An informatics perspective on health literacy
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This document discusses health literacy from an informatics perspective and identifies challenges and opportunities. It provides an overview of key topics, including definitions of health literacy, models of health literacy, the impact of low health literacy, and efforts to address it. Examples are given of digital health literacy interventions using patient portals, mobile apps, and text messaging. Collaboration across disciplines and co-locating health and library services can improve health literacy. Lessons from initiatives in Philadelphia highlight the benefits of needs assessments, small and flexible programs, and evaluating outcomes.
![What Is Health Literacy?
It Depends…..
■ The degree to which individuals have the capacity to obtain,
process and understand basic health information and services
needed to make appropriate health decisions [Institute of
Medicine, 2004]
■ E-Literacy – the ability to seek, find, understand and appraise
health information from electronic sources, and apply the
knowledge gained to addressing or solving a health problem.
Norman CD, Skinner HA. (2006) eHealth literacy: essential
skills for consumer health in a networked world. JMIR 8: e9.
■ [Health] literacy is the product of individuals’ capacities AND the
health literacy related demands and complexities of the
healthcare system. Baker DW. The Meaning and the Measure of
Health Literacy. J Gen Intern Med 2006; 21(8):878-883. 7](https://image.slidesharecdn.com/healthliteracyaninformaticsperspectivepdalrymple05302017-170606161410/85/An-informatics-perspective-on-health-literacy-6-320.jpg)
![Data, Data, Data
■ Health data is ubiquitous
■ Health data is digital
■ Health data can be organized, managed, analyzed,
visualized … and USED
■ Data [usually] don’t lie
■ Data can drive decisions
20](https://image.slidesharecdn.com/healthliteracyaninformaticsperspectivepdalrymple05302017-170606161410/85/An-informatics-perspective-on-health-literacy-18-320.jpg)
An informatics perspective on health literacy
- 1. HEALTH LITERACY An Informatics Perspective Challenges and Opportunities Prudence Dalrymple, M.S., Ph.D., M.S., FMLA
- 2. Acknowledgements ■ Dr. Alla Keselman and Dr. Catherine Arnott Smith, editors of Meeting Health Information Needs Outside of Health Care for their foresight and mentorship ■ Catherine Gold and Elsevier for their invitation and hospitality here today ■ The many librarians, clinicians and public health professionals who will help bend the curve of health illiteracy in the U.S. today Renee Pokorny, Will Torrence, Katie Dangerfield-Fries, Tony Luberti, Autumn McClintock, Barbara Cavanaugh 2
- 3. 3
- 4. Overview ■ What are the best ways to help individuals become more literate and more responsible for their health? ■ What lessons can we learn from the information and informatics communities that can be applied to health literacy research and practice? ■ What values and beliefs must we examine as we attempt to achieve a more health literate society? ■ What unique contributions are librarians making to improve health literacy? 4
- 5. Obstacle: Many Definitions ■ Clinical medicine ■ Public Health ■ eHealth ■ Library & information science 6
- 6. What Is Health Literacy? It Depends….. ■ The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions [Institute of Medicine, 2004] ■ E-Literacy – the ability to seek, find, understand and appraise health information from electronic sources, and apply the knowledge gained to addressing or solving a health problem. Norman CD, Skinner HA. (2006) eHealth literacy: essential skills for consumer health in a networked world. JMIR 8: e9. ■ [Health] literacy is the product of individuals’ capacities AND the health literacy related demands and complexities of the healthcare system. Baker DW. The Meaning and the Measure of Health Literacy. J Gen Intern Med 2006; 21(8):878-883. 7
- 7. Obstacle: Multiple Research Communities 8 ■ Clinical medicine, nursing ■ Public Health ■ Communications, Education and Information Science
- 8. Nutbeam’s Model : Functional literacy which consists of reading, writing, and understanding Communicative/interactive health literacy which consists of communication and social skills to derive meaning and to apply new information as situations change; and Critical literacy, which consists of higher level skills needed to analyze and use information to exert control, over life events and situations, and make decisions Ideally, health literacy supports patient autonomy and empowerment 10 Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promot Internation. 2000;15(3):259-67.
- 9. HL as a Social Determinant of Health 11 Sorensen K, et al. (2012) Health literacy and public health: a systematic review and integration fo defnitions and models,. BMC Public Health, 12(80)
- 10. 12
- 11. Impact of Low Health Literacy Patients with low HL have more … medical non-adherence, serious medication errors, difficulty navigating the health system, communicating with providers, chronic disease and mortality for themselves & their families, problems during transitions of care Which results in …. lower patient engagement and costs as much as $236 billion annually 13
- 12. U.S. Health Literacy 36% of Americans are at or below basic HL * Source: U.S. Department of Education, Institute of Education Sciences, 2003 National Assessment of Adult Literacy. 14
- 13. What Has Been Done to Help? ■Assessment ■Curated information ■Public Health campaigns 15
- 14. HL Assessment Tools Help for clinicians Handy tool for quick assessment 16
- 15. MedlinePlus 17
- 16. Questions Are the Answer 18
- 18. Data, Data, Data ■ Health data is ubiquitous ■ Health data is digital ■ Health data can be organized, managed, analyzed, visualized … and USED ■ Data [usually] don’t lie ■ Data can drive decisions 20
- 19. Make a Decision, Take an Action ■ Harder, more important in today’s complex healthcare system ■ Harness technology to support and guide decisions ■ For clinicians AND consumers ■ Health decisions happen anywhere, any time – Not limited to clinical encounter ■ Patients may want to make decisions outside the clinical context – Time is needed outside the moment to think through, review information, and decide 21
- 20. Digital Health Literacy: Actionable Interventions Embedding Information in Patient Portals – Medline Connect ■ Embedding HL Assessment in the Electronic Health Record – Should be standard part of EHR (Healthy People 2020) – Self assessment of HL comparable to performance based assessment ( Kiechle ES, JGIM 2015) ■ Mobile apps – iPrescribe – Text messaging at 11th Street 22
- 21. Linking Information to Patient Portal 23
- 22. iPrescribe apps 24 iPrescdibeapps will enable providers to “prescribe “ an app to their patients. An email wil be sent enableing the patient to access the site. May nto always be free (drugs aren’t either) but apps will be vetted by phsycians from iMedical Appsl Currenlty in Beta test.
- 23. Apps to Help Patients 25 http://www.imedicalapps.com/
- 24. Informatics: A Team Sport ■ Interdisciplinary ■ Iterative ■ Collaborative 26
- 25. Health Literacy and Informatics ■11th Street text messaging project ■Needs assessment for patient portal ■Decision Counseling for Cancer Clinical Trial 27
- 27. Highest poverty rate of 10 largest U.S. cities 22% of adults lack basic literacy Health literacy is even lower 29 City of Contrasts
- 28. -Children’s Hospital of Philadelphia (CHOP) -Philadelphia Free Library -City of Philadelphia -Philadelphia Department of Public Health -Philadelphia Parks & Recreation 30 South Philly Community Health and Literacy Center
- 29. Free Library 150,000 “customers” Nurse on-site weekly Healthy story time 31
- 30. 32 Health Center 2 City of Philadelphia FQHC Full service adult healthcare Dental services, family planning Nutrition classes
- 31. CHOP Primary Care Center Easy referral from M.D. to librarian 35,000 year--a book each time! Stories, games, puppets, oh my! 33
- 32. Adjacent Park & Rec Center 34 Basketball courts, playground, garden, indoor programs, too
- 33. Collaborative Model 35 Established early Public private partnership Monthly inter-disciplinary meetings Location, location, location Opportunistic Clinician proximity for easy referral Shared goals
- 34. University of Pennsylvania Libraries Community Outreach 36
- 35. UPenn Libraries Community Outreach 37 Biomedical Library, Philadelphia Free Library (3 branches) UPenn School of Nursing Sayre Health Clinic (FQHC) City of Philadelphia Health Clinic Netter Center for Community Partnerships Mid-Atlantic Region NN/LM
- 36. UPenn Community Outreach Locations Cobbs Creek Library Free Library Branch 38
- 37. 39
- 38. Lessons Learned ■ Anonymity & flexibility—reluctant to “enter the room” for a class or deeper discussion ■ Needs assessment ■ Usability, HL in small bits and bytes ■ Citizenship classes very successful ■ Flexible space, jazz concerts, health fairs, active events ■ 1/3 of library users ask health questions ■ Integrate health into other library activities ■ http://www.webjunction.org/explore-topics/ehealth/news.html 40
- 39. Ideas & Opportunities ■ Collaboration across disciplines, across agencies, across time and space? ■ Lend stuff, too—BP cuffs, pedometers… ■ Locations & linkages – Telehealth sessions from the library – Health librarian on call from clinic, information and referral from library – BP, flu vaccine, nurse in library ■ Digital information hub – How to use your patient portal, collect and add data, personal data management ■ Understanding and improving health – Exercise classes, yoga, books and puppets, games and exercise in the clinic – Kitchens for nutrition, numeracy & literacy ■ New skills – Safety net skills training for librarians – Information literacy skills for health professionals 41
- 40. Tips for Success ■ Many hands make light work—team science, many disciplines working together, talking together, and collaborating. ■ Having separate communities of practice that don’t talk to each other is not a good use of resources. ■ Knowing what each of us is good at, and iterate until it’s right ■ Evaluate! ■ Understanding quality information, understanding your own health 42
- 41. Improving Health Literacy Is Affordable Pragmatic Enhances social welfare Has a moderate influence on health outcomes Contested intellectual territory 43
- 42. Staking a Claim ■ Accessibility experts ■ Connectors ■ Subject specialists ■ Collaborators ■ Imaginative 44
- 43. As Promised-- ■ What are the best ways to help individuals become more literate and more responsible for their health? ■ What lessons can we learn from the information and informatics communities that can be applied to health literacy research and practice? ■ What values and beliefs must we examine as we attempt to achieve a more health literate society? ■ What unique contributions are librarians making to improve health literacy? 45
- 44. 46 Let’s begin the conversation….. For additional information or to make comments, please feel free to contact me at pdalrymple@drexel.edu