chapter 3

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Questions and Answers

Which skills are essential for individuals needing health information and services?

The ability to memorize medical terminology

Advanced critical thinking skills

Health literacy skills (correct)

Mathematical problem-solving abilities

What does health literacy NOT primarily involve?

Interpreting food labels

Acquiring advanced medical degrees (correct)

Using computational skills effectively

Making culturally constructed dietary decisions

Which area is not mentioned in the provisions of the Affordable Care Act regarding health literacy?

Shared decision making between patients and providers

Training of practitioners

Healthcare delivery system research

Technology integration in healthcare (correct)

According to the definition provided, health literacy is described as the ability to:

Make appropriate health decisions based on understanding health information Signup and view all the answers

What is a misconception about health literacy?

It requires only reading skills. Signup and view all the answers

Which skill is essential for health professionals to provide effective services?

Understanding cultural beliefs about health Signup and view all the answers

What is a primary goal of the National Action Plan to improve Health Literacy?

Promote changes in healthcare communication Signup and view all the answers

Which principle is NOT part of the National Action Plan for improving health literacy?

Health services should be incomprehensible Signup and view all the answers

How does good health literacy primarily benefit individuals?

Promotes earlier detection and management of diseases Signup and view all the answers

Which of the following is NOT a goal of the National Action Plan's efforts to improve health literacy?

Create elite healthcare services for the wealthy Signup and view all the answers

What does health literacy enable health professionals to do?

Decide which health services work best for individuals Signup and view all the answers

Which of the following actions aligns with the goals of the National Action Plan?

Integrating health information into education at all levels Signup and view all the answers

Which outcome is associated with enhanced health literacy?

Increased use of preventive healthcare measures Signup and view all the answers

What is a significant consequence of low health literacy in individuals?

Higher rates of mortality Signup and view all the answers

Which of the following is NOT a characteristic of individuals with low health literacy?

Greater likelihood of receiving preventive screenings Signup and view all the answers

How does quantitative literacy differ from basic literacy?

It requires mathematical operations for interpretation Signup and view all the answers

What is one financial consequence of having poor health literacy?

Incur four times higher annual healthcare costs Signup and view all the answers

What role does basic literacy play in health literacy?

It serves as a foundation for developing health literacy Signup and view all the answers

What is the purpose of diagrams and concept maps in understanding health literacy?

To visualize how individual facts fit together Signup and view all the answers

What is one challenge associated with health literacy regarding mental models?

Cultural factors can lead to differing understandings of health information Signup and view all the answers

Why is the ability to integrate new health information into a mental model important for health literacy?

It allows for the application of a shared scientific perspective Signup and view all the answers

In 2016, what percentage of the U.S. population was represented by immigrants?

13.5% Signup and view all the answers

What proportion of the immigrant population in 2014 consisted of naturalized U.S. citizens?

47% Signup and view all the answers

What is the primary characteristic of personalistic disease theory?

Illness is caused by supernatural intervention. Signup and view all the answers

Which of the following best defines naturalistic disease theory?

A person's health is influenced by environmental and biological factors. Signup and view all the answers

What challenge might healthcare providers face regarding cultural differences?

Reconciling vastly different views on health and illness. Signup and view all the answers

Which option describes a necessary component of culturally competent healthcare?

Identifying optimal care methods that respect cultural views. Signup and view all the answers

In Philadelphia, which additional languages besides Spanish are commonly provided in healthcare resources?

Chinese and Vietnamese Signup and view all the answers

What dietary factor may affect a patient's treatment decisions?

Religiously motivated food restrictions Signup and view all the answers

In cases where modesty is a concern, what may be required for medical examination?

Removal of religious garb during examination Signup and view all the answers

Which aspect is crucial when providing care to clients with diverse backgrounds?

Equitable and respectful quality care Signup and view all the answers

What might influence a patient's decision regarding organ donation?

Religious beliefs about organ transplantation Signup and view all the answers

Which of the following statements about informed consent is true?

It can include advice from a religious leader. Signup and view all the answers

Which principle should leadership in healthcare organizations prioritize for effective cultural and language assistance?

Governance from the highest levels of leadership Signup and view all the answers

How do patient views on reproductive health relate to cultural competence in healthcare?

They can dictate preferences for certain procedures. Signup and view all the answers

What is an important focus in engaging communities for continuous improvement in healthcare?

Involving community voices in quality improvement efforts Signup and view all the answers

What is the primary purpose of the REALM test?

To assess the number of correctly pronounced medical terms Signup and view all the answers

Which of the following statements about the TOFHLA is true?

It includes multiple-choice as well as fill-in-the-blank questions Signup and view all the answers

What is a unique feature of the NVS assessment?

It includes an ice cream label challenge accepted by patients Signup and view all the answers

What type of literacy does the HLSI primarily measure?

Print literacy as well as numeracy and oral skills Signup and view all the answers

Which aspect does eHEALS assess regarding electronic health literacy?

Knowledge and skills in evaluating electronic health information Signup and view all the answers

What does the NUMi test measure?

Numerical challenges faced in healthcare contexts Signup and view all the answers

Which of the following statements correctly describes the REALM-R?

It is a quick version intended to reduce test anxiety Signup and view all the answers

Which language options are available for the TOFHLA assessment?

English and Spanish Signup and view all the answers

What is a primary reason for assessing a patient's health literacy?

To comply with quality of care standards Signup and view all the answers

Which response choice indicates the highest level of confidence in filling out medical forms?

Extremely Signup and view all the answers

What should be assumed if a patient does not select the most proficient choices in health literacy questions?

They require more simply written materials Signup and view all the answers

What level should message maps be written in for clarity?

Sixth grade level Signup and view all the answers

What is one of the attributes of 'clear and effective' written materials according to CMS?

Attract and hold the reader's attention Signup and view all the answers

How many supporting messages should each primary message in a message map have?

Three Signup and view all the answers

Which of the following would be a suitable method for confirming patient understanding?

Directly asking patients to explain in their own words Signup and view all the answers

What type of response indicates a patient often requires help reading hospital materials?

Sometimes Signup and view all the answers

What does the Flesch-Kincaid Grade Level Readability Test primarily use to determine the reading grade level of text?

Words per sentence and syllables per word Signup and view all the answers

Which of the following elements is NOT part of the CDC's Clear Communication Index?

Community Engagement Strategies Signup and view all the answers

Which action is essential for healthcare organizations to improve health literacy according to the Institute of Medicine's roundtable?

Preparing the workforce to be health literate Signup and view all the answers

What is indicated by a Flesch-Kincaid score of 8.3?

8th-grade reading level Signup and view all the answers

What is a key feature of Patient Decision Aids (PDAs)?

They aid patients in communicating personal values related to treatment. Signup and view all the answers

Which feature of health literacy does NOT focus on avoiding stigmatization?

Integrates health literacy into evaluations Signup and view all the answers

Which area is assessed by the CDC's Clear Communication Index that involves the presentation of data?

Numbers Signup and view all the answers

What is one important design consideration when creating metaphors for health communication?

Ensuring the metaphor is easily recognizable Signup and view all the answers

What is a key aspect of health literacy as it has evolved in recent years?

It is now viewed as an institutional philosophy. Signup and view all the answers

Which of the following is an essential function of effective health literacy communication?

Distributing materials that are easy to understand and act on. Signup and view all the answers

How does health literacy impact the understanding of health plans?

It allows individuals to clearly understand coverage and personal costs. Signup and view all the answers

What role does health literacy play during care transitions?

It facilitates communication about treatment decisions. Signup and view all the answers

What personal capability does health literacy encompass beyond basic skills?

The ability to integrate new health information into personal knowledge. Signup and view all the answers

Study Notes

Health Literacy: A Key to Effective Health Decision-Making

Assessing health literacy involves evaluating an individual's ability to interpret food labels and their understanding of a healthy diet, acknowledging that dietary choices are influenced by cultural factors.
Numeracy skills are assessed alongside health literacy, emphasizing the importance of computational abilities in making informed health decisions.
Health literacy is not seen as a personal deficiency but rather a fundamental right to comprehend and be understood within the healthcare system.
The Affordable Care Act (ACA) of 2010 adopted the National Library of Medicine's definition of health literacy, highlighting its importance in healthcare.
The ACA identifies four key areas to address health literacy: improving healthcare delivery system research and quality, facilitating shared decision-making between patients and providers, presenting prescription drug benefits and risks clearly, and training healthcare practitioners across all fields.
The Patient Protection and Affordable Care Act of 2010 (Title V) defines health literacy as the ability to obtain, communicate, process, and understand basic health information and services to make informed health decisions.
Individuals need health literacy skills to find health information and services, communicate their needs and preferences effectively, understand the meaning and usefulness of health information and services, make informed decisions based on the information and services available, and act upon their choices.

Health Literacy for Healthcare Professionals

Healthcare professionals need health literacy skills to effectively communicate with patients and provide appropriate care.
Key skills include:
- Helping patients find health information and services.
- Communicating about health and healthcare clearly.
- Understanding patients' needs, both explicit and implicit.
- Providing useful information and services.
- Tailoring information and services to different situations and individuals.

National Action Plan to Improve Health Literacy

The U.S. Department of Health and Human Services created the National Action Plan (NAP) in 2010.
The NAP's core principles:
- Everyone has the right to understandable health information for informed decision-making.
- Healthcare delivery should be accessible and easy to understand, improving health outcomes.

Goals of the National Action Plan

Develop and disseminate accurate, accessible, and actionable health and safety information.
Improve healthcare system communication, informed decision-making, and access to services.
Incorporate accurate, developmentally appropriate health and science information into education.
Support community efforts for adult education, English language instruction, and culturally relevant health services.
Build partnerships, create guidelines, and implement policy changes to improve health literacy.
Increase research and development of effective health literacy practices and interventions.

Benefits of Good Health Literacy

Improved understanding of health status.
Increased participation in preventative healthcare.
Enhanced awareness of early detection and disease management.
More efficient use of healthcare services.
Better compliance with treatment plans.

### Health Literacy and Mortality

Individuals with poor health literacy experience higher mortality rates.
They are less likely to engage in preventive screenings like colon, breast, and cervical cancer screenings.
They are less likely to get vaccinated against seasonal flu, pneumonia, and preventable childhood diseases.
They struggle with medication adherence and comprehending labels and health messages.
They may misunderstand or fail to respond appropriately during public health emergencies.
They face difficulties accessing health insurance.

Health Literacy and Healthcare Utilization

Adults with low health literacy tend to utilize emergency departments more frequently.
They have significantly higher annual healthcare costs (approximately 13,000comparedto13,000 compared to 13,000comparedto3,000).
They experience 6% more hospital visits.
Their hospital stays tend to be 2 days longer.

Cost of Poor Health Literacy

Poor health literacy is detrimental to individuals and puts a strain on the overall healthcare system.

Factors Contributing to Poor Health Literacy:

Poor reading ability is a factor in poor health literacy.

Literacy and Health Literacy

Basic literacy refers to the ability to understand information presented in various formats.

Educational Testing Service (ETS) and Literacy

ETS categorizes and measures different types of literacy.
They define literacy as "using printed and written information to function in society, achieve one's goals, and develop one's knowledge and potential."
ETS defines three literacy scales:

Prose Literacy
- The ability to read and comprehend sentences and paragraphs.
Document Literacy
- The ability to interpret tables, forms, graphs, and other structured information.
Quantitative Literacy
- The ability to use information that requires mathematical operations for interpretation.
- Quantitative literacy is a subset of numeracy.

Scaffolding for Learning

The core concept of learning is to build upon existing knowledge as a framework.
This involves adding, remembering, and applying new information.

Language and Culture in Healthcare

Spanish is the most spoken second language in the world.
The most spoken second language in the United States varies depending on location.
Philadelphia has a large immigrant population that speaks languages including Chinese, Vietnamese, and French in addition to Spanish.
Different cultures understand health and illness in different ways.
Navigating cultural differences is more challenging than finding a common language.

Theories of Illness Causation

Personalistic disease theory attributes illness to a purposeful act by:
- A supernatural being (e.g., a god)
- A non-human being (e.g., a ghost, evil spirit)
- A person with supernatural powers (e.g., a witch)
Naturalistic disease theory sees illness as a result of:
- Environmental factors
- Biological agents

Culturally Competent Healthcare

Understanding cultural differences can be crucial in providing appropriate healthcare.
Culturally competent healthcare aims to identify and respect the diverse perspectives on illness.
Providing care that is both effective and culturally sensitive is the goal of culturally competent healthcare.

Religious Beliefs and Healthcare

Patients may have religious beliefs affecting dietary practices, dress and modesty, hygiene, informed consent, and organ transplantation.
Dietary Restrictions: Religious beliefs can affect food choices for meals and medications.
Dress and Modesty: Religious clothing or symbols may need to be removed for examinations or treatments. Some religions dictate modesty during healthcare encounters.
Hygiene: Religious practices may involve washing before prayers and meals. Maintaining facial hair (e.g., beards) can be influenced by religious beliefs.
Informed Consent: Some religions require a family member or religious leader's consultation or approval for medical treatment.
Organ Transplants and Donations: Religious beliefs can influence a patient's willingness to accept donated organs or donate their own.
Reproductive Health: Religions may have views on contraception, abortion, and fertility procedures like in vitro fertilization or sterilization.

Culturally and Linguistically Appropriate Services (CLAS)

CLAS standards aim to provide effective, equitable, understandable, and respectful care that is responsive to diverse cultural health beliefs.
Three main areas for CLAS implementation:
- Governance, Leadership, and Workforce: Organizational leadership is responsible for implementing CLAS.
- Communication and Language Assistance: Organizations should provide language assistance appropriate to their size, scope, and mission.
- Engagement, Continuous Improvement, and Accountability: Focus on quality improvement, community engagement, and evaluation to ensure effectiveness of CLAS implementation.

REALM

Measures patients' ability to pronounce medical terms
Assesses reading level
Takes approximately three minutes to administer
Available only in English

REALM-R

Simplified version of the REALM
Aims to reduce test anxiety and boost confidence

TOFHLA

Comprehensive assessment of health literacy
Available in English and Spanish
Uses multiple-choice and fill-in-the-blank questions
Full-length form takes 20 minutes, short version takes 12 minutes

NVS

Features an ice cream label challenge in English or Spanish
Can be completed in approximately three minutes
Widely accepted by patients as part of standard medical care

eHEALS

Measures electronic health literacy
Assesses an individual's knowledge, skills, and comfort level in navigating electronic health information
Used to evaluate e-health literacy and communication programs

NUMi

Assesses quantitative skills essential for health care
20-item pencil-and-paper test
Measures skills such as reading a thermometer, interpreting charts, and interpreting labels

HLSI

Measures print literacy, numeracy, oral skills, and internet-based information seeking skills
Self-administered via computer, takes approximately 12 minutes to complete
25-item and 10-item versions available

Assessing Health Literacy

It's crucial to evaluate a patient's health literacy to ensure they understand medical information and follow treatment plans effectively.
This helps in complying with quality of care standards and selecting appropriate educational materials, like videos or translated versions.
Tools to measure health literacy include questions on how often a patient struggles with understanding medical information, needs help reading hospital materials, or feels confident filling out medical forms.
Assuming anyone who doesn't choose the "most proficient" answer may require simplified materials.

Communication Strategies

Avoid judging patients based on appearance and strive to communicate clearly with everyone.
It's essential to confirm understanding with every patient to ensure messages are received and comprehended.

Message Mapping

Message mapping is a technique for managing key messages during public health emergencies.
It involves creating concise messages presented in three short sentences, conveying three key messages in about 27 words.
Message maps should be written at a sixth-grade reading level to ensure accessibility.
Each primary message has three supporting messages for additional context.

Clear and Effective Written Material

The Centers for Medicare and Medicaid Services (CMS) defines clear and effective written material as engaging, respectful, understandable, and actionable.
It should attract the reader's attention, hold their interest, make them feel valued, and help them grasp the information while encouraging action.

Readability

The Flesch-Kincaid Grade Level Readability Test uses a formula to determine the reading grade level of the text.
The formula is calculated as (0.39 x Average Sentence Length) + (11.8 × Average Number of Syllables per Word) - 15.59.
A score of 8.3, for example, would indicate an 8th-grade reading level.

Visuals

Many people have difficulty interpreting graphs, charts, and mathematical concepts.
Consider using visuals that are familiar and not ridiculous.
Metaphors are not useful when people misunderstand or do not recognize scale.

Shared Decision Making

Health care is increasingly moving to a position of shared decision making (SDM).
Patient decision aids (PDAs) help patients understand and communicate their preferences to their physicians.

Clear Communication

The CDC's Clear Communication Index (CCI) is a tool to evaluate whether draft materials are effective on multiple levels.
The CCI assesses materials in six areas: main message and call to action, information design, state of the science, behavioral recommendations, numbers, and risk.

Health Literacy

The Institute of Medicine's Health Literacy Roundtable identified 10 features that healthcare organizations can embrace to promote patient understanding and the use of health information.
These features include promoting health literacy as part of the organization's mission, integrating health literacy into planning and evaluation, preparing the workforce, including populations served in the design and evaluation of health information and services, meeting the needs of populations with a range of health literacy skills, and using health literacy strategies in communication.

Health Literacy in Healthcare

Healthcare organizations play a vital role in promoting health literacy.
They provide easy access to health information and services, aiding navigation.
They also design and distribute clear, understandable health content in various formats like print, audio-visual, and social media.
Prioritizing health literacy in high-risk situations like care transitions and medication communication is crucial.
Healthcare organizations must transparently communicate about health plan coverage and individual financial responsibilities.
Health literacy transcends basic skills, encompassing an individual's knowledge base and ability to learn new information for informed health decisions.
It has evolved from an individual competency to an institutional philosophy, essential for advancing healthcare.

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Description

This quiz explores the importance of health literacy as a crucial factor in effective health decision-making. It covers various aspects such as interpreting food labels, cultural influences on dietary choices, and the role of numeracy skills. Additionally, it discusses the implications of health literacy within the healthcare system as defined by the Affordable Care Act.