Key Terms and Definitions

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Slide 1

The following slides will lay the foundation for this presentation. We will define health literacy and readability and the concept of universal design. We will also look at past and present research as well as the resources that were used in the development of this toolkit.

Slide 2

Definition of health literacy from the Institute of Medicine (IOM) Committee on Health Literacy (2004). William Smith served on the committee and has since stated: “Health literacy is not a function of an individual in our minds - but of individuals, organizations, and communities. I wish many times now that we had found a way to put that in the definition and not in an explanatory note. In the definition we used the word "individuals" and everyone interprets that to be patients. Again we failed to clarify that a physician is an individual. Nurses, pharmacists, family members, pharmaceutical executives are also "individuals" who require "the capacity to obtain, process, and understand basic health information....." A physician who does not have the capacity to illicit useful information from a patient, to understand what impact information he gives a patient will have on that patient's compliance, is not health literate. This is equally true for those us working in prevention – we too are individuals who require the capacity to obtain, process and understand health information about our audiences if we are ever to have a health literate America. There is a second aspect of the definition which is often overlooked. It is the word "services". Too much of our energy is going into making written materials clear and in training disadvantaged groups to understand the stupid things we tell them. The services word places emphasis not on what we say, but on what we do to help people make appropriate health decisions. I would love to see a marketing study of the service aspect of health literacy as well as the information aspect. We should have done a better job of making this clear in the definition itself.” (Posted on the National Institute for Literacy listserv, December 4, 2008)

Slide 3

Definition of health literacy from the Institute of Medicine (IOM) Committee on Health Literacy (2004). William Smith served on the committee and has since stated: “Health literacy is not a function of an individual in our minds - but of individuals, organizations, and communities. I wish many times now that we had found a way to put that in the definition and not in an explanatory note. In the definition we used the word "individuals" and everyone interprets that to be patients. Again we failed to clarify that a physician is an individual. Nurses, pharmacists, family members, pharmaceutical executives are also "individuals" who require "the capacity to obtain, process, and understand basic health information....." A physician who does not have the capacity to illicit useful information from a patient, to understand what impact information he gives a patient will have on that patient's compliance, is not health literate. This is equally true for those us working in prevention – we too are individuals who require the capacity to obtain, process and understand health information about our audiences if we are ever to have a health literate America. There is a second aspect of the definition which is often overlooked. It is the word "services". Too much of our energy is going into making written materials clear and in training disadvantaged groups to understand the stupid things we tell them. The services word places emphasis not on what we say, but on what we do to help people make appropriate health decisions. I would love to see a marketing study of the service aspect of health literacy as well as the information aspect. We should have done a better job of making this clear in the definition itself.” (Posted on the National Institute for Literacy listserv, December 4, 2008)

Slide 4

Joanne G. Schwartzberg, MD is the Director of Aging and Community Health for the American Medical Association. She stated: “I would like to broaden the definition of health literacy to include the concept of the ability to act on the medical decisions made. It is not enough to understand the information and make an appropriate decision; patients, professionals and institutions need to be able to know how to actually carry out that decision successfully. Part of the concept of literacy in the 1991 definitions was to enable the person to function in society and obtain their full potential. That concept did not get into the health literacy definition, but it is crucial.” (Posted on the National Institute for Literacy listserv, December 4, 2008)

Slide 5

This definition of literacy comes from the National Assessment of Adult Literacy.

Slide 6

Readability refers to the level of success a group of people has with a document. Success is defined as understanding the information, reading it at an optimal speed, and finding it interesting. An additional criteria for health information is whether or not the patient acts on the information. Providing information to the patient is only half of our job. We also need to help the patient apply this information to their situation and experiences and make appropriate decisions regarding their health.

Slide 7

Legibility is often separated from readability in that it specifically deals with the textual and graphical elements of a document. For the purpose of this presentation and toolkit, the term readability will be used to also cover all aspects of documents design.

Slide 8

The concept of universal design can be applied to documents. The goal is to create a document that can be used as many people as possible. This reduces the need to create several versions for different populations according to their needs. Documents that are universally designed save time and money, and documents that are easy to read and well designed benefit most patients.

Slide 9

Walk up to any major retail store or business these days and the door automatically open for us. Electronic doors were originally designed to provide access for the handicapped. Yet, we all benefit from the convenience and ease of electronic doors. This is universal design. One entrance meets the needs of most people.

Slide 10

A good example of universal design. Note that document uses pictures to show rather than tell you how to set up your computer. The text is limited (and in this example, is actually written in 3 different languages). The steps are numbered, as well as each location on the back of the tower. The components are also color-coordinated. Dell Computers does not need to create several versions of this instruction sheet. Instead, this one document can be used by many people around the world.

Slide 11

And finally, an example from health care. Auxiliary labels on prescription pill bottles give us important information about how to take our medications, how to store the medications, and alert us to possible warnings and side effects. Note that the emphasis is on the icon, or small graphic that accompanies the message and not so much on the word themselves. By designing an icon that can be universally understood ensures that those who cannot read very well, or perhaps cannot read at all, and those who do not speak or read English can still understand the important message on the label. This is universal design. It is a very important component of readability. Universal design allows us to develop a document that can be used by the majority of our patients, without having to adapt, change or create several versions. This saves time and money. Research also shows that even those who read at a high level, say 10th grade and above, appreciate information that is clear and easy to understand, written at the 6th to 8th grade level. Just like we are not offended by having electronic doors automatically open for us, we are not offended by information that is written clearly and documents that are well designed. The goal of universal design is to create health information that can be used by as many patients as possible, 80-90 %. There will be some patients who cannot read, or the visually impaired, or those who do not speak or read English who will not benefit from printed patient education materials. Other methods of patient education are necessary. However, since we are focusing on printed patient education materials, we begin with the assumption that we have assessed the needs of our patients and are providing education and information in a way that meets their needs and preferences.

Slide 1

Part 2 Definitions

Slide 2

Definitions Health Literacy Health literacy is the degree to which individuals have the capacity to obtain, process, and understand health information and services needed to make appropriate health decisions. (IOM Committee on Health Literacy)

Slide 3

Definitions Health Literacy Health literacy is the degree to which individuals, organizations and communities obtain, process, understand and share health information and services needed to make appropriate health decisions. (Revised by William Smith, Academy for Educational Development)

Slide 4

Definitions Health Literacy Health literacy also refers to the capacity of professionals and institutions to communicate effectively so that community members can make informed decisions and take appropriate actions to protect and promote their health. (Joanne G. Schwartzberg, MD Director, Aging and Community Health American Medical Association)

Slide 5

Definitions Literacy Using printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential. (National Assessment of Adult Literacy)

Slide 6

Definitions Readability The sum total (including all the interactions) of all those elements within a given piece of printed material that affect the success a group of readers have with it. The success is the extent to which they understand it, read it at an optimal speed, and find it interesting. (Edgar Dale and Jeanne Chall) Additional criteria for the success of health information: Does the patient act on it? (make a decision, change a behavior, learn a skill, apply knowledge)

Slide 7

Definitions Legibility The ease at which textual and graphical elements of a document are recognized and understood.

Slide 8

Definitions Universal Design Universal design is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design. The intent...is to simplify life for everyone by making products, communications, and the built environment more usable by as many people as possible at little or no extra cost. (Center for Universal Design North Carolina State University)

Slide 11

Improving patient understanding of prescription drug label instructions Davis TC, Federman AD, Bass PF 3rd, Jackson RH, Middlebrooks M, Parker RM, Wolf MS. Improving patient understanding of prescription drug label instructions. J Gen Intern Med. 2009 Jan;24(1):57-62. Epub 2008 Nov 1.

Summary: Definitions and key terms for the Improving Readability by Design toolkit.

Tags: health communications literacy patient education document design readability

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