Findings from the First Annual
PCHC Membership Survey

In March 2006, the Partnership for Clear Health Communication (PCHC) conducted our first membership survey to learn about members' health literacy programs and initiatives, as well as find out what services and information members would like us to offer. We will now be able to use the survey findings to enhance PCHC's offerings and develop programs designed to better meet member needs.

Of PCHC's 352 members, 171 responded to the survey (or about 49%), and many of their responses support our current program ideas and plans - including building our online resources and developing training and technical assistance programs. Some new ideas include adapting Ask Me 3 to help patients and pharmacists discuss prescriptions and take medications properly; publishing Question & Answer (Q&A) articles from experts on health literacy topics as a resource and for members to use in their own publications; and developing an Ask Me 3 training video. We are proud to launch our first Q&A in this e-newsletter. In the article, Helen Osborne talks about how metaphors can be used to effectively communicate health messages.

The biggest surprise of the survey was the tremendous interest members express in advocacy and support for health literacy legislation. With this in mind, PCHC will look for funding and opportunities to build this program area and engage members. In April, PCHC launched our first educational effort aimed at policymakers. We published the Hill Insider, a quarterly e-newsletter designed for health legislative aides and staffers. With additional resources and support from interested organizations, PCHC plans to expand our efforts by hosting at least one Congressional education session in 2006. In addition, we are still working with others to generate interest in Congress for a National Health Literacy Act.

Many thanks to those of you who contributed your valuable perspectives to the 2006 Membership Survey! To request a copy of the full summary report, e-mail memberinfo@p4chc.org.

PARTNERS SPREADING THE WORD:
ACU Assesses Health Literacy Strategies of Primary Care Clinicians

by Sharon E. Barrett, MS*

The Association of Clinicians for the Underserved (ACU), a new member of the Partnership for Clear Health Communication, is a membership advocacy organization for primary care clinicians. This year, ACU is assessing the health literacy practices of safety net providers to determine how to improve communication between clinicians and patients during the clinical visit.

Funded by Kaiser Permanente and the Commonwealth Fund, ACU enlisted the support of more than 23 health professional organizations and their membership to complete Phase I of the study. Over 900 clinicians responded to the Web-based survey sharing their understanding of health literacy, tools and strategies they employ and articulating their personal and organizational needs and recommendations for improving communication with patients that may be challenged with low literacy and low health literacy skills.

The findings from Phase I will provide the basis for site visits during Phase II. ACU research staff will visit selected primary care facilities to conduct in-depth interviews with clinicians and a subset of their patients to further determine what works and how that is translated into treatment plans. ACU will collect information on strategies used by the clinical team to assist patients with low health literacy skills to adhere to treatment recommendations, and gain feedback from patients about their ability to better manage their chronic health conditions at home.

ACU anticipates that the findings from the study, which will be released in the fall of 2006, will help to develop training and resources for its constituency and other safety net providers to equip them to better meet the needs of underserved and vulnerable populations with chronic health conditions. Data will also be made available at the First National Conference in honor of ACU's 10 years of service to the underserved. The conference will be held at the George Washington University's Marvin Center in Washington, DC on September 29-October 1, 2006.

To learn more about ACU, the health literacy study, the health literacy advisory committee and ACU's 10 year Celebration and Conference, visit http://www.clinicians.org.

* Ms. Barrett is the Principal Investigator of the Health Literacy Study and is a consultant to ACU on initiatives and programs concerning health literacy.

HEALTH LITERACY NEWS:

NAAL Reveals Slow Progress in Adult Literacy

The National Assessment of Adult Literacy (NAAL), recently released by the National Center for Education Statistics (NCES) at the U.S. Department of Education, found little change between 1992 and 2003 in adult English-language literacy, except when it comes to literacy tasks that involve computation. The new NAAL shows minimal progress in adults' ability to read and understand sentences and paragraphs, or to understand documents such as newspapers, magazines and job applications in English. The report also showed that 5% of U.S. adults, about 11 million people, were termed "nonliterate" in English, meaning interviewers could not communicate with them or that they were unable to answer a minimum number of questions. The good news: Overall, adults have improved in document and quantitative literacy, with a smaller percentage of adults in 2003 in the "Below Basic" category compared to 1992. The 2003 NAAL assessed a nationally representative sample of more than 19,000 Americans age 16 and older. NAAL uses three categories to define English-language literacy: prose, document and quantitative. Prose literacy includes the skills needed to understand continuous text, such as newspaper articles, while document literacy is the ability to understand the content and structure of documents like prescription drug labels. Quantitative literacy involves using numbers in text, such as computing and comparing the cost per ounce of food items. To view the report, "A First Look at the Literacy of America's Adults," go to http://nces.ed.gov/naal.

UPCOMING NEWS & EVENTS:

JCAHO to Host Health Literacy Symposia this Month in Chicago

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will host another in its series of public policy symposia this month in Chicago. "Health Literacy: The Foundation for Patient Safety, Empowerment, and Quality Healthcare" will examine language implications for the delivery of medical care. The event takes place June 26-27, 2006 at the Sofitel Chicago O'Hare and will present a broad spectrum of solutions developed by leaders in various health care settings. For more information and to register, go to http://www.jcrinc.com/generic.asp?durki=12220.

Looking Ahead to Health Literacy Month 2006

Health Literacy Month has been observed every October since 1999, providing an avenue for raising awareness about the importance of accessible health information. Raising awareness about health literacy often starts with just one person, who invites others to develop Health Literacy Month events, incorporating not only professionals from the health care field, but also members who represent the intended audience in terms of age, gender, race and ethnicity, language and literacy level. Health Literacy Month events are often sponsored by multiple organizations, creating networks among groups such as health care organizations, literacy programs, senior centers, colleges, public libraries and local businesses. Individuals and organizations worldwide participate in ways that meet their unique needs, but they also have the opportunity to network and share ideas on the Events page of the Health Literacy Month Web site, http://www.healthliteracymonth.org.

SUMMER 2006

Recognized as an expert in health literacy, Helen Osborne helps health professionals communicate in ways patients and their families can understand. She is president of Health Literacy Consulting, based in Natick, Massachusetts. Helen is also the founding director of Health Literacy Month, a worldwide campaign to raise awareness about the importance of understandable health information. To learn more about Helen's work, go to http://www.healthliteracy.com. For information about Health Literacy Month, go to http://www.healthliteracymonth.org.

Q&A: Using Metaphors to Communicate Health Messages An Interview with Helen Osborne, M.Ed., OTR/L

Q. What are Metaphors?

A. Like outside pieces of jigsaw puzzles, metaphors (or analogies) provide frameworks for understanding. Metaphors are usually short, clear and include three components:

An everyday example that people already know (analog)

An unfamiliar word, term or concept (target)

A connector word such as "like" or "as"

Q. Why are metaphors useful when communicating health information?

A. In order to fully understand and participate in treatment and care, patients (or anyone receiving health information) need a working knowledge of health care terms. But these terms may be unfamiliar and difficult for patients to comprehend. Providers (or anyone communicating health information) can help by using metaphors that connect new health information to concepts that patients already know.

Q. What are some examples of health metaphors?

A. Health metaphors often use hobbies, weather, food or other everyday examples to explain unfamiliar diagnoses, treatments and medical procedures.

Taken from the Altoona List of Medical Analogies (http://www.altoonafp.org/analogies.htm) these metaphors answer the question: "Why don't we use antibiotics for colds, acute bronchitis and other viral illnesses?"

Using antibiotics for viruses is like using a large net to catch minnows. They just go through the holes.

Using antibiotics for viruses is like putting gas in your gas tank if your battery is dead.

Treating a cold with antibiotics is like using an umbrella to stay warm in winter. It just doesn't work, and when it starts to rain, your umbrella might be worn out.

Q. When and how should I use metaphors?

A. Just like when cooking, a few well-placed metaphors go a long way to spicing up understanding. Here are five steps to keep in mind when using metaphors:

1. Decide when one is needed. Some health care concepts are straightforward and a simple explanation is sufficient. Save metaphors for times when you are teaching information that is unfamiliar or hard to understand.

2. Use words, terms and examples that people know. Choose an analog that has meaning to the person you are speaking with. The most effective will relate to an individual's interests (such as auto-repair or gardening) or life experiences (including age and culture).

3. Explain the metaphor. Metaphors alone are not sufficient. Talk about similarities between your example and the health care term. Follow this with an explanation about differences between the two.

4. Confirm understanding. As with all forms of health communication, make sure that the other person understands your metaphor and its fuller meaning.

5. Move beyond the metaphor. Once you confirm understanding, transition to the correct health care term and use it consistently. Metaphors, like houseguests, should not overstay their welcome.

Q. How can PCHC members and partners learn more about using metaphors for communicating health information?

A. Here are some ways:

Altoona List of Medical Analogies: http://www.altoonafp.org/analogies.htm

Osborne H, 2004. Health Literacy from A to Z: Practical Ways to Communicate Your Health Message: Sudbury, MA: Jones & Bartlett Publishers http://www.jbpub.com

Osborne H, 2003. "In other words. it's like what you already know.using analogies to help patients understand," On Call magazine, 6(1):16-17. Available at the Health Literacy Consulting site, http://www.healthliteracy.com

Finally, I'd like to thank Dr. Terry Ruhl of the Altoona Family Physicians Residency for leading the way with health metaphors. He not only has made it clear how to use metaphors, but also inspired me to teach others.

TOOLS & RESOURCES:

ODPHP Publishes Quick Guide to Health Literacy
The Office of Disease Prevention and Health Promotion (ODPHP) at the U.S. Department of Health and Human Services has released its new Quick Guide to Health Literacy. It includes fact sheets on health literacy basics and the relationship between health literacy and health outcomes; strategies for improving the usability of health information and health services; tips for building knowledge and improving health decision-making; and a primer on advocating for health literacy in your organization. Links to more resources and a backgrounder on how the guide was developed are also included. This new resource is accessible online at http://www.health.gov/communication/literacy/quickguide/.

NIA Offers Free Resource to Help Older Hispanics Communicate with Their Doctors
A new publication from the National Institute on Aging (NIA) at the National Institutes of Health (NIH) helps older adults learn to communicate more effectively with their doctors. "Conversando con Su Medico" is a 38-page Spanish-language publication that includes information on choosing a doctor; communicating effectively with the doctor and other health care providers; working with an interpreter; discussing sensitive topics such as incontinence or sexuality; and finding additional health information in Spanish.

NIA worked to develop the booklet with the input of a group of older Hispanic consumers, who cited a hesitancy to approach their doctors with health concerns, primarily due to communication barriers and a fear of worrying their doctors and/or their families. Although they felt their physicians were a good resource, participants acknowledged difficulty in sharing information with their doctors because of time limitations on their visits. They agreed that patients should have questions ready to ask their doctors and that such questions would help make their time with the doctor more productive.

To order a free copy of "Conversando con Su Médico", call the NIA Information Center at 1-800-222-2225 or go to http://www.niapublications.org/pubs/conversando/index.asp.

Resource on New Study that Ranks Preventive Services
PCHC recently worked with Partnership for Prevention to develop a four-page, easy to understand consumer piece about their new study, which was released on May 16th. The study ranked the health impact and cost effectiveness of 25 preventive services recommended by two nationally recognized sources: 1) U.S. Preventive Services Task Force; and 2) Advisory Committee on Immunization Practices. The study identified preventive services that are most valuable; highest-value preventive services that are most under-utilized; and preventive services that would provide the most gains in health were utilization rates increased. The learn more about the study, go to http://www.prevent.org/content/view/46/96. To see the consumer piece, click on consumers under How Can This Ranking Help You?

The Partnership for Clear Health Communication (PCHC) serves as an information source regarding the scope and impact of health literacy, as well as what providers and patients can do to improve health communication in every provider-patient interaction. PCHC is a national, non-profit organization of health literacy experts, health care provider organizations, consumer groups, public health associations and others committed to raising awareness of and developing solutions for the nation's health literacy crisis.

To learn more about our programs, visit www.p4chc.org.

The PCHC quarterly e-newsletter shares the latest research, news and events regarding health literacy and how to become involved with improving health communication.