Focus on Health Literacy 1

FOCUS ON...HEALTH LITERACY


October is "Health Literacy Month 2002". Health Literacy Month, as listed in Chase's Calendar of Events 2002, is a grass-roots campaign to promote understandable health communication around the world. Advocates everywhere are encouraged to raise awareness about health literacy in their own communities.

"Health literacy" is defined by the National Library of Medicine as "the degree to which people can obtain, process, and understand basic health information and services they need to make appropriate health decisions." But this definition is only a starting point. Health literacy is about the entire process of exchanging healthcare information. It is not just about reading and writing, but how people communicate about health through speaking and drawing pictures. And it is about using such technology as videotapes, audiotapes, CD-ROMs, and the Web.

The National Academy on an Aging Society reports that "over 90 million adults with low health literacy skills have limited ability to read and understand the instructions contained on prescriptions or medicine bottles, appointment slips, informed consent documents, insurance forms, and health educational materials. . . .The estimated additional health care expenditures due to low health literacy skills are about $73 billion in 1998 health care dollars."

To find out more about Health Literacy Month, and ways to participate in this important initiative, visit: www.healthliteracymonth.com

Pfizer conference explores low health literacy's impact on cost, quality, access to medical care

WASHINGTON, D.C., Sept. 19 - - More than 75 percent of patients, physicians and pharmacists say the inability to understand information about prescription medications contributes to poor health outcomes, according to survey results released in September.

The Roper ASW survey also found that one-third of patients and two-thirds of physicians polled said they know of someone who has had health problems because they did not understand how to correctly take a prescription medication. This limited understanding, referred to as low health literacy, affects the health of 90 million Americans and is estimated to cost the health care system tens of billions of dollars annually.

Still, low health literacy is pervasive and growing.

Results of the survey, conducted on behalf of Pfizer Inc. (www.pfizerhealthliteracy.com), were released at the Fifth Annual Pfizer Health Literacy Conference, featuring presentations by leading authorities on the topic of low health literacy from academia, medical and health disciplines, government and industry. The survey also showed:

  • Two-thirds of physicians and pharmacists regularly or occasionally encounter patients who don't understand their prescription medication instructions.
  • Nine out of 10 physicians and pharmacists say most patients have had an experience in which they thought they understood instructions regarding prescription medication -- but later had trouble remembering or knowing what they should do.

"When it comes to medical information, one size doesn't fit all," said Dr. James Curran from the Rollins School of Public Health of Emory University. "Medical language often comes across as jargon to the lay person. We need to continue to look for ways to present health information in a way that is clear to the patient, relevant to his or her individual needs, and culturally sensitive," he added.

Dr. Curran addressed the conference along with other panelists on a range of related topics:

  • David Baker, MD, Division Chief of General Internal Medicine, Northwestern University School of Medicine, "The Health Literacy State of the Union"
  • James Curran, MD, MPH, Dean and Professor of Epidemiology at Rollins School of Public Health of Emory University, "Practicing Health Literacy in a Public Health Crisis"
  • Sen. John Breaux (D-LA), Chairman of the Special Committee on Aging
  • "Practical Health Literacy: Integration Into Care Delivery and Patient Education", featuring distinguished panelists including Joseph Riggs, MD, Trustee, American Medical Association; Myrl Weinberg, CAE, President, National Health Council; Kim Lee, Director of Assessment, Evaluation and GED, Georgia Department of Technical and Adult Education; and Sondra Stein, PhD, National Director, Equipped for the Future, National Institute for Literacy.

Low health literacy can have an impact on anyone -- regardless of age, race, education or income level. However, patients who have difficulty understanding health information are at a higher risk for poor health outcomes. Research shows these patients make more mistakes with their medicines and are less able to comply with treatment.

Patients who have difficulty reading are at a 52 percent higher risk for hospitalization.

"Our business is to develop innovative medicines and we recognize our obligation to make information about those medicines and the diseases they treat, easier for patients to understand," said Barbara DeBuono, MD, MPH, Senior Medical Director, Public Health at Pfizer. "It is the responsibility of everyone involved in health care to offer medical information to patients in a way that is clear, understandable and truly accessible."

Many patients feel intimidated or vulnerable in a medical setting often inhibiting their ability to admit they may not understand the information provided by their health care professionals. This may lead to patients' lack of compliance with physician instructions or not seeking medical care altogether and, ultimately, negative health outcomes.

"Failure is always my companion and, as a low level reader, that's constant," said patient advocate Toni Cordell Seiple. "When you add the vocabulary of the medical profession on top of that, you have just heightened fear and a possibility for humiliation in a way that I don't think that most of us can cope with. If medical professionals speak to patients using the language they use to talk to each other, or give out materials written at that level, it doesn't help patients understand what they need to do to have a good health outcome," Seiple notes.

In fact, in the Roper ASW survey, 79 percent of patients polled say that "other people" have felt awkward communicating their lack of understanding with medical professionals, while only 14 percent of patients say they themselves have felt awkward admitting they did not understand health care information. This 'transfer of blame' may be a sign of the shame many patients feel in admitting they need help with understanding health care information.

"We will have accomplished our goal when the patient says, 'I get it. I understand how to take my medication. I know what questions to ask my doctor and I'm not ashamed to ask any question,'" said Dr. DeBuono.

Ultimately, if patients are able to increase their understanding of health information, experts believe there will be many benefits including: better health outcomes, better provider/patient relationships, improved preventive care, and cost savings to the health care system.

The Roper ASW telephone survey was commissioned by Pfizer and conducted in March/April 2002. The nationally representative sample consisted of 666 patients, 150 primary care physicians, and 151 pharmacists. Patients were defined as adults 18+ currently taking a prescription medication and who had seen a physician in the past six months who had prescribed medication.

Source: Pfizer Pharmaceuticals

For more information on Pfizer's Health Literacy Initiative, visit the company's new website dedicated to the issue: www.pfizerhealthliteracy.com

Pfizer White Paper on Low Health Literacy: An Emerging Public Health Issue

[September 2002 -- abridged]

How would you describe a health situation that:

  • Threatens every person in the US regardless of age, race, education or income level
  • Is estimated to cost tens of billions of dollars per year
  • Can't be detected by a physical examination, a blood test or a state-of-the-art diagnostic imaging system
  • Is not yet a priority for public policy and government decision-makers?

Would you call it a public health emergency?

A growing number of physicians, volunteer health associations, universities and health care companies call it low health literacy, and it is an epidemic -- a silent epidemic. This widespread but hidden health challenge affects all of us, and should serve as both a warning and a call to action: Understanding health information is everyone's right; improving health literacy is everyone's responsibility.

The health literacy problem is a crisis of understanding medical information rather than one of access to information. Medical information is becoming increasingly complex and, all too frequently, physicians do not explain this information to patients. Physicians are under increasing time pressure in today's clinical setting and, even more important, they may not know when patients do not understand medical information or instructions.

Many patients -- because they are embarrassed or intimidated by the power dynamic of the medical encounter do not ask health care providers to explain difficult or complicated information. And if patients do not understand medication and self-care instructions, they may be receiving substandard care -- which may then have an adverse effect on their clinical outcomes.

Health literacy can be considered the foundation of the health care delivery system, affecting the spectrum of care from prevention and screening to history taking and explaining diagnosis and treatment.1 Tools and interventions to improve understanding of health information for all patients must be integrated into written and oral communications between caregivers and patients.

What is Low Health Literacy?

Health literacy is defined as the ability to read, understand and act on health information. Low or inadequate health literacy affects people of all ages, races, education levels and social classes. Many adults have problems reading the instructions printed on prescriptions or on pill bottles. The use of obscure abbreviations and unfamiliar medical jargon can make medication directions difficult to understand. And most adults -- including those with quite good reading skills -- are baffled by informed consent documents and insurance forms.

One in five American adults reads at the fifth-grade level or below, and the average American reads at the eighth- to ninth-grade level. But most health care materials are written above -- sometimes far above -- the tenth-grade reading level.2

Research has demonstrated that, no matter how well people read, most people need help understanding health care information. Quite simply, all patients prefer medical information that is easy to read and understand.3

When people have difficulty reading and understanding health information, serious -- and costly -- consequences may occur. Recent studies have shown that people with low health literacy make more medication and treatment errors.4, 5 They are less able to comply with prescribed treatments and self-care routines.6 They fail to seek preventive care, and they are at higher -- more than doubled -- risk for hospitalization.6, 7

And if they do seek treatment, they lack the skills needed to successfully navigate our complex health care system.6, 7

All these factors combine to produce poorer health outcomes in patients with limited literacy skills. And poor
health literacy skills have been shown to have profound economic consequences. Annual health care costs for individuals with low literacy skills are four times higher than for those with higher literacy skills.6

To date, health literacy has gone largely unnoticed as a public policy issue. Rapid advances in medical research and technology have made communicating patients' diagnostic and treatment options highly complex. As a result, patients often have difficulty understanding their medical conditions and making important decisions about treatment and self-care plans.

And all too frequently, health care providers do not recognize these patients' lack of understanding.

Health care reform efforts must begin to address the increasing complexity of being a patient. Recent health care reform efforts have focused on empowering patients with more health information. But it is critically important that patients' ability to understand and act upon this information be taken into account. Effective tools and interventions must be developed to make health care information more accessible for everyone -- but especially for those who are at higher risk for low health literacy, such as the poor, the elderly, recent immigrants, ethnic minorities, and people with a chronic illness.

Health Literacy myths, misperceptions and reality

A number of myths cloud the health literacy issue and make the problem even more difficult to address.

Myth #1: Illiterates are dumb and learn slowly, if at all.
Reality: When a person has trouble reading, it tends to be related more to economic factors than to low intelligence.2 Most people with low literacy skills have average IQs, and they function well in daily life by compensating for their lack of reading skills in other ways.

Myth #2: Most illiterates are immigrants or minorities.
Reality: An estimated 40 to 44 million adults in the US are functionally illiterate (that is, they can't perform basic reading tasks required to function in society) and 50 million are marginally illiterate.8 Most of these people are white, native-born Americans. However, as a percentage of the US population, more minorities and immigrants do have difficulties reading English. (It is important to note that English is not the primary language of many immigrants, who may be highly literate in their first or native languages.)

Myth #3: People will tell you if they can't read.
Reality: There is a strong stigma attached to people with reading problems, and nearly all non-readers or poor readers try to conceal the fact that they have trouble reading. In a study of 58 patients who admitted having difficulty reading, 67 percent had never told their spouse, and 19 percent had never told anyone.9

Myth #4: The number of completed years of schooling is a good measure of literacy level.
Reality: Surveys have shown that, on average, adults read three to five grade levels lower than the years of schooling they have completed. And through disuse, the reading skills of many older adults may decrease over time.2

Scope of the problem

The finding that more than 90 million people -- almost half the population of the US -- are either functionally or marginally illiterate was reported in the 1993 National Adult Literacy Survey (NALS), conducted by the US Department of Education. (A study now in progress will publish updated adult literacy statistics in 2003.)

Although people of all social classes and conditions may have low literacy skills, several particularly vulnerable populations have been identified:

  • The elderly tend to have fewer years of schooling than younger adults, and more than 66 percent of US adults age 60 and over have either inadequate or marginal literacy skills.
  • About 45 percent of all functionally illiterate adults live in poverty.
  • The greatest number of low-literate Americans are native-born whites. However, 50 percent of Hispanics, 40 percent of Blacks and 33 percent of Asians have literacy problems.
  • Immigrants who are not native English speakers are more likely to have difficulty reading.
  • Among people with a chronic illness, more than 40 percent are functionally illiterate.9

Prescription labels and self-care instructions are among the most important written materials that patients receive. Poor compliance with these treatment regimens can be dangerous. Yet serious mistakes may occur because a patient cannot read or understand the instructions. Only about 50 percent of all patients take medications as directed.10  And, among the elderly, compliance often drops below this level.

Patients who read poorly have more difficulty in complying with recommended treatments. A study of 2,659 patients in two urban public hospitals demonstrated that patients with inadequate health literacy were five times more likely to misinterpret their prescriptions than patients with adequate reading skills.10  At least part of this gap may be attributed to patients' not understanding their medical condition or their need for the prescribed medication.

Patients who have low health literacy skills in combination with a chronic disease such as diabetes, asthma or hypertension have less knowledge of their disease and its treatment and fewer effective self-management skills than more literate patients.4  And patients with poor reading skills suffer from more uncontrolled chronic illness.4

People who have trouble understanding information about their medications and self-care instructions also have difficulty reading insurance forms. In one study of patients with inadequate health literacy, 81 percent could not read the rights and responsibilities section of a Medicaid application, and 74 percent did not know whether they were eligible for free care.10

Consequences of the problem

Using data from a nationally representative sample of the US adult population (aged 16 years and older), the National Academy on an Aging Society examined the impact of literacy on the use of health care services.8 The study found that people with low literacy skills use more health care services than those with adequate or high literacy skills, which creates a significant -- and avoidable -- cost burden on the health care system.

Among adults who stayed overnight in a hospital in 1994, those with low health literacy skills averaged six percent more hospital visits, and stayed in the hospital nearly two days longer than adults with higher health literacy skills. And among adults with at least one doctor visit in 1994, those with low health literacy skills had, on average, one more doctor visit than adults with higher health literacy skills. More important, when self-reported health status is taken into account, patients with low health literacy skills had fewer doctor visits but used significantly more hospital resources.

A new study published in the Journal of the American Medical Association (JAMA) illustrates the correlation between low health literacy and health outcomes in patients with diabetes.11 Patients with inadequate health literacy were found to be less likely than patients with adequate health literacy to have effective glycemic control. Low-literacy patients were also more likely than others to report vision problems caused by their diabetes. The study further suggests that, because people with low health literacy have trouble accessing preventive care, low health literacy may contribute to the disproportionate occurrence of diabetes-related problems among disadvantaged populations.

Culture and context

In creating educational and self-care materials for patients, it is important to be aware of and sensitive to the intended audience's age, gender and ethnicity. Health information is very personal, and the reader should feel that the materials are meant for (and relevant to) him or her.

Culturally sensitive materials acknowledge cultural differences and address them in the choice of content, language and visual elements, so that the intended message is communicated accurately and appropriately to its specific audience. The most effective way to ensure that health information is culturally and personally relevant is to involve members of the intended audience in the initial design and subsequent development of the materials.

The way in which a particular ethnic or age group expresses symptoms (pain, for example) or interprets the concept of health should be borne in mind when developing culturally appropriate health information resources. Other useful guidelines include:

  • Choose words and phrases that are familiar to or easily identified by the audience
  • Use language that is inclusive
  • Suggest a clear course of action that is both within readers' abilities and culturally
    appropriate
  • Avoid overuse of negative wording (Don't eat or You shouldn't)
  • Use graphics that are relevant to the intended audience.

The text and illustrations in materials created for multicultural audiences must affirm the legitimacy of different cultures, lifestyles and values. For example, in a program directed to any of the several Hispanic groups now living in the US, communications should be bilingual, and messages should emphasize family themes and values.

Even the choice of communications media should be assessed for relevance and effectiveness. Written documents, for example, may be less effective than television and radio messages for some cultural or age groups.

Signs of inadequate health literacy

People with low health literacy skills have developed a number of clever and successful coping strategies that allow them to conceal their problems. Some patients bring along a friend or family member who can assist with reading. Patients may also watch the behavior of others in the same situation and copy their actions. Some ask for help from the medical staff, while others may ask for assistance from other patients.

Clues that a patient may have poor health literacy skills include:

  • Registration and other forms filled out incompletely or incorrectly
  • Written materials handed to a relative or other person accompanying the patient
  • I will read this at home
  • I can't read this now; I forgot my glasses
  • Aloofness or withdrawal during physician/provider explanations.

During the course of clinical care, the physician or nurse may notice that the patient frequently misses appointments, including appointments for specialty consultations or additional laboratory tests. The patient may also be seen to make frequent errors in medications or self-care instructions, and consequently may be considered noncompliant.6 All these behaviors could signal a potential health literacy problem.

It is entirely appropriate to ask patients whether they ever have difficulty understanding the information given to them by their physicians. Their answer to this question could open up a dialogue that will provide information about their literacy skills and create an opportunity for physicians to provide better, more effective care.

Measurements of health literacy

Of the many tests that measure reading skills in adults, the one most often used in the setting of clinical medicine is the Rapid Estimate of Adult Learning in Medicine (REALM). The REALM test was designed to be used in public health, primary care and medical research settings to identify patients with low (below the ninth-grade) reading levels.12 This test may be
administered in one to two minutes. The REALM test is based on word recognition, and all the words in the test are medical words. When scored, the test yields an approximate reading level that providers may use to tailor patient education efforts to the needs and ability of a specific patient.

The REALM test's validity and reliability in assessing reading levels compare favorably with those of other adult literacy tests. However, this test cannot measure reading skills in any language other than English, which may limit its usefulness in major urban centers or in areas of the country with large non-English-speaking populations.

The Test of Functional Health Literacy in Adults (TOFHLA) requires 15 to 20 minutes to administer, but it is available in a Spanish-language version.6 Recently, a Short Test of Functional Health Literacy in Adults (S-TOFHLA) has come into use in the clinical setting. This test takes no more than 12 minutes to administer and, like the original TOFHLA, it is available in both English and Spanish versions.

The S-TOFHLA uses actual materials that patients could encounter in a health care setting. The first part of this two-part test is a 36-item reading comprehension assessment. Patients are tested on their ability to read and understand two prose passages -- one written at about the fourth-grade level (preparation instructions for an upper gastrointestinal tract diagnostic radiology examination), and the other written at about the tenth-grade level (the Rights and Responsibilities section of the Medicaid application).

The second part of the S-TOFHLA tests for numeracy skills. This four-item test uses actual hospital forms and labeled prescription bottles to evaluate patients' ability to understand directions for taking medications, monitoring blood glucose levels and keeping clinic appointments.13

Revising written materials for greater understanding

Although innovative alternatives to written materials -- such as pictograms, comic strips, videos, and graphics-rich computer-based training programs -- should be explored more fully for use among patients, sometimes the use of written materials cannot be avoided. Written materials for low-literacy patients should be aimed at the fifth-grade reading level or lower. (Most patient education materials and brochures currently included with medications are written at the tenth- to twelfth-grade reading level.) 14

Simple words and short sentences, as well as larger type and generous use of white (unprinted) space should be used when developing these documents. Complicated medical or technical words should be replaced with simpler choices, and pictures or diagrams that illustrate the concepts being presented are helpful. In fact, comic-strip formats have been found to be very useful for presenting a range of patient information and self-care regimens to patients with low literacy skills.6

The materials should focus on desired behavior rather than on medical facts, and the information should be both culturally sensitive and personally relevant.14, 15

Pfizer, in consultation with health literacy experts, has developed a series of Health Literacy Principles that focus on five key directives for developing written materials for patients:

  • Base the content on a written objective; explain the purpose and limit the content
  • Involve the reader
  • Make the document easy to read (vocabulary)
  • Make the document look easy to read (format and design)
  • Select visuals that clarify and motivate.

Pfizer has committed to including these principles in the development of its patient-directed communications, and the company is encouraging and training other organizations to use the principles in the development of their own health information materials for a wide range of consumer audiences.

Rethinking oral communication

It is important to bear in mind that, although reading skills are important to adequate health literacy, the concept is broader than just being able to read printed information. Having adequate health literacy also means that a patient can understand the oral information given by physicians, nurses, pharmacists and insurers, and can act upon those directions to take medications correctly and to keep appointments with various health care service providers.

Patients with low literacy skills are likely to struggle with oral as well as written communication. For example, patients who have difficulty reading may also have difficulty understanding oral instructions because of limited vocabulary or limited ability to follow complex sentence structure. They may also have inadequate problem-solving skills, or be less likely to change their behavior on the basis of new information. Low literacy skills may, in fact, be a marker for a complicated series of problems with provider-patient communication.7

Physicians and other health care providers should make an effort to speak in simple language, to repeat their instructions to patients and to demonstrate key points. Providers should avoid the use of medical jargon or overly technical language, and try to present only a few key concepts during each instruction session. They should make a point of asking whether patients have understood the information they have received. Providers can evaluate -- and enhance -- patient understanding by asking them to repeat the instructions or other information in their own words.

Teaching methods

It is important for providers to create a blame-free environment in which patients with low literacy skill levels can seek help without feeling ashamed or stigmatized. Medical staff should suspect a reading difficulty if a patient does not know the names of medicines that he or she has been taking for a long time, or makes excuses for not reading the prescription label when asked to do so.

If a provider suspects that a patient may have a literacy problem, he or she might say to the patient, A lot of people have trouble reading and remembering these kinds of materials (or instructions). Is this ever difficult for you? Having patients repeat the information or instructions as they would tell them to a friend (the teach-back method) is an easy way to verify that they understand what they are supposed to do.16

It may also be useful to ask the patient, Is there someone who helps you remember to take your medicine? That person will often be the surrogate reader for the patient, so the provider should help him or her -- often a family member of the patient -- to understand the care instructions so that he or she can reinforce the provider's teaching when the patient is at home.

Recent research with physicians, pharmacists and consumers has revealed that 52 percent of patients report that prescription information and instructions are often written in language that is hard for people to read and understand. And although 70 percent of physicians state that they provide patients with additional resources to help them understand their medications, just 41 percent of patients say they have received this kind of assistance. This critical information gap provides an opportunity for pharmacists to participate actively in educating patients about prescription labels and medication instructions, as well as side effect profiles and possible interactions with other medications they may be taking.17

The fact that low health literacy is a frequently overlooked condition is important to bear in mind during all provider-patient communications. Many patients are either unaware of or unwilling to admit to having difficulty with health care information. In a recent study, only 17 percent of patients reported that they sometimes or very often have trouble reading or understanding medical instructions, and just 14 percent stated that they felt awkward admitting that they found such information hard to understand.

Interestingly, although most patients reject the notion that they personally have experienced difficulty with health information, 79 percent of those surveyed stated that they believe that many other people do have difficulty. Nine out of ten of the patients surveyed reported that they always read the instructions they are given by health care providers, but, revealingly, they estimated that just 34 percent of other people do so.17 And finally, it is important to restate the finding that patients who report that they have had trouble reading and understanding health information represent all racial and age groups in the overall US population.

Health Literacy research/action priorities

Consequences of patients not understanding health care information include rising health costs, a widening of the gap between rich and poor, and too little preventive care. In other words, poor people have poorer health and more health problems. Improvements in understanding health information will improve health literacy and health outcomes.

Although there is no quick fix for the health literacy problem, the active involvement and collaboration of government, health care professionals, patient advocacy groups, health care companies and community-based organizations will help to both raise awareness of the problem and develop interventions to address it.

For example, the federal government might implement health literacy demonstration programs as part of Medicare and Medicaid to help improve health outcomes. These health literacy program elements would be particularly important in the development of documents such as the Health Employer Data Information Set (HEDIS), used by the National Committee for Quality Assurance (NCQA) to accredit health plans. HEDIS documents could then be used to encourage the development and use of materials that facilitate patient understanding of health care information.

Additional government efforts might include:

  • Federal funding of research to better understand the scope of the health literacy problem
  • Adding health literacy evaluations and other quality improvement interventions into
    Medicare's current requirements for provider certification
  • Including in Medicare's Current Beneficiary Survey questions that assess patients' health
    literacy skills
  • Creating health literacy Centers of Excellence through the Health and Human Services
    (HHS) Agency for Health care Research and Quality
  • Creating a clearinghouse for best practices related to addressing low health literacy.

Future research should focus on optimal methods of screening patients to identify those with poor health literacy, investigating the connections between clinical outcomes and increased costs associated with poor health literacy, determining the causal pathway between poor health literacy and health outcomes, and developing effective health education techniques.1

Why it is important to care about Health Literacy

Health care providers, patient advocates, policymakers and payors are beginning to be aware of the health literacy problem as a major public health issue. The reasons for their involvement are varied and compelling, and they certainly include the following:

  • Patients who do not understand providers' instructions for testing, treatment and self-care will not receive quality medical care.
  • Patients with low literacy skills cannot, by definition, be empowered consumers in our market-driven health care system.
  • Health care professionals and hospitals have medicolegal liability for adverse outcomes in cases in which patients do not understand important medical information.
  • Health care expenditures related to the effects of inadequate literacy skills may result in substantial but avoidable costs for the health care system, for health plans, for employers, and for patients and their families.
  • Health literacy problems are more common among populations that depend heavily on public policymakers for their health care (eg, Medicare and Medicaid patients and the uninsured).1

Pfizer's commitment to Health Literacy

Pfizer has taken the lead in raising awareness of the health literacy issue, and the company is actively committed to developing real-world strategies for addressing -- and overcoming -- this national public health problem. Pfizer is the first -- and still the only -- pharmaceutical company to recognize the importance of health literacy. Pfizer has supported more than five years of research (in both academic and clinical settings) to determine the causes of inadequate health literacy, the scope and impact of the problem, and to begin to develop workable solutions.

Creating strategic partnerships is a crucial element in Pfizer's health literacy initiative. The company has joined forces with the American Medical Association Foundation to raise awareness and understanding of health literacy among physicians and other health care professionals, and to develop tools that will improve communications with patients.

Pfizer has awarded a two-year $1.5 million grant to the AMA Foundation that will be used to develop a tool kit and a Web site, and grants to support physician-focused health literacy programs and media outreach efforts.

The AMA's distribution network will be utilized to reach a significant percentage of the AMA membership with health literacy messages, educational programs and tools for use in the clinical setting.

In addition to this provider-focused effort, Pfizer supports programs to build the health literacy research base, to provide training on health literacy issues to health care organizations and voluntary health associations, and to communicate the importance of health literacy to the public.

Some of the company's health literacy efforts include:

  • Applying the Pfizer Health Literacy Principles to patient education materials developed for the company's products, and providing these materials, along with customized training in their use, to health care and advocacy groups.
  • The Florida Health Literacy Study, a clinical trial at the University of South Florida designed to determine the most effective interventions for improving health outcomes for patients with diabetes or hypertension.
  • Community-based initiatives with national patient advocacy groups in association with the National Health Council and other health-related organizations.
  • Sponsoring an annual conference on health literacy.
  • Awarding research grants to health care and academic institutions to develop and test health literacy interventions.

All these tactics represent the first steps in a far-reaching Pfizer health literacy initiative that will continue to grow in strength and influence as this public health issue becomes a public health priority.

References:

  1. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American
    Medical Association. Health Literacy: Report of the Council on Scientific Affairs. JAMA
    1999; 281:552-57.
  2. Doak CC, Doak LG, Root JH. The literacy problem. In: Teaching Patients With Low
    Literacy Skills, 2nd ed. Philadelphia, PA: J.B. Lippincott Co, 1996.
  3. Davis, TC, Bocchini JA, Fredrickson D et al. Parent comprehension in polio vaccine
    information pamphlets. Pediatrics 1996 (97): 804-10.
  4. Williams MV, Baker DW, Honig EG et al. Inadequate literacy is a barrier to asthma
    knowledge and self-care. Chest 1998 (114): 1008-15.
  5. Baker DW, Parker RM, Williams MV et al. The health care experience of patients with low
    literacy. Arch Fam Med. 1996; 5:329-34.
  6. Weiss BD, ed. Twenty Common Problems in Primary Care. New York: McGraw-Hill, 1999.
  7. Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital
    admission. J Gen Intern Med. 1998; 13:791-98.
  8. Schillinger D, Grumbach K, Piette J et al. Association of health literacy with diabetes
    outcomes. JAMA 2002 (288) 475-482.
  9. Davis TC, Long SW, Jackson RH, et al. Rapid estimate of adult literacy in medicine: a
    shortened screening instrument. Fam Med 1993 (25): 391-95.
  10. Gazmararian JA et al. Health literacy among Medicare enrollees in a managed care
    organization. JAMA 1999 (281): 545-51.
  11. Doak LG and Doak CC. Pfizer Health Literacy Principles. New York, NY: Pfizer Inc.,
    2002.
  12. Health Literacy and the Prescription Drug Experience: The Front-Line Perspective from
    Patients, Physicians and Pharmacists. New York, NY: Roper ASW. May 2002.

Source: Pfizer Health Literacy Initiative  www.pfizerhealthliteracy.com

Posted: September 2002


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