Nat'l Quality Forum is developing guidelines on care coordination/medical home.  They do include some info on both health literacy and cultural competency.  The document is open for public comment until 11/6.
http://www.qualityforum.org/projects/care_coordination.aspx?section=PublicandMemberComment2009-10-26
Lauren Agoratus


-----Original Message-----
From: healthliteracy-request at nifl.gov
To: healthliteracy at nifl.gov
Sent: Fri, Nov 6, 2009 1:15 pm
Subject: HealthLiteracy Digest, Vol 50, Issue 12



When replying, please edit your Subject line so it is more specific
han "Re: Contents of HealthLiteracy digest..."


oday's Topics:
   1. [HealthLiteracy 3696] Re: Principles for  healthliteracy
     curriculumthat avoid labeling (Owens, Rosemond)
  2. [HealthLiteracy 3697] interesting blog post - physician as
     translator (MarketWhys Research)
  3. [HealthLiteracy 3698] Re: Labeling "at risk" people?  Or
     labelingpoor communication? (Alec McKinney)
  4. [HealthLiteracy 3699] Re: Principles for health literacyand
     avoid labeling (Wendy Mettger)

---------------------------------------------------------------------
Message: 1
ate: Fri, 6 Nov 2009 10:03:48 -0600
rom: "Owens, Rosemond" <OwensR at centracare.com>
ubject: [HealthLiteracy 3696] Re: Principles for   healthliteracy
   curriculumthat avoid labeling
o: "The Health and Literacy Discussion List"
   <healthliteracy at nifl.gov>
essage-ID:
   <B52F7BEE5A62CF438593DD78A8D765D0021382D1 at CCHSEXCHBE01.centracare.com>
ontent-Type: text/plain;   charset="us-ascii"
Hello,
 Good morning. My name is Rosemond Owens. My institution, CentraCare
ealth System, is member of the Minnesota Health Literacy Partnership. I
m glad all of you health literacy aficionados have been talking about
he shared responsibility of the burden of improving health literacy.
Over at the Minnesota Health Literacy Partnership, anytime we define
ealth Literacy as "A patient's ability to obtain, understand and act on
ealth information" we also talk about how we at the Partnership have
xpanded the definition.
e do this by including  "A provider's capacity to communicate clearly,
ducate about health and empower their patients" in the definition.
May be it's time that the powers that be also expand the formal
efinition.
Please visit the website to see some of what we are doing in Minnesota
o improve the health of all Minnesotans through Clear Communication.

ttp://healthlit.themlc.org/home.html

Exciting times in the field of health literacy indeed!
Sincerely,
Rosemond

Rosemond Sarpong Owens
ealth Literacy/Cultural Competency Specialist
entraCare Health System
520 Whitney Court, Ste.200
aint Cloud, MN 56303
h :( 320) 240-3102
ager (320) 656-7945


inguistically and culturally appropriate care has a direct impact on
uality and safety, and is a growing issue that is not going to go
way." 
-Paul M. Schyve, M.D., Senior Vice President, the Joint Commission

----Original Message-----
rom: healthliteracy-bounces at nifl.gov
mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
ent: Friday, November 06, 2009 9:42 AM
o: healthliteracy at nifl.gov
ubject: [HealthLiteracy 3695] Re: Principles for healthliteracy
urriculumthat avoid labeling
Hello Everyone,
Thanks for this discussion. It is very cool to see this diverse group of
eople weighing in to advance the field of health literacy in this way.
Look at the signature lines of those involved for the variety of fields
nd backgrounds and perspectives you all bring!) Please excuse me for
etting a bit "rah-rah!", but I do think this is an exciting time for
ealth literacy, and we are all part of it. 
As Archie pointed out, we do keep coming back to this: that the burden
f improving health literacy does not lie only on the shoulders of the
atients, but also on the shoulders of all who deliver health care and
ealth information, AND on the shoulders of the systems that drive this
elivery. We also keep coming back to the fact that it is not only those
ith literacy challenges who have trouble staying healthy.
For years on this list and elsewhere, this double-sided concept of
ealth literacy has been evolving, and I think we should adopt it as a
iven. 
  * Can we now talk about health care providers as also "needing to
mprove their health literacy"? Yes! 
  * Should we now let go of the concept of testing patients to see who
s "at risk", and instead realize that in the current system we are ALL
at risk", and so aim to provide clear, simple and appropriate
ommunication and non-intimidating access for everyone? Yes!
  * Should we develop rigorous measures of the health literacy of health
roviders and systems so we can create and evaluate effective
nterventions for them as well as for patients? Yes!
When the Institute of Medicine released their report in 2004, they
obilized the medical community by publicizing the fact that 90 million
mericans "have difficulty understanding and acting on health
nformation". This was tremendously useful in creating widespread
wareness and work toward more understandable health information. But it
as based on a narrower definition of health literacy, which focused on
as Rima said) "the capacities of individuals."
Thanks, Linda, for announcing the Calgary Charter, because I think this
ould become the new definition and set of core principles, which we can
se to mobilize support for the new broader concept of health literacy.
 know that those who collaborated to develop this charter worked hard
o acknowledge the concepts that we have all been discussing in this
ecent conversation on this list. If we agree, perhaps we can talk about
ow to make this understanding more widespread? (And if we don't agree,
hat would also be an interesting discussion!)
I would love to hear what you all think about this. And I am sorry for
oing on so long!
All the best,
ulie

Julie McKinney
ealth Literacy List Moderator
orld Education
mckinney at worlded.org

>> "Linda Shohet" <lshohet at dawsoncollege.qc.ca> 11/05/09 4:19 PM >>>

ello all
In the context of the stimulating discussion over the last few days
egarding 
abeling of "at-risk" patients, I would like to share the most recent
ersion 
f The Calgary Charter on Health Literacy: Rationale and Core Principles
or 
he Development of Health Literacy Curricula, posted at 
ttp://www.centreforliteracy.qc.ca/Healthlitinst/Calgary_Charter_Oct_09.
df.
This document was drafted and revised over the past year by six
ndividuals* 
ho attended the October 2008 Institute on Health Literacy Curricula in 
algary, co-hosted by The Centre for Literacy of Quebec.  The Charter 
roposes a definition and understanding of health literacy and a set of
ore 
rinciples to support the development of curricula and evaluation tools
hat 
mprove the health literacy for diverse audiences and purposes.  It 
pecifically avoids labeling any groups and assumes that health literacy
touches individuals and health systems, and while expressed differently
n 
ifferent contexts, is always based on the same underlying skills and 
bilities.  There is considerable consistency between these principles
nd 
he ones in a proposed US Health Literacy Natiopresented by Cynthia Baur
ast week at the Georgia Health Literacy
ymposium. 
We have shared earlier drafts with this list and with participants at 
elected conferences and events, and have incorporated the feedback we 
eceived.  We will give anyone interested the chance to sign on to the 
harter in the coming days.  In the meantime, we welcome your thoughts
bout 
f or how you might use these principles in your own curriculum or
valuation 
ork.  
* Charter authors, alphabetically
   Clifford Coleman, M.D.    colemanc at ohsu.edu
regon Health & Science University
*   Sabrina Kurtz-Rossi, M.Ed.sabrina_kurtz-rossi at comcast.net
urtz-Rossi & Associates
*   Julie McKinney, M.S.      julie_mcKinney at worlded.org
orld Education, Inc.
*   Andrew Pleasant, Ph.D.     pleasant at AESOP.Rutgers.edu
anyon Ranch Institute & Rutgers University
*   Irving Rootman, Ph.D.      irootman at telus.net
niversity of Victoria, British Columbia
*   Linda Shohet, Ph.D.       ed at centreforliteracy.qc.ca
he Centre for Literacy of Quebec

Linda Shohet

-
inda Shohet, PhD
xecutive Director
he Centre for Literacy of Quebec
100 Marlowe Avenue, Suite 236
ontreal, Quebec
anada, H4A 3L5
el.:(514) 798-5601, ext. 24
ax: (514) 798-5602
-mail: ed at centreforliteracy.qc.ca
eb site: www.centreforliteracy.qc.ca
----------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov
o unsubscribe or change your subscription settings, please go to
ttp://www.nifl.gov/mailman/listinfo/healthliteracy
mail delivered to julie_mckinney at worlded.org
----------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov
o unsubscribe or change your subscription settings, please go to
ttp://www.nifl.gov/mailman/listinfo/healthliteracy
mail delivered to owensr at centracare.com

-----------------------------
Message: 2
ate: Fri, 06 Nov 2009 11:57:19 -0500
rom: MarketWhys Research <research at mrktwhys.com>
ubject: [HealthLiteracy 3697] interesting blog post - physician as
   translator
o: The Health and Literacy Discussion List <healthliteracy at nifl.gov>
essage-ID: <4AF4556F.8060706 at mrktwhys.com>
ontent-Type: text/plain; charset=ISO-8859-1; format=flowed
I happened upon a very interesting blog post this morning,
http://www.psychologytoday.com/blog/medicine-in-translation/200910/medicine-in-translation
in which the author, Danielle Ofri, M.D., Ph.D., examines the role of a 
hysician as someone who translates/explains what is happening in one's 
ody.
Here is a quote from the blog post:  "...  the more existential aspects 
f medicine, I see the doctor as a translator."
She continues:  "For most people, medicine is a foreign country, with 
ts own language, customs, and mores. My patients are immigrants to this 
ountry, and many feel very disoriented. My job, as their physician, is 
o translate this alien world for them, to help them acclimatize and 
opefully thrive.""
I found the article very thought-provoking and wanted to share it with 
ll of you.
nab
_______________________
adine A. Bendycki, Principal
arketWhys *
838 Faversham Road
leveland, Ohio  44118
16-371-0444
16-371-5631 (fax)
16-374-3844 (cell)
esearch at mrktwhys.com
*Turning Market Research into Marketing Insight

-----------------------------
Message: 3
ate: Fri, 06 Nov 2009 12:04:50 -0500
rom: "Alec McKinney" <alec_mckinney at jsi.com>
ubject: [HealthLiteracy 3698] Re: Labeling "at risk" people?   Or
   labelingpoor communication?
o: "The Health and Literacy Discussion List"
   <healthliteracy at nifl.gov>,  <ar at plainlanguageworks.com>
essage-ID: <4AF410E2.6C3E.0093.0 at jsi.com>
ontent-Type: text/plain; charset="utf-8"
Another important point to consider in trying to set some standards is
hat a number of agencies (NCQA and AHRQ) are developing Medical Home
tandards that could eventually be linked to get enhanced reimbursement
or Medicare and Medicaid payment.  These guidelines will cover care
oordination, integration of primary care specialty services, etc. etc.
er the current medical home literature but I have not heard that they
re considering health literacy issues or even cultural competence
raining of providers.  This would be another avenue to explore.

Alec  

lec McKinney
enior Analyst/Project Director
ohn Snow, Inc.
4 Farnsworth Street
oston, MA  02210
ork Phone: 617-482-9485
ell Phone: 617-699-9473
ax: 617-482-0617
-mail: amckinney at jsi.com 

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

i all -
Nancy commented - ?What now is becoming a barrier is that many
nstitutions do have their own "health literacy experts" on staff. These
ndividuals are now turning out improved readability documents...but
t's not enough.?
There are ongoing efforts ? in particular I am thinking of the Joint
ommission ? to develop accreditation standards for hospitals in this
egard ... 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
vailable online at their site. As far as I could tell (and it was I
mphasize a quick search) those proposed changes only add health
iteracy in the following:
Standard PC.02.03.01 The hospital provides patient education and
raining based on each patient?s needs and abilities.
P 1. The hospital performs a learning needs assessment for each
atient, which includes the patient?s
ultural and religious beliefs, emotional barriers, desire and
otivation to learn, physical or cognitive
imitations, health literacy needs, and barriers to communication.
I found no mention of evaluating the health literacy environment of the
ospital ? something that many of us have done in our own work. Nor any
ention of health literacy training for health professionals ? again
omething that is offered by a number of people on this list. Given the
rowing strength and size of people working in health literacy around
he world ? I would suggest those two are very ?doable? now.
One caveat ? this quick search only looked at what was easily
ccessible online at the Joint Commission?s web site ? I would be
elighted to learn there is something more in the works there that is
ither unavailable to the public or that I missed.
So, I hope the folks doing the good work at the Joint Commission take
ancy?s observation to heart and boost the presence of health literacy
n those proposed accreditation guidelines. Evaluating the patient?s
eeds is a good start but, in Nancy?s words, ?it?s not enough.?
Best,
Andrew Pleasant
ealth Literacy and Communication Director, Canyon Ranch Institute
ssistant 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
he responsibility on the institutions etc and challenge them all you
ant but this does NOT mean they have the skills or understanding to
evelop the products that people will understand. I currently am working
ith the health education staff at a large healthcare system. They can
un the readability scales through the tests but they still do not
nderstand 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
ike. We need to continue to push for partnerships between the people
orking with the more vulnerable populations and the institutions to
earn together. What now is becoming a barrier is that many institutions
o have their own "health literacy experts" on staff. These individuals
re now turning out improved readability documents...but it's not
nough. We need to explore ways to make the information "contextual."
hat's the background for this document (ex. Patient Bill of Right?)
hat does a person need to have in terms of background knowledge to make
his piece of paper "memorable" in the context of their life experience.
ut this opens another can of worms because of the many different
ub-populations. 
On Tue, Nov 3, 2009 at 11:26 AM, Audrey Riffenburgh
ar at plainlanguageworks.com> wrote:
reetings, all, 
 
Fran, I DO say ?this makes sense for everyone? and it's true. If you
ook at the NAAL health literacy data, you?ll see that ?only 12% of the
opulation is proficient" in the tasks required for health literacy. But
 think we need to turn that on its head and say ?the health, medical,
nd insurance industries have built systems that do not work for 88% of
heir intended audiences.? I think we ought to start using that kind of
abeling. 
 
As we make the case, we don?t have to point out any specific ?at risk?
opulations because 88% of us are at risk of not being able to handle
he systems that we?re forced to use to get our health care, learn about
ealthy choices, etc. We need to make the case for change from that
erspective and challenge the institutions, corporations, agencies, etc.
o recreate systems and processes that work for everyone, no matter
heir educational, literacy, or language skills. That is their
esponsibility, I believe! In communication, whether patient education,
echnical writing, social marketing, or advertising, the
riters?/speakers? first task is to know their audience and customize
o the audience?s needs and interests. That means one does not use
ethods that reach only 12% of your audience! Let?s put the
esponsibility where it should be.    
 
Audrey  Riffenburgh, M.A., President
lain Language Works, LLC 
Specialists in Plain Language & Health Literacy since 1994
Based Albuquerque, New Mexico,  USA 
hone: (505) 345-1107   E-mail:
r at plainlanguageworks.com<mailto:ar at plainlanguageworks.com> (
ailto:ar at plainlanguageworks.com ) 
========================================
rincipal and Founding Member,
ww.clearlanguagegroup.com<http://www.clearlanguagegroup.com/>
 http://www.clearlanguagegroup.com/ ) 
o-founder and former Faculty,
ww.healthliteracyinstitute.net<http://www.healthliteracyinstitute.net/>
 http://www.healthliteracyinstitute.net/ ) 
h.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

nkind.

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

o

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

eed to identify

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

he skeptics,

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

akes 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

s in some

> situation has problems understanding because of our capacity

variable over time

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

oo 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> (

ttp://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

hared the

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

uts 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

ecome a label

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

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

> y>

> www.hsph.harvard.edu/sisterstogether

http://www.hsph.harvard.edu/sisterstogether> (
ttp://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

lliteracy.

> 

> 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

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

> y>

> www.hsph.harvard.edu/sisterstogether

http://www.hsph.harvard.edu/sisterstogether> (
ttp://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

ospital patients,

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

nyone had

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

reat 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> (

ailto: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

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

> Email delivered to ihabramson at aol.com 

> 

> 

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

> 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 

> Email delivered to ihabramson at aol.com 

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

> 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 

> Email delivered to frances.e.robinson at hitchcock.org 

> --- end of quote ---

> 

> 

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

> 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 

> Email delivered to ar at plainlanguageworks.com 

----------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov 
o unsubscribe or change your subscription settings, please go to
ttp://www.nifl.gov/mailman/listinfo/healthliteracy 
mail delivered to njmeyers at gmail.com 

---------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov 
o unsubscribe or change your subscription settings, please go to
ttp://www.nifl.gov/mailman/listinfo/healthliteracy 
mail delivered to pleasant at aesop.rutgers.edu 
-------------- next part --------------
n HTML attachment was scrubbed...
RL: http://www.nifl.gov/pipermail/healthliteracy/attachments/20091106/25dc8aaa/attachment.html 

-----------------------------
Message: 4
ate: Fri, 06 Nov 2009 12:35:07 -0500
rom: Wendy Mettger <wmettger at mindspring.com>
ubject: [HealthLiteracy 3699] Re: Principles for health literacyand
   avoid labeling
o: The Health and Literacy Discussion List <healthliteracy at nifl.gov>
essage-ID: <4AF45E4B.9040400 at mindspring.com>
ontent-Type: text/plain; charset="utf-8"
Hi all,
Julie, I absolutely agree with your recommendations about broadening the 
oncept of health literacy and including health care providers and 
ystems as part of the change process. I have long been an advocate of 
emoving the "labels" applied to certain individuals, groups, 
ommunities, populations, etc.
Here's the dilemma that I see. Labeling has served an important historic 
unction to draw attention to "less visible" populations. When I 
stablished a communications program for people with "limited literacy" 
kills at the National Cancer Institute back in the early 1990's, it was 
esigned to draw attention to a terribly underserved population. At the 
ime, the vast majority of NCI publications and research interventions 
ere targeting populations with strong reading skills. Part of the 
eason for using terms like "limited literacy" or "low literacy" was to 
raw attention to populations who typically were not on the radar screen 
f public health officials and practitioners. It often seemed to me that 
any health researchers, professionals, and practitioners didn't see or 
cknowledge the existence of people who had different skill levels from 
heir own.
I see how labeling continues today. The Health Literacy Research 
onference in Washington, DC this past October featured a number of 
resentations about research into new methods to measure health literacy 
kills of patients. Many of these efforts are funded by NIH. The issue 
s that the "labeling process" is part of what generates a funding 
tream. My question is how can we remove the labels and stigmas attached 
o those labels and still ensure funding of important research that 
ooks at the need for improving the health literacy skills of our health 
are professionals and access to and navigability of our health care 
ystems?
Wendy
Wendy Mettger, M.A.
resident, Mettger Communications
o-founder and Principal, Clear Language Group
Julie McKinney wrote:

>Hello Everyone,


Thanks for this discussion. It is very cool to see this diverse group of
people weighing in to advance the field of health literacy in this way.
(Look at the signature lines of those involved for the variety of fields
and backgrounds and perspectives you all bring!) Please excuse me for
getting a bit "rah-rah!", but I do think this is an exciting time for
health literacy, and we are all part of it. 

As Archie pointed out, we do keep coming back to this: that the burden
of improving health literacy does not lie only on the shoulders of the
patients, but also on the shoulders of all who deliver health care and
health information, AND on the shoulders of the systems that drive this
delivery. We also keep coming back to the fact that it is not only those
with literacy challenges who have trouble staying healthy.

For years on this list and elsewhere, this double-sided concept of
health literacy has been evolving, and I think we should adopt it as a
given. 

  * Can we now talk about health care providers as also "needing to
improve their health literacy"? Yes! 

  * Should we now let go of the concept of testing patients to see who
is "at risk", and instead realize that in the current system we are ALL
"at risk", and so aim to provide clear, simple and appropriate
communication and non-intimidating access for everyone? Yes!

  * Should we develop rigorous measures of the health literacy of health
providers and systems so we can create and evaluate effective
interventions for them as well as for patients? Yes!

When the Institute of Medicine released their report in 2004, they
mobilized the medical community by publicizing the fact that 90 million
Americans "have difficulty understanding and acting on health
information". This was tremendously useful in creating widespread
awareness and work toward more understandable health information. But it
was based on a narrower definition of health literacy, which focused on
(as Rima said) "the capacities of individuals."

Thanks, Linda, for announcing the Calgary Charter, because I think this
could become the new definition and set of core principles, which we can
use to mobilize support for the new broader concept of health literacy.
I know that those who collaborated to develop this charter worked hard
to acknowledge the concepts that we have all been discussing in this
recent conversation on this list. If we agree, perhaps we can talk about
how to make this understanding more widespread? (And if we don't agree,
that would also be an interesting discussion!)

I would love to hear what you all think about this. And I am sorry for
going on so long!

All the best,
Julie



Julie McKinney
Health Literacy List Moderator
World Education
jmckinney at worlded.org
  


>>>"Linda Shohet" <lshohet at dawsoncollege.qc.ca> 11/05/09 4:19 PM >>>

>>>        

>>>

Hello all

In the context of the stimulating discussion over the last few days
regarding 
labeling of ?at-risk? patients, I would like to share the most recent
version 
of The Calgary Charter on Health Literacy: Rationale and Core Principles
for 
the Development of Health Literacy Curricula, posted at 
http://www.centreforliteracy.qc.ca/Healthlitinst/Calgary_Charter_Oct_09.pdf.

This document was drafted and revised over the past year by six
individuals* 
who attended the October 2008 Institute on Health Literacy Curricula in 
Calgary, co-hosted by The Centre for Literacy of Quebec.  The Charter 
proposes a definition and understanding of health literacy and a set of
core 
principles to support the development of curricula and evaluation tools
that 
improve the health literacy for diverse audiences and purposes.  It 
specifically avoids labeling any groups and assumes that health literacy

touches individuals and health systems, and while expressed differently
in 
different contexts, is always based on the same underlying skills and 
abilities.  There is considerable consistency between these principles
and 
the ones in a proposed US Health Literacy Natiopresented by Cynthia Baur last 
eek at the Georgia Health Literacy
Symposium. 

We have shared earlier drafts with this list and with participants at 
selected conferences and events, and have incorporated the feedback we 
received.  We will give anyone interested the chance to sign on to the 
Charter in the coming days.  In the meantime, we welcome your thoughts
about 
if or how you might use these principles in your own curriculum or
evaluation 
work.  

* Charter authors, alphabetically
?  Clifford Coleman, M.D.    colemanc at ohsu.edu
Oregon Health & Science University

?  Sabrina Kurtz-Rossi, M.Ed.sabrina_kurtz-rossi at comcast.net
Kurtz-Rossi & Associates

?  Julie McKinney, M.S.      julie_mcKinney at worlded.org
World Education, Inc.

?  Andrew Pleasant, Ph.D.     pleasant at AESOP.Rutgers.edu
Canyon Ranch Institute & Rutgers University

?  Irving Rootman, Ph.D.      irootman at telus.net
University of Victoria, British Columbia

?  Linda Shohet, Ph.D.       ed at centreforliteracy.qc.ca
The Centre for Literacy of Quebec



Linda Shohet


--
Linda Shohet, PhD
Executive Director
The Centre for Literacy of Quebec
2100 Marlowe Avenue, Suite 236
Montreal, Quebec
Canada, H4A 3L5
Tel.:(514) 798-5601, ext. 24
Fax: (514) 798-5602
E-mail: ed at centreforliteracy.qc.ca
Web site: www.centreforliteracy.qc.ca

----------------------------------------------------
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
Email delivered to julie_mckinney 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 
ttp://www.nifl.gov/mailman/listinfo/healthliteracy
Email delivered to wmettger at mindspring.com

------------- next part --------------
n HTML attachment was scrubbed...
RL: http://www.nifl.gov/pipermail/healthliteracy/attachments/20091106/d5ea2fd6/attachment.html 

-----------------------------
----------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov
o unsubscribe or change your subscription settings, please go to 
ttp://www.nifl.gov/mailman/listinfo/healthliteracy
End of HealthLiteracy Digest, Vol 50, Issue 12
*********************************************



When replying, please edit your Subject line so it is more specific
han "Re: Contents of HealthLiteracy digest..."


oday's Topics:
   1. [HealthLiteracy 3696] Re: Principles for  healthliteracy
     curriculumthat avoid labeling (Owens, Rosemond)
  2. [HealthLiteracy 3697] interesting blog post - physician as
     translator (MarketWhys Research)
  3. [HealthLiteracy 3698] Re: Labeling "at risk" people?  Or
     labelingpoor communication? (Alec McKinney)
  4. [HealthLiteracy 3699] Re: Principles for health literacyand
     avoid labeling (Wendy Mettger)

---------------------------------------------------------------------
Message: 1
ate: Fri, 6 Nov 2009 10:03:48 -0600
rom: "Owens, Rosemond" <OwensR at centracare.com>
ubject: [HealthLiteracy 3696] Re: Principles for   healthliteracy
   curriculumthat avoid labeling
o: "The Health and Literacy Discussion List"
   <healthliteracy at nifl.gov>
essage-ID:
   <B52F7BEE5A62CF438593DD78A8D765D0021382D1 at CCHSEXCHBE01.centracare.com>
ontent-Type: text/plain;   charset="us-ascii"
Hello,
 Good morning. My name is Rosemond Owens. My institution, CentraCare
ealth System, is member of the Minnesota Health Literacy Partnership. I
m glad all of you health literacy aficionados have been talking about
he shared responsibility of the burden of improving health literacy.
Over at the Minnesota Health Literacy Partnership, anytime we define
ealth Literacy as "A patient's ability to obtain, understand and act on
ealth information" we also talk about how we at the Partnership have
xpanded the definition.
e do this by including  "A provider's capacity to communicate clearly,
ducate about health and empower their patients" in the definition.
May be it's time that the powers that be also expand the formal
efinition.
Please visit the website to see some of what we are doing in Minnesota
o improve the health of all Minnesotans through Clear Communication.

ttp://healthlit.themlc.org/home.html

Exciting times in the field of health literacy indeed!
Sincerely,
Rosemond

Rosemond Sarpong Owens
ealth Literacy/Cultural Competency Specialist
entraCare Health System
520 Whitney Court, Ste.200
aint Cloud, MN 56303
h :( 320) 240-3102
ager (320) 656-7945


inguistically and culturally appropriate care has a direct impact on
uality and safety, and is a growing issue that is not going to go
way." 
-Paul M. Schyve, M.D., Senior Vice President, the Joint Commission

----Original Message-----
rom: healthliteracy-bounces at nifl.gov
mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
ent: Friday, November 06, 2009 9:42 AM
o: healthliteracy at nifl.gov
ubject: [HealthLiteracy 3695] Re: Principles for healthliteracy
urriculumthat avoid labeling
Hello Everyone,
Thanks for this discussion. It is very cool to see this diverse group of
eople weighing in to advance the field of health literacy in this way.
Look at the signature lines of those involved for the variety of fields
nd backgrounds and perspectives you all bring!) Please excuse me for
etting a bit "rah-rah!", but I do think this is an exciting time for
ealth literacy, and we are all part of it. 
As Archie pointed out, we do keep coming back to this: that the burden
f improving health literacy does not lie only on the shoulders of the
atients, but also on the shoulders of all who deliver health care and
ealth information, AND on the shoulders of the systems that drive this
elivery. We also keep coming back to the fact that it is not only those
ith literacy challenges who have trouble staying healthy.
For years on this list and elsewhere, this double-sided concept of
ealth literacy has been evolving, and I think we should adopt it as a
iven. 
  * Can we now talk about health care providers as also "needing to
mprove their health literacy"? Yes! 
  * Should we now let go of the concept of testing patients to see who
s "at risk", and instead realize that in the current system we are ALL
at risk", and so aim to provide clear, simple and appropriate
ommunication and non-intimidating access for everyone? Yes!
  * Should we develop rigorous measures of the health literacy of health
roviders and systems so we can create and evaluate effective
nterventions for them as well as for patients? Yes!
When the Institute of Medicine released their report in 2004, they
obilized the medical community by publicizing the fact that 90 million
mericans "have difficulty understanding and acting on health
nformation". This was tremendously useful in creating widespread
wareness and work toward more understandable health information. But it
as based on a narrower definition of health literacy, which focused on
as Rima said) "the capacities of individuals."
Thanks, Linda, for announcing the Calgary Charter, because I think this
ould become the new definition and set of core principles, which we can
se to mobilize support for the new broader concept of health literacy.
 know that those who collaborated to develop this charter worked hard
o acknowledge the concepts that we have all been discussing in this
ecent conversation on this list. If we agree, perhaps we can talk about
ow to make this understanding more widespread? (And if we don't agree,
hat would also be an interesting discussion!)
I would love to hear what you all think about this. And I am sorry for
oing on so long!
All the best,
ulie

Julie McKinney
ealth Literacy List Moderator
orld Education
mckinney at worlded.org

>> "Linda Shohet" <lshohet at dawsoncollege.qc.ca> 11/05/09 4:19 PM >>>

ello all
In the context of the stimulating discussion over the last few days
egarding 
abeling of "at-risk" patients, I would like to share the most recent
ersion 
f The Calgary Charter on Health Literacy: Rationale and Core Principles
or 
he Development of Health Literacy Curricula, posted at 
ttp://www.centreforliteracy.qc.ca/Healthlitinst/Calgary_Charter_Oct_09.
df.
This document was drafted and revised over the past year by six
ndividuals* 
ho attended the October 2008 Institute on Health Literacy Curricula in 
algary, co-hosted by The Centre for Literacy of Quebec.  The Charter 
roposes a definition and understanding of health literacy and a set of
ore 
rinciples to support the development of curricula and evaluation tools
hat 
mprove the health literacy for diverse audiences and purposes.  It 
pecifically avoids labeling any groups and assumes that health literacy
touches individuals and health systems, and while expressed differently
n 
ifferent contexts, is always based on the same underlying skills and 
bilities.  There is considerable consistency between these principles
nd 
he ones in a proposed US Health Literacy Natiopresented by Cynthia Baur
ast week at the Georgia Health Literacy
ymposium. 
We have shared earlier drafts with this list and with participants at 
elected conferences and events, and have incorporated the feedback we 
eceived.  We will give anyone interested the chance to sign on to the 
harter in the coming days.  In the meantime, we welcome your thoughts
bout 
f or how you might use these principles in your own curriculum or
valuation 
ork.  
* Charter authors, alphabetically
   Clifford Coleman, M.D.    colemanc at ohsu.edu
regon Health & Science University
*   Sabrina Kurtz-Rossi, M.Ed.sabrina_kurtz-rossi at comcast.net
urtz-Rossi & Associates
*   Julie McKinney, M.S.      julie_mcKinney at worlded.org
orld Education, Inc.
*   Andrew Pleasant, Ph.D.     pleasant at AESOP.Rutgers.edu
anyon Ranch Institute & Rutgers University
*   Irving Rootman, Ph.D.      irootman at telus.net
niversity of Victoria, British Columbia
*   Linda Shohet, Ph.D.       ed at centreforliteracy.qc.ca
he Centre for Literacy of Quebec

Linda Shohet

-
inda Shohet, PhD
xecutive Director
he Centre for Literacy of Quebec
100 Marlowe Avenue, Suite 236
ontreal, Quebec
anada, H4A 3L5
el.:(514) 798-5601, ext. 24
ax: (514) 798-5602
-mail: ed at centreforliteracy.qc.ca
eb site: www.centreforliteracy.qc.ca
----------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov
o unsubscribe or change your subscription settings, please go to
ttp://www.nifl.gov/mailman/listinfo/healthliteracy
mail delivered to julie_mckinney at worlded.org
----------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov
o unsubscribe or change your subscription settings, please go to
ttp://www.nifl.gov/mailman/listinfo/healthliteracy
mail delivered to owensr at centracare.com

-----------------------------
Message: 2
ate: Fri, 06 Nov 2009 11:57:19 -0500
rom: MarketWhys Research <research at mrktwhys.com>
ubject: [HealthLiteracy 3697] interesting blog post - physician as
   translator
o: The Health and Literacy Discussion List <healthliteracy at nifl.gov>
essage-ID: <4AF4556F.8060706 at mrktwhys.com>
ontent-Type: text/plain; charset=ISO-8859-1; format=flowed
I happened upon a very interesting blog post this morning,
http://www.psychologytoday.com/blog/medicine-in-translation/200910/medicine-in-translation
in which the author, Danielle Ofri, M.D., Ph.D., examines the role of a 
hysician as someone who translates/explains what is happening in one's 
ody.
Here is a quote from the blog post:  "...  the more existential aspects 
f medicine, I see the doctor as a translator."
She continues:  "For most people, medicine is a foreign country, with 
ts own language, customs, and mores. My patients are immigrants to this 
ountry, and many feel very disoriented. My job, as their physician, is 
o translate this alien world for them, to help them acclimatize and 
opefully thrive.""
I found the article very thought-provoking and wanted to share it with 
ll of you.
nab
_______________________
adine A. Bendycki, Principal
arketWhys *
838 Faversham Road
leveland, Ohio  44118
16-371-0444
16-371-5631 (fax)
16-374-3844 (cell)
esearch at mrktwhys.com
*Turning Market Research into Marketing Insight

-----------------------------
Message: 3
ate: Fri, 06 Nov 2009 12:04:50 -0500
rom: "Alec McKinney" <alec_mckinney at jsi.com>
ubject: [HealthLiteracy 3698] Re: Labeling "at risk" people?   Or
   labelingpoor communication?
o: "The Health and Literacy Discussion List"
   <healthliteracy at nifl.gov>,  <ar at plainlanguageworks.com>
essage-ID: <4AF410E2.6C3E.0093.0 at jsi.com>
ontent-Type: text/plain; charset="utf-8"
Another important point to consider in trying to set some standards is
hat a number of agencies (NCQA and AHRQ) are developing Medical Home
tandards that could eventually be linked to get enhanced reimbursement
or Medicare and Medicaid payment.  These guidelines will cover care
oordination, integration of primary care specialty services, etc. etc.
er the current medical home literature but I have not heard that they
re considering health literacy issues or even cultural competence
raining of providers.  This would be another avenue to explore.

Alec  

lec McKinney
enior Analyst/Project Director
ohn Snow, Inc.
4 Farnsworth Street
oston, MA  02210
ork Phone: 617-482-9485
ell Phone: 617-699-9473
ax: 617-482-0617
-mail: amckinney at jsi.com 

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

i all -
Nancy commented - ?What now is becoming a barrier is that many
nstitutions do have their own "health literacy experts" on staff. These
ndividuals are now turning out improved readability documents...but
t's not enough.?
There are ongoing efforts ? in particular I am thinking of the Joint
ommission ? to develop accreditation standards for hospitals in this
egard ... 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
vailable online at their site. As far as I could tell (and it was I
mphasize a quick search) those proposed changes only add health
iteracy in the following:
Standard PC.02.03.01 The hospital provides patient education and
raining based on each patient?s needs and abilities.
P 1. The hospital performs a learning needs assessment for each
atient, which includes the patient?s
ultural and religious beliefs, emotional barriers, desire and
otivation to learn, physical or cognitive
imitations, health literacy needs, and barriers to communication.
I found no mention of evaluating the health literacy environment of the
ospital ? something that many of us have done in our own work. Nor any
ention of health literacy training for health professionals ? again
omething that is offered by a number of people on this list. Given the
rowing strength and size of people working in health literacy around
he world ? I would suggest those two are very ?doable? now.
One caveat ? this quick search only looked at what was easily
ccessible online at the Joint Commission?s web site ? I would be
elighted to learn there is something more in the works there that is
ither unavailable to the public or that I missed.
So, I hope the folks doing the good work at the Joint Commission take
ancy?s observation to heart and boost the presence of health literacy
n those proposed accreditation guidelines. Evaluating the patient?s
eeds is a good start but, in Nancy?s words, ?it?s not enough.?
Best,
Andrew Pleasant
ealth Literacy and Communication Director, Canyon Ranch Institute
ssistant 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
he responsibility on the institutions etc and challenge them all you
ant but this does NOT mean they have the skills or understanding to
evelop the products that people will understand. I currently am working
ith the health education staff at a large healthcare system. They can
un the readability scales through the tests but they still do not
nderstand 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
ike. We need to continue to push for partnerships between the people
orking with the more vulnerable populations and the institutions to
earn together. What now is becoming a barrier is that many institutions
o have their own "health literacy experts" on staff. These individuals
re now turning out improved readability documents...but it's not
nough. We need to explore ways to make the information "contextual."
hat's the background for this document (ex. Patient Bill of Right?)
hat does a person need to have in terms of background knowledge to make
his piece of paper "memorable" in the context of their life experience.
ut this opens another can of worms because of the many different
ub-populations. 
On Tue, Nov 3, 2009 at 11:26 AM, Audrey Riffenburgh
ar at plainlanguageworks.com> wrote:
reetings, all, 
 
Fran, I DO say ?this makes sense for everyone? and it's true. If you
ook at the NAAL health literacy data, you?ll see that ?only 12% of the
opulation is proficient" in the tasks required for health literacy. But
 think we need to turn that on its head and say ?the health, medical,
nd insurance industries have built systems that do not work for 88% of
heir intended audiences.? I think we ought to start using that kind of
abeling. 
 
As we make the case, we don?t have to point out any specific ?at risk?
opulations because 88% of us are at risk of not being able to handle
he systems that we?re forced to use to get our health care, learn about
ealthy choices, etc. We need to make the case for change from that
erspective and challenge the institutions, corporations, agencies, etc.
o recreate systems and processes that work for everyone, no matter
heir educational, literacy, or language skills. That is their
esponsibility, I believe! In communication, whether patient education,
echnical writing, social marketing, or advertising, the
riters?/speakers? first task is to know their audience and customize
o the audience?s needs and interests. That means one does not use
ethods that reach only 12% of your audience! Let?s put the
esponsibility where it should be.    
 
Audrey  Riffenburgh, M.A., President
lain Language Works, LLC 
Specialists in Plain Language & Health Literacy since 1994
Based Albuquerque, New Mexico,  USA 
hone: (505) 345-1107   E-mail:
r at plainlanguageworks.com<mailto:ar at plainlanguageworks.com> (
ailto:ar at plainlanguageworks.com ) 
========================================
rincipal and Founding Member,
ww.clearlanguagegroup.com<http://www.clearlanguagegroup.com/>
 http://www.clearlanguagegroup.com/ ) 
o-founder and former Faculty,
ww.healthliteracyinstitute.net<http://www.healthliteracyinstitute.net/>
 http://www.healthliteracyinstitute.net/ ) 
h.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

nkind.

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

o

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

eed to identify

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

he skeptics,

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

akes 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

s in some

> situation has problems understanding because of our capacity

variable over time

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

oo 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> (

ttp://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

hared the

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

uts 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

ecome a label

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

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

> y>

> www.hsph.harvard.edu/sisterstogether

http://www.hsph.harvard.edu/sisterstogether> (
ttp://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

lliteracy.

> 

> 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

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

> y>

> www.hsph.harvard.edu/sisterstogether

http://www.hsph.harvard.edu/sisterstogether> (
ttp://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

ospital patients,

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

nyone had

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

reat 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> (

ailto: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

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

> Email delivered to ihabramson at aol.com 

> 

> 

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

> 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 

> Email delivered to ihabramson at aol.com 

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

> 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 

> Email delivered to frances.e.robinson at hitchcock.org 

> --- end of quote ---

> 

> 

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

> 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 

> Email delivered to ar at plainlanguageworks.com 

----------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov 
o unsubscribe or change your subscription settings, please go to
ttp://www.nifl.gov/mailman/listinfo/healthliteracy 
mail delivered to njmeyers at gmail.com 

---------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov 
o unsubscribe or change your subscription settings, please go to
ttp://www.nifl.gov/mailman/listinfo/healthliteracy 
mail delivered to pleasant at aesop.rutgers.edu 
-------------- next part --------------
n HTML attachment was scrubbed...
RL: http://www.nifl.gov/pipermail/healthliteracy/attachments/20091106/25dc8aaa/attachment.html 

-----------------------------
Message: 4
ate: Fri, 06 Nov 2009 12:35:07 -0500
rom: Wendy Mettger <wmettger at mindspring.com>
ubject: [HealthLiteracy 3699] Re: Principles for health literacyand
   avoid labeling
o: The Health and Literacy Discussion List <healthliteracy at nifl.gov>
essage-ID: <4AF45E4B.9040400 at mindspring.com>
ontent-Type: text/plain; charset="utf-8"
Hi all,
Julie, I absolutely agree with your recommendations about broadening the 
oncept of health literacy and including health care providers and 
ystems as part of the change process. I have long been an advocate of 
emoving the "labels" applied to certain individuals, groups, 
ommunities, populations, etc.
Here's the dilemma that I see. Labeling has served an important historic 
unction to draw attention to "less visible" populations. When I 
stablished a communications program for people with "limited literacy" 
kills at the National Cancer Institute back in the early 1990's, it was 
esigned to draw attention to a terribly underserved population. At the 
ime, the vast majority of NCI publications and research interventions 
ere targeting populations with strong reading skills. Part of the 
eason for using terms like "limited literacy" or "low literacy" was to 
raw attention to populations who typically were not on the radar screen 
f public health officials and practitioners. It often seemed to me that 
any health researchers, professionals, and practitioners didn't see or 
cknowledge the existence of people who had different skill levels from 
heir own.
I see how labeling continues today. The Health Literacy Research 
onference in Washington, DC this past October featured a number of 
resentations about research into new methods to measure health literacy 
kills of patients. Many of these efforts are funded by NIH. The issue 
s that the "labeling process" is part of what generates a funding 
tream. My question is how can we remove the labels and stigmas attached 
o those labels and still ensure funding of important research that 
ooks at the need for improving the health literacy skills of our health 
are professionals and access to and navigability of our health care 
ystems?
Wendy
Wendy Mettger, M.A.
resident, Mettger Communications
o-founder and Principal, Clear Language Group
Julie McKinney wrote:

>Hello Everyone,


Thanks for this discussion. It is very cool to see this diverse group of
people weighing in to advance the field of health literacy in this way.
(Look at the signature lines of those involved for the variety of fields
and backgrounds and perspectives you all bring!) Please excuse me for
getting a bit "rah-rah!", but I do think this is an exciting time for
health literacy, and we are all part of it. 

As Archie pointed out, we do keep coming back to this: that the burden
of improving health literacy does not lie only on the shoulders of the
patients, but also on the shoulders of all who deliver health care and
health information, AND on the shoulders of the systems that drive this
delivery. We also keep coming back to the fact that it is not only those
with literacy challenges who have trouble staying healthy.

For years on this list and elsewhere, this double-sided concept of
health literacy has been evolving, and I think we should adopt it as a
given. 

  * Can we now talk about health care providers as also "needing to
improve their health literacy"? Yes! 

  * Should we now let go of the concept of testing patients to see who
is "at risk", and instead realize that in the current system we are ALL
"at risk", and so aim to provide clear, simple and appropriate
communication and non-intimidating access for everyone? Yes!

  * Should we develop rigorous measures of the health literacy of health
providers and systems so we can create and evaluate effective
interventions for them as well as for patients? Yes!

When the Institute of Medicine released their report in 2004, they
mobilized the medical community by publicizing the fact that 90 million
Americans "have difficulty understanding and acting on health
information". This was tremendously useful in creating widespread
awareness and work toward more understandable health information. But it
was based on a narrower definition of health literacy, which focused on
(as Rima said) "the capacities of individuals."

Thanks, Linda, for announcing the Calgary Charter, because I think this
could become the new definition and set of core principles, which we can
use to mobilize support for the new broader concept of health literacy.
I know that those who collaborated to develop this charter worked hard
to acknowledge the concepts that we have all been discussing in this
recent conversation on this list. If we agree, perhaps we can talk about
how to make this understanding more widespread? (And if we don't agree,
that would also be an interesting discussion!)

I would love to hear what you all think about this. And I am sorry for
going on so long!

All the best,
Julie



Julie McKinney
Health Literacy List Moderator
World Education
jmckinney at worlded.org
  


>>>"Linda Shohet" <lshohet at dawsoncollege.qc.ca> 11/05/09 4:19 PM >>>

>>>        

>>>

Hello all

In the context of the stimulating discussion over the last few days
regarding 
labeling of ?at-risk? patients, I would like to share the most recent
version 
of The Calgary Charter on Health Literacy: Rationale and Core Principles
for 
the Development of Health Literacy Curricula, posted at 
http://www.centreforliteracy.qc.ca/Healthlitinst/Calgary_Charter_Oct_09.pdf.

This document was drafted and revised over the past year by six
individuals* 
who attended the October 2008 Institute on Health Literacy Curricula in 
Calgary, co-hosted by The Centre for Literacy of Quebec.  The Charter 
proposes a definition and understanding of health literacy and a set of
core 
principles to support the development of curricula and evaluation tools
that 
improve the health literacy for diverse audiences and purposes.  It 
specifically avoids labeling any groups and assumes that health literacy

touches individuals and health systems, and while expressed differently
in 
different contexts, is always based on the same underlying skills and 
abilities.  There is considerable consistency between these principles
and 
the ones in a proposed US Health Literacy Natiopresented by Cynthia Baur last 
eek at the Georgia Health Literacy
Symposium. 

We have shared earlier drafts with this list and with participants at 
selected conferences and events, and have incorporated the feedback we 
received.  We will give anyone interested the chance to sign on to the 
Charter in the coming days.  In the meantime, we welcome your thoughts
about 
if or how you might use these principles in your own curriculum or
evaluation 
work.  

* Charter authors, alphabetically
?  Clifford Coleman, M.D.    colemanc at ohsu.edu
Oregon Health & Science University

?  Sabrina Kurtz-Rossi, M.Ed.sabrina_kurtz-rossi at comcast.net
Kurtz-Rossi & Associates

?  Julie McKinney, M.S.      julie_mcKinney at worlded.org
World Education, Inc.

?  Andrew Pleasant, Ph.D.     pleasant at AESOP.Rutgers.edu
Canyon Ranch Institute & Rutgers University

?  Irving Rootman, Ph.D.      irootman at telus.net
University of Victoria, British Columbia

?  Linda Shohet, Ph.D.       ed at centreforliteracy.qc.ca
The Centre for Literacy of Quebec



Linda Shohet


--
Linda Shohet, PhD
Executive Director
The Centre for Literacy of Quebec
2100 Marlowe Avenue, Suite 236
Montreal, Quebec
Canada, H4A 3L5
Tel.:(514) 798-5601, ext. 24
Fax: (514) 798-5602
E-mail: ed at centreforliteracy.qc.ca
Web site: www.centreforliteracy.qc.ca

----------------------------------------------------
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
Email delivered to julie_mckinney 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 
ttp://www.nifl.gov/mailman/listinfo/healthliteracy
Email delivered to wmettger at mindspring.com

------------- next part --------------
n HTML attachment was scrubbed...
RL: http://www.nifl.gov/pipermail/healthliteracy/attachments/20091106/d5ea2fd6/attachment.html 

-----------------------------
----------------------------------------------------
ational Institute for Literacy
ealth and Literacy mailing list
ealthLiteracy at nifl.gov
o unsubscribe or change your subscription settings, please go to 
ttp://www.nifl.gov/mailman/listinfo/healthliteracy
End of HealthLiteracy Digest, Vol 50, Issue 12
*********************************************

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://www.nifl.gov/pipermail/healthliteracy/attachments/20091106/9f895844/attachment-0001.html