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  p
ublic.)
 
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&l
inkpos=3&log$=relatedarticles&logdbfrom=pubmed_ 
(http://www.ncbi.nlm.nih.gov/pubmed/16338915?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP
anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=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_ 
(http://www.ncbi.nlm.nih.gov/pubmed/17931135?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_Resu
ltsPanel.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.Pubm
ed.Pubmed_ResultsPanel.Pubmed_RVDocSum_ 
(http://www.ncbi.nlm.nih.gov/pubmed/17992564?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pub
med_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_R
VDocSum_ 
(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_Disco
veryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&dbfrom=pubmed_ 
(http://www.ncbi.nlm.nih.gov/pubmed/16881950?ordinalpos=1&itool=EntrezSystem2.PE
ntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&lin
kpos=3&log$=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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