate health literacy were able to name any of their antihypertensive medications, compared to 68.3% of those with adequate health literacy
  • Improper MDI technique
40
Q

how can health lit affect adherence?

A
  • Uncertain effect, conflicting
  • Some showed pt less likely to be adherent to their medications
  • Some studies concluded that health literacy is not independently associated with adherence
  • Some found increase in adherence
41
Q

how can health lit increase healthcare costs?

A
  • Patients with limited health literacy tend to seek medical care when they are sicker, leading to higher use of emergent care and longer hospitalizations
  • caring for persons with limited health literacy is associated with higher healthcare costs
42
Q

what are shortcomings to leaflets?

A
  • Numerous studies indicate that most health information handouts are written at a level far beyond that which an average adult can understand
  • The average American adult reads at about the eighth grade level and most handouts exceed these levels
  • Patients with lower literacy were less likely to have looked at the medication guides (16.7% vs 32.9%)
43
Q

what are shortcomings to med labels?

A
  • Font too small
  • Color and boldface were used to highlight items most useful to the pharmacist as opposed to highlighting -the information that is most useful to the consumer
  • Variable warning instructions
44
Q

what are shortcomings to counseling?

medication names?

A
  • Patients with limited health literacy are significantly less likely to ask questions of their providers
  • physicians only communicate about three of the five expected elements of drug information (name of medication, purpose, dose and timing, duration, and adverse effects)

-drug mixups which can be dangerous

45
Q

what are common signs for limited health liteacy (informal assessments)

A
  1. Reads slowly
  2. Has difficulty telling a coherent story
  3. Fills out forms incorrectly/incompletely
  4. Uses excuses such as I forgot my glasses, read this later, don’t have time to read this now
  5. Brings along a friend or family member for assistance
  6. Fails to show up for appointments or is late for refills
  7. Doesn’t ask questions for clarification
  8. Has difficulty following instructions
  9. Nods in agreement or expresses understanding but doesn’t truly understand information

during med review
Do not know contents of what they are taking
Old bottles with personal markings

46
Q

what formal assessments can be used?

A
  • Screen patients then tailor accordingly or use universal precautions
  • The REALM is a word-recognition test and estimates health literacy based on patients’ ability to pronounce a list of medical terms. The TOFHLA consists of a reading comprehension section to measure prose literacy and a numeracy section.
  • The Newest Vital Sign (NVS) assesses health literacy by having patients review a nutrition label and answer six questions about the label.
47
Q

strategies for clear communication on med management

A
  • Increase health literacy awareness (Pharmacy students, Workshops)
  • Obtain complete medication history
  • Promote med safety, prevent errors
  • Conduct pharmacy health literacy assessment
  • Personalize health information
  • (The combination of assessing each person’s health literacy as well as their learning preference provided a more powerful mechanism to enhance learning than either alone)

Improve med counseling skills (see list)

b2 (34 decks)

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