Transcript Geriatric Health Literacy: A Skills-Based Workshop

Geriatric Health Literacy:
A Skills-Based Workshop
Seema S. Limaye, MD
Section of Geriatrics and Palliative Medicine
University of Chicago
I have no conflict of
interest
Acknowledgements
Sincere thanks to the Stanford Geriatric Education Center for the granting me
the privilege of re-producing, incorporating, and disseminating geriatric health
literacy materials developed for use as part of the Stanford Faculty Development
Program in Health Literacy and Geriatric Education.
Stanford Geriatric Education Center Faculty Development Program in Health Literacy and
Ethnogeriatrics Curriculum. Stanford CA: Stanford Geriatric Education Center, Stanford
University. 2009.
Health Literacy Workshop (HLW):
Goals
1.
2.
3.
Understand the impact of low health literacy
with geriatric patients
Develop communication skills to improve
patients’ understanding of their medical issues.
Analyze what constitutes effective patient
handout materials.
Nuts and Bolts
of HLW





Low cost
Need facilitator
Seminar style format
4-20 learners ideal size
About 2.5hours
Nuts and Bolts of HLW (cont)
Educational Methods
Time
On line module
http://www.reynolds.med.a
rizona.edu/EduProducts/
HealthLit/index.html
Self-study
25 min
Lecture on Geriatric Health
Literacy
Instructor led
40 minutes
Role-playing and teach-back Dyads or triads
cards
10 minutes each person in
dyad
Patient handout materials
assessment
30-45 minutes
Individual or Small group
(2-3 learners)
Models of Health Care Messages

In what ways can health care messages be
delivered?
 Oral

TEACH BACK/ ROLE PLAYING
 Written

or printed information:
ASSESS PATIENT HANDOUT MATERIAL
 Visual
 Technological
Stanford Geriatric Education Center
HLW: Findings To Date
How did learners rate their abilities to
communicate before and after the workshop?
Mean Ratings (1=Poor,
5=Excellent)
PGY1 Mean Ratings of Health Literacy Skills: 1/2010 - 8/2011
5.0000
*
4.0000
*
*
*
*
3.0000
2.0000
1.0000
.0000
Explain dose change
N=21
Explain new diagnosis
N=21
Explain diagnostic test
N=21
Explain referral N=19
Select materials N=19
Retro Pre-test
3.3300
3.3800
3.2900
3.4700
3.1100
Post-test
4.1200
4.0238
3.9800
3.8700
3.8700
Health Literacy Skills
*p<0.001 for all
Part I:
Excerpts from lecture
Take two tablets by
mouth twice daily…
Understand - “Take Two Tablets
by Mouth Twice Daily”
80.9
Davis T., Wolf M.S., Bass, P.T., et. al. (2006) Literacy and Misunderstanding
Prescription Drug Labels, Annals of Internal Medicine. 145, 887-894.
Stanford Geriatric Education Center
Importance of Enhanced
Communication with Geriatric Patients

High-risk patients!
Cognitive impairment
 Impaired sensorium
 Low functional health literacy
 Complicated medical history with multiple, chronic
medical problems and complex medical regimens.

US Census Bureau 2000:
Projected Population Growth of Elderly
Blacks, American Indian/Alaska Natives,
Asian and Pacific Islander, Hispanic/Latino
16%
41%
59%
84%
2000
U.S. Census. www.census.gov.
Whites
2050
Functional Health Literacy

Measure of person's capacity to function in the
health care setting as determined by literacy and
numeracy
Literacy: comprehension of written health care
materials
 Numeracy: ability to understand and act on
numerical health care instructions

What the Levels Mean
Stanford Geriatric Education Center
What the Levels Mean
Stanford Geriatric Education Center
Millions of Americans have
“Below Basic” Literacy
Stanford Geriatric Education Center
Low Health Literacy Outcomes

People with low health literacy:
 Use screening/preventive services less
 Present for care with later stages of disease
 Are more likely to be hospitalized
 Have poorer understanding of treatment and their own
health
 Adhere less to medical regimens
 Have increased health care costs
 Die earlier
Schwartzberg , VanGeest , & Wang , 2004.
Sudore, et al, 2006.
First Step: Bringing Up the Topic
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“What things do you like to read?”
“We need help fixing the information we give to
people, what do you think we could make
better?”
“How far did you go in school?”
Ask patient to read prescription bottle.
BIGGEST BARRIER: SHAME!
Stanford Geriatric Education Center
Before Patients Leave …
These questions should be answered:
 What health problems do I have?
 Why is that important to me?
 What should I do about them?
 Where do I go for any tests, medicine, and
appointments that I need next?
 How should I take my medicine?
 Any other instructions necessary?
 Who to call with questions?
Stanford Geriatric Education Center
Workshop—Part II
Teach-back Method
Teach-back Method


Technique to improve communication and
confirm understanding, esp among individuals
with limited literacy skills
Involves individuals to recall or explain in their
own words what has been discussed.

Eg: “I always ask my patients to repeat things back
to me to make sure I explained things clearly. I’d like
you to tell me how you’re going to take the new
medicine we discussed today.”
Stanford Geriatric Education Center
Figure 1
Closing the loop: physician communication with diabetic patients who
have low health literacy
Schillinger D; Piette J; Grumbach K; Wang F; Wilson C; Daher C; Leong-Grotz K; Castro C; Bindman AB
Archives of Internal Medicine. 163(1):83-90, 2003 Jan 13.
Copyright © 2009 Wolters Kluwer.
3
Teach-back Cards
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3 cards to complete during rotation
Remind your attending that they’ll need to
directly supervise you and sign-off on the card
Workshop—Part II
Role Playing Exercise


Have your group break into teams of 2-3
learners.
Assign one learner to be clinician, one patient,
and if needed, one to be observer


Providing feedback is important
Cases are posted on pogoe.org
Nursing
 SW
 Physician

Workshop—Part II
Direct-observation checklist
Explain things clearly and use plain language
 Emphasize 1 to 3 key points during visit and
repeat ideas throughout visit
 Effectively encourage patients to ask
questions—use an open-ended approach
 Use teach-back method to confirm patient
understanding (use demonstration of skill, if
needed)
 Write down important information for patient

Kripalani and Weiss, 2006.
Workshop—Part III

Task: Analyze patient education
materials: 40 min


Tools to analyze material and find a patient
handout
Homework: revise the actual patient
discharge handout material and bring it back
to class
Creating Effective Health Care
Messages for Older Adults
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Realistic objectives
Focus on behaviors and
skills, less on facts
Establish a context for new
information
Partition/”chunk” complex
instructions
Cultural values/beliefs
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Include interactive or
experiential activity
Repeat important
information
Motivate the learner
Relate to past experience
Write for the patient, not the
formula
An older learner must understand what to
do and feel enabled to take action.
Stanford Geriatric Education Center
Doak, Doak, and Root, 1996
Tools for Assessing the Suitability
of Health Messages

How suitable is the health information?
 Understandable?
 Acceptable?
 Helpful?
Stanford Geriatric Education Center
Categories of
Assessment Tools
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Attribute checklists
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Readability formulas
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Suitability of Assessment of Materials (SAM)
Stanford Geriatric Education Center
Attribute Checklists
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Simple and quick method of assessing appropriateness
of health messages
Assessment categories:
 Organization
What would be
 Writing style
important for
older adults from
 Appearance
different cultures?
 Appeal
Area Health Education Center, Biddeford, Maine
Stanford Geriatric Education Center
Readability Formulas
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Assess reading difficulty based on
 Word difficulty (number of syllables)
 Length of sentences
Not suitable for tables, charts, word lists
Many different formulas exist
 Micrsoft Word Program
 Simple Measure of Gobbledygook (SMOG):
http://www.harrymclaughlin.com/SMOG.htm
 Many are available in different languages
Stanford Geriatric Education Center
Suitability of Assessment
of Materials (SAM)
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Used for printed materials, illustrations, videos
and audio taped instructions
Validated with different ethnic populations and
different medical specialities
Indicates need for supplemental instructions
Doak, Doak, & Root, 1996
Stanford Geriatric Education Center
SAM Categories
1.
2.
3.
4.
5.
6.
Content
Literacy demand
Graphics
Layout and typography
Learning stimulation, motivation
Cultural appropriateness
Ratings: Superior material; Adequate material; Not suitable
Stanford Geriatric Education Center
Doak, Doak, & Root, 1996
Task: Use the SAM
Choose a patient HO material you
frequently use or one you think may be
useful
 Put the HO to the test!

 Score
the HO
 Improve the HO
Questions/Thoughts?