6/30/2015 Origins: Educational Health Literacy: Research & Findings Time to Refocus & Adult literacy skills in industrialized nations Expand 1990s: NALS, IALS 2003: NAAL, ALLS Dr. Rima E. Rudd 2012: PIAAC Department of Social & Behavioral Sciences Harvard T.H. Chan School of Public Health Words Get in the Way Significant numbers of adults in most industrialized nations are limited in their ability to participate in economic & civic life Dr. Rudd - April 2015 1
6/30/2015 New Area of Inquiry: Time for Action Health Literacy Research Documented : Literacy & numeracy skills of adults Literacy is linked to health outcomes Documented : Literacy skills are linked to social factors • Health Promotion Documented: Literacy skills are linked to health • Disease Prevention • Screening & outcomes Early Detection • Chronic Disease Management AHRQ Implications: Health Disparities • Morbidity Reviews 2004 2011 • Mortality IOM Report 2004 Dr. Rudd - April 2015 Dr. Rudd - April 2015 2
6/30/2015 Dilemma: How? Action Objective for the Nation: Improve Health Literacy Connect the Dots : Use 4 straight connected lines Once you begin: Do not lift pen from paper Dr. Rudd - April 2015 Dr. Rudd - April 2015 3
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6/30/2015 Think Outside the Box Poised for Action Dr. Rudd - April 2015 Dr. Rudd - April 2015 5
6/30/2015 Understand Literacy Boxed In Measure Examine Contextual Factors Task Difficulty Literacy: Reading & Writing Speaking & Listening Narrow Focus on Skills Calculations & Without Attention to Key Variables Calibrate Numeracy Text Complexity Text, Task, Context Dr. Rudd - April 2015 6
6/30/2015 Consider Key Variables Boxed In Institutional Professionals’ Norms, Policies & Practice Rigor & Skills Health Literacy: Accessible Information, Care, Focus on One Player & Services Accessible Information & One Side of the Coin Health Materials & Tools Dr. Rudd - April 2015 Dr. Rudd - April 2015 7
6/30/2015 Thinking Outside the Box Boxed In Civic Engagement: Community Health Activities at Work & in Community Environmental Health Health Policy Health Literacy: Accessible Information, Limited Research Settings Engagement, Advocacy, in Clinical Encounter Public Health Activities at Home & in Health Care With and for Loved Ones Dr. Rudd - April 2015 Dr. Rudd - April 2015 8
6/30/2015 Health Literacy: Conceptual Errors An Evolving Concept Don Nutbeam, Social Science and Medicine , 2008 the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health Nutbeam, WHO, 1998 the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions USDHHS, 2010 engagement in a wide range of health actions that extend from personal behaviors to social action to address the Limited Misplaced Neglected determinants of health Nutbeam, SSM, 2008 Focus & Responsibility Context Measure Dr. Rudd - April 2015 Dr. Rudd - April 2015 s 9
6/30/2015 New Definitions Change & Action Consider a definition that shifts attention to the Current Shifts capacity of professionals and health From Skills of individuals institutions to provide access to information Mismatch and support the active engagement of people from Public’s Capabilities Rudd, McCray, Nutbeam. Health Literacy and Definition of Professionals’ Skills Terms, chapter 2 in Health Literacy in Context: International Perspective. Canada: Nova Science. 2012. from Practitioners’ Actions Institutional Culture & Literacy Environment Dr. Rudd - April 2015 Dr. Rudd - April 2015 10
6/30/2015 The capacity of professionals & health institutions to provide access to information Needed: New Measures and support the active engagement of people [Rudd 2010, Rudd, McCray, Nutbeam 2012] A definition determines the scope of a concept A definition determines measures We have : Over 50 measures of patients’ skills/deficits We lack : Measures of tool complexity/ease of use Measures of professionals’ skills Measures of practice attributes Health Literacy Measures of institutional characteristics [complexity & demands] Dr. Rudd - April 2015 Dr. Rudd - April 2015 11
6/30/2015 Needed Research: Expand the Scope Systemic Change & Health Outcomes Public Health Literacy Study options t hat Reduce Complexity, Eliminate Barriers, & Increase Access to • Accessible Information: Scientific Findings Information, Care, and Services • Welcomed Participation: Engagement in Examine our health and Deconstruct health Identifying Community Health Issues & Problem health care systems & activities to Solving institutions and identify the understand the facilitating factors and • Key Issues for Equity: Occupational Health, complexity of health barriers that support or tasks, health texts, Environmental Health, Disaster Planning & inhibit access to information and health related Management and active engagement of tools people Dr. Rudd - April 2015 Dr. Rudd - April 2015 12
6/30/2015 Action Create a Balance Dentists Patient Public Health Advocates Workers Social Workers Hospitals Pharmacies Health Occupational Insurers Journalists Health Community Public Health Workers Departments Clinics Physicians Adult Nurses Education Libraries Mental Health Interpreters Programs Workers Researchers Pharmacists Program Planners Educators Environmental Health Workers Bench Scientists Dr. Rudd - April 2015 Dr. Rudd - April 2015 13
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