APIH Fellowships Traiig: Health Literacy Ad Plai Laguage Sabria Kurtz-Rossi, M.Ed. Jauary 29, 2016 Associatio for Prevetio Teachig ad Research
Overview What is health literacy? Plai Laguage: A Strategic Respose Beyod Readability Resources & Assigmet
What is Literacy?
Discussio Questio: What are the literacy demads i health ad healthcare?
What is Health Literacy? The degree to which idividuals have the capacity to obtai, process, ad uderstad basic health iformatio ad services eeded to make appropriate health decisios (IOM, 2004) Source: Istitute of Medicie Committee o Health Literacy: A Prescriptio to Ed Cofusio. Nielse-Bohlma L, Pazer AM, Kidig DA, eds. Washigto, DC: The Natioal Academies Press; 2004.
Health Literacy Framework Source: Istitute of Medicie Committee o Health Literacy: A Prescriptio to Ed Cofusio. Nielse-Bohlma L, Pazer AM, Kidig DA, eds. Washigto, DC: The Natioal Academies Press; 2004.
... a fairly recet movemet, gaiig mometum. Healthy People 2010 (DHHS 2000) Prescriptio to Ed Cofusio (IOM 2004); Evidece Report (AHRQ 2004) Improvig Health Literacy to Protect Patiet Safety (Joit Commissio 2007) Natioal Actio Pla to Improve Health Literacy (DHHS 2010); Plai Laguage Act (2010); Affordable Care Act (2010) Te Attributes of Health Literate Orgaizatios (IOM Roudtable 2012)
At First Glace - Readability Numerous studies show readability of health materials far exceed skills of patiets Studies of Web-based health iformatio show similar results Source: Istitute of Medicie Committee o Health Literacy: A Prescriptio to Ed Cofusio. Nielse-Bohlma L, Pazer AM, Kidig DA, eds. Washigto, DC: The Natioal Academies Press; 2004.
Affects o Health Outcomes Low health literacy is liked to Uder-utilizatio of services Icreased medicatio errors Poor kowledge about health Icreased hospitalizatios Poor health outcomes Icreased healthcare costs Source: Berkma N, Sherida S, Doahue K, et al. Health Literacy Itervetios ad Outcomes: A Updated Systematic Review. Evidece Report/Techical Assessmet No. 199. Prepared by RTI Iteratioal-Uiversity of North Carolia Evidece-based Practice Ceter uder cotract No. 290-2007-10056-1. AHRQ Publicatio Number 11-E006. Rockville, MD. Agecy for Healthcare Research ad Quality. 2011.
Who is at Risk? Nearly 50% of adults with less tha a high school diploma had Below Basic health literacy Percetage of Adults i Each Health Literacy Level by Highest Educatioal Attaimet Source: U.S. Departmet of Educatio, Istitute of Educatio Sciece, Natioal Ceter for Educatio Statistics, The Health Literacy of America s Adults: Results from the 2003 Natioal Assessmet of Adult Literacy. http://ces.ed.gov/aal/health_results.asp
Who is at Risk? Adults i the oldest age group age 65 ad older had lower health literacy tha adults i the youger age groups Percetage of Adults i Each Health Literacy Level by Age Source: U.S. Departmet of Educatio, Istitute of Educatio Sciece, Natioal Ceter for Educatio Statistics, The Health Literacy of America s Adults: Results from the 2003 Natioal Assessmet of Adult Literacy. http://ces.ed.gov/aal/health_results.asp
Health Literacy ad Health Equity Literacy: Amog adults with limited health literacy, 45% are from racial or ethic miority group. Laguage: People with limited Eglish proficiecy (LEP) are at risk of limited literacy i their ative laguage. Culture: Health iformatio may ot be relevat whe Wester costructs of health ad healthcare are assumed. Source: Adrulis, DP ad Brach, C. (2007) Itegratig Literacy, Culture, ad Laguage to Improve Health Care Quality for Divers Populatios. Am J Health Behav. 31(Suppl 1):S122-133.
What Are We Doig About It? Icrease the health literacy of health professioals ad systems Icrease the health literacy o idividuals, families ad commuities Source: Berkma N, Sherida S, Doahue K, et al. Health Literacy Itervetios ad Outcomes: A Updated Systematic Review. Evidece Report/Techical Assessmet No. 199. Prepared by RTI Iteratioal-Uiversity of North Carolia Evidece-based Practice Ceter uder cotract No. 290-2007-10056-1. AHRQ Publicatio Number 11-E006. Rockville, MD. Agecy for Healthcare Research ad Quality. 2011.
Plai Laguage: A Strategic Respose Use of orgaizatios, words, seteces, toe, layout, graphics, ad iteractio to help make writte material both more relevat ad easy to read (Osbor 2005) Writig ad desig to create readig ease (Stableford ad Mettger 2007) No oe techique defies plai laguage. Rather, plai laguage is defied by results it is easy to read, uderstad, ad use (www.plailaguage.gov)
Discussio Questio: What do you fid hard to read ad why? What about the laguage? What about desig?
Readability Formulas What are readability formulas? Assess the readig grade level at which materials are writte Mathematically calculated ad expressed as school grade Why are they so popular? What are their limitatios?
Beyod Readability Suitability Assessmet of Materials (SAM) http://www.hsph.harvard.edu/healthliteracy/resources/ PEMAT-P http://www.ahrq.gov/professioals/prevetio-chroic-care/improve/selfmgmt/pemat/idex.html CDC Clear Commuicatio Idex http://www.cdc.gov/healthliteracy/pdf/clear-commuicatio-user-guide.pdf
Audiece-Cetered Developmet Idetify your AUDIENCE Specify educatioal OBJECTIVES Cosider how the material will be USED ad select a FORMAT Develop the CONTENT
Processig Text Adapted from Doak C, Doak L, Root J. Teachig Patiets with Low Literacy Skills (2 d editio). Lippicott 2007 Proficiet Readers Iterpret meaig, geeralize Below Basic Readers Take words literally Read with fluecy Read slowly, or oe word at a time Get help for ucommo words Skip over ufamiliar words Grasp the cotext, make ifereces Persists i readig Miss the cotext, may ot make ifereces Tires quickly whe readig
Writig Tips Write i everyday laguage Defie ufamiliar words Use actio words ad active voice Use shorter words ad seteces Avoid abbreviatios ad acroyms Give pro-u-see-ay-shu if eeded
Avoid Techical Terms Diagosis.. Ati-iflammatory. Nasal cogestio.. Lesio.. Risk factor.. Cause of your illess Lowers fever ad swellig Stuffy ose Woud, sore, ifected patch of ski Will icrease your chace of gettig
Helpful Techiques Q & A format ( I / you ) Bulleted lists Iteractio Story tellig Dialogues
Processig Visuals Adapted from Doak C, Doak L, Root J. Teachig Patiets with Low Literacy Skills (2 d editio). Lippicott 2007 Proficiet Readers Sca the visual to fid cetral cocept Quickly idetify key features i a visual Separate key poits from details Quickly iterpret visual iformatio to derive meaig Below Basic Readers Eyes wader, difficulty fidig cetral focus May skip over key features May get lost i or too focused o details Iterpret visuals more literally
Desig Tips Lots of white space ad wide margis Use SERIF fot for text, NON SERIF for headers Larger type (12 pt or larger) UPPER AND LOWER CASE NOT ALL CAPS Avoid italics, script, facy fots
Desig Tips Bold, cocise headers Cosider use of colums Ragged right edge Appealig colors High cotrast Use relevat images
Processig Text Olie Proficiet Readers Quickly sca the text to fid what they wat, ad scroll dow for more Easily idetify key features ad cotet Ca glace at a list of avigatio optios ad select the oe they wat Use search fuctio ad dig deeper to fid what they wat Below Basic Readers Read word for word, sped time o ufamiliar words, ot scroll for more Focus o each word ad slowly plow the text lie by lie Read each word i each optio carefully or completely skip over Challeged by spellig ad results, will give up diggig deeper Source: Adapted from Nielse J. Lower-Literacy Users. Alertbox 2005.
Plai Laguage 2.0 Navigatio Miimize scrollig Step by step avigatio, show breadcrumbs Cosistet layout Icorporate back ad ext buttos Make buttos large ad easy to use Provide search fuctio
RECOMMENDED REGARDING WRITING IN TERMS OF ITS RECEPTION IT IS NOT INAPPROPRIATE, WHEN USING PRINT MEDIA TO IMPART MATERIAL OF A FACTUAL OR INTERPRETIVE NATURE WHICH HOLDS THE INTENTION OF CONVEYING CRITICAL INFORMATION TO AND/OR INCLUDING A CRITICAL ACTION BY ITS PROSPECTIVE RECIPIENTS, TO EMPLOY RELATIVELY NONCOMPLEX VERBIAGE SO AS TO MAXIMIZE COMRPEHENSION IN THE AFOREMENTIONED POPULATION. Credit: Lessos i Plai Laguage 1992, PLAN, Ic.
Passive Voice For good protectio, su scree must be applied every few hours. Fish high i mercury should ot be eate by pregat or ursig wome. Chroic disease ca be maaged by patiets i partership with their doctors.
Abstract ad Vague Adults eed adequate sleep to fuctio effectively i their jobs. Patiet vital sigs will be take at every visit. Good oral health is importat to teeth ad gums.
Tips for Commuicatig Numbers Reduce effort, do the math Provide fewer optios Keep deomiator the same (1 i 100 / 4 i 10) Use appropriate visuals Use labels carefully (poor, fair good, excellet) Use frequecy (1 out of 10) vs percet (10%) www.cdc.gov/healthliteracy/umeracy-course
Additioal Resources http://www.cdc.gov/healthliteracy/
Write it Easy to Read Assigmet Create a easy to read material (oe-page 8 x 11, frot ad back) Choose a health topic of iterest Cosider your audiece iformatio eeds Use plai laguage writig priciples Limit your cotet to eed to kow Apply plai laguage desig priciples Cosider orgaizatio, iclude pictures/graphics, Clarify actio steps Upload by Friday, Feb 5 th
Summary of Key Poits Everyoe is affected by low health literacy Kow ad ivolve your audiece! Go beyod readability Apply plai laguage writig ad desig priciples Use the CDC Health Literacy Website http://www.cdc.gov/healthliteracy/
Cotact Iformatio Sabria Kurtz-Rossi, M.Ed., Assistat Professor, Departmet of Public Health ad Commuity Medicie, Tufts Uiversity School of Medicie sabria.kurtz-rossi@tufts.edu Director, Health Literacy Leadership Istitute go.tufts.edu/summeristitute