PROPOSAL:  We should never give a health care provider a tool to
evaluate the health literacy of their patients unless we also give them
a tool at the same time to evaluate their own health literacy competence
and the competency of their practice, hospital and setting. 
 
I think this is such an important issue.  I have gotten many requests
from health care providers for guidance on "How do I know if a patient
has low health literacy?"  
 
My concern is I have never had a health care provider ask-  "How do I
know if I have a health literate practice?"...or "Can you help me find
our how health literate I am?"
 
Our choice of word-  "literacy" keeps coming back to haunt us. 
Literacy is a characteristic of a person -highly associated in all our
minds with illiteracy.  The association, no matter how hard we try,
seems to be immutable.  The use of the words science literacy, and
economic literacy exacerbate the problem because they are typically
taken to mean-  do you know the vocabulary and principle of science and
economics.  
 
We have only 12% of Americans who can understand what we are telling
them about their health.  That is not their fault.  We who write health
information, design health settings, and talk to patients are too blame
for a large % of that problem.  Yes, we need to make improvements in
patients ability to protect and understand their health; but we must
make the biggest changes in our behavior.  I think a duel health
literacy assessment would be a great first step and an important signal
to send. 
 
 
Wm. Smith
Executive Vice President
Academy for Educational Development
1825 Connecticut Ave., NW
Washington, D.C. 20009

Organize policy until self-interest
does what justice requires.
Phone: 202-884-8750
Fax: 202-884-8752
e-mail: bsmith at aed.org 


>>> "Seubert, Douglas" <seubert.douglas at marshfieldclinic.org> 5/27/2008

10:36 AM >>>
This article, although it never mentions it by name, is talking about
the Newest Vital Sign (NVS), developed by Pfizer.  

Every now and then I'll have a physician ask if there are any tools
that can be used in the exam room to test a patient's health literacy. I
developed a health literacy toolkit for our providers (over 700
physicians across 41 locations) and I included information about
assessing health literacy, sticking with the three "biggies" -- REALM,
TOFHLA and NVS. Mostly I agree with Dr. Schwartzberg in the article
mentioned in the previous post that "this is fine for research" but not
always appropriate for clinical practice. I like her quote, "Clinicians
can better spend their time ensuring that their patients understand the
medical information they need to know to care for themselves."

With that in mind, our online health literacy toolkit for providers
includes information about the standard assessments that are available,
along with a "fair and balanced" look at the current literature. The NVS
assessment, for example, has research that both hails it as a useful
tool and criticizes it as a waste of time:

Quick assessment of literacy in primary care: the newest vital sign.
http://www.ncbi.nlm.nih.gov/pubmed/16338915?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed


Measuring adult literacy in health care: performance of the newest
vital sign.
http://www.ncbi.nlm.nih.gov/pubmed/17931135?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum


So it depends on who you ask and where you look for your information.

But I'm guessing the AMA is going to conclude that assessing for health
literacy in the exam room is not effective and that plain language ,
coupled with the "teach back method" and short, clearly written handouts
should be used with every patient.

And since we're discussing assessment tools, check out these articles
(I included them in our health literacy toolkit):

Paasche-Orlow MK, Wolf MS. Evidence does not support clinical screening
of literacy. J Gen Intern Med. 2008 Jan;23(1):100-2. Epub 2007 Nov 9.
http://www.ncbi.nlm.nih.gov/pubmed/17992564?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum


Wolf MS, Williams MV, Parker RM, Parikh NS, Nowlan AW, Baker DW.
Patients' shame and attitudes toward discussing the results of literacy
screening. J Health Commun. 2007 Dec;12(8):721-32.
http://www.ncbi.nlm.nih.gov/pubmed/18030638?ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum


I also thought this article was interesting: One screening question,
"How confident are you filling out medical forms by yourself?" was
accurate in detecting limited and limited/marginal health literacy
skills. 

Wallace LS, Rogers ES, Roskos SE, Holiday DB, Weiss BD. Brief report:
screening items to identify patients with limited health literacy
skills. J Gen Intern Med. 2006 Aug;21(8):874-7.
http://www.ncbi.nlm.nih.gov/pubmed/16881950?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&dbfrom=pubmed



Doug Seubert
Quality Improvement & Care Management
Family Health Center/Community Heath Access

Marshfield Clinic
1000 N Oak Avenue
Marshfield, WI 54449
www.marshfieldclinic.org/quality 

(715) 387-5096 (1-800-782-8581 ext. 75096)
seubert.douglas at marshfieldclinic.org 

------Original Message------
From:"David J. Rosen" <djrosen at comcast.net>
Date:Tue May 27, 2008 -- 05:06:58 AM
To:healthliteracy at nifl.gov 
Subject:[HealthLiteracy 2034]  AMA Medical News Article on Health
Literacy

Health Literacy Colleagues

I would like to call your attention an article, dated June 2, 2008  
(interesting dateline) in the American Medical news of the
AMA . It poses this question:

Should physicians adjust the communication level for each patient, or 

are comprehension difficulties so common that simpler language should 

be used with everyone?

Doctors are being urged by some researchers to administer  a short  
(on average, just under 3 minutes)  literacy test to their patients  
to increase the doctors' health literacy awareness. Others argue that 

while appropriate for research,  this does not make sense for  
clinical practice. They argue for plain language for all patients.

How many patients are proficient in managing their own medical care?  
One recent study found that

only 12% of adults have the skills to proficiently manage their own  
medical care.

The article mentions that the AMA Foundation will release a report in 

July  on assessing the country's health literacy.

You'll find the article at:

http://www.ama ( http://www.ama/
)-assn.org/amednews/2008/06/02/hlsd0602.htm


David J. Rosen
djrosen at comcast.net 




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