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Chapter 5 Health Literacy and Clear Health Communication: Keys to Engaging Older Adults and Their Families Objectives (1 of 3) Define the term health literacy. Describe the health literacy skills of older adults according to their performance on the 2003 National Assessment of Adult Literacy, as well as according to other research studies. Describe the impact of older adults’ limited health literacy skills on their health. Describe the role of health system communication, processes, and demands. Objectives (2 of 3) List six plain language standards for verbal patient teaching.

Compare the reading level of health materials with the reading abilities of the majority of older adults, and discuss the mismatch or gap between them. List 5 to 10 plain language standards for written information. Objectives (3 of 3) List three health professional organizations and three federal agencies that publish standards or policies related to health literacy. Discuss how you can address health literacy in your health career. Understanding and Using Health Care: Why Older Adults Often Struggle (1 of 4) Health literacy challenges Individual health literacy “Degree to which an individual has the capacity to obtain, communicate, process, and understand health information and services in order to make appropriate health decisions†Also includes complexities and challenges presented by healthcare organizations Understanding and Using Health Care: Why Older Adults Often Struggle (2 of 4) Organizational barriers Organizational systems and processes can be challenging for patients and providers Providers and staff usually have little or no training in verbal communication skills Patients and their families may struggle to understand print and web-based information Understanding and Using Health Care: Why Older Adults Often Struggle (3 of 4) Individual factors Individuals may feel rushed, afraid, and too intimidated to ask questions Other challenges patients may face: Mastering arcane health insurance systems Having specialized vocabulary, knowledge and skills to manage their own health Using multiple information format in multiple locations to accomplish multiple tasks Understanding and Using Health Care: Why Older Adults Often Struggle (4 of 4) Additional barriers to adequate health literacy may include: Diminished cognitive skills Language and cultural differences Lack of experience using technology and/or navigating the internet Literacy, Numeracy, and Health Literacy Challenges (1 of 2) Literacy Includes: Reading and writing Speaking and listening Thinking analytically and making decisions Literacy, Numeracy, and Health Literacy Challenges (2 of 2) Numeracy Refers to a variety of skills, including: Basic computing Measuring and timing medicines Assessing risk Calculating percentages and statistics Interpreting food labels Reading medical devices Impacts of Literacy and Health Literacy Skills: Two Major Keys to Good Health Inadequate health literacy is associated with: Greater risk of hospital admission Higher likelihood of using emergency departments Lower use of preventive health services Poorer physical and mental health Higher all-cause mortality The Impact of National Policies on Health Literacy Practice (1 of 2) From an organizational perspective, health literacy means: Attending to communication demands placed on patients How well or poorly an organization accommodates their communications needs The Impact of National Policies on Health Literacy Practice (2 of 2) Most organizations place health literacy demands on most adults significantly beyond their literacy skills Situational stress further compromises their ability to absorb and process information Communication disconnect results in serious consequences for care systems and patients Accrediting, Standard Setting, and Policy Organizations (1 of 6) Joint Commission Accredits hospitals around the country Identifies communication failures as the underlying root cause of 65% of sentinel events 2010 Roadmap for Hospitals Encourages use of plain language Integrates health literacy with cultural competence Reflects new accreditation requirements Accrediting, Standard Setting, and Policy Organizations (2 of 6) National Committee for Quality Assurance (NCQA) 2017 Recognition Standards for a Patient Centered Medical Home calls for establishing processes that address health literacy Accrediting, Standard Setting, and Policy Organizations (3 of 6) National Board of Medical Examiners Requires medical students to demonstrate communication competence on the United States Medical Licensing Examination Accrediting, Standard Setting, and Policy Organizations (4 of 6) American Medical Association (AMA) Publishes policy statements and white papers alerting physicians about the dangers of “medspeak†and how to improve communications Accrediting, Standard Setting, and Policy Organizations (5 of 6) Allied health professions organizations Have urged consideration of health literacy in policy statements and by promoting resources for student and practitioner learning Accrediting, Standard Setting, and Policy Organizations (6 of 6) National Academy of Medicine Health Literacy Roundtable has resulted in numerous publications linking health literacy and key healthcare issues Vital Direction for Health and Health Care 2017 report links attention to health literacy with the changing expectations of health care to improve quality, achieve better outcomes, and reduce costs Federal Government Agencies (1 of 3) Plain Writing Act Requires all government information created for the public be written in plain language Centers for Disease Control and Prevention Offers the Clear Communication Index, an assessment tool for written materials Federal Government Agencies (2 of 3) National Institutes of Health States that health literacy “Saves Lives.

Saves Time. Saves Money.†Agency for Healthcare Research and Quality offers: Health Literacy Universal Precautions Toolkit Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys for patients to assess quality of care Federal Government Agencies (3 of 3) Department of Health and Human Services Updated Cultural and Linguistic Access Standards (CLAS) requires “easy-to-understand print and multimedia materials and signage†Office of Disease Prevention and Health Promotion Promotes the National Action Plan to Improve Health Literacy The Business and Legal Case for Health Literacy (1 of 2) Centers for Medicare and Medicaid Services Use standardized patient satisfaction data captures in CAHPS surveys to help determine merit-based incentive payments Medicare hospital reimbursements for patients with traditional Medicare are based partly on “Value-Based Purchasing†Hospitals with superior patient experiences generate higher financial return The Business and Legal Case for Health Literacy (2 of 2) Risk avoidance Assuring informed consent helps healthcare providers and systems avoid needless risk Means that written and verbal information is understandable to the patient or patient’s agent Poor communication is a major cause of malpractice claims Clear Health Communication: An Often Overlooked Necessity (1 of 2) Communication is often treated as an afterthought Questions: How best to communicate?

What will motivate leaders of healthcare systems to systematically address communication challenges? What are the best solutions? Clear Health Communication: An Often Overlooked Necessity (2 of 2) Certain techniques increase the likelihood that adults will be able to understand and use health information Teaching techniques such as “teach back†Plain writing techniques such as avoiding jargon Joint Commission report Contains 35 specific recommendations for improving communication What Is Plain Language? How Will I Know It If I Hear It? (1 of 2) AMA verbal communication tips: Slow down Use plain, nonmedical language Show or draw pictures Limit the amount of information and repeat it Use the teach back technique Create a shame-free environment What Is Plain Language?

How Will I Know It If I Hear It? (2 of 2) Additional tips to help older adults learn more effectively from healthcare visits: Frame the conversation first Encourage older adults to bring a friend or family member to the visit Give plain language–written information that reminds the patient of what to do, how to do it, and why What Is Plain Language? How Will I Know It If I See It? (1 of 3) Plain language guidelines Content Information is accurate, up-to-date, and limited Focus on behavior Break up complex information Structure/organization Structure from the user’s perspective Convey key points in headings Begin with clear action messages What Is Plain Language? How Will I Know It If I See It? (2 of 3) Plain language guidelines (continued) Writing style Talk directly to the reader in a positive, friendly tone Use everyday language Explain the meaning and pronunciation of any medical terms that are used Keep sentences short Use mostly active voice Include testimonials or short example stories What Is Plain Language?

How Will I Know It If I See It? (3 of 3) Plain language guidelines (continued) Appearance and appeal Make sure print materials and websites are attractive and inviting, and look easy to read Include sufficient white space Use large enough print for reading ease Limit the use of fancy typefaces and underlining Use appropriate images to humanize materials A Call to Action (1 of 2) There is no one solution to the complex problem of communicating effectively with diverse patients and audiences Well-planned and simply written information and the use of teach back can improve understanding A Call to Action (2 of 2) Healthcare professionals Must take the lead in learning effective verbal and written communication techniques Healthcare organizations and systems Must build health-literate organizations Communication excellence Essential to thrive in the era of “pay-for-performance†and “bundled care†1.

Top of Form 1. There will always be consequences when one borrows money. In fact, the borrower of the loan always loses, because they have to always pay more than the money they received. This is not to say that all debt is bad, because it definitely has its place. Going into debt can free up funds for individuals and businesses to grow that would be near impossible to achieve without saving up long term.

Furthermore, loans can provide for people who need homes, cars, and medical bills paid so that they can keep providing for their families. I agree with Proverbs 22:7, in that whoever loans money does rule over the person who borrowed it. This is not to necessarily say that it is wrong to borrow money, but one must be aware that they risk financial entrapment if they cannot pay the required funds back. Several other times in Proverbs, it mentions that it is unwise to pay off the loan of another individual. This is a great practice to live by, because it is better to encourage a person to take responsibility for the debt that they owe, then carry the load for them and have them not learn from their mistakes.

The idea of co-signing a loan may be a good idea for married couples, who Biblically speaking are one body. However, in most instances it is unwise to co-sign a loan, because it encourages you and/or the other party to not take full responsibility of the money owed and can lead to financial ruin, even if one party pays their fair share. A poll done by CreditCards.com states that 4 in 10 co-signers lose money and that 1 in 4 co-signers credit score was damaged due to the other party. Additionally, 38% of the co-signers in the poll had to pay some or all of the other parties' debt (Kossman, 2016). In conclusion, it is obvious that there are inherent risks with going into debt and cosigning a loan.

It is important as Christians to rely on God for our needs and not go into debt unless we feel that God wants us to. Kossman, S. (2016). Poll: 4 in 10 Co-signers Lose Money . CreditCards.com. Retrieved from 2.

Borrowing money is something that most people will do within their lifetime. Additionally, many companies need to borrow money to finance business activities (Chen, 2020). Most Americans will borrow money in some form during a lifetime, where we are talking about a teenager who wants a 20$ forward on allowance or a couple purchasing their first home. Some of the natural consequences of borrowing money are having to pay interest. When we borrow in an official form we owe more than we borrowed because we have interest.

I imagine many of us are already familiar with this in some way with a car loan or student loans. Another consequence is making payments. Cosigning a loan is when someone cosigns for a person, it means that the cosignor would be responsible for the debt if the person defaults. People who don't have great credit or limited credit would do this. For example, when I was 19 years old I got my first apartment.

I had no credit at all, so my father cosigned for me. I paid my rent, he simply helped cosign because I didn't have credit. This was a lease, but cosigning a loan happens in the same way for similar reasons. The verses from Proverbs cautions people against borrowing in general and against cosigning for someone. Proverbs does say it is not smart to cosign for an outsider, it can be a way to get hurt.

These verses from Scripture do really caution us against cosigning or borrowing at all, however, I think when it's for family it is not really an outsider. The obligations of anyone who borrows money is that they must pay it back in the agreed time frame and at the agreed interest rate. The verse from Psalm 37:21 shows how important it is to repay something if we borrow. The verses included in this discussion do seem to caution us against borrowing. However, we do see some areas in Scripture that encourage us to lend freely, without charging interest and lending to help others.

Matthew 5:42 states "Give to the one who begs from you, and do not refuse the one who would borrow from you". Exodus 22:25 tells us not to be like a money lender and not to shark people for interest. Overall, Scripture wants us to give freely when we can. Scripture advises us to be careful and not end up a slave to the lender. Sometimes, borrowing cannot be avoided in the US.

If we want a home, we will likely have to borrow unless we are very wealthy. We can borrow responsibly and always pay back what we owe on time. I believe if we give freely and borrow responsibly for things we need then we do serve God in doing that. If I buy a home for my wife and my children, I do believe that is serving the Lord. If I care for my wife and my aging parents I do believe that serves God.

If I want a roof over my head I may have to borrow, but I must do it responsibly. Chen, J. (2020). Debt financing. Investopedia, Retrieved from The Holy Bible Bottom of Form Case 1: Arnold, a 62-year-old plumber, had been experiencing a series of symptoms, including increased thirst, frequent urination, and unusual weight loss. After some prodding from his wife, he went to see his family physician, Dr.

Lopez. The doctor gave him a physical exam, ordered some blood work, and scheduled a follow-up appointment. On the return visit, Arnold sat down with the doctor to discuss his diagnosis. Dr. Lopez explained, “You have noninsulin-dependent diabetes or type 2 diabetes, which is a chronic condition that affects the way your body metabolizes glucose.

Insulin is a pancreatic hormone that transforms dietary glucose into energy for your cells. If you had type 1 diabetes, it would mean that your pancreas produces little or no insulin. However, with type 2 diabetes, your pancreas produc- es sufficient amounts of insulin, but your cells are no longer utilizing it efficiently, which causes fluctuation in your blood glucose levels. To treat your condition, you’ll need to start eating a healthy diet, start exercising regularly, and monitor your blood sugar. I’m writing you a prescription for Metformin and a glucose monitor.†After finishing his explanation, Dr.

Lopez asked Arnold if he had any questions. Slightly stunned, Arnold just shook his head and replied, “No.†Dr. Lopez also told him that his practice has a diabetes fact sheet posted on their website and suggested that he look it up and read it. Arnold thanked him and left. He went to the pharmacy to have his prescription filled and also bought a bottle of glucosamine, a dietary supplement used by some people to treat joint pain.

When his wife asked what the glucosamine was for, Arnold said, “I think I’m supposed to be taking it. The doctor mentioned it a few times.†1. What are some reasons why Arnold likely did not understand what Dr. Lopez told him? 2.

What could Dr. Lopez have done to better present the information in a way that Arnold would understand? 3. Was it a good idea for Dr. Lopez to refer Arnold to his practice’s website for more information?

Why or why not? Case 2: Dr. Falk and Dr. Keller operate a family medical practice. One afternoon, as they ate lunch in the break room, they discussed an article about health literacy that Dr.

Falk was reading in a national news magazine. “There’s been a growing trend toward healthcare or- ganizations becoming health literate,†Dr. Keller said. “The statistics are pretty surprising,†Dr. Falk replied.

“More than half of the people surveyed had only basic or below basic health literacy skills.†“Do you think it’s something we should look into at our practice?†Dr. Keller asked. “I think we should,†Dr. Falk replied. While they were talking, Amanda, the office manager, and Jean, one of the nurses, came into the break room to get some coffee.

They overheard what the doctors were discussing, and Amanda asked Jean, “What does health literacy mean?†Jean answered, “I think it refers to understanding your own health and knowing what you need to do to stay healthy.†Gerontology for the Health Care Professional, Fourth Edition Regula H. Robnett, Nancy Brossoie, and Walter C. Chop CHAPTER 5 CASE STUDIES Gerontology for the Health Care Professional, Fourth Edition Regula H. Robnett, Nancy Brossoie, and Walter C. Chop 1.

Is Jean’s explanation of health literacy accurate? Why or why not? 2. Do you agree that Dr. Falk and Dr.

Keller should address the issue of health literacy in their practice? Why or why not? 3. What are some resources that Dr. Falk and Dr.

Keller can use to improve the level of health literacy at their practice? Case Studies_1: Case Studies_2: Case Studies_3: Case Studies_4: Case Studies_5: Case Studies_6:

Paper for above instructions

Health Literacy and Clear Health Communication: Engaging Older Adults and Their Families

Defining Health Literacy

Health literacy is a term that encompasses an individual's capacity to obtain, process, and understand basic health information and services essential for making informed health choices (Nutbeam, 2000). The evolution of this concept has highlighted the complex interplay between individual capabilities, healthcare systems, and social factors. According to the 2003 National Assessment of Adult Literacy, many older adults exhibited limited health literacy skills, indicating a significant barrier to effective healthcare utilization (Berkman et al., 2011). Studies have found that about 40% of older adults possess only basic or below-basic health literacy skills, thus hindering their ability to manage preventive care and understand treatment regimens (Berkman et al., 2004).

Health Literacy Skills of Older Adults

Older adults often struggle with various health literacy skills, particularly in areas demanding numerical comprehension and understanding complex medical terminology (Berkman et al., 2011). The demands of modern healthcare, which frequently involves navigating intricate insurance systems and understanding specialized language, compound these struggles (Davis et al., 2006). Older adults may face additional challenges due to cognitive decline or sensory impairments, making it even more difficult to comprehend health information effectively.
The implications of limited health literacy are profound. Studies demonstrate that inadequate health literacy is associated with poor health outcomes, increased hospitalization rates, and higher healthcare costs (Berkman et al., 2011). For instance, individuals with low health literacy are less likely to engage in preventive health behaviors and more likely to encounter complications from chronic diseases (Berkman et al., 2004).

Organizational Barriers to Effective Communication

Organizations must also consider the challenging communication landscape that patients encounter. Healthcare providers often lack training in effective communication strategies, leading to potential disconnects between provider information and patient understanding (Fredrickson et al., 2012). The healthcare environment adds layers of complexity that can overwhelm patients and their families, such as time constraints during appointments and the use of jargon (McCoy et al., 2016).

Plain Language Standards for Patient Education

To bridge the gap between health literacy and patient education, practitioners should employ clear and accessible communication strategies. Plain language standards for verbal patient teaching include:
1. Use non-medical language: Avoid jargon and explain terms clearly (Institute of Medicine, 2004).
2. Limit information: Focus on essential information rather than overwhelming patients with details (CDC, 2020).
3. Use visuals: Diagrams, charts, and models can enhance understanding (Davis et al., 2006).
4. Break complex information into chunks: This technique simplifies the content for retention (McCoy et al., 2016).
5. Encourage questions: Create an environment where patients feel comfortable asking clarifying questions (Rudd et al., 2020).
6. Utilize the teach-back method: Ask patients to repeat back what they've learned to ensure understanding (Schillinger et al., 2003).
For written health materials, standards can include:
1. Limit the reading level: Aim for materials written at a 5th-8th grade level.
2. Use headings and subheadings: Organizing information logically aids comprehension (Institute of Medicine, 2004).
3. Use bullet points: Clearly structured lists can improve readability (CDC, 2020).
4. Incorporate white space: Visual appeal helps enhance legibility (Rudd et al., 2020).
5. Choose readable typefaces: Select fonts that are easy to read without excessive embellishments (McCoy et al., 2016).

Addressing Health Literacy in Healthcare Professions

Addressing health literacy should be a priority within health care settings. Various organizations and agencies advocate for health literacy improvements. Three health professional organizations that publish standards include:
1. The American Medical Association (AMA): Offers recommendations for clear communication.
2. The National Board of Medical Examiners: Promotes communication competence through standardized testing.
3. The American Nurses Association (ANA): Encourages nursing education to include health literacy training.
Federal agencies influential in health literacy policy include:
1. The Centers for Disease Control and Prevention (CDC): Provides guidelines and tools for effective communication.
2. The Agency for Healthcare Research and Quality (AHRQ): Develops toolkits for integrating health literacy into care.
3. The National Institutes of Health (NIH): Advocates for health literacy research and principles.

Implementing Changes in Practice

Healthcare professionals can champion health literacy through active engagement in continual learning. Creating a health-literate organization involves equipping staff with training on effective communication strategies, utilizing health literacy tools, providing consistent resources, and fostering a culture that values clear communication (Berkman et al., 2011; Rudd et al., 2020).
Building relationships with patients requires listening to their concerns and ensuring they leave healthcare encounters with a clear understanding of their health conditions and care plans. Health professionals should advocate for policy changes that prioritize health literacy training within curricula and encourage collaborations across health systems to standardize information-sharing practices.

Conclusion

Health literacy is a crucial component of effective healthcare interaction, especially among older adults who face unique challenges in navigating the healthcare system. By understanding the dynamics of health literacy, implementing clear communication strategies, and promoting education among healthcare professionals, we can significantly improve health outcomes for older adults and address the disparities that arise from inadequate health literacy. Concerted efforts from healthcare leaders and practitioners are essential to foster environments that facilitate understanding and empower patients in their health journeys.

References

1. Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Health literacy interventions and outcomes: An updated systematic review. Evidence Report/Technology Assessment No. 199, AHRQ.
2. Berkman, N. D., Davis, T., & McCormack, L. (2004). Health literacy: What is it? Journal of Health Communication, 9(S1), 10-24.
3. Centers for Disease Control and Prevention (CDC). (2020). Health literacy tools. Retrieved from [https://www.cdc.gov/healthliteracy/](https://www.cdc.gov/healthliteracy/)
4. Davis, T., & Wolf, M. S. (2006). Health literacy and cancer communication. Cancer, 107(7), 1969-1975.
5. Fredrickson, K., et al. (2012). Health care reform, health literacy, and pharmacy practice. The Annals of Pharmacotherapy, 46(8), 1109-1114.
6. Institute of Medicine. (2004). Health Literacy: A Prescription to End Confusion. National Academies Press.
7. McCoy, L., Theeke, L. A., & Lemke, L. R. (2016). Health literacy and patient safety: Advancing patient safety through the application of health literacy principles. Patient Safety in Health Care, 3(15).
8. Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259-267.
9. Rudd, R. E., et al. (2020). Health literacy: New directions in research, theory, and practice. Health Communication, 35(10), 1166-1175.
10. Schillinger, D., et al. (2003). A conceptual framework for understanding health literacy: A review of the literature. Patient Education and Counseling, 51(3), 315-322.