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Flashcards in L1-2: Health Literacy Deck (47)
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Health Literacy Definition

The ability to access, understand and act on info for health


How many levels of health literacy



What is the % of health literacy in Canada

60% of Canadians of Canadians lack the skills to manage their health care needs
Assuming level 3 is minimum required


What are some high risk groups when it comes to health literacy (7)

● Seniors
● Minorities
● Immigrants
● Unemployed
● Non-official Language
● Prisoners
● Persons with limited education

These groups are not related to health literacy by causality but by correlation


Level 1 Health Literacy

Level 1—Very poor literacy skills. An individual may, for
example, be unable to determine from a package
label the correct amount of medicine to give a child.


Level 2 Health Literacy

Level 2—A capacity to deal only with simple, clear
material involving uncomplicated tasks. People at this level may develop everyday coping skills


Level 3 Health Literacy

Level 3—Adequate to cope with the demands of everyday life and work in an advanced society. It roughly denotes the skill level required for successful high-school completion and college entry.


Level 4/5 Health Literacy

Levels 4 and 5—Strong skills. An individual at these levels can process information of a complex and demanding nature.


Recall the Avg health literacy scores for the high risk groups and some ranges of literacy

- Age 26-35 high level 2 ~ 275. BEST
- Age 16-25 high level 2 ~ 270.
- Employed high level 2 ~ 265.
- Immigrant, non-official language low level 2 ~ 225.
- Aboriginal mid level 2 ~ 245.
- French minority high level 2
- Not Employed low level 2 ~ 235.
- 66+ level 1 ~ 210. (lowest)

Age is related to education levels that lead to health literacy
Language can be a barrier for health literacy scores


When do you suspect low literacy?

● Low-literacy patients commonly hide their difficulty
● Many feel ashamed
● Avoidant behaviors

Identified by a gut feeling, based on patients’ nonverbal and verbal communication
Other patient characteristics such as hearing disabilities and mental health problems as indicators
“You can tell by the things they say. These patients look lost”
Recognized non-verbal signals, nervousness, looking lost


What are possible indicators of low health literacy?

● Excuses: “I forgot my glasses.”
● Lots of papers folded up in purse/pocket
● Lack of follow-through with tests/appts.
● Seldom ask questions
● Questions are basic in nature
● Difficulty explaining medical concerns or how
to take meds


Informal Assessments for identifying low health lit (2)

- common signs
- med review


Formal Measures for identifying low health lit (2)

- Single Item Questions
- Multiple Item Measures (9 listed most not practical for


What are 2 One-time measures for determining health literacy?

“How confident are you filling out medical forms by
yourself?” (0, extremely; 1, quite a bit; 2,
somewhat; 3, a little bit; 4, not at all)
“How often do you have someone help you read
hospital material?” (0, none of the time; 1, a little of
the time; 2, some of the time; 3, most of the time;
4, all of the time)

positve answers: some, most, all of the time


3 Universal Precautions (not too sure what this means)

● Can’t tell (identify) by looking
● Communicate clearly with everyone
● Confirm understanding with everyone


Why does Health Literacy Matter?

up to 2.5x the odds of having fair or poor health, being on income support and not participating in community activities for level 1

- 2.5 times poorer health if you have a level 1-2 health literacy
- Less have poor health if you have a level 4, 5 health literacy
- More on income support (2.5x more likely) with level 1-2
- More people not participating in community activities with level 1-2
- Controlled age, gender, education, language, immigration, Indigenous status


Misinterpretation of Warning Labels Table

Review common misconceptions like nursing infants


3 criteria used in the Sri Lankan paper for rating patient's ability to read and understand dosing instructions

Instructions: Completeness, readability, comprehensibility

Comprehensibility is understanding and acting on health info which is health literacy


Medication errors: Original statement: Take two tablets by mouth twice daily. How would you revise?

Take 2 pills by mouth at 8am and 2 pills at 6pm. Is this better? The first one can mean 2/day or 2/day twice?

creating a visual schedule
Larger text for increased readability
Colour-coded icons for times of day


5 things that make a good instruction label

1. Clear refill details make re-ordering a snap
2. Simplified dosage schedule for clearer directions
3. Color-coded icons for times of day
4. Larger text for increased readability
5. Easy to find prescription info


What makes giving clear dosing instructions challenging? (3)

● Increasingly complex health system
- Greater self-care requirements
- Increased medications for chronic conditions
- Formulary and manufacturer changes
- Medication reconciliation
● Most patient instructions are written
- Low-literacy pts have trouble understanding
● Verbal instructions
- Often complex
- Delivered rapidly
- Easy to forget in stressful situation


6 Recommended Strategies to Improve Communication

1. Explain things clearly in plain language
2. Focus on key messages and repeat
3. Use a “teach back” or “show me” technique to
check understanding
4. Effectively solicit questions
5. Use patient-friendly educational materials to
enhance interaction
6. Communicate numbers effectively


Describe: 1. Explain things clearly in plain language

● Slow down the pace of your speech
● Use plain, nonmedical language
- “Blood pressure pill” instead of “antihypertensive”
- Pay attention to patient’s own terms and use them back
● Avoid vague terms
- “Take 1 hour before you eat breakfast” instead of “Take on an empty stomach”
- Be specific when explaining


What could we say instead of...
side effect?
For external use only?

rxn to a med
low blood sugar
when you need it
use only on skin
breathe in; take a breath


What is the readability test and avg grade of reading level?

Flesch Kincaid test, avg Gr 6
Lexi-comp has a good reading level for patients
Micromedex, Drugs.com, Medline Plus too high


What is SMOG?

Simple Measure of Gobbledygook... simple tool that provides some info about the potential literacy difficulty of written health info


What 3 things influence reading level? (Flesch tools and SMOG)

● document(layout, color, font, spacing, legibility, and grammar);
● person (education, comprehension, health literacy, motivation, prior knowledge, information needs, anxiety levels); and
● style of writing (cultural sensitivity, context, comprehensiveness, and


What is important to consider for Plain Language - Audience?

● Everyone benefits
● Know your audience and purpose
● What is my message? How urgent?
● Organize your content


What is important to consider for Plain Language - Writing?

● Use personal pronouns when appropriate
● Use common everyday words
● Use active voice.
● Keep it short, simple, and direct.
● Use positive language - Don’t forget to refill your pills. vs Refill your pills.


What is important to consider for Plain Language - Presentation?

● Put your main message at the top
● Include only the details your reader needs
● Only use technical words if needed. Define them.
● Consider readability, but clarity is more important.