Perhaps the problem is framing (low) health literacy as a deficit in the
individual, instead of as a systemic problem.  Some critics have argued that
individual  literacy historically has been used to explain and deflect
attention from larger issues related to economic pressure and increased
diversity, problems currently plaguing healthcare and the Nation. For
example Congress currently has before it 73 bills related to  “financial
literacy” which have been introduced in response to the mortgage crisis.
Similarly the National Health Literacy Act of 2007 was introduced in Dec.
Despite the language of empowerment in literacy discussions and in these
bills, policy that focuses on individual’s deficits is unlikely to  foster
independent, “healthcare consumers” who can mobilize their own knowledge and
associational assets to self-manage their medical care and promote personal,
family and community health.  ss

Sandra Smith, MPH CHES

800-444-8806  206 -441-7046

www.BeginningsGuides.net

sandras at u.washington.edu

 

From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of William Smith
Sent: Friday, May 30, 2008 5:25 AM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 2047] Re: AMA Medical News Article on
HealthLiteracy

 

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.
HYPERLINK
"http://www.ncbi.nlm.nih.gov/pubmed/16338915?ordinalpos=1&itool=EntrezSystem
2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_
RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed"http://www.ncbi.nlm.nih.g
ov/pubmed/16338915?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Re
sultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relateda
rticles&logdbfrom=pubmed

Measuring adult literacy in health care: performance of the newest vital
sign.
HYPERLINK
"http://www.ncbi.nlm.nih.gov/pubmed/17931135?ordinalpos=6&itool=EntrezSystem
2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"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. HYPERLINK
"http://www.ncbi.nlm.nih.gov/pubmed/17992564?ordinalpos=5&itool=EntrezSystem
2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"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. HYPERLINK
"http://www.ncbi.nlm.nih.gov/pubmed/18030638?ordinalpos=7&itool=EntrezSystem
2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"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. HYPERLINK
"http://www.ncbi.nlm.nih.gov/pubmed/16881950?ordinalpos=1&itool=EntrezSystem
2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_
RA&linkpos=3&log$=relatedarticles&dbfrom=pubmed"http://www.ncbi.nlm.nih.gov/
pubmed/16881950?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Resul
tsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarti
cles&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:

HYPERLINK
"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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