Evidence Based Practice Health Literacy Teaching Strategies: Uniting Old School with New School Methods in an Associate Degree Nursing Curriculum

Transcription

1 Evidence Based Practice Health Literacy Teaching Strategies: Uniting Old School with New School Methods in an Associate Degree Nursing Curriculum Carolyn M. Mosley, DNP, APN Barbara J. Taylor DNP, APN, CNE 1

2 Objectives Identify the significance of inclusion of health literacy content in an Associate Degree Nursing curriculum Describe the domains of the Health Literacy Expanded Model Discuss student learning objectives and activities utilizing the Health Literacy Expanded Model 2

3 Health Literacy Definition The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions Ratzan & Parker, 2000, p. 23 3

4 Prevalence of Low Health Literacy National Assessment of Adult Literacy million adults lack skills to utilize healthcare information National - 36% of adults have basic and below basic literacy level New Jersey - 17% of adults have basic and below basic literacy level Kutner, Greenberg, Jin, & Paulsen, 2006; Nielson-Bohlman, Panzer, & Kindig,

5 Economic Impact and Health Literacy Approximately $106 to $238 billion is spent annually due to low health literacy Vernon, Trujillo, Rosenbaum, & DeBuono,

6 Common Myths About Literacy Take a short quiz with your phone 6

7 Low Health Literacy and Health Outcomes Invisible Handicap Twice as likely readmitted to a hospital Baker, Parker, Williams, & Clark, 1998; Bastable, 2008; 7

8 Low Health Literacy and Health Outcomes 46.3 % Misunderstanding prescriptions 47.7% Misunderstanding of discharge instruction Difficulty making decisions for informed consent and end of life Davis et al., 2006; DeWalt, Boone, & Pignone, 2007; Lindquist et al., 2011; U.S. HHS Healthy People 2010,

9 AMA Video This video highlights health literacy and the need for good communication between providers and persons served. 9

10 Health Literacy and Older Adults Highest risk group: Increased co-morbidities Complex self-care régimes Decreased cognitive functioning Carter-Pokras & Baquet, 2002; Center for Disease Control [CDC], 2009; HHS Office of Administration on Aging, 2011; The Medicare Advisory Commission,

11 Health Literacy and Older Adults 71% of adults older than age 60 had difficulty in using print materials 80% had difficulty using documents such as forms or charts 68% had difficulty with interpreting numbers and doing calculations CCenter for Disease Control [CDC], 2009 Kutner, Greenberg, Jin, & Paulsen, 2006; Nielson-Bohlman, Panzer, & Kindig,

12 Disparities and Minorities Additional populations that experience health disparities are cultural and ethnic minorities due to: effects of limited educational achievement poor socio-economic circumstances inadequate healthcare access Nutbeam, 2008; Schillinger et al,

13 Health Literacy and Nursing Key role in communicating and educating patients Lack instruction in identifying and adapting for low HL HL education mainly through RN continuing education HL education for pre-licensure students is essential DeSilets & Dickerson, 2009; Dennison-Himmelfarb & Hughes,

14 Health Literacy and Nursing Curricula Support teaching pre-licensure nurses about HL Federation of Associations of Schools of Health Professions (FASHP) 14

15 Old School Teaching Content On Client Education Learning Factors Ability to learn/learning challenges Learning Environment 15

16 Health Literacy Knowledge New School Include Health Literacy Health Literacy Assessment Clear Communication Low Health Literacy Client Teaching Strategies Mosley & Taylor,

17 HL Expanded Model Four Domains Fundamental Literacy Cultural Literacy Health-literate Individual Civic Literacy Scientific Literacy Adopted from Zarcadoolas, Pleasant, & Greer,

18 Cultural Literacy Refers to the understanding of how culture; Plays a role seeking out healthcare Methods of describing symptoms Choosing treatment options Adherence of the plan of care Use of alternative healthcare practices Andrulis & Brach,

19 Cultural Literacy Influences Communication and Impacts Health Outcomes 55 million Americans speak a language other than English Limited English proficiency access & quality of care Communication of Public Health Issues Ethical Responsibility Coulter, Parsons, & Ashkam, 2008; Gazmararian, Ours, Robison, & Baur, n. d.; Koh et al., 2012; U.S. Census Bureau, 2010; Wilson, Chen, Grumbach, Wang, & Fernandez, 2005; Yip,

20 Cultural Domain Finkelman & Kenner,

21 Cultural Match Appropriate logic, language, and experience of the client. Client s understanding of the health care professional s culture. Doak, Doak, & Root

22 Scientific Literacy What science must a client know to comprehend or act on a health message? What assumptions about the listener's scientific literacy are made by developers of heath messages Adopted from Zarcadoolas, Pleasant, & Greer,

23 Scientific Literacy Zarcadoolas et al.,

24 Scientific Domain National Patient Safety Foundation, n.d. 24

25 Civic Literacy What does a patient need to judge source and quality of information? Know where and how to access the information needed Know how to advocate for one s self and others Zarcadoolas et al.,

26 Civic Domain Understand the relationship between one s actions and the larger social group Incorporate civic literacy into simulations Zarcadoolas et al.,

27 Fundamental Domain Clear Communication, 2013; Cornett, 2010; Dickens & Piano, 2013; Dudas, 2011; Smith & Zsohar,

28 Fundamental Domain Clear Communication, 2013; Cornett, 2010; Dickens & Piano, 2013; Smith & Zsohar,

29 Fundamental Domain Exercise Practice using plain English http; 29

30 Fundamental Domain What would you tell your husband about the changes that were made in your blood pressure medication? Pretend I am him and explain it to me. Clear Communication, 2013; Cornett, 2010; Dickens & Piano, 2013; Smith & Zsohar,

31 Fundamental Domain Older adults: Keep information focused Repeat as needed Allow time to process information Highlight the short-term benefits of taking a specific action Provide sufficient follow up Center for Disease Control [CDC], 2009; 31

32 Fundamental Domain Active voice Plain language No more than 4 main messages Focus on behavior rather than medical principles Doak, Doak, & Root 1996; 32

33 Fundamental Domain Make materials look easy to read Use 12 point font, use visuals Line length 40 to 50 characters Test forms with intended users and revise as needed Doak, Doak, & Root 1996; 33

34 Suitability Assessment of Materials (SAM) Content Literacy demand Graphics Layout and Typography Learning simulation, motivation Cultural appropriateness Doak, Doak, & Root 1996; 34

35 Health Literacy Evidence Based Practice HL Content Gauge Advantages of Health Literacy integration into nursing curricula Nursing faculty become a catalyst in addressing patient safety Cornett, 2010; Cutilli,

36 Clinical Agencies and Health Literacy How is your clinical agencies addressing health literacy? What health literacy assessment practice have you witnessed or implemented? What are means or methods to improve awareness of assessment of health literacy? 36

37 Putting Health Literacy Principles into Action 10 Attributes of Health Organizations Brach et. al.,

38 Federal Initiatives and Health Literacy Universal Precautions tool kit - Phased guideline for organizations Health Literate Care Model - Systematic approach to implement toolkit DeWalt et al., 2010; Koh, Brach, Harris, & Parchman,

39 Health Literacy and the EHR Brief Health Literacy Screen (BHLS) 1. How confident are you filling out medical forms by yourself? Extremely, Quite a bit, Somewhat, A little bit, Not at all 2. How often do you have someone help you read hospital materials? 3. How often do you have problems learning about your medical condition because of difficulty understanding written information? All of the time, Most of the time, Some of the time, A little of the time, None of the time Cawthron,. Mion,.Willens, C.Roumie & Krupalni,2015 ; Speros, 2011

40 System changes are needed to align health care demands better with the public s skills and abilities Parker, 2009; Rudd,