Does that 12% include the 1 in 7 Americans who speaks another language at home? (Census 2000) And how does our work intersect with the fact that there are more speakers of English as a second or as a foreign language throughout the world than there are speakers of English as a first or dominant language? (See Graddol's English Next, www.britishcouncil.org/learning-research-englishnext.htm)
   
  Suddenly 12% seems pretty high. And the stakes for clear, simple, non-condescending communication are even higher
Lendoak at aol.com wrote:
      Wm Smith,
   
  We couldn't agree more!  If the literacy score of every patient was already recorded on the medical record for the docs and nurses to see - how would they communicate differently with patients at 2nd grade, 8th grade, 12 the grade, 16th (college grad) levels? We believe that the answer is: For most, they wouldn't know what (if anything) to do differently!  
   
  In fairness, a lot has been done to create awareness of the problem by IOM, AMA and others.  But with the survey showing that only 12% of patients are fully competent to understand and be motivated by their healthcare instructions, it is pretty clear that virtually the entire patient population could benefit by better communication strategies.  This are not rocket science - strategies that work and take little or no additional time can be listed on a single page that can be learned in about an hour. (We provided this a few years ago for Pfizer's "Principles" guidelines for their communications with the public.)
   
  What would it take to make progress on this?
   
  Len and Ceci Doak
   
   
   
    In a message dated 5/30/2008 9:51:01 A.M. Pacific Daylight Time, BSMITH at aed.org writes:
    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-assn.org/amednews/2008/06/02/hlsd0602.htm


David J. Rosen
djrosen at comcast.net




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