Health literacy, as defined in the Institute of Medicine
report, is the interaction between skills of individuals and
demands of the health care system".
The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.
Healthy People definition is similar. The only difference is the addition of "communicate" to the legislative definition. The American Dental Association (ADA) defines oral health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. U.S. Department of Health and Human Services(2000) NIDCR Working Group on Functional Health Literacy (2004) American Dental Associaiton (2006)
Health literacy is meant to include both words and numbers(numeracy) The public needs to acquire, understand, and use information about their health and health services to make appropriate and informed health decisions; Research indicates that today's health information is presented in ways that are not usable by most adults. "Limited health literacy" occurs when people can't find and use the health information and services they need. www.cdc.gov/healthliteracy/Learn Anyone, regardless of age, race, income and education, can be challenged by the tasks required to find and understand information about their health. A new healthcare problem, a new health care provider or health care system can increase those challenges.
Any person may not be familiar with medical/dental terms or how their bodies work. Be scared/anxious or confused with a new or serious diagnosis, which limit understanding of information presented to them Have difficulty understanding numbers and words associated with risk or prognosis; this can limit decision making. www.cdc.gov/healthliteracy/Learn
Less likely to engage in screening & prevention Less likely to have chronic disease under control More likely to be hospitalized More likely to report poor health More likely to die earlier Rudd, http://www.hsph.harvard.edu/wp- content/uploads/sites/135/2012/09/overview_slides.pdf know how to locate and navigate a health facility; read, understand, and complete many kinds of forms to receive treatment and payment reimbursement; articulate their signs and symptoms; listen to providers; know about various types of health professionals and what services they provide and how to access those services; trust the provider; know how and when to ask questions or ask for clarification when they do not understand; understand their options in all procedures; and understand that oral health is part of total health and that individuals can keep their mouths healthy A. Horowitz. IOM Roundtable on Health Literacy: Oral Health Literacy Workshop Summary, 2013 The following slide is one framework for how multiple factors are related to produce oral health. This is just one model there are others.
Given what you know or have experienced in your patient population regarding oral health literacy, would place it in the same spot in this model? Why or why not? Change daily habits: brush, floss, improve dietary choices (read labels)
Monitor and describe symptoms: bleeding gums
Compliance: brush, floss, protocol for chlorhexidine use (time, dose)
Access care: make and keep more frequent recalls
What literacy skills are needed for each of these actions? General Health Literacy; Oral Health Literacy
Available Tools REALM; REALM-D are word recognition lists varying from 84 to 20-items. Useful in research, shown to have validity, but may not be practical for clinic.
HeLD (Health Literacy in Dental scale; 29-items, new
Single item screeners; 2 items often used; patient indicates how often they need help completing medical forms and how confident in completing medical forms; quick, easy, some validity with more complex assessments. A validated screener for health literacy that has a patient demonstrate reading a nutrition label; called the NVS
Its short, but should be administered by a staff person, not patient self-administered
Not dental specific, but demonstrates prose and numeracy skills.
Has been used in various settings, but not dental (that I can find) See Resources for this module.
Combined with a 2-item screener, quick & easy assessment (there is not sufficient evidence to call this best practices, but it is interesting)
If you screen for OHL and confirm its presence, what will you do about it? Improve the literacy skills of your patients
Improve your communication skills
Redesign or choose other materials that you use in education/health promotion
Language: simplified language swap-out periodontal -> gum hypertension -> high blood pressure occlusal -> chewing surface
Motivational Interviewing-Based: patient centered respects patient autonomy; patient defines goals; skills for communicating about behavior change
Teach-Back Method: Patient repeats instructions, demonstrates a skill; enhances clarity and confirms understanding; particularly good for self-care skills
Health information should be: Accurate: Using health literacy best practices does not mean "dumbing-down" the information. Health literacy practices ensure that the information is presented accurately AND in ways that people can understand.
Accessible: the issue of access. Are you providing reading materials from other sources? Does your office/clinic stock brochures on specific topics? Posters? Are they linguistically appropriate for your patient population? Are you creating your own brochures/ messages? What is the reading level? Pictures can match/enhance the text. Do your patients ask for information? Do your patients ask for clarification of what you mean when explaining a procedure or treatment plan?
http://www.cdc.gov/healthliteracy/developmaterials/index.html Health information should be:
Actionable: In the health field, we typically want people to start or stop doing something, or do more or less of something. If you are creating a health message, the information should be
relevant (how does it affect them),
they need to perceive a need to make the change (how is their current behavior not in line with they really want for their health),
they need to believe they can make the change (self-efficacy),
they need to hear/see the ACTION required to perform(what actionable recommendation is being made), they typically need to believe there is a benefit to their action. Take a look at the materials you currently use
Apply the previous guidelines to them
There are some standardized ways to assess materials (check the cdc website in the References)
Use the above guidelines if you develop your own materials
At a minimum, there is a reading level indicator in Word that you can apply to your materials or any written communication with your patients.
Get administration involved Consider collaboration with medical Choose an assessment instrument/method Assess OHI Choose a topic or patient subgroup Choose a format to change Parents; prevention Patients with diabetes Look for evidence- based practices Adapt the evidence to your setting Use the PDSA cycle Test in your setting
Written materials Commmunication methods Best practices for health literacy interventions; Motivational Interviewing; Teach-back Think of health literacy across medical & dental Obviously there are condition-specific terms, but that may be addressable in individual conversation with patients. Assessing the patients level of health literacy would benefit the patients total care and is information that should be shared, like vital signs, among healthcare providers, for true patient-centered care
Oral Health Workshop Summary, published by National Academy Press(NAP), 2013. http://www.nap.edu/openbook.php?record_id=13484 You can read this online or download the entire proceedings for free.
Gironda M, et al. A brief 20-item dental/medical health literacy screener(REALMD-20). Journal of Public Health Dentistry 75 (2013) 5055
Shah LC, et al. Health literacy instrument in family medicine: the newest vital sign ease of use and correlates. (J Am Board Fam Med 2010;23:195 203.)