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Health Sciences
Health Sciences 2000A/B
Leichelle Little

Health Education and Literacy The Health Literacy Problem Literacy Ability to understand and use reading, writing, speaking and other forms of communication as ways to participate in society and achieve one’s goals and potential “Ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course” More than the availability of information and service Mediated by: Education Culture Language Communication skills of professionals Nature of materials/messages Settings in which health-related supports are provided Health Literacy Linked to Health People who are educated have high literacy and also have a higher level of health If we can work on one part of this triangle of support, other areas could be increased with less cost Background Canadian Public Health Association (CPHA) expert panel: researchers and policy-makers in the health and education fields Examined health-literacy skills in a variety of health contexts and against the almost daily health-related activities that take place in homes, worksites and community systems Health Related Tasks 191 daily tasks were judged to measure health-related activities in 5 domains: Health Promotion Health Protection Disease Prevention Health-care and disease management Navigation Health Activities Focus Examples of Materials Examples of Tasks Health Promotion Enhance and maintain ­ Articles in ­ Purchase food health newspapers and ­ Plan exercise magazines, regimen booklets, brochures ­ Food and product labels Disease Prevention Take preventive ­ News alerts: ­ Determine risk measures and engage TV, radio, Engage in ­ in early detection newspapers screening or ­ Letters related diagnostic tests to test result ­ Follow up Health Care and Seek care and form a Education booklets and - Collect information on Maintenance partnership with brochures, health merits of various health-care providers information on the treatment regimens for internet discussion with health professionals Background Tested more than 23000 Canadians Consider Level 3 minimum requirement Any score below: individual possesses very limited to restricted literacy proficiencies Key Findings: Overall Average Level of Health Literacy Key Findings: Inequality of Health Literacy Large differences in average literacy exist between different population sub-groups within Canada – especially among the elderly “Due to our aging population and growing pressures on our health-care system, there is an urgent need to address the level of health literacy across our country,” – Dr. Cappon Key Findings: Linkage of Health Literacy and Health Status Significant improvements in overall levels of population health might be realized if a way could be found to raise adult health-literacy levels Provided that health literacy generates health, policies aimed at increasing levels of health literacy might turn out to be low-cost alternatives to existing practice Improving Health Literacy Health Literacy Research Approximately 50% of adults are unable to understand the available printed health care material Health professionals: work on improving the way in which they communicate complex health information More than 1000 published articles on the subject can be divided into 4 general areas of investigation Level of literacy that the health system demands of adults in terms of capacity to use materials, access services and seek care Differences between patients with strong reading skills and limited reading skills and their abilities to understand and interpret information related to their health behaviours/hospitalization, etc. Improvement of health literacy Numeracy, listening and speaking skills of health providers and their patients Improvement of Health Literacy Reducing health-system literacy demands Improving the health-literacy skills of adults Written resources, communication strategies, delivery of information Problems  Wall of text, small print Design Principles: LID Language ­ Plain language ­ Active voice ­ Positive tone ­ SMOG readability test Information ­ Appropriate length, and content ­ Suitable amounts of headings and categories ­ Place most important information at beginning and end of document ­ Limit lists from 5 – 6 items ­ Important information emphasized Design ­ Provide typographic clues ­ Appropriate use of multimedia ­ Uncluttered and organized structure ­ Conservative use of colours, with light background colour ­ “Print-friendly” Active Voice Active: “Steve loves Am.” Steve is the subject, and he is doing the action Passive: “Amy is loved by Steve.” The subject of the sentence becomes Amy, but she isn’t doing anything SMOG Grade 8 – in general reading level Depends on the audience Some 800 studies published between 1970 and 2006 indicate that most health-related materials are written at reading levels that exceed the reading skills of an average high-school graduate Adult Learning Theory: Malcolm Knowles Educational materials will be useful, effective, and show increased conceptual understanding…? Knowles:Adult’s Self-Concept of Autonominity Knowles:Adults are Largely Intrinsically Motivated Knowles:Adults use Past Experience in Learning VARK Learning Styles: Niel Flemming Visual Aural Read/write Kinesthetic Flemming: Visual Flemming:Aural Aural Communication Research indicates low health literate patients face difficulties understanding information communicated orally during the provider-patient encounter Studies indicate patients only understand and retain about half of what a provider tells them Flemming: Read/Write Flemming: Kinesthetic Flemming: Multimodal Numeracy Abasic understanding of numerical concepts is arguably as important for informed decision making as literacy In addition to basic reading and writing skills, people need an understanding of numbers and basic mathematical skills to use numerical information presented in text, tables, charts or presentation of risks General population and even highly educated laypersons and health professionals have an inadequate understanding of probabilities, risks, and other chance related concepts Presenting Numbers Many audiences, including those with limited health literacy, have difficulty comprehending numbers Stick figures/faces graph: shown to increase uptake of information relative to other graphics suggesting that patients may interpret the stick figures as a group of neighbours or peers and thus will respond more strongly to the risk information No research has shown that a single format works best Depends largely on the situation, the type of audience, context and purpose of communication Relative risk: May provide compelling language but can be misleading Example: Odds ratio (two times greater risk for behaviour X versus behaviour Y) Absolute risk (1/500 people affected) Advised to present absolute and relative risk numbers Framing “Logically equivalent choice situations in different ways” Gain-framed: Can refer to both good things that will happen and bad things that will not happen Loss-framed: Bad things that will happen and good things that will not happen People tend to avoid risk when a positive frame is presented but seek risks when a negative frame is presented Risk aversion when behaviour that they perceive involves some risk of an unpleasant outcome (may detect a health problem, i.e. screening) Risk seeking when behaviour that they perceive is low risk (e.g. could prevent the onset of a health problem) Delivering the Message Difference between raising awareness versus raising health literacy Websites Needs to be quality standards to ensure the integrity of websites Alur et al. (2002) reviewed medical teaching websites and found that fewer than 50% were based on any learning paradigms eHealth can successfully teach but must follow established…? Viral Marketing Digital and social media: newer communication channels with opportunities for engagement and real-time data collection Tap into our obsession with celebrities and provide entertainment and humor Social media programs can demonstrate results that directly correlate to public health programs Genetic Literacy Genetics has been described as “one of the most difficult scientific concepts for students to learn” It has been shown that even adults familiar with terms like genes and DNA, may not understand the underlying concepts Lanie and Colleagues (2004) Public may have some severe misconceptions of genetics Boujemaa and Colleagues (2010) Well-educated university students had difficulties distinguishing the structure of genes and their functions The Next Steps Increase the capacity of healthcare professionals to communicate more effectively and otherwise address the problems faced by people with low health literacy Review existing and emerging research to identify evidence-based methods of communicating health information and serving people with low health literacy Develop a health literacy toolkit designed to build literacy and self advocacy skills for use in adult education settings Final Exam 03/27/2014 80% Lecture 20% Readings What was the main finding in each reading? Information gathered through family history can: A) Provide information about empiric risk B) Explore the social impact of a disorder for a family C) Build rapport D) All of the above It is important that health care workers understand the client’s own definition of “health”. This is an exam
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