Health Literacy &
Jann Keenan, Ed.S.
DC Convention Center, May 20, 2008
The travesty of health
“It’s intolerable that a in nation as wealthy
as ours, there are people who cannot get
the right care at the right time”
Richard Carmona, June 14, 2003 AMA House of Delegates Meeting)
After today’s talk you will walk away with…
Part 1: An understanding of the impact of low
health literacy on health outcomes
Part 2: Next steps you can take to get a health
literacy initiative going in your area. To get
providers on board.
Which is the biggest predictor of a
person’s health status?
Racial or ethnic group
Literacy skills— yep! How well you
can read and understand!
Greater % of ethnic groups and seniors
The majority of those with low literacy skills in
the United States are white, native-born
Yet ethnic minority groups and seniors are
disproportionately affected by low literacy.
(the Center for Health Care Strategies)
The numbers = real people
50% of Hispanic Americans
40% of African Americans
33% of Asian Americans
66% of US adults age 60 plus
Here in the District
Literacy skills substantially lower than those
in the US overall 1
36% of DC adults have functional illiteracy
versus 21% nationally.
Translation: 1 in 3 in DC versus 1 in 5 in the
(FI means trouble with bus schedules, reading maps, filling out job applications) 2
1 DC State of the Workforce Report, 2003 2 Phase 1 of the 2204 Study by State Education Agency
One contributor from report
Growing number of Hispanic and Ethiopian
residents who are not proficient in English
Leap to Functional 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. (IOM and Parker)
In plain English . . .
A person ability to understand and act on health information.
We’re All at Risk . . .
People of all ages, races, incomes and
education levels are challenged by low health
The accountant who can’t fill out insurance
The provider who speaks “medicalese”
Anyone who doesn’t know “take on an empty
stomach” or “light snack” means
Still . . . at most risk . . .
Chronically ill most at risk (Prudential study)
Ethnic groups. African Americans and HPB,
sleep problems, heart attack, stroke. Latinos
Low health literacy is a threat to the health
and well-being of Americans!
Many patients don’t understand the best way
to take care of themselves and prevent
When Patients Don’t
Understand. . .
People with limited literacy skills:
Have poorer overall health
Use health services more often
Are less likely to go to screenings
Are more likely to be hospitalized
Seek treatment in later stages of disease
Have less understanding of their treatment
and less adherence to medical regimes
Significant relationship between good
health and literacy
Adults with lower-than-average reading skills
are less likely to get
Screening tests such as mammograms and
Flu shots and pneumonia vaccines
Their kids to well child visits and more . .
2,659 patients were surveyed
On an empty stomach--1,100 off base
Next appointment--691 perplexed
Upper GI tract XRay--886 in the dark
Informed consent form--1,582 didn’t get it
Lofty materials/not speaking to culture
When low-income Hispanic and African
American women got culturally appropriate
materials/easy-reads- smoking during and
after pregnancy went down! (Lillington, 1995)
SNAP (Stanford Nutrition Action Program)
worked for people with low-literacy. More diet
23 folks with low-literacy and heart failure had
100% weigh in compared to 32% without
When materials and information are
75 African American women being treated for
HPB (CDC. 1990)
54 said they had “pressure trouble” or
32 believed they had 2 diseases
“High-blood” a disease where the blood was too
“hot” “rich” or “thick.
“High-pertension” a condition where blood would
“shoot up “ toward their head when they were
emotionally excited and “fall back” as they calmed
For the 32 women using folk meds
The treatment for the “high blood”
lemon juice, vinegar, or garlic water to “cool
and thin” their blood so it would drop t o the
lower level in the body
The treatment for the High-pertension
lower stress by not eating pork, hot, or spicy
foods, or grease
Message to providers-listen about folk
medicine. Have respect . . .
Low health literacy is a threat to the
well-being on the medical system
REPORT: Low Health Literacy: Implications
for National Health Policy
$106-$236 per year. U of CT in Oct 2007
Adequate health literacy
Essential to promoting good health—
especially in preventing disease
Instead of helping folks stay healthy . . .
We treat them when they are sick . . .
Review and take aways from Part 1
Most materials are lofty and not culturally
relevant. (Grade 10 or above. Nearly 1 out of 2 US adults read at grade 8 or lower)
Ineffective communication and low health
literacy combine to affect patient safety and
Everyone is at risk- yet ethnic groups,
chronically ill, poorer, and older adults at
On to Part 2-
The Best Part
Turning the tide! Some Solutions!
What providers can do
Use “living room” language
Benign = not cancer
Lateral = side
Anaphylactic reaction = shock, throat closing
Oral= by mouth
Monitor = watch
Hypertension = blood pressure
And there’s more . . .
Limit information given at one time. Repeat and
Show or draw pictures
Use “teach back” or “show me”
Be respectful, welcoming, and caring
Consider culture “saving my last nerve” “falling out”
“evil” on the “down low. low ”
Ethno-medicine—herbs. Spirit moves me.
The Outcome? A way to empower patients to
participate in their own health care
What communities can do
Transformational change through
“Community Youth Mapping”
In the selected cities, youth help
1. How many people in the community have
problems with health literacy
2. Where the average person can go to get
help understanding their health paperwork
3. If doctors & hospitals have support in
creating health literate materials
4. If pharmacies have programs to help
people understand their medicines
5. If written materials are tested in the
6. If adult literacy programs include
health lit examples
Who can help make a change in the
Adult end classes can add health content to
their adult literacy classes.
Elder organizations can help senior citizens
understand their medicines & provide tools to
remember when to take meds
Patient advocacy groups can provide tools to
prepare for a doctor's visit
Local advertising & marketing agencies can
volunteer their services to test print materials
for readability & comprehension.
Health professionals collaborate in
Michigan Dept of Community Health (2003)
Employed cultural competency and health
92% of docs are Caucasian and Asian/PI
Difficulty in effective cross cultural
Established a “shame-free” environment
AMA.ORG for Tool Kit- 35 bucks
Free, free, & low fee for Ask Me 3
The “Ask me 3” questions
1. What is my main problem?
2. What do I need to do?
Why is it important for me to do
Safe Use of Medicines—FREE!
Take your medicines the right way - each day!
An easy-to-read booklet from the National Institute on Aging.
This booklet offers practical tips to make sure you are taking all your medicines the right way:
• Medicine safety
• How to stay on track and get the best results from your medicines
• Questions you should ask your doctor and pharmacist
More patient centered communications
What did the doctor say? White paper 2/07
describes interventions to improve the ability
of patients to understand complex medical
Hospitals, Language, and Culture.3/07
Report recommends strategies of 60 US
hospitals providing health care to diverse
Speak Up Program 3/02 with Brochures on
surgical safety, infection, preventing med
mistakes, patients rights.
Joint Commission & Iowa Health
Grant proposal in review
At the NIH
To develop new evidence-based performance
To provide critical information about how well
hospitals address the health literacy needs of
To review next steps
Doctors can improve communication by
looking to Ask Me 3 and AMA tool kit.
Communities can seek grants for community
Can get freebies from the Gov’t and the Joint
Commission and Gov’t.
Can look at best practice & do it!
Can encourage more funding for literacy
programs to include health teachings
Each one- Teach one
Spread the word!