Ginger's Weblog

Adult Health Literacy

gminner — Mon, 15 Dec 2008 10:06:48 +0000

This is a multi-media video I produced and narrated about adult health literacy. Through extensive research, I found that adults with low levels of health literacy are facing increasing complexities within America’s health care system. I also found that adults are not communicating effectively with health care providers, comprehending prescription medication labels, and that the elderly and those with communication disorders pose an increased risk to low health literacy. My video is a shortened version of my I-Search Paper, thus, for more information please refer to it. I hope to provide adults with increased awareness and possible strategies to implement when engaging in health care interactions.

References

gminner — Sun, 07 Dec 2008 07:35:20 +0000

References

Banja, J. D. (2007, Nov). My what? American Journal of Bioethics, 7, (11), 13-15. Retrieved November 16, 2008, from EBSCOhost.

Barnett., S. (1999). Clinical and cultural issues in caring for deaf people. Family Medicine, 31, (1), 17-22.

Castro, C., Wilson, C., Wang,F. & Schillinger, D. (2007, Sept/Oct). Babel babble: Physicians’ use of unclarified medical jargon with patients. American Journal of Health Behavior, 31, S85-S95. Retrieved November 16, 2008, from EBSCOhost.

Davis, T., Wolf, M., Bass, P., Thompson, J., Tilson, H., Neuberger, M. et al. (2006). Literacy and misunderstanding prescription drug labels. Annals of Internal Medicine, 145, (12), 887-W246. Retrieved November 16, 2008, from EBSCOhost.

Koo, M., Krass, I., & Aslani, P. (2006, June). Enhancing patient education about medicines: factors influencing reading and seeking of written medicine information. Health Expectations, 9, (2), 174-187, Retrieved November 16, 2008, from EBSCOhost.

MacLaughlin, E., Raehl, C., Treadway, A., Sterling, T., Zoller, D. & Bond, C. (2005). Assessing medication adherence in the elderly: Which tools to use in clinical practice? Drugs & Aging, 22, (3), 231-255. Retrieved December 3, 2008, from EBSCOhost.

Medscape. (2007) Poor health literacy in the elderlypredicts all-cause and cardiovascular mortality. Retrieved December 3, 2008 from http://www.medscape.com/viewarticle/560695

Parker, R., Wold, M., & Kirsch, I. (2008, Aug). Preparing for an epidemic of limited health literacy:Weathering the perfect storm. Journal of General Internal Medicine, 23 (8), 1273-1276. Retrieved November 4, 2008, from EBSCOhost.

Schillinger, D., Wang, F., Palacios, J., Rodriguez, M., Machtinger, E., & Bindman, A. (2006, Oct/Nov). Language, literacy, and communication regarding medication in an anticoagulation clinic: A comparison of verbal vs. visual assessment. Journal of Health Communication, 11, (7), 651-664. Retrieved November 4, 2008, from EBSCOhost.

Schwartzberg, J. G., Cowett, A., Vangeest, J., & Wolf, M. S. (2007, Sept/Oct). Communication techniques for patients with low health literacy: A survey of physicians, nurses, and pharmacists. American Journal of Health Behavior, 31, S96-S104. Retrieved November 16, 2008, from EBSCOhost.

U.S. Department of Education. (2003). Literacy skills of adults, by type of literacy, proficiency levels, and selected characteristics: 1992 and 2003. Retrieved December 3, 2008 from http://nces.ed.gov/programs/digest/d07/tables/dt07_373.asp

U.S. Department of Health and Human Services: Health Resources and Services Administration. (n.d.) Health Literacy. Retrieved December 3, 2008 from http://www.hrsa.gov/healthliteracy/default.htm

U.S. Department of Health and Human Services. (n.d.) Quick guide to health literacy and older adults. Retrieved December 3, 2008 from http://www.health.gov/communication/literacy/olderadults/literacy.htm#p2

Volandes, A., & Paasche-Orlow, M. (2007, Nov). Health literacy, health inequality and a just healthcare system. American Journal of Bioethics. 7 (11), 5-10. Retrieved November 4, 2008, from EBSCOhost.

Wolf, M., Gazmararian, J., & Baker, D. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165, (17), 1946-1952. Retrieved December 3, 2008 from EBSCOhost.

I-Search Paper

gminner — Sun, 07 Dec 2008 07:33:49 +0000

Introducing/Questioning

Before this project, I simply thought literacy meant one could read or write. However, it wasn’t until my CD 315 class discussed literacy that I realized it had many other aspects. I had no idea being competent in health care was considered a type of literacy. I have always had an interest in the medical field after working in emergency rooms, on hospital floors, and in nursing homes during my high school years. Thus, I chose to research adult health literacy. Before starting my research, I thought health literacy meant being competent in medical issues as a whole. I had never thought of the many different aspects one could, and should be, competent in to ensure adequate health care is received. I also recognized that those with higher education appear to be more health care literate than those with less education. Further, I recognized that older adults appeared to be less informed than middle-aged and younger adults. From here I formed my research questions. My essential question is: What do adults with low health literacy need to know in order to manage their medical affairs? My foundation questions include: What do adults with low health literacy need to know about communicating with their health care providers?, What do adults with low health literacy need to know in order to correctly manage prescriptions?, and What do adults 65 and older or who have a communication disorder need to know about managing their medical affairs?

Searching

Health literacy is defined as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions” (Volandes & Paasche-Orlow, 2007,5). Research has shown that 90 million Americans are not proficient in health literacy. Low health literacy is most often seen in those with chronic diseases, minorities, the elderly, and those with lower levels of education. Low levels of health care literacy pose an increased risk of mortality rates, health status, and hospitalization. Volandes & Paasche-Orlow (2007) and Baker et al. (1997) stated, “Limited health literacy has been shown to be a more powerful predictor of health status and health-related behaviors than race or education” (5). Research also shows that America’s health-care system is increasing in complexity. Parker et al. (2008) reported, “Modern health systems increasingly make extraordinary and difficult demands on patients, including those required to access, use, and follow through with suggested diagnostic studies, therapies, and self-management plans” (1273). How are those with lower levels of health literacy to overcome these demands? Essentially, what do adults need to know in order to manage their medical affairs?

Mis-communication and mis-comprehension between health care providers and adult patients were the first themes to emerge from research. Research showed that medical professionals are not communicating in ways that adults with low health literacy can comprehend. Techniques shown to be effective with low health literate patients have been made known to health care providers. However, medical providers have yet to routinely practice the techniques in their entirety. Schwartzberg et al. (2007) found that medical professionals report to most frequently using techniques not included in the proven effective techniques. Castro, Wilson, Wang & Schillinger (2007) found that 81% of patient/physician interactions included one unclarified term. Further, it was illustrated that patient comprehension did not reach adequate levels during patient/physician interactions. Banja (2007) also found that physicians are not breaking down barriers of adult health literacy, but prolonging them. Banja (2007) stated such practices by health care providers are not permissible–rather highly unethical. Patients are suffering from mis-understanding and mis-comprehension–proven effective techniques must be implemented immediately. “Discharging patients from hospitals who subsequently mismanage their healthcare because they have not been reasonably helped to understand it is unforgivable, not to mention unethical…as Autumn Fiester recently argued, “the separation of communication from ethics is…a false dichotomy: communication is ethics” (Banja, 2007, 15). Koo et al. (2006) also found that patients with low levels of health literacy are concerned about offending health-care providers by applying more assertive, information seeking strategies.

The second theme to emerge from research was those with lower levels of literacy are shown to mis-read and mis-interpret prescription drug labels–which can ultimately lead to overdoses, gastrointestinal bleeding, and even death. As Schillinger et al. (2006) stated, “patients most likely to experience errors in medication-related communication are patients with…limited health literacy.” Koo, Krasi, & Aslani (2006) and Davis et al. (2006) have found that most patients are apt to read drug labels and are interested in reading them, but are not apt to search for information themselves (Koo et al. 2006). Furthermore, those with higher states of disease, lower levels of health control, weaker coping styles, lower occupation status, and lower levels of health literacy were less likely to seek information regarding their health affairs. As Koo et al. (2006) stated, “Written medicine information…is integral to informing and educating patients about their medicines” (175). Davis et al. (2006) found that only 50% out of 446 patients questioned could read or correctly affirm prescription labels. Further, Davis et al. confirmed that, “patients reading at or below sixth grade levels were less able to understand all…label instructions” (887). In 2003 the National Assessment on Adult Literacy (NAAL) confirmed that only 29% of adults in the United States attained basic proficiency reading levels. Reading includes comprehension, and Schwartzberg et al. (2007) found that most adults cannot comprehend drug prescription labels. Koo et al. (2006) also found that patients cannot comprehend drug labels correctly. However, Schillinger et al. (2006) found that 66% of patients comprehended prescription labels upon visual reading versus 50% comprehension when the labels were read aloud.

The third theme that emerged from my research was that adults with special circumstances are more likely to be among those with low health literacy, as well as low reading literacy. Two groups were among those with special circumstances–those with communication disorders and the elderly. Barnett (1999) found that Deaf patients are among those with the highest risk for low health literacy because of their low reading proficiency–upon high school graduation most deaf students read at a fourth to fifth grade level–and less access to ambient information, which is obtained by overhearing radio or TV programs and parent and family conversations about health issues. Barnett (1999) stated that, “With the passage of the Americans with Disabilities Act of 1990 (ADA) Deaf people will have improved access to the health care system” (17). Research also shows that the elderly are among those at risk for increased levels of low health literacy. According to the U.S. Department of Health and Human Services (2003), “Adults age 65 and older have lower health literacy scores than all other age groups surveyed. Only 3 percent of the older adults who were surveyed were measured as proficient.” MacLaughlin et al. (2005) found the cause for low levels of health literacy and non-adherence to medication to be, “co-morbid conditions and [the] presence of cognitive, vision and/or hearing impairment” (232). Further, “Poor Health Literacy in the Elderly Predicts All-Cause and Cardiovascular Mortality” (MedScape Today, 2008, Introduction section, ¶ 1; Baker et al., 2007) reported that, “Elderly patients with poor health literacy have higher incidence of all-cause mortality and cardiovascular death.”

Conclusions

Research yields that adults must become aware of the risks of low health literacy. Sadly, it appears many who are non health literate may not even be aware of their risks. Further, adults need to understand the importance of taking an assertive approach to health care. Adults with high levels of health literacy are more likely to experience better results from medical care, including interactions with medical professionals and when utilizing prescriptions. Second, in order to effectively communicate with health care providers, adults need to be more assertive in medical interactions and when seeking medical counsel. Third, when utilizing prescription medicines, adults need to understand the risks of mis-using medications. Research shows that visually reading instructions (versus verbally hearing instructions) increases patient comprehension of instructions. Thus, adults need to cautiously and visually read prescription medication instructions in order to ensure correct dosage is consumed. Finally, adults with special considerations, those with communication disorders and the elderly, must realize their increased risk for low health literacy and take more assertive steps in their medical affairs. Low levels of health literacy plague 90 million Americans–leaving them with increased risk of mortality rates, health status, and hospitalization. As Volandes & Paasche-Orlow (2007) stated, “Limited health literacy has been shown to be a more powerful predictor of health status and health-related behaviors than race or education” (5). These factors are daunting; however, not as daunting as the fact that in most cases, adults are not even aware of the risks they have imposed upon themselves by their low health literacy. If these numbers are to decrease, adults must be made aware of the risks and take the necessary steps to be more assertive in their medical affairs. If they don’t–who will?

Acknowledgments

gminner — Sun, 30 Nov 2008 09:10:40 +0000

I first stumbled upon the aspect of health literacy in my CD 315 class when my professor, Karen McComas, mentioned it in class. Accordingly, I would like to thank her for giving me the idea! She also helped me to narrow my question to adults with low health literacy–and the ways that older adults can be more health literate in regards to prescriptions and communication with medical providers. She also helped me to narrow my fundamental questions to more specific areas related to my topic.

I would like to thank Gabrielle ‘Gabby’ Gardner for allowing me to use her voice recorder, being my speech coach, and helping me figure out the video. Gabby helped me to figure out how to use Microsoft Movie Maker & upload it to Google Videos. She was truly a lifesaver!

Finally, I would like to thank the other members of CD 315. Throughout this semester you all have reviewed and commented on my work–I want to thank you! In addition, you all provided interesting comments in regards to the discussion before Thanksgiving break. I was excited to share my research with you all to see your responses. You all really helped me to think about some of the important aspects of adult health literacy!

Preface

gminner — Sun, 30 Nov 2008 02:39:13 +0000

I first decided to research health literacy when my professor, Karen McComas, mentioned the topic in class. I have always been very interested in the medical field and decided I would enjoy researching this topic. I orginally wanted to research health literacy in regards to children and how the subject is being implemented in schools. However, after receiving feedback from my peers, I changed my question to center around adult health literacy. Next, I drafted fundamental questions. However, after meeting with my professor, I changed my essential question to: “What do adults need to know in order to manage their medical affairs?” My foundation questions then changed to: “What do adults need to know in order to correctly mangage prescriptions?” “What do adults need to know about communicating with their health care providers?” “What do adults with special circumstances: 65 and older, retired, or who have a communication disorder need to know about managing their medical affairs?” After meeting with professor McComas, I began directing my research towards peer-reviewed articles with those topics. I found many articles and I am still analyzing and extracting the information I will use.

I chose this topic after reading a NY Times article regarding the current state of adult health literacy in the United States. I was appalled at the staggering statistics included in the article! I also know from personal experience that many older adults are not as health literate as one needs to be in the current medical world. Thus, I want to provide accurate and benefical information for adults to implement in their lives. I hope that when internet users search health literacy in their web browsers that my Weblog comes up. I hope they can use the information I have researched and gathered to better prepare them to manage their medical affairs. Upon completition of this project I hope to show it to some of my adult family members to demonstrate to them ways in which they can better manage their medical affairs.

A10.4: Progress Memo 2-The ‘Hands On’ Unit

gminner — Fri, 31 Oct 2008 09:15:13 +0000

Content Summary

Throughout the second leg of CD 315, I learned about social bookmarking though Diigo and Blogs, wikis, podcasts, and other powerful web tools for classrooms which allows one to choose websites to ‘tag’ and share with a group, critically analyzed and evaluated software used in the communication disorders field, customized Google Reader to receive information about my academic and personal interests, researched and formulated a presentation on an adaptive technology, evaluated websites using accepted academic standards, and gained a deeper understanding of the different types of ‘digital literacy.’ However, I feel the main focus of my learning was on the Adaptive Technology Project and Software evaluation. For the Adaptive Technology Project, I chose to research the Super Switch, which is a computer switch, by R.J. Cooper & Associates. The Super Switch can be used as a mouse or keystroke to aid one in utilizing a computer. I also learned how to make a power point presentation about the Super Switch using a program other than Microsoft Office—I was pretty excited! In regards to the Software evaluation, I evaluated the Speech Pacer/Free Form. The Speech Pacer halts or accelerates the pace of the highlighted text that the client reads, thus helping clients to monitor their speech pace. The Free Form is merely a program with worksheets for clinicians to print off and use in therapy.

Process Summary

I have learned so much in this unit. I feel as though in the last section I learned a lot about technology, and in this unit I am learning how to utilize and evaluate technology. I feel as though this unit was more hands on! As stated above, my learning mainly occurred in the Adaptive Technology Project & Software Evaluation. Regarding the Super Switch, I feel I learned a lot about computer switches; before this project I didn’t know what one was! Now, I understand how they work and how they can aid those with communication disorders and muscle weakness. I also understand how they can be utilized with other programs, such as Text-to-Speech programs, to further increase communication skills. For the Software Evaluation, I learned that not all computer software is legitimately adequate and appropriate to use in therapy. When our class met to discuss our various types of software, it seemed as though only 5 of the programs would be appropriate to use in therapy. It also seems as though many people think software programs are cutting edge and will transform clients’ lives. However, through this evaluation, I learned that many software programs are not beneficial to clients at all. Considering both sides, I learned that one must take extreme caution if and when to use software in therapy. I also learned how to develop a more critical eye in evaluating Websites. The Better Dog Food Website truly boggled me! I had no idea information this ridiculous was posted on the Internet.

Assessment

The information was valuable to me in that it provided me with an array of resources to use when I begin practicing as a clinician. For example, I will be knowledgeable of at least one adaptive technology used to aid those with communication disorders and muscle weakness. I will also be able to better recognize appropriate software programs used in the field of communication disorders. Second, the information was valuable to me in that I now question the organization/author of Websites. I want to ensure I am using the most accurate information possible in my academic, as well as personal, life; acquiring this skill from the unit has been very beneficial.

Reflection

I believe the work I have done in Unit 2 has prepared me for when I become a practicing clinician, as well as increasing my skepticism of life in general. As stated above, I feel the work I’ve done has given me valuable resources to utilize in the future. It has also given me an advantage over other future clinicians who have not researched adaptive technologies or computer software programs. Second, since coming to college I have become a very skeptical person in general, and I critically evaluating websites has only increased my questioning nature. However, I believe it is good to question things…Websites and their author’s…life in general. I feel one has to question something before they can truly understand and ‘own’ it as their own—technology is no different.

A10.2: Web Evaluation II

gminner — Fri, 31 Oct 2008 05:00:56 +0000

http://www.nytimes.com/2007/01/30/health/30brody.html

Authorship
The article I read was in The New York Times and was written by Jane E. Brody. I did not recognize the author’s name; however it wasn’t hard to find additional information about her. The biographical website I found wasn’t working, but from other websites I gathered that Jane is an award-winning health columnist. Her name was also linked to other articles she has written. Further, an e-mail address link was included; however, as the evaluation guide states—this provides no more information than I already had. In conclusion, I did not find much biographical information about the author, but because she works for this well-known and respected newspaper and has won awards for her writings on health issues, I feel she is an appropriate author for this article.

The Publishing Body
The affiliating organization of this article is The New York Times, a world-renowned newspaper. A header is included on the article, but there is no distinctive watermark demonstrating this website is of academic origin. I could not contact the Webmaster from this web page and further, could not find information about the Webmaster. This newspaper is not recognized in my field of study; but it is well known and respected for excellent journalism on a global level. Due to this factor, I do find The New York Times suitable for addressing the topic of the article. The author of the article is a reporter/journalist who works for The New York Times; the article was prepared as a professional duty and was within the author’s area of expertise. The identity of the server can be verified and this web page is part of an official Web site.

Point of View or Bias
The New York Times does not seem to have a clear stake in regards to adult health literacy—the topic of the article. However, it is clear the author believes doctors are not meeting their responsibilities in helping patients understand the full implications, directions, and preventative measures of healthcare. But, The New York Times as an organizational whole does not seem to be biased in regards to adult health literacy. Although most, if not all newspapers have an agenda, it appears The New York Times does not have a philosophical or political agenda. I can find no presence of philosophical or political agenda’s in the article.

Referral to and/or knowledge of the literature
The article does not include a biography; I addressed this issue in the authorship section. The author does allude to other sources of information including: two studies from the Internal Medicine Journal, a quote from The Journal of General Internal Medicine, American Medical Association, National Academy’s Institute of Medicine, and quotes from two Medical Doctor’s. The author gives proper attribution to these information sources. The author also displays knowledge of information appropriate for the topic of her article in that she includes various sources. Links to other health articles are available; it is clear she has a wealth of information about health issues. This article was not written in a research manner and thus, new theories or techniques were not stated. The author’s treatment of the subject is not especially controversial, although the tone that doctors are not educating patients correctly is felt throughout the article. The author does not acknowledge this tone.

Accuracy or verifiability of details
The journalistic methodology used in the article is appropriate to the topic and clearly allows the article to be duplicated for verification. The article heavily relies on other sources and most of the sources are linked to the websites themselves. The article does include names of Medical Doctors whose personal suggestions regarding adult health literacy appear to not have been previously published before this article. The background information used in this article can be verified because the sources are linked to the Web sites themselves.

Currency
The document includes the date the article was published—January 30, 2007. However, the sources used do not include dates as to when the information was gathered. There is no need to update the information included in the article on a regular basis, nor is a ‘last updated’ date given. This article was written as a one-time news story, not as a continuous story. The article includes a 2007 copyright from The New York Times.

Search Engine
I used the Google database to find the article. I referred to the Search Engine Showdown written by Greg R. Notess for further information about Google’s ordering of requested and advertised information. From this web page, I found that typically Google’s paid advertisements are usually displayed “on the right side (or top) under a “Sponsored Links” heading” (Notess). In addition, Google gives relevance to websites with more links and better authority—how these factors are determined I am not sure. Thus, I found Google to be a moderately accurate database.

Revised Adaptive Technology Presentation

gminner — Wed, 29 Oct 2008 03:31:24 +0000

A9.1: Adaptive Technology Project-Self Evaluation

gminner — Mon, 27 Oct 2008 01:58:09 +0000

Regarding the Standards for the project, I think my power point is fairly understandable in that the meaning of my presentation is reasonably clear-I am reporting information about the Super Switch. I don’t think I could elaborate further without becoming too wordy. I reported on what types of populations the Super Switch can be used with and other ways it can be used to facilitate communication, such as Text-to-Speech. However, I need to clear up my explanation of how one uses Super Switch. My power point is free from spelling or grammar errors, but I have a graphic error on slide 6. My text is not aligned with my graphic. I checked and verified those errors by reviewing my power point. I feel I was precise in my explanations; because as I stated above, if I were more detailed, my presentation would become too wordy. However, I am able to give more details and be more exact in my explanation of how one utilizes the Super Switch. My power point relates to the problem of those with communication disorders using adaptive technologies for increased computer use. My power point clearly allows my audience to have a better understanding of the adaptive technologies available for those with communication difficulties. The factor that caused the most problem, and presented the most depth, was the near lack of peer-reviewed information concerning computer switches. I was able to find one good article that described the uses of a computer switch; I wish I could have found more. I had to widely search for this article-more research needs to be done with computer switches! I feel as though I do not need to look at my power point from another perspective because I did not take a side or present biased information about the Super Switch. I presented information from the company’s website and a journal article. I feel that my presentation does make logical sense because I first state what it can be used for, the population, and cost, then include a journal article detailing how it is utilized, next I include how it improves communication and what programs clients should now be able to access, and finally other ways in which the Super Switch can be used. I do not feel I have contradictions in my power point. My information follows the evidence found on the company’s website and from the journal article. I believe how one utilizes the Super Switch is the most important idea for me to focus on, and I need to make that more clear. I did not have any vested interest in computer switches before researching and completing this assignment. I feel as though I am informing my audience about the Super Switch-not persuading them to implement it. In regards to the additional questions, I feel my power point appropriately answers who, how, when, where, and why questions about the Super Switch. However, as stated above, I feel as though I need to make the how part more lucid. Second, my presentation shares general information such as costs, features, and capabilities based on the product’s website. Third, my presentation includes supporting details from the website and a journal article. Fourth, my power point could be used to share the uses and benefits of the Super Switch. After I clear up my explanation of how to utilize the Super Switch, I feel my power point will be much easier for others to understand. Finally, I re-checked my statements and feel my project is professionally produced and spelling/grammar error free. However, I do need to add citations from the clipart I used on my website and fix my text/graphic issue on slide 6.

A9.4: Research Question on Literacy

gminner — Sun, 26 Oct 2008 11:45:43 +0000

What types of health literacies are being taught in classrooms?