Epidemiology of Health and Illness.

Community Health Planning

Implementation and evaluation 

Read chapter 5, 7 and 8 of the class textbook and review the attached PowerPoint presentations.  Once done answer the following questions;

1.  Define epidemiology and identify the epidemiological models used to explain disease and health pattern in populations.
2.  How can you apply the epidemiological methods to describe the stated of health in the community or aggregate?
3. Mention and analyze the factors that have contributed to the failure of health planning legislation to control health care costs.
4. Compare and contrast Freire’s approach to health education with individualistic health education model.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 2 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard which is a mandatory requirement.  A minimum of 2 evidence-based references (besides the class textbook) no older than 5 years must be used.  You must post two replies on different dates to any of your peers sustained with the proper references no older than 5 years as well and make sure the references are properly quoted in your assignment. The replies can’t be posted on the same day, I must see different dates in the replies in order to verify attendance.  

A minimum of 800 words is required (excluding the first and reference page).  Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.

Chapter 5

Epidemiology

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Epidemiology Is …
… the study of the distribution and determinants of health and disease in human populations
(Harkness, 1995)
… the principal science of public health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2

Historical Perspective
Investigations of disease pattern in the community; comparing people who had disease or who remained healthy
Person-Place-Time Model
Person: “Who” factors, such as demographic characteristics, health, and disease status
Place: “Where” factors, such as geographic location, climate and environmental conditions, political and social environment
Time: “When” factors, such as times of day, week, or month and secular trends over months and year
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3

Different Types of Epidemiology
Descriptive Epidemiology
Study of the amount and distribution of disease
Used by public health professionals
Identified patterns frequently indicate possible causes of disease
Analytic Epidemiology
Examine complex relationships among the many determinants of disease
Investigation of the causes of disease, or etiology
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4

Epidemiological Triangle
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Figure 5-1

Agent of Disease
(Etiologic Factors)
Nutritive elements
Excesses, deficiencies
Chemical agents
Poisons, allergens
Physical agents
Ionizing radiation, mechanical
Infectious agents
Metazoa, protozoa, bacteria, fungi, rickettsia, viruses
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6

Host Factors–Intrinsic Factors
(Susceptibility, or Response to Agent)
Genetic
Age
Sex
Ethnic group
Physiological state
Prior immunological experience
Active/, passive
Intercurrent or preexisting disease
Human behavior
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7

Environmental Factors— Extrinsic Factors…
… influence existence of the agent, exposure, or susceptibility to agent
Physical environment
Biological environment
Human populations, flora, fauna
Socioeconomic environment
Occupation, urbanization and economic development, disruption
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8

Wheel Model of
Human-Environment Interaction
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Figure 5-2
Redrawn from Mausner JS, Kramer S: Mausner and Bahn epidemiology: an introductory text, ed 2, Philadelphia, 1985, Saunders.

Web of Causation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Figure 5-3
From Friedman GD: Primer of epidemiology, ed 4, New York, 1994, McGraw-Hill.

Ecosocial Approach
Emphasize the role of evolving macro-level socioenvironmental factors along with microbiological process in understanding health and illness (Smith & Lincoln, 2011)
Challenges the more individually focused risk factor approach to understanding disease origins
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11

Calculation of Rates
Rates are arithmetic expressions that help practitioners consider a count of an event relative to the size of the population from which it is extracted
Number of health events in a specified period
Population in same area in same specified period
Proportion multiplied by a constant (k)
For example, the rate can be the number of cases of a disease occurring for every 1000, 10,000 or 100,000 people in the population
Can make meaningful comparisons
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12

Morbidity Rates
Incidence rates
New cases or conditions
Attack rate
Number of new cases of those
exposed to the disease
Prevalence rates
All cases of a specific
disease or condition at
a given time

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Prevalence Pot
The relationship between incidence
and prevalence
Figure 5-4
Redrawn from Morton RF, Hebel JR, McCarter RJ: A study guide to epidemiology and biostatistics, ed 3, Gaithersburg, MD, 1990, Aspen Publishers.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Morbidity Rates (Cont.)

Incidence Rate
 

Prevalence Rate
Number of existing cases
Total Population 
_____

Number of new cases
_in given time period
Population at risk in
same time period
___75___
4000–250
× 1000
= 0.02
0.02 × 1,000 = 20 per 1000 per time period
250
4000
= 0.0625
0.0625 × 1000 = 62.5 per 1000

Mortality Rates
(routinely collected birth and death rates)
Other rates
Crude rates
Age-specific rates
Age-adjusted rates or standardization of rates
Proportionate mortality ratio (PMR)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Number of deaths in year
Total population size
_1720_
200,000
× 100,000
= 0.0086
Number of births in year
Total population size
_2900_
200,000
× 100,000
= 0.0145

Concept of Risk
Risk—probability of an adverse event
Risk factor
Refers to the specific exposure factor
Often external to the individual
Attributable risk
Estimate of the disease burden in a population
Relative risk ratio
Divide the incidence rate of disease in the exposed population by the incidence rate of disease in the nonexposed population.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17

Use of Epidemiology
Disease prevention
Primary prevention
Health promotion and specific prevention
Secondary and tertiary prevention
Establishing causality
Screening
Surveillance
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18

Use of Epidemiology (Cont.)
Health services
Used to describe the distribution of disease and its determinants in populations
Study population health care delivery
Evaluate use of community health services
Nurses must apply findings in practice
Incorporate results into prevention programs for communities and at-risk populations
Extend application into major health policy decisions
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19

Community health nurses should exercise “social responsibility” in applying epidemiological findings, but this will require the active involvement of the consumer.
Community health nurses collaborating with community members can combine epidemiological knowledge and aggregate-level strategies to affect change on the broadest scale.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20

Epidemiological Methods
Descriptive epidemiology
Focuses on the amount and distribution of health and health problems within a population
Analytic epidemiology
Investigates the causes of disease by determining why a disease rate is lower in one population group than in another
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21

Analytic Epidemiology
Observational studies
Descriptive purposes
Etiology of disease
No manipulation by investigator
Cross-sectional studies
Sometimes called prevalence or correlational studies
Examine relationships between potential causal factors and disease at a specific time
Impossible to make causal inferences
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22

Analytic Epidemiology (Cont.)
Retrospective studies
Compare individuals with a particular condition or disease with those who do not have the disease
Data collection extends back in time
Prospective studies
Monitor a group of disease-free individuals to determine if and when disease occurs
Cohort shares a common experience within a defined time period
Monitors cohort for disease development
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23

Analytic Epidemiology (Cont.)
Experimental design
Also called a Randomized Clinical Trial (RCT)
Subjects assigned to experimental or control group
Apply experimental methods to test treatment and prevention strategies
Ethical considerations with human subject rights review
Also useful for investigating chronic disease prevention
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24

Chapter 7

Community Health Planning, Implementation, and Evaluation

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

The Community as Client
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Figure 7-1

Levels of
Community Health Nursing Practice
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Client Example Characteristics Health Assessment Nursing Involvement
Individual Lisa McDonald Individual with various needs Individual strengths, problems, and needs Client-nurse interaction
Family Moniz family Family system with individual and group needs Individual and family strengths, problems, and needs Interactions with individuals and the family group
Group Boy Scout troop
Alzheimer’s support group Common interests, problems, and needs
Interdependency Group dynamics
Fulfillment of goals Group member and leader
Population group AIDS patients in a given state
Pregnant adolescents in a school district Large, unorganized group with common interests, problems, and needs Assessment of common problems, needs, and vital statistics Application of nursing process to identified needs
Organization A workplace
A school Organized group in a common location with shared governance and goals Relationship of goals, structure, communication, patterns of organization to its strengths, problems and needs Consultant and/or employee application of nursing process to identified needs
Community Italian neighborhood
Anytown, USA An aggregate of people in a common location with organized social systems Analysis of systems, strengths, characteristics, problems, and needs Community leader, participant, and health care provider

Health Planning Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Figure 7-2
Hogue (1985)

Steps in the Health Planning Model
Assessment
Meet with group leaders of aggregate to clarify mutual expectations
Determine sociodemographic characteristics
Interview a key informant
Consider both positive and negative factors
Compare the aggregate with the “norm”
Research potential problems
Identify health problems and needs
Prioritize the identified problems and needs to create an effective plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5

Four Types of Needs to Assess
Expressed needs
Demand for services and the market behavior of the targeted population
Normative needs
Lack, deficit, or inadequacy of services determined by health professionals
Perceived needs
Wants and desires expressed by audience
Relative needs
Gap showing health disparities between advantaged and disadvantaged population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6

Factors for Determining Priorities
Aggregates preferences
Number of individuals affected by the health problem
Severity of the health need or problem
Availability of potential solutions
Practical considerations such as skills, time, and available resources
May use Maslow’s hierarchy of needs or levels of prevention to further refine priorities
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7

Community Involvement Is Essential
“Start where the people are!”
Five spheres of empowerment
Interpersonal (personal empowerment)
Intragroup (small group development)
Intergroup (community)
Interorganizational (coalition building)
Political action
– Labonte (1994)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8

Steps in the Health Planning Model (Cont.)
Planning
Determine the intervention levels
Subsystem, aggregate system, and/or suprasystem
Plan interventions for each system level
Primary, secondary, or tertiary levels of prevention
Validate the practicality of the planned interventions according to available resources
Personal, aggregate, and suprasystem
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9

Development of Goals and Objectives
Goals—where we want to be
Objectives—steps needed to get there
Measurable
Specific measures
Instructions to guide population
Used to measure outcomes
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10

Steps in the Health Planning Model (Cont.)
Intervention
Often the most enjoyable stage for the nurse and the clients
Implementation should follow the initial plan
Should include a variety of strategies
Prepare for unexpected problems
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11

Interventions by
Type of Aggregate and System Level
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Project Type of Aggregate System Level for Intervention
Rehabilitation group Group Subsystem and aggregate system
Textile industry Organization Aggregate system and suprasystem
Crime watch Group, organization, and population group Aggregate system and suprasystem
Bilingual students
(case study) Community Aggregate system and suprasystem

Steps in the Health Planning Model (Cont.)
Evaluation
Include the participant’s verbal or written feedback and the nurse’s detailed analysis
Reflect on each previous stage to determine the plan’s strengths and weaknesses
Evaluate both formative (process) and summative (product/outcome) aspects
Communicate follow-up recommendations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13

Importance of Each Step in the Nursing Process
Aggregate assessments must be thorough.
Should elicit answers to key questions about the aggregate’s health and demographic profile
Should compare this information with similar aggregates presented in the literature
The nurse must complete careful planning and set goals that the nurse and the aggregate accept.
Mutual planning is very important.
Interventions must include aggregate participation and must meet the mutual goals.
Evaluation must include process and product evaluation and aggregate input.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14

PRECEDE-PROCEED Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15

Federal Legislation Affecting Health Planning
Hill-Burton Act
Regional Medical Programs (RMP)
Partnership for Health Program (PHP)
Certificate of Need (CON)
National Health Planning and Resources Development Act
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16

Comprehensive Health Reform
Patient Protection and Affordable Care Act (2010)
Preventive services based on evidence-based recommendations
National strategy to improve the nation’s health
CMMS innovation center
National quality improvement strategy for services and population health
Improved access to care
Reduction in the growth of Medicare spending
National workforce strategy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17

Nurses’ Role
Work collaboratively with health planners to improve aggregate health
Fuse technology with knowledge of health care needs and skills
Become directly involved in the planning process
Engage in aggregate-level projects
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18

Chapter 8

Community Health Education

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Health Education …
… is any combination of learning experiences designed to predispose, enable, and reinforce voluntary behavior conducive to health in individuals, groups or communities.
– Green and Kreuter, 2004
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2

Health Education’s Goals
To understand health behavior and to translate knowledge into relevant interventions and strategies for health enhancement, disease prevention, and chronic illness management
To enhance wellness and decrease disability
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3

Health Education’s Goals (Cont.)
Attempts to actualize the health potential of individuals, families, communities, and society
Includes a broad and varied set of strategies aimed at influencing individuals within their social environment for improved health and well-being
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4

Learning Theories
Humanistic theory helps individuals develop their potential in a self-directing and holistic manner.
Cognitive theory recognizes the brain’s ability to think, feel, learn, and solve problems; theorists in this area train the brain to maximize these functions.
Social learning is based on behavior that explains and enhances learning through the concepts of efficacy, outcome expectation, and incentives.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5

Adult Learners
Need to know
Concept of self
Experience
Readiness to learn
Orientation to learning
Motivation
– Knowles (1980, 1989)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6

Health Education Models
Health Belief Model (HBM)
Perceived susceptibility
Perceived severity
Perceived benefits
Perceived barriers
Self-efficacy
Demographics
Cues to action
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7

Health Education Models (Cont.)
Health Promotion Model (HPM)
Individual characteristics and behaviors
Prior behaviors, personal factors
Behavior—specific cognitions and affect
Activity-related affect, interpersonal influences, situational factors, commitment to plan of action, perceived self-efficacy, immediate competing demands and preferences, perceived benefits of health-promoting behaviors, perceived barriers to health-promoting behaviors
Behavioral outcome
Health-promoting behavior
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8

Model of Health Education Empowerment
… nurses cannot assign power and control to the individual within the community but rather … the “power” must be taken on by the individual and community with the nurse guiding this dynamic process.
– Van Wyk, 1999
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9

Model of Health Education Empowerment (Cont.)
Process includes examining
Education
Health literacy
Gender
Racism
Class
Recognizes the structural and foundational changes that are needed to elicit change for socially and politically disenfranchised groups
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10

Problem-Solving Education …
…centers on empowerment (Freire, 2005)
Allows active participation and ongoing dialogue
Encourages learners to be critical and reflective about health issues
Involves individuals as subjects, not objects
Increases health knowledge through a participatory group process
Involves activism on the part of the educator
Facilitator-educator is a resource person and is an equal partner with the other group members
Leads to sustainable lateral relationships
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11

Participatory Action Research (PAR)
Goal of PAR is social change
Embraces the use of community-based participatory methods
Participation and action from stakeholders and knowledge about conditions and issues helps to facilitate strategies reached collectively
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12

Community Empowerment
Community members take on greater power to create change
Based on community cultural strengths and assets
Attention must be given to collective rather than individual efforts to ensure that outcomes reflect voices of the community and truly make a difference in people’s lives
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13

The Nurse’s Role in Health Education
Become a partner with individuals and communities
Serve as catalyst for change
Activate ideas
Offer appropriate interventions
Identify resources
Facilitate group empowerment
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14

Framework for Developing
Health Communications
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Figure 8-1

Health Education Model
Stage I: Planning and strategy selection
Questions to Ask
Who is the intended audience?
What is known about the audience and from what sources?
What are the communication and education objectives and goals?
What evaluation strategies will the nurse use?
What are the issues of most concern?
What is the health issue of interest?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16

Health Education Model
Stage I: Planning and strategy selection (Cont.)
Collaborative Actions to Take
Review the available data.
Get community partners involved.
Obtain new data.
Determine perceptions of health problems.
Determine the community’s assets and strengths.
Identify underlying issues and knowledge gaps.
Establish goals and objectives.
Assess resources.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17

Health Education Model
Stage II: Developing and pretesting concepts, messages, and materials
Questions to Ask
What channels are best?
What formats should be used?
Are there existing resources?
How can the nurse present the message?
How will the intended audience react to the message?
Will the audience understand, accept, and use the message?
What changes may improve the message?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18

Health Education Model
Stage II: Developing and pretesting concepts, messages, and materials (Cont.)
Collaborative Actions to Take
Identify the messages and materials.
Decide whether to use existing materials or produce new ones.
Select channels and formats.
Develop relevant materials with the target audience.
Pretest the message and materials and obtain audience feedback.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19

Health Education Model
Stage III: Implementing the program
Questions to Ask
How should we launch the health education program?
How do we maintain interest and sustainability?
How can we use process evaluation?
What are the strengths of the health program?
How can we keep on track within timeline and budget?
How do we know if we have reached our intended audience?
How well did each step work (process evaluation)?
Are we maintaining good relationships with partners?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20

Health Education Model
Stage III: Implementing the program (Cont.)
Collaborative Actions to Take
Work with community organizations to enhance effectiveness.
Monitor and track progress.
Establish process evaluation measures.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21

Health Education Model
Stage IV: Assessing effectiveness and making refinements
Questions to Ask
What was learned?
How can outcome evaluation be used to assess effectiveness?
What worked well, and what did not work well?
Has anything changed about the intended audience?
How can we refine methods, channels, and formats?
What lessons were learned? What modifications could strengthen the health education activity?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22

22

Health Education Model
Stage IV: Assessing effectiveness and making refinements (Cont.)
Collaborative Actions to Take
Conduct outcome evaluations.
Reassess and revise goals and objectives.
Modify unsuccessful strategies or activities.
Generate continual support from community groups.
Provide justification for continuing/ending the program.
Summarize in an evaluation report.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23

23

Health Literacy Definitions Evolved Over Time
National Literacy Act (1991)
Literacy is operationally defined as the ability to read and write at the fifth-grade reading level in any language and can be measured according to a continuum.
IOM Report (2004)
The capacity to obtain, interpret, and understand basic health information and services and the competence to use such information and services to enhance health
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24

In 1999, the AMA’s Report of the Council on Scientific Affairs reported that patients with the most health care needs are often the least able to read and understand information that would enable them to function successfully within
the health care system.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Health Literacy

Health Literacy (Cont.)
Health literacy is about empowerment …
Having access to information, knowledge, and innovations
Increasingly important for social, economic, and health development
A key public health issue in the delivery of safe, effective care
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
26

Low Literacy
Increases the use of health care services
Decreases self-esteem; increases shame and stigma
Adversely affects outcomes and treatment of some medical conditions
Poses barriers to obtaining informed consent
Impacts participation in research
Leads to health care and linguistic isolation
Impedes patient-provider communication
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
27

Literacy Concerns
Serious mismatch exists between the reading levels of materials and patient’s reading skills.
Materials often fail to incorporate the intended audience’s cultural beliefs, values, languages, and attitudes.
Low literacy prevents many from gaining the full benefits of health care.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
28

Literacy Concerns (Cont.)
Inability to read and understand instructions influences self-care abilities and health and wellness.
Individuals with very low literacy skills are at an increased risk for poor health, which contributes to health disparities.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
29

Levels for Interventions
Functional/basic literacy
Increasing basic reading/writing skills
Communicative/interactive literacy
Understanding and using information with providers
Critical literacy*
Analyzing and using information in life situations
*Most important because it increases empowerment and success in everyday situations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
30

Helpful Tips for Effective Teaching
Assess reading skills
Determine what client needs to know
Identify motivating factors
Stick with essentials
Set realistic goals and objectives
Use clear and concise language
Develop a glossary of common words
Space teaching over time
Personalize health messages
Incorporate methods of illustration, demonstration, and real-life examples
Give and get
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
31

Helpful Tips for Effective Teaching (Cont.)
Summarize often
Be creative
Use appropriate resources and materials
Put patients at ease
Praise patients
Be encouraging
Allow time for questions
Employ teach-back methods
Remember that comprehension and understanding take time and practice
Conduct learner verification
Evaluate the teaching plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
32

Assess Materials
Become a Wise Consumer and User
Evaluate health materials, including websites, before disseminating them
Materials should strengthen previous teaching
Materials should be used as an adjunct to health instruction
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
33

Assessing the Relevancy of Health Materials
Do materials match the intended audience?
Are materials appealing and culturally and linguistically relevant?
Do they convey accurate and up-to-date information?
Are messages clear and understandable?
Do messages promote self-efficacy and motivation?
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
34

Assessment of Reading Level
Assess reading levels of intended audience
Rapid estimate of adult literacy in medicine (REALM)
Single Item Literacy Screener (SILS)
Short Assessment of Health Literacy for Spanish-Speaking Adults (SAHLSA)
Assess readability of educational resources
SMOG readability formula
Flesch-Kincaid formula (on most computers)
Verify understanding of learner
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
35

Role of Social Media
Numerous platforms now available
May reach diverse community constituents with important public health messages
Potential to…
Facilitate interactive communication
Increase sharing of health information
Personalize and reinforce health messages
Can empower community members to make informed health decisions
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
36