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5/23/2010




    Improving Health Literacy
             through
      Clear Communication
       ___________________
    Manisha H. Maskay, Ph.D.
       Kim Whatley, B.A.
         17th TEXAS HIV/STD CONFERENCE

                   May 25, 2010




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.
                       - Healthy People 2010




Health Literacy impacts
-Health Promotion
-Health Protection
-Disease Prevention
-Health Care and Health Maintenance
-Navigation
    Literacy and Health in America, ETS 2004




                                                      1
5/23/2010




  Challenges โ€ฆ
  โ€ข 93 million or 47 % of U.S. adults perform at
    the lowest level of literacy (NALS 2003)
  โ€ข 19 % of US adults had skills at the lowest
    level of the Health Activity Literacy Scale
    (HALS 2003)
     - Approx ยฝ of those 65 + scored at the lowest levels




  Challenges contd โ€ฆ
  โ€ข Health care relies heavily on the written
    and spoken word to communicate
    information.
  โ€ข Health care consumers must โ€œread to doโ€.
  โ€ข Health materials are written at reading
    grade levels that far exceed the average
    reading skills of high school graduates.
  โ€ข Health professionals do not use language
    which is easy to understand.




Source:
Health Literacy - A Prescription to End Confusion, Institute of Medicine, 2004




                                                                                        2
5/23/2010




Effective Communication
           โ€“ a tool to improve health literacy

                        Audience


              Receipt                Message




                Delivery           Messenger




 Enhance Communication!
 Explain Context
 Categorize
 Illustrate and Demonstrate
 Show Empathy
      -   Be respectful
      -   Address embarrassment
      -   Invite interaction
      -   Promote self efficacy
      -   Pay attention
      -   Slow down




 Enhance Communication!
 Use plain language - fancy words do not help
      -   logical order
      -   clear
      -   active voice
      -   everyday language/common words
      -   short words/short sentences
      -   explain hard words
      -   no jargon
 Stay focused and on message
      - key points
      - begin and end with most important




                                                        3
5/23/2010




Message and communication effectiveness:
โ€ข Message
      - Client focused?
      - Relevance?
      - Accuracy ?
      - Clarity?
      - Client feedback?




Message & communication effectiveness:

โ€ข Written
      - Accuracy
      - R d bilit
        Readability
      - Organization
      - Appearance
            print โ€“ font size, color
            background โ€“ color, white space
      - Suitability for audience




Message & communication effectiveness

โ€ข Verbal
      - Accuracy
      - Clarity
      - Organization
      - Suitability for audience
      - Credibility of person delivering message
      - Delivery




                                                          4
5/23/2010




Subject to interpretation?

- Practice safe sex
- Use protection
- Avoid drugs
- Know your status




Subject to interpretation?

- Practice safe sex
- Use protection
- Avoid drugs
- Know your status




Subject to interpretation?

- Practice safe sex
- Use protection
- Avoid drugs
- Know your status




                                    5
5/23/2010




Subject to interpretation?

- Practice safe sex
- Use protection
- Avoid drugs
- Know your status




Subject to interpretation?

- Drink plenty of water
- Eat a low sodium diet
- Eat plenty of fiber
- Get plenty of exercise




Subject to interpretation?

- Drink plenty of water
- Eat a low sodium diet
- Eat plenty of fiber
- Get plenty of exercise




                                    6
5/23/2010




Subject to interpretation?

- Drink plenty of water
- Eat a low sodium diet
- Eat plenty of fiber
- Get plenty of exercise




Subject to interpretation?

- Drink plenty of water
- Eat a low sodium diet
- Eat plenty of fiber
- Get plenty of exercise




Subject to interpretation?

- Apply locally
- It may have adverse effects
- Take on an empty stomach
- Take as needed




                                       7
5/23/2010




Subject to interpretation?

- Apply locally
- It may have adverse effects
- Take on an empty stomach
- Take as needed




Subject to interpretation?

- Apply locally
- It may have adverse effects
- Take on an empty stomach
- Take as needed




Subject to interpretation?

- Apply locally
- It may have adverse effects
- Take on an empty stomach
- Take as needed




                                       8
5/23/2010




 Why do we care?
 โ€ฆ Health Literacy is essential to the
     prevention and treatment of HIV/AIDS!




                       Personsย Livingย withย HIV/AIDSย inย Texas
                      Total                                63,109                     100ย %
     Status           HIV                                  26,827                     43ย ย %
                      AIDS                                 36,191                     57ย %
     Gender           Maleย                                 49,224                     78ย %
                      Female                               13,795                     22ย %
     Race/            White                                22,405                     36ย %
     Ethnicity        Black                                23,986                     38ย %
                      Hispanic                             15,906                     25ย %
                      Asianโ€Pacificย islander                  531                     โ€ฆ
                      Americanย Indianย โ€Alaskanย Native
                      American Indian Alaskan Nati e          105                     โ€ฆ
                      Multiโ€racial/Notย Specified               87                     โ€ฆ
     Age              Underย 2                                  24                     โ€ฆ
                      2โ€12                                    242                     โ€ฆ
                      13โ€24                                 2,787                      4ย %
                      25โ€44                                31,960                     51ย %
                      45+                                  28,007                     45ย %
     Modeย ofย          MSM                                  33,914                     54ย %
     Transmission     IDU                                   9,631                     15ย %
                      MSM/IDU.                              4,516                      7ย %
                      Heterosexual                         14,066                     22ย %
                      Perinatal/Other                      530/363                     1ย %

   Adapted from: Texas Dept of State Health Services 2010 TX Integrated Epidemiologic Profile for HIV/AIDS Prevention
   and Services Planning, April 2010.




Tailor messages to specific needs:
Assess whether messages
- Resonate with, engage, and meet the needs of your
  audience?
    di     ?
- Communicate key information?
- Achieve the desired effect?
    - improved understanding and knowledge
    - change in attitude
    - change in behavior




                                                                                                                               9
5/23/2010




 Tailor your message . . .




Tailor your message . . .




Tailor your message . . .




                                   10
5/23/2010




    Tailor your message . . .




We must improve health literacy to enable
our community
- to understand,
- to learn, and
     learn
- to do
             โ€ฆwhat is necessary to be healthy and safe!




Understanding is a two-way street โ€ฆ

                             Eleanor Roosevelt




                                                                11
5/23/2010




   Lets all try harder to communicate
            more effectively โ€ฆ


         Thank you for your time today!




 Helpful Resources:
 Centers for Disease Control and Prevention, Marketing and
 Communications Strategy Branch. (2009). What We Know
 About Health Literacy. www.cdc.gov/healthmarketing/
 resources.htm Accessed April 12, 2010.
 Centers for Disease Control and Prevention. Health Literacy for
 C       f Di        C      l  dP       i    H l h Li        f
 Public Health Professionals Course.
 www2a.cdc.gov/TCEOnline/registration/detailpage.asp?res_id=
 2074 Accessed April 12, 2010.
 Doak CC, Doak LG, Root JH. Teaching Patients with Low
 Literacy Skills. 2nd Edition. 1996.
 www.hsph.harvard.edu/healthliteracy/resources/doak-
 book/index.html Accessed May 23, 2010.




Helpful Resources (contd):
Institute of Medicine. (2004). Health Literacy: A Prescription to
End Confusion. Washington, DC: National Academies Press.
Kutner, M., Greenberg, E., Jin,Y., and Paulsen, C. (2006). The
Health Literacy of Americaโ€™s Adults: Results From the 2003
National Assessment of Adult Literacy (NCES 2006โ€“483). U S
N ti   lA           t f Ad lt Lit             2006 483) U.S.
Department of Education. Washington, DC: National Center for
Education Statistics.
National Cancer Institute. (2008). Making Health Communication
Programs Work. U.S. Dept of Health and Human Services.
www.cancer.gov/pinkbook Accessed May 23, 2010.




                                                                          12
5/23/2010




Helpful Resources (contd):
National Cancer Institute. (1994; revised 2003). Clear & Simple:
Developing Effective Print Materials for Low-Literate Readers.
U.S. Dept of Health and Human Services. 1994; revised 2003
www.cancer.gov/aboutnci/oc/clear-and-simple Accessed May
23, 2010.
23 2010
Rudd RE, Kirsch I, Yamamoto K. Literacy and Health in
America. ETS Policy Report #19. Princeton NJ: Educational
Testing Services. 2004.
www.ets.org/Media/Research/pdf/PICHEATH.pdf Accessed
May 23, 2010.
Multimedia
American Medical Association. Health Literacy Educational Kit
2007.




                                                                         13

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Health Literacy through Clear Communication, TX HIV/AIDS Conference

  • 1. 5/23/2010 Improving Health Literacy through Clear Communication ___________________ Manisha H. Maskay, Ph.D. Kim Whatley, B.A. 17th TEXAS HIV/STD CONFERENCE May 25, 2010 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. - Healthy People 2010 Health Literacy impacts -Health Promotion -Health Protection -Disease Prevention -Health Care and Health Maintenance -Navigation Literacy and Health in America, ETS 2004 1
  • 2. 5/23/2010 Challenges โ€ฆ โ€ข 93 million or 47 % of U.S. adults perform at the lowest level of literacy (NALS 2003) โ€ข 19 % of US adults had skills at the lowest level of the Health Activity Literacy Scale (HALS 2003) - Approx ยฝ of those 65 + scored at the lowest levels Challenges contd โ€ฆ โ€ข Health care relies heavily on the written and spoken word to communicate information. โ€ข Health care consumers must โ€œread to doโ€. โ€ข Health materials are written at reading grade levels that far exceed the average reading skills of high school graduates. โ€ข Health professionals do not use language which is easy to understand. Source: Health Literacy - A Prescription to End Confusion, Institute of Medicine, 2004 2
  • 3. 5/23/2010 Effective Communication โ€“ a tool to improve health literacy Audience Receipt Message Delivery Messenger Enhance Communication! Explain Context Categorize Illustrate and Demonstrate Show Empathy - Be respectful - Address embarrassment - Invite interaction - Promote self efficacy - Pay attention - Slow down Enhance Communication! Use plain language - fancy words do not help - logical order - clear - active voice - everyday language/common words - short words/short sentences - explain hard words - no jargon Stay focused and on message - key points - begin and end with most important 3
  • 4. 5/23/2010 Message and communication effectiveness: โ€ข Message - Client focused? - Relevance? - Accuracy ? - Clarity? - Client feedback? Message & communication effectiveness: โ€ข Written - Accuracy - R d bilit Readability - Organization - Appearance print โ€“ font size, color background โ€“ color, white space - Suitability for audience Message & communication effectiveness โ€ข Verbal - Accuracy - Clarity - Organization - Suitability for audience - Credibility of person delivering message - Delivery 4
  • 5. 5/23/2010 Subject to interpretation? - Practice safe sex - Use protection - Avoid drugs - Know your status Subject to interpretation? - Practice safe sex - Use protection - Avoid drugs - Know your status Subject to interpretation? - Practice safe sex - Use protection - Avoid drugs - Know your status 5
  • 6. 5/23/2010 Subject to interpretation? - Practice safe sex - Use protection - Avoid drugs - Know your status Subject to interpretation? - Drink plenty of water - Eat a low sodium diet - Eat plenty of fiber - Get plenty of exercise Subject to interpretation? - Drink plenty of water - Eat a low sodium diet - Eat plenty of fiber - Get plenty of exercise 6
  • 7. 5/23/2010 Subject to interpretation? - Drink plenty of water - Eat a low sodium diet - Eat plenty of fiber - Get plenty of exercise Subject to interpretation? - Drink plenty of water - Eat a low sodium diet - Eat plenty of fiber - Get plenty of exercise Subject to interpretation? - Apply locally - It may have adverse effects - Take on an empty stomach - Take as needed 7
  • 8. 5/23/2010 Subject to interpretation? - Apply locally - It may have adverse effects - Take on an empty stomach - Take as needed Subject to interpretation? - Apply locally - It may have adverse effects - Take on an empty stomach - Take as needed Subject to interpretation? - Apply locally - It may have adverse effects - Take on an empty stomach - Take as needed 8
  • 9. 5/23/2010 Why do we care? โ€ฆ Health Literacy is essential to the prevention and treatment of HIV/AIDS! Personsย Livingย withย HIV/AIDSย inย Texas Total 63,109 100ย % Status HIV 26,827 43ย ย % AIDS 36,191 57ย % Gender Maleย  49,224 78ย % Female 13,795 22ย % Race/ White 22,405 36ย % Ethnicity Black 23,986 38ย % Hispanic 15,906 25ย % Asianโ€Pacificย islander 531 โ€ฆ Americanย Indianย โ€Alaskanย Native American Indian Alaskan Nati e 105 โ€ฆ Multiโ€racial/Notย Specified 87 โ€ฆ Age Underย 2 24 โ€ฆ 2โ€12 242 โ€ฆ 13โ€24 2,787 4ย % 25โ€44 31,960 51ย % 45+ 28,007 45ย % Modeย ofย  MSM 33,914 54ย % Transmission IDU 9,631 15ย % MSM/IDU. 4,516 7ย % Heterosexual 14,066 22ย % Perinatal/Other 530/363 1ย % Adapted from: Texas Dept of State Health Services 2010 TX Integrated Epidemiologic Profile for HIV/AIDS Prevention and Services Planning, April 2010. Tailor messages to specific needs: Assess whether messages - Resonate with, engage, and meet the needs of your audience? di ? - Communicate key information? - Achieve the desired effect? - improved understanding and knowledge - change in attitude - change in behavior 9
  • 10. 5/23/2010 Tailor your message . . . Tailor your message . . . Tailor your message . . . 10
  • 11. 5/23/2010 Tailor your message . . . We must improve health literacy to enable our community - to understand, - to learn, and learn - to do โ€ฆwhat is necessary to be healthy and safe! Understanding is a two-way street โ€ฆ Eleanor Roosevelt 11
  • 12. 5/23/2010 Lets all try harder to communicate more effectively โ€ฆ Thank you for your time today! Helpful Resources: Centers for Disease Control and Prevention, Marketing and Communications Strategy Branch. (2009). What We Know About Health Literacy. www.cdc.gov/healthmarketing/ resources.htm Accessed April 12, 2010. Centers for Disease Control and Prevention. Health Literacy for C f Di C l dP i H l h Li f Public Health Professionals Course. www2a.cdc.gov/TCEOnline/registration/detailpage.asp?res_id= 2074 Accessed April 12, 2010. Doak CC, Doak LG, Root JH. Teaching Patients with Low Literacy Skills. 2nd Edition. 1996. www.hsph.harvard.edu/healthliteracy/resources/doak- book/index.html Accessed May 23, 2010. Helpful Resources (contd): Institute of Medicine. (2004). Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press. Kutner, M., Greenberg, E., Jin,Y., and Paulsen, C. (2006). The Health Literacy of Americaโ€™s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006โ€“483). U S N ti lA t f Ad lt Lit 2006 483) U.S. Department of Education. Washington, DC: National Center for Education Statistics. National Cancer Institute. (2008). Making Health Communication Programs Work. U.S. Dept of Health and Human Services. www.cancer.gov/pinkbook Accessed May 23, 2010. 12
  • 13. 5/23/2010 Helpful Resources (contd): National Cancer Institute. (1994; revised 2003). Clear & Simple: Developing Effective Print Materials for Low-Literate Readers. U.S. Dept of Health and Human Services. 1994; revised 2003 www.cancer.gov/aboutnci/oc/clear-and-simple Accessed May 23, 2010. 23 2010 Rudd RE, Kirsch I, Yamamoto K. Literacy and Health in America. ETS Policy Report #19. Princeton NJ: Educational Testing Services. 2004. www.ets.org/Media/Research/pdf/PICHEATH.pdf Accessed May 23, 2010. Multimedia American Medical Association. Health Literacy Educational Kit 2007. 13