2010 USPHS Scientific and
Training Symposium
Dana Abbey, MLS
Wednesday – May 26, 2010
2:30-3:00p
National Network of Libraries of Medicine
MidContinental Region
Learning Objectives
 Recognize the impact low health literacy
has on patient care
 Name five resources and strategies to
improve health information literacy
 Describe the health literacy services
offered by the library
National Network of Libraries of Medicine
MidContinental Region
What is 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
National Network of Libraries of Medicine
MidContinental Region
Skills Needed for Health
Literacy
 Evaluating information for credibility and
quality
 Analyzing relative risks and benefits
 Calculating dosages
 Interpreting test results
 Locating health information
National Network of Libraries of Medicine
MidContinental Region
Skills Also Include
 Visually literate (able to understand
graphs or other visual information)
 Computer literate (able to operate a
computer)
 Information literate (able to obtain and
apply relevant information)
 Numerically or computationally literate
(able to calculate or reason numerically)
National Network of Libraries of Medicine
MidContinental Region
What Factors Affect Health
Literacy?
 Health literacy is dependent on individual
and system factors
 Communication skills
 Information and knowledge
 Culture and language
 Demands of the system
 Learning disabilities
 Cognitive declines in older adults
 Lack of educational opportunity
National Network of Libraries of Medicine
MidContinental Region
Why is Health Literacy
Important?
 Low health literacy is linked to…
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Under-utilization of services
Increased medication errors
Poor knowledge about health
Increased hospitalizations
Poor health outcomes
Increased healthcare costs
National Network of Libraries of Medicine
MidContinental Region
Who is at High Risk?
 Elderly
 Low Income
 Unemployed
 Less than High School education
 Minority Ethnic Group
 Recent Immigrant
 English as a Second Language
You can’t tell by looking!
National Network of Libraries of Medicine
MidContinental Region
Health Literacy and Cancer
Screening
Women with low health literacy are less
likely to have had a mammogram or Pap
test than women with higher health
literacy skills
National Network of Libraries of Medicine
MidContinental Region
Source: Davis, et al (1996). Caner. Lindau, et al (2002). Am J Obstet Gynecol.
Health Literacy and
HIV/AIDS Knowledge
National Network of Libraries of Medicine
MidContinental Region
Source: Kalichman, et al (2000). Am J Prev Med.
Health Literacy and Diabetes
Management
Low
Moderate
Need to Know:
symptoms of low blood
sugar (hypoglycemia)
High
Low
Moderate
Need to Do:
correct action for
hypoglycemic symptoms
High
0
20
40
60
80
100
Percent of patients with diabetes correctly answering
questions according to literacy level (low, moderate, high)
National Network of Libraries of Medicine
MidContinental Region
Source: Williams, et al (1998). Arch Int Med.
Health Literacy and
Healthcare Costs
Annual Healthcare Costs of Medicaid Enrollees
$12,000
$10,000
$10,688
$8,000
$6,000
$4,000
$2,000
$2,891
$0
Low-literacy
(<3rd-grade reading level)
Better literacy
(>4th-grade reading level)
National Network of Libraries of Medicine
MidContinental Region
Source: Weiss, et al (2004). J Am Board Fam Pract.
How is Information Critical to
Health Literacy?
 Health information is key to:

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Patient and provider communication
Shared health care decision making
Understanding and following directions
Recognizing when to seek care
Learning and adopting healthy behaviors
National Network of Libraries of Medicine
MidContinental Region
What are the Challenges?
 Health literacy in the U.S.

Readability of health materials

Health information and the Internet
National Network of Libraries of Medicine
MidContinental Region
Health Literacy in the U.S.
93 million adults have basic or below health literacy skills
13%
Proficient
44%
Below
Basic
Intermediate
14%
Basic
29%
National Network of Libraries of Medicine
MidContinental Region
Source: The Health Literacy of American Adults. Results from the 2003 National Assessment of Adult Literacy. National Center for Education Statistics (2006).
http://nces.ed.gov/naal/health.asp
Readability of Health
Information
 Adults, on average, read at an 8th grade level
 Health care information is generally written at a
college level
 Over 300 studies show health-related materials
far exceed the reading ability of U.S. adults
 Increasing number of studies show similar
results when looking at the readability of online
health information
National Network of Libraries of Medicine
Source: NLM Region
Bibliography—Understanding Health Literacy and Its Barriers (2004).
MidContinental
www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html
Effective Communication
Strategies
 Plain, non-medical language
 Speak slowly and clearly
 Limit content to 3-5 key points
 Repeat key points
 Be concrete – draw pictures, use
illustrations and/or models
 Encourage patients to ask questions
 Use the Teach-back method
National Network of Libraries of Medicine
MidContinental Region
Enhancing Patient
Understanding
 40-80 percent of the medical information
patients receive is forgotten immediately1
and nearly half of the information retained
is incorrect

Teach-back method is a way to confirm that
your patient understands what they need to
know
National Network of Libraries of Medicine
MidContinental Region
Strategies to Improve Health
Literacy
 Use “living room” language
 Limit information (3-5 key points)
 Use easy-to-read print materials
 Practice teach-back
 Use Information Rx
 Address culture and language needs
National Network of Libraries of Medicine
MidContinental Region
“Living Room” Language
Name common terms  Hypertension
for…
 Insomnia
 Benign
 Hazardous
 Disorder
 Option
 Poultry
 Routinely
National Network of Libraries of Medicine
MidContinental Region
Information Rx
 Health literacy
intervention
 Empowers patients
 Reduce the
number of poor
quality Internet
searches
http://www.informationrx.org
National Network of Libraries of Medicine
MidContinental Region
Brown Bag Medication
Review
 Improve communication about medications
 “Out of 10-15 brown bag reviews, only 2 were
accurate.”
 “Out of five brown bag reviews, we found three
that had duplicate medicine bottles resulting in
double dosing and one discontinued medicine that
was still being taken.”
 “We found errors in every review, including one
where a patient stopped the provider did not know
about, and others where the medicines did not
match what was in the chart.”
National Network of Libraries of Medicine
MidContinental Region
Medication Safety
 Prescriptions filled
 Average number per
year: 11.5
 Average number for
persons 60 and over:
15.6
 10% of all hospital
admissions are the
result of patients not
taking medications
correctly
 28% of all hospital
admissions for
those over 65 are
caused by medical
non-compliance
 $414 billion
projected sales
National Network of Libraries of Medicine
MidContinental Region
Medication Identification
 Drug Digest –www.drugdigest.org/
 Pill Identification Wizard http://www.drugs.com/imprints.php
 Pillbox beta –http://pillbox.nlm.nih.gov/
 DailyMed –
http://dailymed.nlm.nih.gov/dailymed/prdsearch.cfm
 Drug Information Portal –
http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp
National Network of Libraries of Medicine
MidContinental Region
Health Literacy Universal
Precautions Toolkit
 http://www.nchealthliteracy.org/toolkit/
After implementing some of these tools, we
really felt like we were more able to connect
with our parents about the health of their
child. ” -MD, urban pediatric practice
“This toolkit made us more aware of the
challenges that our patients face and guided
us to make meaningful changes throughout
our practice.”-Office manager, rural family practice clinic
National Network of Libraries of Medicine
MidContinental Region
MedlinePlus
 www.medlineplus.gov
 47 other languages
 Over 800 health topics
 No advertising
 NIHSeniorHealth
 No endorsements
 In English and
 Anatomy videos
Spanish
 165 interactive
tutorials on
procedures and
conditions in easy-to
read language
 Medical pictures
 Prescription
information
 Alternative
medicine/therapies
National Network of Libraries of Medicine
MidContinental Region
Refugee Health Information
Network
 http://rhin.org/
 Collaboration of health professionals
serving refugee populations
 Identify, collect and archive materials
produced in refugee languages
 Brochures, fact sheets, audio, and video
formats
 FREE!
National Network of Libraries of Medicine
MidContinental Region
SPIRAL
 http://spiral.tufts.edu/
 9 Asian languages
 Search by topic or language
 Links to Asian-language patient care
documents
 Materials created by non-profit health
agencies and organizations
 FREE!
National Network of Libraries of Medicine
MidContinental Region
How Can Librarians Help?
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Free access to the Internet
Information Rx Program
Patient information packets
Consumer health collection
Native language resources
Teaching and training
Virtual chat / email assistance
Health literacy workgroup
National Network of Libraries of Medicine
MidContinental Region
“The safety of patients cannot be assured
without mitigating the negative effects of
low health literacy and ineffective
communication on patient care.”
The Joint Commission
National Network of Libraries of Medicine
MidContinental Region
Source: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety. The Joint
Commission (2007). www.jointcommission.org/PublicPolicy/health_literacy.htm
Take Home Points
 Accurate and reliable health information is
critical to health literacy
 Health literacy practices improve health
outcomes
 There are numerous free consumer health
resources to improve health information
literacy
 Librarians are a valuable resource in helping
patients and caregivers locate appropriate
consumer health information
National Network of Libraries of Medicine
MidContinental Region
Learning Objectives
Revisited
 Recognize the impact low health literacy
has on patient care
 Name five resources and strategies to
improve health information literacy
 Describe the health literacy services
offered by the library
National Network of Libraries of Medicine
MidContinental Region
Thank You!
Dana Abbey, MLS
National Network of Libraries of Medicine, MidContinental Region
University of Colorado Denver, Anschutz Medical Campus
Toll Free 1-800-338-7657, select option 1, then option 2, then option 3
http://nnlm.gov/mcr/
National Network of Libraries of Medicine
MidContinental Region
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