Workforce Development: Advancing Health Literacy at the Minnesota Department of Health (MDH)

Transcription

1 Workforce Development: Advancing Health Literacy at the Minnesota Department of Health (MDH) November 21, 2013 Don Bishop, Genelle Lamont, Charity Kreider

2 Overview What is health literacy to public health? Barriers to and opportunities for Health Literacy in Minnesota What is our role and capacity as a State Public Health Agency to address health literacy? National Assessment of Adult Literacy (1992, 2003) Importance March 2013 CHP Health Literacy Workshop Evaluation Results How MDH can advance health literacy

3 Health Literacy is the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health. -National Academies of Sciences, Institute of Medicine (2004)

4 Transition The scope of health literacy should be expanded to include the ability to access, understand, evaluate, and communicate information on the social determinants of health (WHO, 2008)

5 Public Health Literacy the degree to which individuals and groups can obtain, process, understand, evaluate, and act on information needed to make public health decisions that benefit the community. -Freedman et al., Am J PrevMed 2009;36(5)

6 Barriers to Health Literacy Complexity of written health information in print/web. Lack of health information in languages other than English and inadequate translations. Lack of cultural appropriateness of health information. Inaccuracy or incompleteness of information in mass media. Low-level reading abilities, especially among undereducated, elderly and some segments of ethnic minority populations. Lack of empowering content that targets behavior change as well as direct information (social marketing strategies). Source: Zarcadoolas, Pleasant and Greer (2006)

7 Barriers to Health Literacy in Minnesota By 2030 number of Minnesotans over age 65 expected to double -will then comprise 20% of population Schools increasingly segregated Rapidly changing demographics Growth in charter schools School choice option Home ownership gap: Of Color 38.6%; White non- Hispanic 76.2% 38% gap in Minnesota compared to 25% gap in U.S.

8 Barriers to Health Literacy in Minnesota Roughly 25% of foreign born (any race) lack high school degree or GED compared to 6% of native-born Of all black children in state, 35% have foreign-born parent For children age 0-19, 1 in 6 is the child of an immigrant; for children age 0-4, 1 in 5 is child of an immigrant. Four year high school graduation rate in 2012: Of Color 57%; White (non-hispanic) 84% Up from 43% and 79% in 2003

9 Percent of Minnesota residents under 65 without health insurance in 2011 American Indian 23.1 Asian 12.4 Black (U.S. born) 12.6 Black (foreign born) 24.8 White 8.6 Hispanic 29.3 Overall 10.1

10 Impact of ACA on Minnesota s Uninsured In ,200 in Minnesota were uninsured By 2016 expected that uninsured will be reduced to between 159,000 and 254,000. Eligibility Medicaid < 138% federal poverty level MinnesotaCare % federal poverty level Private Coverage > 200% of fed poverty level

11 U.S. Adult Health Literacy 88% of American adults do not have proficient health literacy skills needed to make important individual and family health choices. Source: National Center for Education Statistics (2006). The Health Literacy of America s Adults: Results from the 2003 National Assessment Of Adult Literacy. Washington, DC: U.S. Department of Education.

12 Percent of Adults in Below Basic Health Literacy NAAL Population: 2003 Characteristic % in Below Basic % in total population Did not graduate from high school Did not speak English before starting school Adults reporting poor health 10 4 Hispanic adults Age No medical insurance Did not obtain informationover internet Black adults One or more disabilities Source: U.S. Dept. of Education, Institute of Education Sciences, National Center for Education Statistics, 2003 National Assessment of Adult Literacy (NAAL)

13 Risk Factors for Low Health Literacy Older adults (65+ years) Limited English Proficiency (LEP) Socioeconomically disadvantaged Lower educational attainment Lower income level Higher percent minorities Medicare/Medicaid recipients or uninsured Chronic and severe health conditions

14 Low Health Literacy Composite by Census Tract in Minnesota, Twin Cities Minneapolis Saint Paul Low Health Literacy Composite Source: American Community Survey Minnesota/prepared by the U.S. Census Bureau, Composite measure of 0-6 points defined as 1 point for a) Non Hispanic White <25%, b) >15% Speaking English Less than "Very Well"; c) >20% Foreign Born; d) >16% Living in Poverty; e) >23% Age 65 or Over; f) <75% with High School education or more Map by James Peacock, MDH Heart Disease & Stroke Prevention Unit, June 2013

15 Importance Adults with limited health literacy have less knowledge of disease management, report poorer health status, and are less likely to seek preventative care. (IOM, 2004) Low health literacy costs the U.S. healthcare industry $73 billion per year in misdirected or misunderstood healthcare services (Vernon, 2009; Friedland, 1998; Howard, 2005) Public health has ethical and legal obligation to promote health literacy (Gazmararianet al. 2005)

16 Birth of Workshop

17 Purpose Create a public health workforce at MDH fluent in health literacy principles and best practices.

18 Methodology Conducted comprehensive literature review Developed workshop learning objectives and content Arranged guest speakers, facilitators and panelists Arranged workshop venue and catering service Advertisements and invitations sent via MDH Intranet and MS Outlook Calendars Assessed participant learning needs for break-out group activity: CDC Training Module and Simply Put Checklist Created Participant Workshop and Resources Packet

19 Learning Objectives 1. Define health literacy and describe conceptual models. 2. Discuss the individual, medical, public health, economic, and political importance of health literacy. 3. Identify populations vulnerable to low health literacy rates. 4. Describe effective use of theory-based models in design and evaluation of culturally sensitive health literate materials. 5. Give examples of basic concepts for communicating with a diverse audience (e.g. cultural competency, participatory action and learning). 6. Apply lessons learned from the workshop to current public health work for improvement and use in future work.

20 CDC Online Health Literacy Course Course Title: Health Literacy for Public Health Professionals Simply Put: A guide for creating easy-to-understand materials (see Appendix D: Checklist for easy to understand print materials)

21 Pre-Workshop Homework Assignment Assemble work team from your program area (heart disease, stroke, diabetes, oral health, LEP, obesity, tobacco, injury & violence, etc.) Complete online training: CDC Health Literacy for Public Health Professionals Team members review CDC Health Literacy checklist and core health literacy articles Team members meet and apply concepts from CDC health literacy online course to a current project

22 Pre-Workshop Homework Assignment: Project Description Content 1. Target/main audience 2. Goals/objectives 3. Main activities and project deliverables 4. Does your project currently address health literacy? If so, please describe how: 5. Will your project include an evaluation? 6. Does this evaluation have a health literacy component? If so, please describe:

23 Pre-Workshop Homework Assignment: Final Step: Create Health Literacy Plan If your project and project evaluation currently addresses health literacy, please describe areas for improvement. If not, please create a brief plan on how your group could address health literacy in your project and project evaluation.

24 Health Literacy Workshop Agenda Morning Health literacy overview -Don Bishop, PhD, Minnesota Dept. of Health Using health behavior theory to target, design, and evaluate health messages Marco Yzer, PhD, University of Minnesota Implementing health literacy in a state public health department Jennifer Dillaha, MD, Arkansas Dept. of Health Lunch Video Screening: Say It Visually! Stan Shanedling, PhD, Minnesota Dept. of Health

25 Say It Visually

26 Health Literacy Workshop Agenda Afternoon Break-out group activity building on pre-workshop homework applying health literacy tools/strategies to existing MDH activities: led by Alisha Elwood, MA, LMFT, Minnesota Health Literacy Partnership, Blue Cross Blue Shield Minnesota Panel Discussion: Communicating with a diverse audience [Panel: Genelle Lamont, Moderator, MPH, DHPE Fellow; Maria Veronica Svetaz, MD, MPH, Hennepin County Medical Ctr; Sara Chute, MPP, Minn. Dept. of Health; Mary Beth Dahl, RN, StratisHealth] Wrap-up & Final Thoughts

27 Resources Participants received Welcome letter Agenda Learning objectives Speaker bios Presentation slides Directory of resources MDH Communication policies/resources Panel questions Copies of pre-workshop assignment These and additional health literacy resources were made available online through MDH Intranet to participants

28 Participants ~85 attended Required Center for Health Promotion (CHP) Invited Health Promotion & Chronic Disease (HPCD) Office of Statewide Health Improvement (OSHII) Office of Communications Refugee Health Program Office of Minority & Multicultural Health Executive Office U of MN School of Public Health and Journalism graduate students

29 Evaluation Results (51 of 85 attendees) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Understood the objectives of this workshop. 90% 86% Very/Somewhat likely to attend another health literacy workshop. Workshop content was relevant to my work. 61% 70% 84% 82% Folder packet provided me with useful resources & tools. Overall I learned a lot from this workshop. 78% The presentations and panel discussion were engaging. The activities gave me sufficient practice and feedback.

30 Evaluation Results (continued) More information requested: Culture-specific communications and health literacy Applying health behavior models to project planning Web design and videos that address health literacy How to apply health literacy principals into RFPs and measure effectiveness

31 Advancing Health Literacy at MDH (1)Create a MDH Health Literacy Committee (2)Create a full-time Health Literacy Coordinator (3)Develop MDH Health Literacy Guidance Document (4)Develop and formalize MDH staff training curricula in health literacy (5)Develop staff competencies and performance measures & monitor written and oral communications for health literacy (checklist)

32 Looking Forward Health Literacy as a part of Health Equity Upcoming Health Equity Report to state legislature: advancing health equity in Minnesota Culture change and a transitioning workforce Working more closely with low health literacy populations with a better health literacy lens Regional health literacy workshops for local public health agencies and communities Development of a State Health Literacy Action Plan with Minnesota partners Duty to the public to do no harm

33 Health Literacy Intervention Points Culture & Society Health System Education System Adapted from: Healthy Literacy: A Prescription to End Confusion, IOM, 2004

34 Acknowledgements Center for Health Promotion Leadership Mark Kinde, Injury & Violence Prevention Supervisor Stan Shanedling, Heart Disease & Stroke Prevention Supervisor Gretchen Taylor, Diabetes Program Supervisor Merry Jo Thoele, Oral Health Program Supervisor Jim Bluhm, Assistant Section Manager Minnesota Department of Health Mary Manning, Promotion & Chronic Disease (HPCD) Director Jose Gonzalez, Office of Minority & Multicultural Health (OMMH) Director Jim Peacock, Epidemiologist Senior Heart Disease & Stroke Prevention Directors of Health Promotion & Education Steve Owens, Director of Health Equity Karen Thompkins, Internship & Fellowship Manager Liz Traore, Evaluation & Epidemiology Manager Cheryl Welbeck, Executive Assistant

35 Don Bishop Genelle Lamont Charity Kreider