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On the note of treating low health literacy as an individual deficiency
and of ignoring important aspects of the social environment--e.g.,
social support and resources, check out a paper in the <i>Social
Science & Medicine</i>. An electronic copy is attached.<br>
<br>
Daniel Lee<br>
<br>
Sandra Smith wrote:
<blockquote cite="mid20070201224425.2770F33F46@smtp2.cypresscom.net"
type="cite">
<pre wrap="">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
<a class="moz-txt-link-abbreviated" href="http://www.BeginningsGuides.net">www.BeginningsGuides.net</a>
<a class="moz-txt-link-abbreviated" href="mailto:sandras@u.washington.edu">sandras@u.washington.edu</a>
-----Original Message-----
From: <a class="moz-txt-link-abbreviated" href="mailto:healthliteracy-bounces@nifl.gov">healthliteracy-bounces@nifl.gov</a>
[<a class="moz-txt-link-freetext" href="mailto:healthliteracy-bounces@nifl.gov">mailto:healthliteracy-bounces@nifl.gov</a>] 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
</pre>
<blockquote type="cite">
<pre wrap="">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:
<a class="moz-txt-link-abbreviated" href="http://www.madison-co-ky-health.org">www.madison-co-ky-health.org</a>
-----Original Message-----
From: <a class="moz-txt-link-abbreviated" href="mailto:healthliteracy-bounces@nifl.gov">healthliteracy-bounces@nifl.gov</a>
[<a class="moz-txt-link-freetext" href="mailto:healthliteracy-bounces@nifl.gov">mailto:healthliteracy-bounces@nifl.gov</a>]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: <a class="moz-txt-link-abbreviated" href="mailto:DICKERR2@ihs.org">DICKERR2@ihs.org</a>
Website: <a class="moz-txt-link-abbreviated" href="http://www.ihsdesmoines.org">www.ihsdesmoines.org</a>
-----Original Message-----
From: <a class="moz-txt-link-abbreviated" href="mailto:healthliteracy-bounces@nifl.gov">healthliteracy-bounces@nifl.gov</a>
[<a class="moz-txt-link-freetext" href="mailto:healthliteracy-bounces@nifl.gov">mailto:healthliteracy-bounces@nifl.gov</a>] On Behalf Of Julie McKinney
Sent: Friday, January 26, 2007 12:35 PM
To: <a class="moz-txt-link-abbreviated" href="mailto:healthliteracy@nifl.gov">healthliteracy@nifl.gov</a>
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:
<a class="moz-txt-link-freetext" href="http://www.askme3.org/">http://www.askme3.org/</a>
Also, look at the the online videos from AMA's group: Educating
Physicians on Controversies in Health
<a class="moz-txt-link-freetext" href="http://www.ama-assn.org/ama/pub/category/15369.html">http://www.ama-assn.org/ama/pub/category/15369.html</a>
Check this out for lots of links to other good resources:
The Health Literacy area of the ALE Wiki:
<a class="moz-txt-link-freetext" href="http://wiki.literacytent.org/index.php/Health_Literacy">http://wiki.literacytent.org/index.php/Health_Literacy</a>
Good luck!
Julie
Julie McKinney
Discussion List Moderator
World Education/NCSALL
<a class="moz-txt-link-abbreviated" href="mailto:jmckinney@worlded.org">jmckinney@worlded.org</a>
</pre>
<blockquote type="cite">
<blockquote type="cite">
<blockquote type="cite">
<pre wrap=""> "Zeitz, Howard" <a class="moz-txt-link-rfc2396E" href="mailto:hzeitz@uic.edu"><hzeitz@uic.edu></a> 01/25/07 8:49 PM >>>
</pre>
</blockquote>
</blockquote>
</blockquote>
<pre wrap="">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:
</pre>
<blockquote type="cite">
<pre wrap=""> Hello. I really enjoy being part of this list and having access not
</pre>
</blockquote>
<pre wrap="">only
</pre>
<blockquote type="cite">
<pre wrap=""> to some great minds and terrific resources, but participating in
networking that really supports our work. This is the first time I
</pre>
</blockquote>
<pre wrap="">have
</pre>
<blockquote type="cite">
<pre wrap=""> reached out to the network. I am developing training curriculum that
</pre>
</blockquote>
<pre wrap="">is
</pre>
<blockquote type="cite">
<pre wrap=""> indirectly about patient communication skills, patient/physician
communication. The training is for health and human service providers
</pre>
</blockquote>
<pre wrap="">on
</pre>
<blockquote type="cite">
<pre wrap=""> 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
</pre>
</blockquote>
<pre wrap=""> > building patient communications skills , what resources, activities,
</pre>
<blockquote type="cite">
<pre wrap=""> 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
<a class="moz-txt-link-abbreviated" href="http://www.hcsm.org/sphere">www.hcsm.org/sphere</a> <a class="moz-txt-link-rfc2396E" href="http://www.hcsm.org/sphere"><http://www.hcsm.org/sphere></a>
</pre>
</blockquote>
<pre wrap="">========================================================================
===
</pre>
<blockquote type="cite">
<pre wrap=""> Julie McKinney
Discussion List Moderator
World Education/NCSALL
<a class="moz-txt-link-abbreviated" href="mailto:jmckinney@worlded.org">jmckinney@worlded.org</a>
----------------------------------------------------
National Institute for Literacy
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</pre>
</blockquote>
<pre wrap="">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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<pre wrap=""><!---->
--
-----------------------------------------------
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
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