October is health literacy month, and the revived Health Literacy Kentucky wants you to know it's a topic that affects everyone

By Melissa Patrick
Ketnucky Health News

Most states do not have have an organization dedicated to health literacy, but Kentucky does, and it's spending 2017 re-branding itself and letting Kentuckians know what it offers.

Health Literacy Kentucky is a statewide coalition of volunteers who work toward improving the state's health outcomes through improved health literacy.

"Health literacy affects everyone and is critical in helping us make choices for the best health that we can -- for ourselves and for our family and friends," Charles Jackson, The Humana Foundation's consultant for the initiative, said in an interview with Kentucky Health News.

Jackson, who is also the head of the HLK steering committee, noted that the American Medical Association says "Health literacy is a stronger predictor of health than age, income and employment status, education or race."

HLK's website says the impact of low health literacy is well-documented. It says people with poor health literacy have overall poorer health, higher rates of emergency-department use, lower use of preventive services and increased difficulty managing their chronic conditions. It adds that poor health literacy cost the nation up to $238 billion every year.

HLK was founded in 2009 and has focused most of its past efforts and resources hosting an annual health literacy conference that largely targeted health care providers. But this year, Jackson said it's working to re-brand itself and increasing public awareness -- and it also has a new partner.

In June, HLK signed a memorandum of understanding with the Center for Health Service Research at the University of Kentucky, which will now house the organization and offer it administrative and operational support. Center Director Mark Williams, who has done research on health literacy since 1990, said they expect this partnership to be a "powerful" one.

"Health literacy encompasses far more than just literacy. It represents an individual’s ability to obtain and use health information to make decisions," Williams said. "Through this partnership with Health Literacy Kentucky, the UK Center for Health Services Research can support efforts to work with patients, their family caregivers and community providers to address health literacy education and research."

Jackson noted that one of their first efforts as partners will be to conduct a heath-literacy needs assessment of health professionals to help inform future HLK strategies.

Another new initiative for the organization is its first Kentucky Health Literacy Award, of which it will soon call for nominations. The award will be presented at the Dec. 5 Kentuckiana Health Collaborative forum in Louisville, which will focus on health literacy. The results of the needs assessment survey will also be announced at this forum.

Elizabeth Edghill, who is also on HLK's steering committee, says the need for health literacy is "profound" for everyone.

"We need to recognize that it's not about education, it's not about income or language barriers," she said. "Those are all huge contributors and of course they can make one at higher risk for low health literacy, but I really think we have to use what we call a universal precaution approach. We need to assume that anyone can be having a low health literacy moment at any encounter and treat them respectfully and with good communication."

Edghill is a registered nurse who is the manager of refugee and immigrant services for Family Health Centers in Louisville. Along with a co-worker, she has initiated several health-literacy programs, including one for all of the center's patients; one that involves a patient advisory group that helps create better health related materials, and another that focuses on health-insurance literacy.

Asked how individuals could immediately improve their health literacy, Edghill said: "One of the most important ways to improve your health literacy is to find a way to record the information."

Edghill told a story illustrating how three people can hear the same health information from a health-care provider and leave with three different interpretations. She offered several suggestions on how to record information, including asking the provider if you can record the conversation; taking notes during the visit; taking someone with you to listen and take notes; or to make sure you understand the after-visit summary that is often provided before you leave the office.

Edghill has been named the 2017 Medi Star Dickinson Wright Nurse of the Year, an award  she will receive Oct. 24 in Louisville.

Jackson said health departments and libraries are great resources to improve health literacy. "Those are the kind of resources we want people to feel comfortable using," he said.

He also noted some free online resources, which he said are important for areas with poor access to health care. They include "Learning About Diabetes;" "The Depression and Bipolar Support Alliance;" and another for children who are overweight or obese called "Weigh2Rock."

Also, the HLK website offers resources for individuals and communities, a "tools for teaching" page, a free online course with continuing-education credits, and training for health-care providers.

Williams noted that the UK Center for Health Services Research was awarded a $4.5 million grant in July to identify and address the social determinants of health in 27 Appalachian counties and parts of Louisville Metro. He said that after determining the most vulnerable patients in these areas, the researchers will then  identify their unmet social needs that contribute to poor health, like unstable housing or a lack of transportation, and then connect them with  community resources to meet these unmet needs.

"This is related to health literacy," he said, "because these patients on their own don't have the health literacy skills to be able to find these resources which could help them personally, and that results in improved, overall health."

6th annual Kentucky Health Literacy Summit in Louisville Oct. 7

The 6th Annual Kentucky Health Literacy Summit, "Health Literacy in the Age of the Affordable Care Act," will be held Wednesday, Oct. 7 at the Founder's Union Building on the University of Louisville, Shelby Campus in eastern Jefferson County.

The Summit is hosted by Health Literacy Kentucky and will showcase national health literacy and plain language experts.

Speakers will include: Wilma Alvarado-Little, principal and founder of Alvarado-Little Consulting LLC, which advocates for linguistically and culturally appropriate health services; Craig Blakely, dean of the UofL School of Public Health and Information Sciences; Elizabeth Edghill, refugee health educator and coordinator for Family Health Centers Inc.; Carlos Marin, assistant dean, Community and Cultural Engagement at the University of Kentucky's College of Medicine; Glen Mays, director of the National Coordinating Center for Public Health Services and System Research at UK; Kristen Munro-Leighton, health educator at Family Health Centers; and former journalist Kim Parson, a strategic consultant at Humana Inc.

The summit is targeted toward physicians, physician assistants, pharmacists, psychologists, social workers, health education specialists, dentists, dental hygienists, and extension agents. Continuing education credits are available. Registration fees are $95 or $25 for students. For more information and to register click here: http://www.cecentral.com/live/9828.

Health literacy is 'at a tipping point' as an issue to be confronted, federal official tells second Kentucky Health Literacy Summit

By Tara Kaprowy, Kentucky Health News

BOWLING GREEN, Ky. – The idea that people will be healthier if they can better navigate the boggy, confusing landscape of health care and insurance is gaining traction in Kentucky – which, relatively speaking, has poor health and low literacy.

On Thursday and Friday, scores of health professionals and their allies in the health-literacy cause gathered in Bowling Green for the annual Kentucky Health Literacy Summit. It was the second such gathering, but the first was by invitation, so this was the first opportunity for anyone interested in health literacy to attend a statewide conference about it. The first conference resulted in the formation of Health Literacy Kentucky, an alliance of more than 35 groups.

Health literacy is the "degree that an individual can obtain, communicate, process and understand" basic health information, said Dr. Linda Harris, a Bowling Green native who leads the health communication unit in the U.S. Department of Health and Human Services. Only 12 percent of U.S. adults are considered proficient in health literacy, while 21 percent have basic knowledge and 14 percent are below basic. About half of adults have intermediate knowledge, between basic and proficient.

Health literacy has become an increasing problem as health care has become more technical and complex, and as America has more people for whom English is a second language. If people can't understand what they're being told about their health, they are more likely to get sick -- and less likely to get better once they're ill, Harris said.

She illustrated her point with the story of "Mrs. Jones," a composite individual with issues requiring health literacy: a 62-year-old woman with diabetes, heart failure, low income and a history of depression. She gets sick, goes to the doctor, is prescribed several medications she doesn't know how to take, avoids taking them and eventually needs to be hospitalized. Then she is given a second set of prescriptions that she also doesn't understand. She is re-hospitalized "and the cycle continues," Harris said.

Harris said the issue is at a "tipping point" because it has gone from simply being discussed among advocates to being made policy in legislation like the Patient Protection and Affordable Care Act; the National Action Plan for Health Literacy, the Plain Writing Act of 2010; and Healthy People 2020. "We really think this is the moment," Harris said. "It's not just those people who have been laboring in the vineyards for so long."

Insurance companies making headway

Some of the most innovative health-literacy work is being done by insurance companies, most of which are taking steps to make sure their policyholders understand the forms and documents they're sending them, Humana Inc. marketing consultant Betsy Shirey said. In the past year, Humana has simplified more than 400 of its documents, most of which have been rewritten at a sixth-grade level, as determined by a computerized assessment tool, she said.

To test the rewritten materials, Humana had some of its Medicare members look at the new documents. One person said a form could be simplified if it only had a date at the bottom of it. "They told us about really simple things, and yet we hadn't done it," Shirey said.

The new forms are better designed, with headlines and age-appropriate photography, and "always have a P.S., because everyone always reads the P.S," Shirey said. The document that gives patients a rundown of their to-date expenses, medications and doctors' visits looks like a credit-card statement. "You have a complete picture both financial and medical," Shirey said.

(Humana was the major sponsor of the summit, along with the University of Kentucky and Western Kentucky University.)

Revelations among providers

Simplifying documents was also the goal at People's Community Clinic in Texas, when Special Projects Supervisor Dana Carpenter came across a form that detailed how to take birth control pills. "Someone with a Ph.D. would have trouble understanding it," she said. With help from patients, Carpenter simplified the form, adding photos and "plenty of white space."

About 80 percent of the clinic's patients are Hispanic, so Carpenter was shocked to learn that, when she called the clinic, there was no telephone prompt asking the caller if they wanted to converse in Spanish. "You had to listen to the entire English menu before it would roll into Spanish," she said, and the clinic's directional signs were all in English and hidden by clutter. New signage is bilingual and prominently displayed.

Christine Nagy and Diane Sprowl said they went through a similar process in a joint venture between Western Kentucky University and the Barren River District Health Department. The goal was to get participants in the Women, Infants and Children food program to eat more fruits and vegetables. Patients were asked to fill out surveys, which needed to be designed for people who did not speak English well. Nagy, Sprowl and WKU students designed materials with bullet points, white space and culturally appropriate graphics. They kept the reading level low by using words with few syllables. They also met with patients face to face to help avoid communication breakdown.

Oral communication

More than just rewriting forms, health literacy involves making sure people understand what they're being told. To that end, insurance firms like Humana and providers like the People's Community Clinic are teaching employees how to communicate in a simple, uniform way. Often this involves the "teach-back technique," where you "have them explain back what you've gone over," said Dr. David Susman, psychology services coordinator at Eastern State Hospital.

Susman said it's important to look for clues that a person is having difficulty understanding, such as incomplete forms, lack of adherence to directions, or even looking in a pill bottle to determine what pill they're taking rather than reading the label.

Ultimately, the goal is to keep patients from the fate of Mrs. Jones. "No one is going to say, 'Oh by the way, I have limited health literacy,'" Susman said. "And no one complains about information being too simple."

For a list of advance registrants for the summit, click here.