Another important point to consider in trying to set some standards is
that a number of agencies (NCQA and AHRQ) are developing Medical Home
Standards that could eventually be linked to get enhanced reimbursement
for Medicare and Medicaid payment.  These guidelines will cover care
coordination, integration of primary care specialty services, etc. etc.
per the current medical home literature but I have not heard that they
are considering health literacy issues or even cultural competence
training of providers.  This would be another avenue to explore.
 
-Alec  
 
Alec McKinney
Senior Analyst/Project Director
John Snow, Inc.
44 Farnsworth Street
Boston, MA  02210
Work Phone: 617-482-9485
Cell Phone: 617-699-9473
Fax: 617-482-0617
E-mail: amckinney at jsi.com 


>>> Andrew Pleasant <pleasant at AESOP.Rutgers.edu> 11/5/2009 2:09 PM >>>

Hi all -

Nancy commented - “What now is becoming a barrier is that many
institutions do have their own "health literacy experts" on staff. These
individuals are now turning out improved readability documents...but
it's not enough.”

There are ongoing efforts – in particular I am thinking of the Joint
Commission – to develop accreditation standards for hospitals in this
regard ... Or we hope in this regard.

However, prompted by Nancy’s comment I just did a quick search for
“health literacy” in the proposed accreditation changes currently
available online at their site. As far as I could tell (and it was I
emphasize a quick search) those proposed changes only add health
literacy in the following:

Standard PC.02.03.01 The hospital provides patient education and
training based on each patient’s needs and abilities.
EP 1. The hospital performs a learning needs assessment for each
patient, which includes the patient’s
cultural and religious beliefs, emotional barriers, desire and
motivation to learn, physical or cognitive
limitations, health literacy needs, and barriers to communication.

I found no mention of evaluating the health literacy environment of the
hospital – something that many of us have done in our own work. Nor any
mention of health literacy training for health professionals – again
something that is offered by a number of people on this list. Given the
growing strength and size of people working in health literacy around
the world – I would suggest those two are very ‘doable’ now.

One caveat – this quick search only looked at what was easily
accessible online at the Joint Commission’s web site – I would be
delighted to learn there is something more in the works there that is
either unavailable to the public or that I missed.

So, I hope the folks doing the good work at the Joint Commission take
Nancy’s observation to heart and boost the presence of health literacy
in those proposed accreditation guidelines. Evaluating the patient’s
needs is a good start but, in Nancy’s words, “it’s not enough.”

Best,

Andrew Pleasant
Health Literacy and Communication Director, Canyon Ranch Institute
Assistant Professor, Rutgers University



On 11/5/09 8:52 AM, "nancy meyers" <njmeyers at gmail.com> wrote:

On my more frustrating days, I agree, somewhat. However, you can put
the responsibility on the institutions etc and challenge them all you
want but this does NOT mean they have the skills or understanding to
develop the products that people will understand. I currently am working
with the health education staff at a large healthcare system. They can
run the readability scales through the tests but they still do not
understand at a deeper level the difference between "reading" and
"comprehension." Only the people who have worked with the more
"vulnerable at risk populations" can understand what this really looks
like. We need to continue to push for partnerships between the people
working with the more vulnerable populations and the institutions to
learn together. What now is becoming a barrier is that many institutions
do have their own "health literacy experts" on staff. These individuals
are now turning out improved readability documents...but it's not
enough. We need to explore ways to make the information "contextual."
What's the background for this document (ex. Patient Bill of Right?)
What does a person need to have in terms of background knowledge to make
this piece of paper "memorable" in the context of their life experience.
But this opens another can of worms because of the many different
sub-populations. 

On Tue, Nov 3, 2009 at 11:26 AM, Audrey Riffenburgh
<ar at plainlanguageworks.com> wrote:
Greetings, all, 

 

Fran, I DO say “this makes sense for everyone” and it's true. If you
look at the NAAL health literacy data, you’ll see that “only 12% of the
population is proficient" in the tasks required for health literacy. But
I think we need to turn that on its head and say “the health, medical,
and insurance industries have built systems that do not work for 88% of
their intended audiences.” I think we ought to start using that kind of
labeling. 

 

As we make the case, we don’t have to point out any specific “at risk”
populations because 88% of us are at risk of not being able to handle
the systems that we’re forced to use to get our health care, learn about
healthy choices, etc. We need to make the case for change from that
perspective and challenge the institutions, corporations, agencies, etc.
to recreate systems and processes that work for everyone, no matter
their educational, literacy, or language skills. That is their
responsibility, I believe! In communication, whether patient education,
technical writing, social marketing, or advertising, the
writers’/speakers’ first task is to know their audience and customize
to the audience’s needs and interests. That means one does not use
methods that reach only 12% of your audience! Let’s put the
responsibility where it should be.    

 

Audrey  Riffenburgh, M.A., President
Plain Language Works, LLC 

Specialists in Plain Language & Health Literacy since 1994

Based Albuquerque, New Mexico,  USA 
Phone: (505) 345-1107   E-mail:
ar at plainlanguageworks.com<mailto:ar at plainlanguageworks.com> (
mailto:ar at plainlanguageworks.com ) 

========================================
Principal and Founding Member,
www.clearlanguagegroup.com<http://www.clearlanguagegroup.com/>
( http://www.clearlanguagegroup.com/ ) 
Co-founder and former Faculty,
www.healthliteracyinstitute.net<http://www.healthliteracyinstitute.net/>
( http://www.healthliteracyinstitute.net/ ) 
Ph.D. Student in Health Communication, Univ. of New Mexico

 
 


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



> From: healthliteracy-bounces at nifl.gov

[mailto:healthliteracy-bounces at nifl.gov] 


> On Behalf Of Frances E. Robinson



> Sent: Tuesday, November 03, 2009 8:20 AM



> To: The Health and  Literacy Discussion List



> Subject: [HealthLiteracy 3673] Re: Simulated Hospital Patients



> 



> I agree completely that labeling seems inappropriate and often

unkind.


> Unfortunately, as long as we still need to constantly "make the case"

to


> disbelievers of the need for health literacy advocacy, we will still

need to identify


> the "at-risk" populations.  Evidence and statistics help to convince

the skeptics,


> but data needs to be "labeled."  If only we could just say, "This

makes sense for


> everyone..."



> 



> Fran Robinson



> Patient Education Coordinator



> Patient Education Services



> Dartmouth-Hitchcock  Medical Center



> One  Medical Center Drive



> Lebanon,  New Hampshire 03756



> (603) 650-6439



> 



> --- You wrote:



> I am missing why the patient needs to be labelled at all--everyone of

us in some


> situation has problems understanding because of our capacity

(variable over time


> and situation) and the demands placed on us.  These situations are

too common


> to even need to label the person.



> 



> Connie  Davis, MN, RN



> Co-director, Health Literacy in Communities Prototype Collaborative



> Senior Faculty



> Impact BC



> 



> 450 - 1385 West 8th Avenue



> Vancouver,  BC V6H 3V9



> 



> cell: 604 991-4563



> Tel: 604 742-1772



> Toll Free: 1 888 742-1772



> Fax: 604 742-1773



> 



> Email: cdavis at impactbc.ca 



> Web: www.impactbc.ca <http://www.impactbc.ca> (

http://www.impactbc.ca ) 


> ________________________________________



> From: healthliteracy-bounces at nifl.gov

[healthliteracy-bounces at nifl.gov] On


> Behalf Of IHABRAMSON at aol.com [IHABRAMSON at aol.com] 



> Sent: Monday, November 02, 2009 2:29 PM



> To: healthliteracy at nifl.gov 



> Subject: [HealthLiteracy 3666] Re: Simulated Hospital Patients



> 



> Rima,



> 



> Depending on the situation, I have used other terms such as 

"undereducated


> adults."  By the way, we once had a governor here in Michigan who

shared the


> sentiment you refer to [you had your chance] - and he promptly made

cuts to


> many adult education programs.



> 



> Ilene



> 



> 



> 



> 



> In a message dated 11/2/2009 1:58:44 PM Eastern Standard Time,



> rrudd at hsph.harvard.edu writes:



> Ilene,



> Yes, that is true but illiteracy is such a loaded word -- it has

become a label


> shaded by blame [you had your chance] and filled with shame and a

sense of


> disgrace.  I would not use it as a metaphor.



> Rima....



> 



> Rima E. Rudd, ScD, MSPH



> Department of Society, Human Development & Health



> Harvard  School of Public Health



> 677  Huntington Avenue



> Boston  MA 02115



> Phone: 617 432 1135



> fax:     617 432 3123



> web:



> www.hsph.harvard.edu/healthliteracy

<http://www.hsph.harvard.edu/healthliteracy> (
http://www.hsph.harvard.edu/healthliteracy )
<http://www.hsph.harvard.edu/healthliterac 


> y>



> www.hsph.harvard.edu/sisterstogether

<http://www.hsph.harvard.edu/sisterstogether> (
http://www.hsph.harvard.edu/sisterstogether )
<http://www.hsph.harvard.edu/sisterstoget 


> her>



> 



> >>> <IHABRAMSON at aol.com> 11/1/2009 11:45 AM >>>



> Thank you for your response, Rima.  A lot depends on how one defines

illiteracy.


> 



> Ilene



> 



>  In a message dated 11/1/2009 11:40:32 AM Eastern Standard Time,



> rrudd at hsph.harvard.edu writes:



> Please keep in mind that while many people may struggle with the

written word,


> very few people in the US are illiterate.



> Rima



> 



> Rima E. Rudd, ScD, MSPH



> Department of Society, Human Development & Health



> Harvard  School of Public Health



> 677  Huntington Avenue



> Boston  MA 02115



> Phone: 617 432 1135



> fax:     617 432 3123



> web:



> www.hsph.harvard.edu/healthliteracy

<http://www.hsph.harvard.edu/healthliteracy> (
http://www.hsph.harvard.edu/healthliteracy )
<http://www.hsph.harvard.edu/healthliterac 


> y>



> www.hsph.harvard.edu/sisterstogether

<http://www.hsph.harvard.edu/sisterstogether> (
http://www.hsph.harvard.edu/sisterstogether )
<http://www.hsph.harvard.edu/sisterstoget 


> her>



> 



> >>> <IHABRAMSON at aol.com> 10/30/2009 2:13 PM >>>



> Hello Everyone.



> 



> I am in the process of preparing a curriculum involving simulated

hospital patients,


> particularly those who might be illiterate, and was wondering if

anyone had


> sample material to share. Given all our tight schedules, it's never

great to re-


> invent the wheel. Thank you in advance.



> 



> 



> Ilene



> 



> Ilene Abramson, Ph.D.



> Member- Policy Committee



> Michigan Board of Pharmacy (2009 - 2011)



> 



> Member - Rules Committee (2009-2012)



> Michigan Board of Respiratory Care



> 



> ihabramson at aol.com<mailto:ihabramson at aol.com> (

mailto:ihabramson at aol.com )


> Tel:    248-926-0695



> Fax:   248-926-9080



> 



> 



> 



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



> National Institute for Literacy



> Health and Literacy mailing list



> HealthLiteracy at nifl.gov 



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



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> --- end of quote ---



> 



> 



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