Health Literacy Forum: Poster Abstracts

Health Literacy: Its Impact on Health Care and Health Care Costs
Presenters: Merle Rosenzweig and Anna Ercoli Schnitzer
Affiliation: University of Michigan Taubman Health Sciences Library

This poster describes the impact of health literacy on patient care as well as its impact on both the individual and society.  Statistical studies of costs and the multifaceted implications resulting from health literacy issues reveal the depth of this universal problem.

Improving Communication with Patients Having Poor English Literacy

Presenter: Pat Martin
Affiliation: University of Michigan Taubman Health Sciences Library

The 2003 National Assessment of Adult Literacy (NAAL) estimates that 30 million adults in the U.S., 14% of the country’s adult population, have only the most minimal ability to read and write in English. This very real handicap has implications for health care because these people have limited ability to read and understand the instructions contained on prescriptions or medicine bottles, appointment slips, informed consent documents, insurance forms, and health education materials. The purpose of this poster is to raise awareness of low literacy as a barrier to living a healthy life and to illustrate some of the remedies that clinicians can use to improve communication with patients. Resources available to assist both physicians in practice and physicians in training will be introduced. These range from Internet based resources to local community and UMHS resources.

Parish Nursing:  A Community Based Resource for Health Care Education
Presenter: Marguerite DeBello RN MSN ACNS, BC NP
Affiliation: Eastern Michigan University School of Nursing and Prince of Peace Lutheran Church (Farmington Hills, MI)

Parish Nursing is providing a unique health education resource needed due to decreased hospital stays, increased severity of illness, and shortage of registered nurses at the bedside to instruct the patient on health, disease and treatment management.    Parish nurses provide small community, family and individual education on health care issues through a faith-based community.  The parish nurse also identifies at-risk populations with knowledge deficits through post hospitalization follow-up, individual conferencing about healthcare concerns, health screening, workshops, and home visits. Clients of faith-based nursing practice have identified that parish nursing is a benefit that provides needed information that otherwise may be difficult to obtain.  It also is a resource for clients to find accurate information on disease rather than unreliable community sources.   Parish nurses are also in the distinctive position of finding low cost healthcare and education resources in the community that reduce the strain on the already stressed family unit.

Application of plain language guidelines in the development of patient education materials – an interdisciplinary approach
Presenter: Susanne Brooks RN, MSN, OCN, AOCNS
Affiliation: Spectrum Health
The PEC, an interdisciplinary team, is accountable for the comprehensive strategy related to patient education for Butterworth Hospital, Blodgett Hospital and Helen DeVos Children’s Hospital, Grand Rapids, MI.

The PEC, a component of the Nursing Shared Governance Structure, formed in August 2006.   Prior to the formation of the PEC, processes related to the development and cataloging of patient education materials were lacking.  Materials were developed or purchased without review for plain language, consideration of what is available within the system, and accuracy of externally translated materials.  Furthermore, there was not a centralized repository for patient education materials.

Since the inception of the PEC, processes have been developed and embedded across three campuses to address:
•    development of patient education materials using plain language guidelines
•    partnership with Translation and Interpretation Services for review of accuracy of externally translated materials
•    centralized repository for approved patient education materials

Using MERLOT in Health Education
Presenter: Irene Knokh
Affiliation: University of Michigan Health System

MERLOT stands for Multimedia Educational Resources for Learning and Online Teaching. MERLOT is a peer reviewed repository of online resources freely available for the use in teaching/educating.  The participants will learn about using MERLOT repository, ELIXR, MERLOT on YouTube,   MERLOT VOICES, and the vast possibilities of using MERLOT in health education and across the disciplines.

The presenter will share her MERLOT collection and will  have a sign up list to find out more about MERLOT at  UM Community of Practice.

Genetic Health Literacy
Presenters: Erin Payne, MPH, Heather Honoré, PhD, Jody Platt, MPH
Affiliation: American Public Health Assocation Genomics Forum Policy Committee

We are entering a new, rapidly advancing genomic age.  As this era unfolds, a health communications challenge is to ensure access to knowledge and skills necessary for understanding the technical intricacies of genomic information; genetic testing, screening, personalized medicine, and risk assessment represent areas of concern.  In conjunction with the APHA Genomics Forum Policy Committee, comprised of professionals, experts, and students, we completed a literature review of a critical issue in genomics and public health today; specifically, our review addresses genomic literacy as a workforce competency and implications for public health and policy.  We then offer recommendations for improving genomic literacy within the existing workforce and creating infrastructure for training future practitioners in genomics.

But Names Can Never Hurt Me? Verbal Abuse,  Low Health Literacy and Why It’s Everyone’s Problem
Presenter: Ilene Abramson, Ph.D.

Despite the extensive literature on health literacy, one aspect of the construct is virtually undiscussed.  This is Educator-Induced Post-Traumatic Stress Disor¬der (EIPTSD), the emotional distress from an  instructor-related incident from days or even years ago. 

Nearly 60 percent of any group recalls at least one school occurrence – usually inadvertent  humiliation from a teacher -  resulting in trauma able to compromise  life choices and lower health  literacy.   For example, EIPTSD victims may choose part-time jobs without insurance rather than ponder returning to the dreaded classroom and re-training for a new career. Unprotected and with limited funds, these semi-employed with EIPTSD avoid medical appointments,  thus losing the opportunity to meet the clinician and improve their health literacy.  Furthermore, such workers might deny themselves inoculations, become ill and place others at risk.   This poster offers data regarding these issues and additionally, speculate on the effect of the EIPTSD-Health Literacy link on the entire population.

Campus Mind Works - Helping UM Students with Psychiatric Disorders to Succeed in College
Presenter: Stephanie Salazar
Affiliation: University of Michigan Depression Center

The Campus Mind Works project was created to identify existing resources, simplifying access to information, and improve the health literacy of UM students with psychiatric disorders through the development of web-based educational and informational materials specifically designed for this audience. The project aims to improve student motivation and self-confidence by helping them to more easily locate appropriate support services, and increase their capacity to manage their mental health and be successful in a college environment.

MuJERs: Mujeres Juntas Estableciendo Relaciones Saludables (Women United Establishing Healthy Relationships) Developing an Intervention to Reduce HIV Risk Among Immigrant Latina Women
Presenter: Jamie McGuire
Affiliation: University of Michigan School of Public Health

The Latino population in the Southeastern US is the fastest-growing in the country, and carries a disproportionate rate of HIV burden. Few efficacious HIV interventions exist for Latinos, and none exists for recently arrived, Spanish-speaking, less-acculturated Latina women. We describe an intervention developed by a community-based participatory research partnership of key Latina community members, representatives from local organizations, and academic researchers. We developed a Lay Health Advisor intervention designed to increase condom use and HIV testing among recently arrived Latinas. Based in health education theories, the MuJEReS intervention is interactive and blends formative data collected during focus groups, in-depth interviews, and quantitative assessments. A pilot test of the intervention seeks to evaluate a Spanish-language intervention that is culturally congruent and gender-specific, emphases issues of health literacy and communication particular to HIV risk reduction, enhances social support, and builds self-efficacy in using skills such as interpersonal negotiation and navigating healthcare services.

Developing a disease self-management intervention for older adults with asthma
Presenter: Jamie McGuire
Affiliation: University of Michigan School of Public Health

Asthma is often thought of as a disease that mainly affects children, however older adults have the highest asthma morality rate of any age group. As asthma is often overlooked in the geriatric population, many older adults go undiagnosed or misdiagnosed, or lack tailored self-management strategies.  We describe the process of developing materials for the “Older Adults with Asthma” intervention tailored to the health literacy and communication issues older adults face around their asthma self-management. Preliminary focus group data identified five domains that were integrated into the intervention: atypical asthma symptoms, inability to distinguish asthma from other medical conditions, use of complementary and alternative therapies, desire for independence in asthma management, and a lack of participation in asthma education.  This pilot intervention sought to evaluate the feasibility of group interventions for older adults, exploring the use of various health education materials and methods adapted from existing self-management programs based on self-regulation theory.

All in for Health Literacy at UMHS
Presenter: Elizabeth Nolan, MS, RN, APRN-BC
Affiliation: University of Michigan Health System

This poster will illustrate several initiatives in place at UMHS related to health literacy.

Health Literacy and Primary Care - Beginning an Integration Aimed at Communication
Presenter: Renee McCune
Affiliation: University of Michigan School of Nursing

In primary care settings, means to identify patient health literacy (HL) capabilities and staff knowledge, attitudes and beliefs (KAB) must be known prior to work on improving communication skills. The study aims for this primary care exploratory study examined the feasibility of: 1) assessing patient HL using the Newest Vital Sign (NVS) 1 and 2) measuring staff use/effect of an online intervention, “Health Literacy in Primary Care”.

Awareness and Appreciation of Limited English Proficient (LEP) Populations: A Collaborative Approach
Presenter: Petronella Hove
Affiliation: University of Missouri Center for Health Policy
The Missouri Limited English Proficiency (MO LEP) Workgroup was formed in June 2007 to address the needs of Missourians with limited English proficiency (LEP). To gain more information, the group developed the Missouri Interpretation and Translation Survey; a twelve question, online survey which was distributed for a one-month period in the fall of 2008 to health care providers around the state. Results indicated that the most frequently used types of translation and interpretation services were written materials often obtained from the Internet.  In-person interpreter services are rare and phone services are infrequent.  Most providers cited poor access to written translation materials and lack of cultural competency training of staff as barriers. Following this study we recommend, a more comprehensive survey to reveal what providers believe are the most needed services. Additionally, another separate survey could identify patients’ needs. Furthermore, comparison of these surveys will help determine gaps in communication services.

Health Literacy and Health Disparities in Missouri Combining Collaborative Efforts
Presenter: Petronella Hove
Affiliation: University of Missouri, Missouri Foundation for Health and Health Care Foundation of Greater Kansas City
Health Literacy Missouri was established through funding from MFH in response to the increasing awareness of the role health literacy plays in the health of Missourians. The initiative fosters collaboration among diverse resource centers located across the state to provide a clearinghouse of resources, technical assistance, policy analysis, education and outreach to improve the health literacy of Missourians.

Estimating and Mapping Community-Level Health Literacy
Presenter: Laurie Martin ScD, MPH
Affiliation: RAND Corporation
Stakeholders seeking to improve health and health care increasingly recognize that low health literacy (LHL) contributes to poor health. Yet, resources to screen individuals for LHL are limited, and individually-tailored interventions may not be feasible or affordable in the long run. Focusing on communities, rather than individuals, provides opportunities for action by helping communities ‘own’ the problem and turning LHL into a shared responsibility that can lead to efficient resource use and a positive return on investment. To facilitate efforts to identify geographic areas with a high concentration of individuals with LHL (i.e., ‘hot spots’), we developed predictive models using data from the 2003 National Assessment of Adult Literacy. Using these models and information about the demographic makeup of census areas, we generated estimates of health literacy for each geographic area. We then mapped the results to identify ‘hot spots’ of low health literacy across Missouri, and are currently developing this into an interactive web-based tool.

Improving Health Management Skills for People with Spinal Cord Injury and Disease
Presenter: Mary Burton
Affiliation: University of Michigan health System and Department of Physical Medicine and Rehabiliatation

Many people with SCI/D (spinal cord injury/disease) have high rates of related health conditions. Health disparities between people with and without a disability are substantial. Factors such as poverty, lower educational status, lower literacy levels and minority status are associated with a reduced ability to manage health and interact effectively with healthcare providers.

A program was created to teach basic skills, (self-monitoring, problem solving and others) to people with SCI/D. Advisory boards of healthcare providers and people with SCI/D provided feedback on content and provider-patient relationships. An evidence-based program was developed with input from both people with SCI/D and healthcare providers. Both groups described issues that impact this interaction.
The program will undergo systematic review by focus groups of people with SCI/D at three sites. Additional testing is needed by people with SCI/D, particularly those with characteristics of the target population. 

Disability Community Needs Assessment Summary
Presenter: Carolyn Grawi
Affiliation: Ann Arbor Center for Independant Living

During the summer of 2007, 137 Ann Arbor Center for Independent Living constituents were surveyed to evaluate community life in Washtenaw County from the disability perspective. Respondents were surveyed on the importance of 54 community indicators and the adequacy of the resources addressing those indicators. The results of this survey were analyzed and compared to the results of a 2006 community survey, conducted by Washtenaw United Way and FERA, to see if there are statistically significant differences between the two groups.

There were many differences between the perceptions of community residents and those of the disability community. In particular, almost all questions within the area of education, health, and housing & poverty showed highly significant differences. Clearly, these areas are particular ‘hot-button’ issues among the Disability community.

In all but five specific issues, the Disability Community believed resources were less adequate than did Community Residents interviewed for the United Way study. Differences were particularly noticeable in the following areas: civic engagement, crime and safety, adults and continuing education, healthy kids and adults, housing and poverty, and income and jobs.

The impact of what this survey shows is that even when could health care is available often people with disabilities are unable to access it. Sometimes due to other elements that were also surveyed, including access transportation to obtain the health care.

Parental Health Literacy and Health Care Utilization in Asthmatic Children
Presenter: Michelle Macy, MD, MSc and Rachel Stanley, MD, MHSA
Affiliation: University of Michigan Department of Emergency Medicine and Pediatrics and Division of General Pediatrics, Child Health Evaluation and Research Unit
Background:  Patterns of parental health literacy and health care utilization in asthmatic children seeking emergency care have not been previously characterized.   
Sample:  203 parents of asthmatic children, age 2-14 years old, seeking care in an urban ED. Health Literacy Measure:  Rapid Estimate of Adult Literacy in Medicine (REALM). 
Primary Outcomes:  Visits to ED, primary care provider, and asthma specialist, and asthma hospitalizations. Analyses:  Chi square and Wilcoxon rank sum tests. 
Results:  75 mothers, 7 fathers, and 17 other caregivers were recruited.  61 (30%) had low (< high school) health literacy which was significantly associated with more ED visits (p=0.028), more hospitalizations (p=0.047), and less subspecialist care (p=0.004).  No differences were identified for PCP visits, reason for ED visit, insurance, child age, months with asthma, or symptom severity. Conclusion:    Frequent ED utilization by low health literacy parent’s signals a need to provide asthma instructions that are sensitive to literacy levels.

Page maintained by Kate Saylor
Last modified: 03/24/2011