Do you see promotoras as a potential channel to promote functional health
literacy? SS

Sandra Smith, MPH CHES
800-444-8806  206 -441-7046
www.BeginningsGuides.net
sandras at u.washington.edu

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Muro, Andres
Sent: Friday, February 02, 2007 8:46 AM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 626] Re: question on
patientcommunicationskillstrainings

In the southwest, the networks of paraprofessionals that go to people's
homes to promote health education are called Promotoras (promoters). They
don't just focus on prenatal, early childhood, but they focus on all areas
of disease awareness.

Andres

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Sandra Smith
Sent: Thursday, February 01, 2007 3:38 PM
To: 'The Health and Literacy Discussion List'
Subject: [HealthLiteracy 617] Re: question on patientcommunication
skillstrainings

Yes! Excellent observation, Andrew.  There is an urgent need to take
understanding of health literacy beyond the medical model which frames low
health literacy as a deficiency disease, measures it as a single
individualistic trait (reading skill) unrelated to social support or
resources,  and prescribes improved information delivery as the cure.
Certainly improved information delivery is important, but it is not likely
to fully mitigate individual and systemic problems related to low literacy
and low health literacy. We need new channels, in addition to healthcare
providers, to promote functional health literacy. One possibility is the
existing national network of home visitation programs, which send nurses and
trained paraprofessionals into the homes of disadvantaged families during
pregnancy and early parenting, a time when readiness to learn is high and
young women are accessing significant health services, often for the first
time, and becoming health decision makers for their growing families. These
home visitors already provide social services and links to resources (often
including literacy enhancing services) and likely promote functional health
literacy without being aware of it. They are well-positioned to empower
clients to make measurable strides toward higher functioning in the
heathcare system and in health contexts at home.  This strategy is limited
to maternal and child health, yet it is highly leveraged since skills
learned during pregnancy and early parenting could improve functioning for
all family members throughout their lives. If we look beyond our own walls,
we are likely to discover similar solutions. SS

Sandra Smith, MPH CHES
Health Education Specialist & Principal Investigator
University of WA Center for Health Education & Reseasch
800-444-8806  206 -441-7046
www.BeginningsGuides.net
sandras at u.washington.edu


-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Andrew Pleasant
Sent: Thursday, February 01, 2007 12:14 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 614] Re: question on patientcommunication skills
trainings

Hi everyone,

Isn't this sadly not uncommon story from Ruth 
Davis one of the best reasons to expand the 
field's foci beyond doctor/patient interaction? 
That is a relatively (for most peole) small 
amount of time each year compared to the much 
greater percentage of time that individuals 
interact with information about health, use their 
literacy skills, and make decisions about their 
health.

That is not to say do not address doctor/ patient 
interactions but isn't the most effective time to 
equip people with health literacy skills to 
enhance their personal empowerment  to defend 
their right to health and health care before they 
encounter such a physician?

Don't these observations also further demonstrate 
that health literacy is much more than the 
ability to pronounce medical words, fill in the 
vocabulary blanks, or (thanks Andres) is 
something that only patients and the public lack? 
For instance, briefly, that scenario is not only 
about writing down health information 
(fundamental health literacy), it is also about 
the components of health literacy related to 
culture (role of physicians in society) and civic 
literacy (navigating systems) and the scientific 
component of health literacy (understanding 
uncertainty and/ or knowledge uptake gaps as it 
relates to utility of second opinions - for 
example). What if, let us hope not, that 
physician also has not kept up with best medical 
practices (as is clearly the case regarding 
communication skills)?

Regarding strategies at the larger scale, the 
final path to embed health literacy skills into 
medical education is not only through individual 
grand rounds given or CMEs issued but by putting 
health literacy into medical education and 
hospital accreditation standards as well as 
payment schemes. These are challenging tasks and 
require a bit of a paradigm change in approaches 
to health, health policy and systems, and health 
literacy. Challenging does not mean impossible or 
infeasible.

In order to reach those goals, I suggest the 
field must first develop and agree on a 
comprehensive definition and model/framework of 
health literacy grounded in the entire range of 
contexts in which people interact with health 
information and make decisions about health. That 
model must be able to support both the 
development of curriculum for physicians and 
nurses in training as well as a very robust 
assessment tool. On this issue ... this is where 
I have to stop because our article outlining that 
is not yet published.

Additionally and importantly, such a broader 
approach could/should also facilitate greater 
interaction between the health system and the 
educational system (esp. ABE/ESOL) writ large.


Andrew Pleasant








>We have been promoting the use of Ask Me 3 

>locally for about 2 years now and it is 

>difficult to determine how often it or similar 

>efforts are used by the consumers. I was 

>presenting the Ask Me 3 information at a local 

>university's senior scholars program last week 

>when a couple of group participants shared the 

>following stories.

>

>	During an office visit with a physician, 

>a woman stated she had started writing down 

>information the	physician was sharing 

>with her that she wanted to remember when she 

>left the office. He inquired as to	what she 

>was writing in her notebook. When she shared 

>back with him, she said he told her to put her 

>	notebook away and that he would take care 

>of her and there was no need for her to be 

>writing anything	down. She also conveyed 

>that he stated he had only 7.5 minutes to spend 

>with her and that he did not have	the time 

>for her to be writing information down as they 

>were talking. When I inquired about how she 

>	responded to this, she stated that she 

>felt intimidated and stopped writing. She did 

>not leave with any	printed information or 

>instructions from the visit.

>

>	Another participant asked what was being 

>done in medical schools related to training on 

>communications.	He further stated that 

>his former physician had retired and that his 

>current physician always seemed to	be in a 

>rush and was not very patient when he had 

>questions or asked for clarification. Others in 

>the	group nodded their heads and several 

>stated they experienced similar behaviors.

>

>While I realized this is not always what 

>individuals encounter with their primary care 

>providers, I think it brings to light some very 

>real situations that consumers of health care 

>are facing when seeking information from health 

>professionals. Many times the reality of getting 

>health professionals to pay attention to the 

>many issues associated with health literacy is 

>not deemed to be a high priority. I have found 

>it has been difficult and sometimes impossible 

>to get on the agenda of professional groups' 

>staff meetings to discuss health literacy (using 

>the Ask Me 3 information) or to provide a 

>continuing educational offering on the program. 

>Also, health professional educational programs 

>seldom seem to address the complex issues 

>related to health communications to any depth in 

>our area.

>

>The frustration of this reality is that we may 

>help our consumers to be more engaged in seeking 

>information, but if health care professionals 

>are not receptive to this active involvement, 

>the consumers most likely will retreat.

>

>Ruth R. Davis MSN, RN, CHES

>Community Health Nursing Supervisor

>         for Public Health Education

>Madison County Health Department

>1001 Ace Drive, P.O. Box 1047

>Berea, KY  40403

>859-228-2041

>Website address:

>www.madison-co-ky-health.org

>

>

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov

>[mailto:healthliteracy-bounces at nifl.gov]On Behalf Of Dickerson, Robert

>Sent: Friday, January 26, 2007 7:35 PM

>To: The Health and Literacy Discussion List

>Subject: [HealthLiteracy 603] Re: question on patientcommunication

>skills trainings

>

>

>We have done some focused work with Ask Me 3 with some very positive

>results. Unfortunately I think it is a program that is not used properly

>at times or to it's full potential.

>

>Thanks,

>Bob

>

>Bob Dickerson, MSHSA, RRT

>Quality Improvement Coordinator, Clinical Quality

>Iowa Health - Des Moines

>Des Moines, Iowa

>Phone: (515) 263-5792

>Fax: (515) 263-5415

>E-mail: DICKERR2 at ihs.org

>Website: www.ihsdesmoines.org

>

>

>-----Original Message-----

>From: healthliteracy-bounces at nifl.gov

>[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney

>Sent: Friday, January 26, 2007 12:35 PM

>To: healthliteracy at nifl.gov

>Subject: [HealthLiteracy 597] Re: question on patient communication

>skills trainings

>

>Mindy,

>To add to the plug for AskMe3, it is also designed to train patients as

>well as providers. You can find it at:

>http://www.askme3.org/

>

>Also, look at the the online videos from AMA's group: Educating

>Physicians on Controversies in Health

>http://www.ama-assn.org/ama/pub/category/15369.html

>

>Check this out for lots of links to other good resources:

>

>The Health Literacy area of the ALE Wiki:

>http://wiki.literacytent.org/index.php/Health_Literacy

>

>Good luck!

>

>Julie

>

>Julie McKinney

>Discussion List Moderator

>World Education/NCSALL

>jmckinney at worlded.org

>

>>>>  "Zeitz, Howard" <hzeitz at uic.edu> 01/25/07 8:49 PM >>>

>With regard to training for health care professionals, consider the ASK

>ME 3 program. It targets healthcare organizations and professionals.

>

>With regard to patients, consider the programs from Stanford Univ (Dr.

>Kate Lorig and colleagues). They include a 6 week program known as the

>Chronic Disease Self Management Program (CDSMP) as well as programs

>targeted to individuals with specific diseases (eg, HIV, arthritis,

>etc).

>

>Howard J Zeitz

>

>========================================================================

>===

>On Thu, January 25, 2007 12:15 pm, Mindy Domb wrote:

>>  Hello. I really enjoy being part of this list and having access not

>only

>>  to some great minds and terrific resources, but participating in

>>  networking that really supports our work.  This is the first time I

>have

>>  reached out to the network. I am developing training curriculum that

>is

>>  indirectly about patient communication skills, patient/physician

>>  communication.  The training is for health and human service providers

>on

>>  how they can better support their clients with HIV and Hepatitis C to

>>  better communicators with their medical providers.

>>

>>  I am wondering if anyone has done this kind of training before or

>>  trainings on the importance of patient/physician communication, or

>  > building patient communications skills , what resources, activities,

>>  powerpoints were effective.

>>

>>  Many thanks!

>>  Mindy Domb

>>

>>  Mindy Domb

>>  Director

>>  HIV/viral Hepatitis Integration Programs SPHERE/The Statewide

>>  Homeless/HIV Integration Project HCSM, Inc.

>>  942 W. Chestnut Street

>>  Brockton, MA 02301 USA

>>  413.256.3406

>>  fax: 413.256.6371

>>  www.hcsm.org/sphere <http://www.hcsm.org/sphere>

>========================================================================

>===

>>  Julie McKinney

>>  Discussion List Moderator

>>  World Education/NCSALL

>>  jmckinney at worlded.org

>>

>>  ----------------------------------------------------

>>  National Institute for Literacy

>>  Health and Literacy mailing list

>>  HealthLiteracy at nifl.gov

>>  To unsubscribe or change your subscription settings, please go to

>>  http://www.nifl.gov/mailman/listinfo/healthliteracy

>>  ----------------------------------------------------

>

>Howard J Zeitz, MD

>Rockford Regional Partnership for Health Literacy (RRPHL)

>1601 Parkview Ave

>Rockford, IL 61107

>T: 815-395-5964

>F: 815-395-5671

>

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--
-----------------------------------------------
Andrew Pleasant
Assistant Professor
Department of Human Ecology
Extension Department of Family and Community Health Sciences
Rutgers, the State University of New Jersey
Cook Office Building, 55 Dudley Road #207
New Brunswick, NJ 08901
phone: 732-932-9153 x. 320; fax: 732-932-6667
----------------------------------------------------
National Institute for Literacy
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To unsubscribe or change your subscription settings, please go to
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----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy
----------------------------------------------------
National Institute for Literacy
Health and Literacy mailing list
HealthLiteracy at nifl.gov
To unsubscribe or change your subscription settings, please go to
http://www.nifl.gov/mailman/listinfo/healthliteracy