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10/23/2015
Health Literacy By The Numbers (Health Numeracy) Alisha Ellwood Odhiambo, MA, LMFT Sr. Provider Quality Program Manager Blue Cross Blue Shield of Minnesota Chair, Minnesota Health Literacy Partnership October 21, 2015
Health Numeracy Strategies for Increasing Comprehension Alisha Ellwood Odhiambo, MA, LMFT Sr. Provider Quality Program Manager Blue Cross Blue Shield of Minnesota Chair, Minnesota Health Literacy Partnership
Brought to you by the Minnesota Health Literacy Partnership
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Objectives Define health literacy and health numeracy Explain why health numeracy matters Learn strategies for using numbers (if at all!) in patient communication
What is health literacy? Health Literacy is our ability to read, understand, and act on health information.
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What is health numeracy? “Mathematical literacy as it relates to health.” “Numeracy is an aspect of health literacy that includes the quantitative skills necessary to understand and act on numerical directions given by health care providers.” - Journal of Asthma, “Asthma Numeracy Skill and Health Literacy”
What is health numeracy? “Health numeracy is the ability to access, interpret, and use quantitative information to manage one’s health.” - Fairview Health Services
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What is health numeracy?
Why health numeracy matters Low numeracy is tied to: Shorter life expectancy Lower health outcomes overall Higher incidence of ER visits Higher hospital recidivism Poor medication adherence Poor chronic disease management Higher comorbidity Higher body mass index
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Why health numeracy matters Direct relation to health disparities Emphasis on shared decision-making More quantitative information than ever
The scope of the problem • Over half of U.S. adults have only basic or below-basic number skills • Math anxiety and health events further diminish numeracy ability • Elderly, less-educated, non-English-speaking, and those of low socioeconomic status are at greater risk
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How Patients Learn
How Patients Learn Data: Friend or Foe? Knowing when not to use numbers is just as important as knowing how to use them Reduce the cognitive burden Focus instead on outcomes and actions
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How Patients Learn The “Curse of Knowledge” Once we know something, we find it hard to imagine what it was like not knowing it!
How Patients Learn Fuzzy-Trace Theory Verbatim thinking – precise details and facts. Quantitative. Gist-based thinking – the bottom line. Relational, categorical, intuitive. Also subjective/based upon emotion, culture, education, experience, world view.
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How Patients Learn Focus on bridging information and action through gist-based messaging first.
If necessary, reinforce the message carefully with data.
How Patients Learn “Well Mr. Fischer, your systolic blood pressure is 150 and your diastolic is 95, indicating primary hypertension. You’ll cut your risk of heart disease by 50% if you can quit smoking. We could also get you on 25 milligrams of beta-blockers once a day. What do you think about that?”
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How Patients Learn “Well Mr. Fischer, your systolic blood pressure is 150 and your diastolic is 95, indicating primary hypertension. You’ll cut your risk of heart disease by 50% if you can quit smoking. We could also get you on 25 milligrams of beta-blockers once a day. What do you think about that?” “Mr. Fischer, your blood pressure is high. [pause] If you quit smoking, you can cut your risk of heart disease in half. [pause] There are also medications that can help.” [pause]
How Patients Learn “Well Mr. Fischer, your systolic blood pressure is 150 and your diastolic is 95, indicating primary hypertension. You’ll cut your risk of heart disease by 50% if you can quit smoking. We could also get you on 25 milligrams of beta-blockers once a day. What do you think about that?” “Mr. Fischer, your blood pressure is high. [go to visual aid] If you quit smoking, you can cut your risk of heart disease in half. [action plan] There are also medications that can help.” [decision aid]
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Using Numbers with Patients
Using Numbers with Patients Category Basic
Examples • Reading numbers • Counting • Telling time
Computational • Arithmetic operations Analytical
• Ranges • Frequencies & percentages • Reading basic tables & graphs
Statistical
• Interpreting risk statements • Reading complex graphs • Comparing numbers on different scales
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Using Numbers with Patients
• • • •
Increase knowledge Instruct how to Inform decision-making Persuade/motivate
Using Numbers with Patients Order • Start with the most important information • Put figures in logical order (such as by date or alphabetically) • Consider using descending order when “big” equals “bad” or is the most important value
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Using Numbers with Patients Less is More • Unpack complex concepts • One idea at a time • Keep pieces logical, organized • Underscore the gist of each piece
Using Numbers with Patients Rounding and Denominators • Round numbers are easier to understand, compare, and recall • Keep denominators consistent Instead of this…
Use this…
78.64%
79%, or about 80%
1 in 10 vs. 1 in 5
1 in 10 vs. 2 in 10
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Using Numbers with Patients Do the Math • Do the computations for the patient • Suggest online tools and calculators • Mark medicine cups and syringes • Use pill cards
Using Numbers with Patients Visual Aids and Cues • Can clarify, reinforce, reframe • Helpful for visual learners • Visual analogies • Highlight the most relevant information
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Using Numbers with Patients Visual Aids and Cues Use caution with graphs, charts, icon arrays, and handouts!
Using Numbers with Patients Narrative Support • Context and reframing • Links abstract to concrete • Humanizes numbers
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Using Numbers with Patients Consider Cultural Differences • U.S. Standard or metric • Meanings and connotations • Symbols • Colors
Using Numbers with Patients Plain Language • Always advisable in health communication! • Avoid technical and medical terminology • Background information on a need-to-know basis plain
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Using Numbers with Patients Teach-Back & Open-Ended Questions • Have them teach it back in their own words • What will they tell their spouse/partner/etc.? • Emphasize that this is testing your abilities, not theirs • Avoid yes-or-no questions, especially, “Do you understand?”
Visualizing Health Information
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Visualizing Health Information True or False? Images like infographics are easier to understand than a paragraph of plain text because pictures don’t require literacy skills.
Visualizing Health Information True or False? Images like infographics are easier to understand than a paragraph of plain text because pictures don’t require literacy skills.
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Visualizing Health Information Document literacy: the ability to search, comprehend, and use non-continuous texts Reading a table requires: • Understanding rows and column headings • Selecting the right row + column of interest • Locating the cell at that intersection • Scanning up and down and back and forth repeatedly
Visualizing Health Information Simplify • • • • •
One message per graph Fewer categories Downplay the noise White space is your friend! Avoid embellishments
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Visualizing Health Information Clarify • • • • • •
Audience-appropriate Order Intuitive, consistent Able to stand alone Underscore the gist Highlight or circle
Visualizing Health Information Text • • • • •
Right-justify numbers in tables 10-14 point fonts Simple, no-frills font Clear and concise labels and legends Title (who, what, when)
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Visualizing Health Information Color • • • • •
White or subdued background Adequate contrast Printer-friendly Color-blind safe Action colors
Visualizing Health Information Choosing a Display Type • Remember the “why” • Underscore the gist! • Use as a supplement
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Visualizing Health Information Pie and Donut Charts • Displays related parts of a whole (proportions) • Good for highlighting smallest/largest piece • Adds up to 100% • Variation: donut chart
Visualizing Health Information Pie and Donut Charts Do: • Point the largest slice at 12 o’clock • Use short labels or a legend • Slices in clockwisedescending order Don’t: • Show >6 slices
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Visualizing Health Information Bar Graphs • Show relative differences/patterns • Vertical: emphasize rise and fall • Horizontal: allows for longer labels; may be more intuitive
Visualizing Health Information Bar Graphs Do: • Use 6 or fewer bars • Select intervals, and beginning/ending values carefully Don’t: • Use overlays or stacked bars
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Visualizing Health Information Line Graphs • Great for showing trends over time • Effective for before and after differences • Obvious rising, falling, and stasis of data
Visualizing Health Information Line Graphs Do: • Use indicators to highlight key events • Use intervals and beginning/ending values that make sense Don’t: • Use >4 trend lines • Add too much text/data
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Visualizing Health Information Icon Arrays (Pictographs) • Great for probability data (absolute risk) • Units can be counted, making them easier to understand • Shows parts-to-whole relationship without percentages • Can also use height cue
Visualizing Health Information Icon Arrays (Pictographs)
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Visualizing Health Information Icon Arrays (Pictographs) Do:
• Consider using people-shaped icons to humanize the data • Highlight the numerator • Place icons adjacently • Keep common denominators between arrays
Visualizing Health Information Icon Arrays (Pictographs) Don’t: • Use too many colors or symbols within one array •
Crowd with text or numbers
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Questions? Comments?
Additional Resources NIH Making Data Talk: A Workbook: Key concepts, practical suggestions, and examples on communicating health-related data to the public, policy makers, and the media
cancer.gov/publications/health-communication
Minnesota Health Literacy Partnership: Free resources to help educate individuals and health care professionals about the importance of health literacy
healthliteracymn.org
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Additional Resources Health Literacy Out Loud: Podcasts and articles about health literacy
healthliteracyoutloud.com
Centers for Disease Control and Prevention: Toolkits and courses from the CDC and beyond
www.cdc.gov/healthliteracy/gettraining.html
Additional Resources University of Michigan Risk Science Center: Explore and make your own data visualizations
iconarray.com vizhealth.org
Tools for selecting color schemes for graphics: color-blindness.com (simulator) colorbrewer2.org
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Acknowledgements Minnesota Health Literacy Partnership healthliteracymn.org Minnesota Literacy Council mnliteracy.org Minnesota Hospital Association Patient and Family Advisory Council mnhospitals.org Community Health Initiative | U of M Kate Murray, University of Minnesota School of Public Health Intern Made possible by a grant from Medica diversity.umn.edu/bced/chi
Thank you! Alisha Ellwood Odhiambo
[email protected]
Brought to you by the Minnesota Health Literacy Partnership
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All presenters have declared that no copyrighted material is included in this presentation without the express, written consent of its authors. Any unlawful use of copyrighted material is solely the responsibility of the presenters. This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI/MN/WI-B4-15-50 101915
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