Health literacy and the emergency room

A multicenter, cross-sectional study in last month's Academic Emergency Medicine administered a short health literacy assessment questionnaire to 300 patients in 3 Boston emergency rooms. In addition to examining raw scores, investigators also looked at correlations with other sociodemographic variables.

Older age, less education, and lower income were all associated with reduced functional health literacy. Associations with ethnicity, race, and language were not statistically significant in the multivariate analysis (i.e. after correcting for other variables).

The authors note "In this sample, one-quarter of ED patients would be expected to have difficulty understanding health materials and following prescribed treatment regimens. Advanced age and low socioeconomic status were independently associated with limited health literacy. The ability of a significant subgroup of ED patients to understand health information, especially during illness or injury, requires further study."

One potential limitation that comes to mind - a cross-sectional study gives just a snapshot, rather than a longitudinal assessment -- the questionnaire results reflect each individual's completion of a brief test during their stay in the ED setting, which is a fairly difficult environment given the complexity of this kind of healthcare encounter (stress of the health condition, urgency, family issues, financial considerations, etc.). The competing concerns of the environment may shift individual test results downward. If you tested the same person while they were going to a routine visit at their doctor, their results may be different.

On the other hand, the methods of the current study would seem to give an accurate picture of functional health literacy at the moment of crisis, which speaks more to how people may (or may not) be able to handle, process, and retain information in that particular setting.

So, having a librarian stationed in the ED might not, then, be a good idea, but do other strategies come to mind for aiding individuals with lower health literacy in this setting?

Reference: Ginde AA, Weiner SG, Pallin DJ, Camargo CA Jr. Multicenter study of limited health literacy in emergency department patients. Acad Emerg Med. 2008 Jun;15(6):577-80. PubMed abstract

Health and older Americans

Report released yesterday by the National Institute on Aging and the National Center for Health Statistics, among others from the Federal Interagency Forum on Aging-Related Statistics -- Older Americans 2008: Key Indicators of Well-Being, including a special section on literacy and health literacy

More:
- the press release
- PowerPoint slides of charts
- US News & World Report article on the report

African American health literacy

Aetna has put out an African American history calendar this year focusing on health literacy. Each day features facts from African American history (on today in 1924, jazz singer Sarah Vaughan was born) and each month features pictures and profiles of individuals involved in promoting health literacy in different venues (including December - in the library, covered more in an item here in the Charleston Post & Courier).

The introduction to the calendar, Marginal literacy: a growing issue in health care, further discusses both literacy and health literacy issues among African Americans

You can download the calendar from the Aetna site or order your own fancy copy from the company for $4.

(Also, to find literacy programs focused on basic reading proficiency in your area, consult America's Literacy Directory)

Health literacy promotion strategies in primary care

Sponsored by the Commonwealth Fund in NY and Kaiser Permanente, an examination of health literacy-related "promising practices" for clinicians and office staff in the primary care setting - "Health Literacy Practices in Primary Care Settings: Examples from the Field"

This report presents findings from a 2005 study in which the Association of Clinicians for the Underserved first did an online survey of health care facilities across the country and then followed it up with visits to five selected sites for staff and patient interviews. The study identified five health literacy practices that staff considered especially valuable for their group’s patients and potentially applicable to other clinics: a team effort, beginning at the front desk; use of standardized communication tools; use of plain language, face-to-face communication, pictorials, and educational materials; clinicians partner with patients to achieve goals; and organizational commitment to create an environment where health literacy is not assumed.

(via the Health Policy blog)

Health literacy and Magic Johnson

Magic Johnson Enterprises and Aetna have announced a new partnership focused on urban businesses:

Working together, the two companies will strive to empower businesses and ethnically diverse communities to make informed choices about their health care options by improving health care literacy, showing them the benefits of wellness, exercise and healthy eating, and other initiatives...

The principal goals of the relationship are to:

-- Create a dialogue and action in diverse urban communities to help people understand the health resources, products and services available to them, and encourage them to take a more active role in their health and wellness.

-- Give credible voice, via a recognized and respected leader, to major issues in health care such as the need to improve "health literacy." This will include community events and community-based initiatives to increase people's comfort with the language of health care, as well as encourage better understanding of treatment needs and better adherence to a physician's care plan.

-- Raise awareness of racial and ethnic inequality in health care within these communities to empower people to ask questions, seek answers and create a demand for high-quality health care that respects their cultural preferences.

(the project website, which doesn't include much more information yet)

Consumer health: searching confidence

From the Patient Centered Health Information Technology blog - “Confidence” in Health Searches a Poor Indicator of Finding Good Information talks about a new study from the Journal of Medical Internet Research noting:

1. Searching high-quality online resources improves consumers’ health knowledge; and
2. Consumers’ degree of “confidence” in their answers is not a good indicator of whether their answers are correct.

The JMIR study:
Lau AYS, Coiera E. Impact of Web Searching and Social Feedback on Consumer Decision Making: A Prospective Online Experiment. J Med Intern Res 2008;10(1):e2.

Health literacy training

From the MidContinental Region NN/LM blog:

The Health Resources and Services Administration offers a new, free, online course, "Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency”. Those taking the course can receive five credits (CEU/CE, CHES, CME, CNE). The course is valuable for librarians as they reach out to provide support and information to the public and health professionals and would provide them another option to obtain continuing education units. In addition, The Unified Health Communication course complements The Medical Library Association and National Institutes of Health/National Library of Medicine (NLM) work in literacy research, curriculum design and hospital outreach. Freely share this information with other colleagues. http://www.hrsa.gov/healthliteracy/training.htm