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Essay Instructions: This is a nursing scholary project

The name of the project is Community Nurse Diabetic Clinic

The target market is the Hispanic Community in Allentown Pennsylvania.

I need a Table of Contents Introduction , Scope of Problem , Project( Business Plan for a Nurse Managed Free Diabetic Community Clinic) , Literature Review( please include stats ) , Demographics etc , everything that is needed in a thesis and also the Appendix( demographics) , charts, tables. i don't need a Hypothesis Chapter or a Methodology chapter or Discussion Results , I do however need the other chapters.
I will send over the corrected version from my professor , please include my own notes and build upon it, unfornately a lot of things are not cited so you may or may not be able to use it , but you'll have a general idea. This paper is like an introduction to the Business Plan , so it has to lead into the Plan that I have written to create a Nurse Managed Diabetic Clinic.

Please see below notes , it is choppy , wordy and the transitions are not there.

I really need help . Please make sure it is in APA with page # and Title Page included . Please make sure works cited throughout paper are all listed on the Reference Page. Please also check for all of the other items your company has stated they would include.

Please see below notes:



Community Nurse Diabetic Clinic

Renee Wilson



Introduction


Scope of the Problem

Roughly 41.3 million people in the United States today are Hispanic. That breaks down to one in every seven people. Hispanic Americans represent the second-largest and fastest-growing minority group in the United States.
According to the 2003 U.S. Centers for Disease Control and Prevention report, more than 1.5 million Hispanic Americans had diabetes, up from less than 1.2 million in 1997. This high rate of diabetes does not include undiagnosed cases.

Disease Prevention and Treatment by the Life Extension Foundation states that roughly 5.4 million people in the United States have diabetes and are unaware of it. "Minorities are at particular risk. Compared with Caucasians, blacks have a 60 percent higher risk of developing diabetes and Hispanics have a 90 percent increased risk." According to the National Diabetes Information Clearinghouse (NDIC), Hispanics are 1.9 times more likely to have diabetes than whites.

Pennsylvania had a significant rate of increase in diabetes hospitalizations; accounting for more less than ten per cent over the last two years. Eight per cent of adults of this state are affected by diabetes, which is higher than one per cent above the national average. Moreover patients from various counties in Western Pennsylvania have high rates of end-stage kidney disease , one complication of diabetes.

In 2004, diabetes was the principal diagnosis in 23,725 admissions in Pennsylvania hospitals, accounting for 132,000 hospital days and more than $673 million in hospital charges. 15.4 percent of patients with diabetes were hospitalized two or more times. Multiple hospitalizations were more common among certain populations, such as Hispanics and including Medicaid and Medicare recipients.

In the United States, one especially important determinant of access to care is whether or not one has health care benefits. In 2005, there were 46 million uninsured people in the United States (about 16% of the population). The uninsured rate and number of uninsured increased from 2002 to 2003 for non-Hispanic Whites (from 10.7 % and 20.8 million to 11.1 % and 21.6 million, the number of uninsured increased for Hispanics (from 12.8 million to 13.2 million), their uninsured rate was unchanged at 32.7 %. The number of people who are inadequately insured is much larger. There are 52 million people in the U.S. who are uninsured or underinsured. The development of community based diabetic clinics aims to focus on those that are at the greatest risk; the uninsured and underinsured. This project will aim to address those needs by providing free diabetic health care.


Project
This project is to develop a business plan targeting the Hispanic Community of Allentown Pennsylvania; this business plan will guide the development of a community nurse managed diabetic health care center. This project will serve as a basis for further DNP work and implementation of this business plan.


Literature Review

Diabetes is a chronic disease affecting approximately 760,000 Pennsylvanians . Many people have no symptoms and learn they have diabetes only when they seek help for one of the many complications. At the present time there is no cure for diabetes, but research has shown that complications of diabetes can be greatly reduced with proper blood sugar control through healthy eating, physical activity, and use of medications. Still, diabetes is one of the leading causes of death in the United States and is responsible for nearly 3,600 deaths in Pennsylvania each year. (PA Department of Health, Bureau of Health Statistics and Research).

Diabetes is usually diagnosed in children and young adults and results from the body’s failure to produce insulin. Type 1 account for 5% to 10 % of all diagnosed cases of diabetes (Centers for Disease Control, National Diabetes Fact Sheet ). The most form of diabetes is Type II, this type accounts for about 90 to 95 % of all diagnosed cases of diabetes (Centers for Disease Control, National Diabetes Fact Sheet ). Pre- diabetes is a condition often present prior to the development of Type II diabetes. In pre-diabetes blood glucose levels are higher than normal, but not high enough to be considered diabetic. Pre-diabetes does not have to lead to the development of diabetes to controlling weight and increasing physical activity can prevent or delay the onset of diabetes. There are 41 million Americans who have pre-diabetes (Centers for Disease Control, National Diabetes Fact Sheet). There is extensive documentation regarding the correlation between diabetes and the increased death rates among Hispanics. In California where there is a large Hispanic community, diabetic related deaths are on the rise.
Collins (2009) noted that diabetes is killing Latinos in Ventura County at twice the rate it is claiming lives in other racial and ethnic groups. Nearly 6 percent of Latinos who died in Ventura County in 2005 and 2006 were killed by diabetes. The death records by The Star and Scripps Howard News Service indicate that the diabetes death rate is more than twice the rate for non-Latino whites and African-Americans. Doctors say those numbers are alarming but hardly shocking. (AMA, 2010) Diabetes has been increasing for years among Latinos, they say , not only among adults but also teenagers and young children. The diabetes death rate is at 10.4% for Hispanics because people with the disease often die from other conditions. (American Diabetic Association 2010) In those cases, diabetes would not be listed on the death certificate as the cause of death, although it often is a contributing factor.

Diabetes is an urgent health problem in the Latino community. The rates of deaths are almost double those of non-Latino whites. Disbursement of information to the Hispanic community about the seriousness of diabetes, risk factors and ways to manage the disease is essential
.

Demographic Profile of Spanish/Hispanics by State/County/SMSA is based on the 2000 Census. The Bureau of the Census classified Hispanic origin as those reporting their race as Mexican, Mexican-American, Spanish-American, Hispanic, Hispano, Latino, Puerto Rican, Cuban, Chicano, and "other Spanish/Hispanic" categories. This means that persons of Hispanic origin may be of any race. The Demographic table below provides some useful statistical data that reflects the geographical profile of Hispanics. Hispanics have been and will continue to be a major segment of the consumer market that is evident by the product information on many consumer products. See Table 1.

The Pew Hispanic Center released an extensive study of young Hispanics, those aged 16 to 25 and their uneven assimilation into mainstream American society. The Pew Hispanic Center points out that Hispanics accounted for roughly 60 percent of the growth of America's uninsured between 1999 and 2008. By the end of that period, Hispanics represented less than 16 percent of the overall U.S. population but 31.4 percent of those who lacked health insurance at any given time, according to the Census Bureau . The 2008 National Health Interview Survey found that 34 percent of non-elderly (under age 65) Hispanics reported being uninsured, compared with just 14 percent of non-elderly non-Hispanics. About 43 percent of those uninsured Hispanics said they had never been insured, compared with only 15 percent of the non-Hispanic uninsured. As Samuelson i ndicates, the uncertainty of immigration flows makes it difficult to predict how many of the Democrats healthcare legislation would reduce the number of uninsured. Over the past few decades, the Hispanic population has exploded. Latin America provided half of all the immigrants who came to the U.S. between 1965 (when LBJ dramatically liberalized the immigration system) and 2008; Mexico alone provided 29 percent. While stronger border enforcement and the economic downturn have contributed to a steep drop in Mexican immigration since the mid-2000s, a July 2009 Pew study concluded that there had not been an increase in migration back to Mexico. Foreign born and less assimilated Latinos , those who mainly speak Spanish, who lack U.S. citizenship, or who have had only short tenures in the United States are less likely than other Latinos to report that they have a usual place to go for medical treatment or advice.
The Pennsylvania Commonwealth Fund 2002 report states that Hispanics are less involved in their health care than they would like, Hispanics find it harder to understand instructions from their doctors and do not fully understand their treatment plans. Hispanics also had more communication problems with their doctors and less satisfaction with their quality of health care.

Given the increasing growth of the Hispanic population in the United States, it is imperative that the American health system continue to develop cultural competence policies that address attitudes, knowledge and skills about cross-cultural education .

Hispanics are regional and sub-group dominant with their own cultural peculiarities that health policies should include. Hispanics have demographic trends, historical traditions, traditional medicine knowledge, fundamental values and beliefs, legal status , language/communication needs that must be addressed.
Previous research by the U.S. Centers for Disease Control and Prevention has shown that Hispanics are about twice as likely as non-Hispanic blacks and three times as likely as non-Hispanic whites to lack a regular health care provider. Hispanics are a diverse community, and the 2007 Latino Health Survey explores not only their access to health care, but also their sources of health information and their knowledge about diabetes at greater depth than any national survey done to date by another research organization or the federal government.
The survey finds that among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated and those with no health insurance. A similar demographic pattern applies to the non-Hispanic adult population that lacks a regular health care provider.
Four-in-ten (41%) non-citizen, non-legal permanent resident Hispanic adults state, that their usual provider is a community clinic or health center. Some 15% of Latino adults who are neither citizens nor legal permanent residents report that they use private doctors, hospital outpatient facilities, or health maintenance organizations when they are sick or need advice about their health.
An additional 6% of Latino adults who are neither citizens nor legal permanent residents report that they usually go to an emergency room when they are sick or need advice about their health .
Some 37% of Latino adults who are neither citizens nor legal permanent residents have no usual health care provider. More than one-fourth (28%) of the people in this group indicate that financial limitations prevent them from having a usual provider 17% report that their lack of insurance is the primary reason, while 12% cite high medical costs in general. This is where nurse managed centers and free community clinics could play a crucial role in the delivery of diabetic preventative care.
Nurse managed centers working collaboratively with physicians, clinical nurse specialists and other healthcare providers provide health care for the uninsured. Federal and state funding along with corporate grants, assist in providing primary, non emergent-care services that vary according to the healthcare needs of the communities served (Fox Rose, 2009).
Among those treated are people of low income who cannot afford health insurance, the underinsured, homeless people and those who have immigrated to the U.S. without financial resources or English skills. The promotion of disease prevention and wellness are universal clinic goals, as health teaching is central to care delivery systems (Joan Fox Rose, 2009).
In response to this problem, hundreds of communities across the country have found solutions by developing and supporting free clinics. The Free Clinic in Doylestown is an example of a successful clinic. Peggy Dator MSW is the Executive Director and founder of the clinic. Ms. Dator stated that this clinic was one of the first free clinics in Pennsylvania. It was founded in 1994 by local nurse practitioners and a local community hospital, to meet the medical needs of low income uninsured and underinsured, adults and children residing in the central Bucks County community. The Free Clinic of Doylestown provides free medical care to adults and children. Ms. Dator is the only paid full time staff and there are five nurse practitioners who volunteer in the clinic and two of which provide free care in their offices upon referral. Annually they serve 1,000 adults and children. To date they have served over 7,300 individuals and have provided almost 30,000 patients visits in their free clinic program.

Another example of a free clinic is the “Diabetes Drive-Thru”. This may conjure up images of fast-food indulgences and insulin overload, but the blood-sugar screening program at King’s Daughters Hospital in Temple, Texas, actually serves up something sweeter. In about five minutes, “customers” drive through three nurse-staffed stations and receive free tests, results, and information without leaving their cars (Nursing Spectrum Staff, 2009). Nurse-managed health centers have been the catalyst. They proved they're effective, that they provide high-quality care. Over the past two years there's been a lot of political support that recognized the importance that providers such as nurses can help strengthen the safety net. Funding is crucial for a successful clinic. Federal funding is limited however there is donations grants and philanthropy .

The Independence Foundation, a Center City-based nonprofit philanthropic organization founded in 1932 by steelmaker William H. Donner, has invested millions of dollars in twelve areas nurse-managed health centers (George, 2009). “We are proud of our support of this innovative model of care, but our support is not enough to sustain these centers,” said Susan E. Sherman, the foundation’s president, speaking at an American Academy of nursing media briefing earlier this year. “We need federal funding to bolster the private sector” (George, 2009).
Pennsylvania Gov. Ed Rendell spoke in favor of nurse-managed health centers, a component of his state health-care reform plan, at the same briefing. “Greater nurse practitioner involvement in chronic care and rapid response is the inoculation we need to prevent rising health-care costs and ensure greater access to health care,” Rendell said (George, 2009 ).
Generally free clinics focus on filling gaps in local services instead of attempting to provide comprehensive care so as to conserve their resources on unmet needs.
Pennsylvania free clinics care for an average of 1,128 patients annually, of which 530 are new patients. Annually, Pennsylvania clinics provide an average of 2,175 medical visits and 339 dental visits. The mean operating budgets of free clinics are $287,810 with a mean for Pennsylvania clinics of 223,868 and a median of 96,000. Only 69 % of Pennsylvania free clinics have any paid staff, and of those that have paid staff, 55 % have any full time paid staff and 48% have part time paid staff. Ms. Daton stated that 55 % of the funding came from individuals and their annual special events with the rest from foundation grants. They typically received only a small amount from local and state government sources and they receive a onetime grant from the federal government to reconstruct space for the clinic.
Another unique feature of free clinics is that free clinics tend to be highly collaborative with other organizations. Most free clinics have some arrangement with local hospitals to provide free or low cost outpatient testing. Most work with the pharmaceutical companies to obtain free medications. Most collaborate with other community agencies to maximize access to services. The Free Clinic of Doylestown, for example, shares space with the Lower Bucks YWCA to provide medical services at a low-income apartment complex.

Nurse managed centers of primary health care have emerged as one of the newest innovative models. With Managed care systems and state level reforms being introduced in an attempt to control health care costs, the nursing profession has increasing opportunities to demonstrate, the ability to contribute in the area of health care access, quality and cost effectiveness . This project will provide quality comprehensive diabetic health serviced to all people served with special attention to the uninsured Hispanic community of Allentown, Pennsylvania.


There are faxes for this order.

Essay Instructions: 1.Health Care System Evolution,how the evolution of health care delivery systems has influenced current health care system about Medicare/Medicaid. 4 pages that include 2 references


2.Organizational Analysis for the Centers for Disease Control and Prevention that include stakeholders impacted by this component and they affected. 4 page that include 2 reference

3.Continuum of Care for Diabetes care program in U.S. that includes services provided and how theses fit in the continuum of care, how does the entity contribute or not contribute to the overall management of health care resources, and examine the future trends of health care and discuss how these services will be impacted or need to change to meet these future trends 6 page that include 2 reference

There are faxes for this order.

Essay Instructions: Please use the directions below to write a 2 page paper and please include a reference page.

Health Literacy
In order to effectively manage their own health, individuals need to have competencies in two areas??"basic literacy and basic health literacy. What is the difference? Basic literacy refers to the ability to read, even simple language. 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” (National Coalition for Literacy, 2009). Unfortunately, according to a Department of Education report on health literacy, only 12% of adults aged 16 and older are considered to have a proficient level of health literacy (U.S. Department of Education, 2006). Acquiring health literacy skills has become more complicated with the explosion of online health information, some credible and some misleading.
In this Discussion, you focus on how to help individuals find credible information on the Internet and develop strategies nurses can use to increase the health literacy of their patients.
To prepare:
• Think about the nurse’s role in improving the health literacy of patients.
• Consider the many ways patients access health information, including blogs, social media, patient portals, websites, etc.
• Reflect on experiences you have had with patients who self-diagnose using online medical sources.
• Using the Internet, the Walden Library, or other trustworthy sources, identify a resource that you could introduce to patients to help them evaluate the credibility of health information found online.
• What are some strategies you could employ to improve the health literacy of patients?
Post on or before Day 3 your assessment of the nurse’s role in improving the health literacy of patients. Then, identify the resource you would recommend to patients for evaluating online health information and why it would be beneficial. Describe additional strategies for assisting patients in becoming informed consumers of online health information.





Quick Guide?to Health Literacy
? Fact Sheets Strategies
@

Resources






U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion




Quick Guide to Health Literacy
Who is the Quick Guide for?
The Quick Guide to Health Literacy is for government employees, grantees and contractors, and community partners working in healthcare and public health fields.
It contains:
• A basic overview of key health literacy concepts
• Techniques for improving health literacy through communication, navigation, knowledge-building, and advocacy
• Examples of health literacy best practices
• Suggestions for addressing health literacy in your organization ?These tools can be applied to healthcare delivery, policy, administration, communication, and education activities aimed at the public. They?also can be incorporated into mission, planning, and evaluation at the organizational level. ?If you are new to health literacy, the Quick Guide will give you the information you need to become an effective advocate for improved health literacy. If you are already familiar with the topic, you will find user-friendly, action-oriented materials that can be easily referenced, reproduced, and shared with colleagues. ?How to use the Quick Guide ?The guide is designed to be a quick and easy reference, filled with facts, definitions, helpful tips, checklists, and resources you can use on the job. You can print out the materials and keep them at your desk, share them with colleagues, or bookmark this Web page on your computer. ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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About This Guide













About This Guide
The Quick Guide is divided into the following three sections:
1. The first section contains fact sheets on health literacy, including a basic overview of key concepts and definitions and information on health literacy and health outcomes.
2. The second section contains practical strategies for improving health literacy. These include: ?• Improve the usability of health information?• Improve the usability of health services?• Build knowledge to improve decisionmaking?• Advocate for health literacy in your organization
3. The final section contains a list of resources, including Web sites, research studies, and additional publications on health literacy.

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Fact Sheet

?
Health Literacy Basics

What is health literacy?
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.1
Health literacy is dependent on individual and systemic factors:
• Communication skills of lay persons and professionals
• Lay and professional knowledge of health topics
• Culture
• Demands of the healthcare and public health systems
• Demands of the situation/context ?Health literacy affects people’s ability to:
• Navigate the healthcare system, including filling out complex forms and locating providers and services
• Share personal information, such as health history, with providers
• Engage in self-care and chronic-disease management
• Understand mathematical concepts such as probability and risk ?Health literacy includes numeracy skills. For example, calculating cholesterol and blood sugar levels, measuring medications, and understanding nutrition labels all require math skills. Choosing between health plans or comparing prescription drug coverage requires calculating premiums, copays, and deductibles. ?In addition to basic literacy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge?or have misinformation about the body as well as the nature and causes?of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes. ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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HEALTH LITERACY

Health Literacy Basics
Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.
What is literacy?
Literacy can be defined as a person’s ability to read, write, speak, and compute and solve problems at levels necessary to:
• Function on the job and in society
• Achieve one’s goals
• Develop one’s knowledge and potential2 ?The term “illiteracy” means being unable to read or write. A person who has limited or low literacy skills is not illiterate. ?What is plain language? ?Plain language is a strategy for making written and oral information easier to understand. It is one important tool for improving health literacy. ?Plain language is communication that users can understand the first time they read or hear it. With reasonable time and effort, a plain language document is one in which people can find what they need, understand what they find, and act appropriately on that understanding.3 ?Key elements of plain language include:
• Organizing your information so that the most important points come first
• Breaking complex information into understandable chunks
• Using simple language and defining technical terms
• Using the active voice ?Language that is plain to one set of readers may not be plain to others.3 It is critical to know your audience and have them test your materials before, during, and after they are developed.

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Health Literacy Basics
Speaking plainly is just as important as writing plainly. Many plain language techniques apply to verbal messages, such as avoiding jargon and explaining technical or medical terms.
What is cultural and linguistic competency?
Culture affects how people communicate, understand, and respond?to health information. Cultural and linguistic competency of health professionals can contribute to health literacy. Cultural competence is the ability of health organizations and practitioners to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of diverse populations, and to apply that knowledge to produce a positive health outcome.4 Competency includes communicating in a manner that is linguistically and culturally appropriate.5
Healthcare professionals have their own culture and language. Many adopt the “culture of medicine” and the language of their specialty as a result of their training and work environment. This can affect how health professionals communicate with the public.
For many individuals with limited English proficiency (LEP), the inability to communicate in English is the primary barrier to accessing health information and services. Health information for people with LEP needs to be communicated plainly in their primary language, using words and examples that make the information understandable.
Why is health literacy important?
Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy. In other words, nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease. Fourteen percent of adults (30 million people) have Below Basic health literacy. These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy.6 Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher healthcare costs.

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Health Literacy Basics
Who is at risk?
Populations most likely to experience low health literacy are older adults, racial and ethnic minorities, people with less than a high school degree or GED certificate, people with low income levels, non-native speakers of English, and people with compromised health status.7 Education, language, culture, access to resources, and age are all factors that affect a person’s health literacy skills.
Who is responsible for improving health literacy?
The primary responsibility for improving health literacy lies with public health professionals and the healthcare and public health systems. We must work together to ensure that health information and services can be understood and used by all Americans. We must engage in skill building with healthcare consumers and health professionals. Adult educators can be productive partners in reaching adults with limited literacy skills.
1 U.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington,?DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.
2 Public Law 102-73. The National Literacy Act of 1991.
3 Plain Language Action and Information Network. What is Plain Language? Available at www. plainlanguage.gov. Accessed on October 21, 2005.
4 U.S. Department of Health and Human Services. 2001. National Standards for Culturally and Linguistically Appropriate Services in Health Care. Washington, DC: Office of Minority Health.
5 McKinney J, Kurtz-Rossi S. 2000. Culture, Health, and Literacy: A Guide to Health Education Materials for Adults With Limited English Skills. Boston, MA: World Education.
6 National Center for Education Statistics. 2006. The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education.
7 Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press.


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Fact Sheet

?
Health Literacy and Health Outcomes

Choosing a healthy lifestyle, knowing how to seek medical care, and taking advantage of preventive measures require that people understand and use health information. The ability to obtain, process, and understand health information needed to make informed health decisions is known
as health literacy.
Given the complexity of the healthcare system, it is not surprising that limited health literacy is associated with poor health. This fact sheet summarizes key research study findings on the relationship between health literacy and health outcomes.
Use of preventive services
According to research studies, persons with limited health literacy skills are more likely to skip important preventive measures such as mammograms, Pap smears, and flu shots.1 When compared to?those with adequate health literacy skills, studies have shown that patients with limited health literacy skills enter the healthcare system when they are sicker.2
Knowledge about medical conditions and treatment
Persons with limited health literacy skills are more likely to have chronic conditions and are less able to manage them effectively. Studies have found that patients with high blood pressure,3 diabetes,3-5 asthma,6 or HIV/ AIDS7-9 who have limited health literacy skills have less knowledge of their illness and its management.
Rates of hospitalization
Limited health literacy skills are associated with an increase in preventable hospital visits and admissions.10-13 Studies have demonstrated a higher rate of hospitalization and use of emergency services among patients with limited literacy skills.12
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion
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HEALTH LITERACY

Health Literacy and Health Outcomes
Health status
Studies demonstrate that persons with limited health literacy skills are significantly more likely than persons with adequate health literacy skills to report their health as poor.10,12,14
Healthcare costs
Persons with limited health literacy skills make greater use of services designed to treat complications of disease and less use of services?designed to prevent complications.1,11-13 Studies demonstrate a higher rate?of hospitalization and use of emergency services among patients with limited health literacy skills.10-13 This higher use is associated with higher healthcare costs.15,16
Stigma and shame
Low health literacy may also have negative psychological effects. One study found that those with limited health literacy skills reported a sense of shame about their skill level.17 As a result, they may hide reading or vocabulary difficulties to maintain their dignity.18

About the research
In producing this fact sheet, the Office of Disease Prevention and Health Promotion relied extensively on both the Institute of Medicine (2004) and the Agency for Healthcare Research and Quality (2004) reports, which include comprehensive reviews of the literature on health literacy and health outcomes. For your convenience, the original studies are cited.
In these studies, health literacy was measured by the Rapid Estimate of Adult Literacy in Medicine (REALM) or Test of Functional Health Literacy in Adults (TOFHLA). Both the IOM and AHRQ reports conclude that REALM and TOFHLA are assessments of reading ability, and as such are inadequate measures of health literacy.
Persons with limited health literacy were compared to those?with adequate health literacy. Although an increasing number of studies have linked limited health literacy to poor health, the causal relationship between health literacy and health is unknown.

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Health Literacy and Health Outcomes

1 Scott TL, Gazmararian JA, Williams MV, Baker DW. 2002. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Medical Care. 40(5): 395-404.
2 Bennet CL, Ferreira MR, Davis TC, Kaplan J, Weinberger M, Kuzel T, Seday MA, Sartor O. 1998. Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. Journal of Clinical Oncology. 16(9): 3101-3104.
3 Williams MV, Baker DW, Parker RM, Nurss JR. 1998. Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine. 158(2): 166-172.
4 Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan G, Bindman AB. 2002. Association of health literacy with diabetes outcomes. Journal of the American Medical Association. 288(4): 475-482.
5 Schillinger D, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. 2003. Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 163(1): 83-90.
6 Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. 1998. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 114(4): 1008-1015.
7 Kalichman SC, Ramachandran BB, Catz SP. 1999. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of General Internal Medicine. 14(5): 267-273.
8 Kalichman SC, Rompa D. 2000. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 25(4): 337-344.
9 Kalichman SC, Benotsch E, Suarez T, Catz S, Miller J, Rompa D. 2000. Health literacy and health-related knowledge among persons living with HIV/AIDS. American Journal of Preventive Medicine. 18(4): 325-331.
10 Baker DW, Parker RM, Williams MV, Clark WS. 1997. The relationship of patient reading ability to self-reported health and use of health services. American Journal of Public Health. 87(6): 1027- 1030.
11 Baker DW, Parker RM, Williams MV, Clark WS. 1998. Health literacy and the risk of hospital admission. Journal of General Internal Medicine. 13(12): 791-798.
12 Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, Ren J, Peel J. 2002. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health. 92(8): 1278-1283.
13 Gordon MM, Hampson R, Capell HA, Madhok R. 2002. Illiteracy in rheumatoid arthritis patients as determined by the Rapid Estimate of Adult Literacy (REALM) score. Rheumatology. 41(7): 750-754.

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Health Literacy and Health Outcomes
14 National Center for Education Statistics. 2006. The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education.
15 Friedland R. 1998. New estimates of the high costs of inadequate health literacy. In: Proceedings of Pfizer Conference “Promoting Health Literacy: A Call to Action.” October 7-8, 1998, Washington, DC: Pfizer, Inc., 6-10.
16 Howard DH, Gazmararian J, Parker RM. 2005. The impact of low health literacy on the medical costs of Medicare managed care enrollees. The American Journal of Medicine. 118: 371-377.
17 Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. 1996. Shame and health literacy: The unspoken connection. Patient Education and Counseling. 27(1): 33-39.
18 Baker DW, Parker MR, Williams MV, Ptikin K, Parikh NS, Coates W, Imara M. 1996. The health care experience of patients with low literacy. Archives of Family Medicine. 5(6): 329-334.

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Strategies

Improve the Usability of Health Information

Consider the following questions as you develop and deliver health information:
• Is the information appropriate for the users?
• Is the information easy to use?
• Are you speaking clearly and listening carefully? ?Is the information appropriate for the users? ?The information below is a summary of best practices in health communication that can aid in improving health literacy. Many of these concepts are discussed in depth in the National Cancer Institute’s Making Health Communication Programs Work (a.k.a. the “Pink Book”) and in the Centers for Disease Control and Prevention’s tool CDCynergy. ?Identify the intended users of the health information and services. ?Identify the intended users based?on epidemiology (who is affected?), demographics, behavior, culture, and attitude. This is known as segmentation. ?Be sure the materials and messages reflect the age, social and cultural diversity, language, and literacy skills of the intended users. Consider economic contexts, access to services, and life experiences.1 ?Beyond demographics, culture, and?language, consider the communication capacities of the intended users. Approximately one in six Americans has a communication disorder or difference resulting in unique challenges.2 These individuals will require communication strategies that are tailored to their needs and abilities. ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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Attention:
These principles also apply if you are using existing resources. Be sure to select materials that are accurate and appropriate for the intended users.










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Improve the Usability of Health Information
Evaluate users’ understanding before, during, and after the introduction of information and services.
Talk to members of the intended user group before you design your communication intervention to determine what information they need to know and how they will use it. Then, pretest messages and services to get feedback.
Test your messages again, after they have been introduced, to assess effectiveness. Refine content when necessary. Use a post-test to evaluate the effectiveness of the information.
Acknowledge cultural differences and practice respect.
Cultural factors include race, ethnicity, language, nationality, religion, age, gender, sexual orientation, income level, and occupation. Some examples of attitudes and values that are interrelated with culture include:
• Accepted roles of men and women
• Value of traditional medicine versus Western medicine
• Favorite and forbidden foods
• Manner of dress
• Body language, particularly whether touching or proximity is permitted in specific situations1 ?Ensure that health information is relevant to the intended users’ social and cultural contexts. ?Is the information easy to use? ?Limit the number of messages, use plain language, and focus on action. _,_ ?Keep it simple. The number of messages will depend on the information needs of the intended users. As a general guideline, use no more than four main messages. Give the user specific actions and recommendations. Clearly state the actions you want the person to take. Focus on behavior rather than the underlying medical principles.

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Use familiar language and an active voice. Avoid long or run-on sentences. Organize similar information into several smaller groups.
Many of the same plain language techniques that make the written word understandable also work with verbal messages, such as avoiding jargon and using everyday examples to explain technical or medical terms the first time they are used.
For more information on plain language, visit www.plainlanguage.gov. Supplement instructions with visuals.
Individual learning styles differ. For many people, visuals are a preferred style, especially for technical information.3 Simple line drawings can help users understand complicated or abstract medical concepts. Make sure to place images in context. When illustrating internal body parts, for example, include the outside of the body.
Use visuals that help convey your message. (Don’t just “decorate,” as this will distract users.) Make visuals culturally relevant and use images that are familiar to your audience. Show the main message on the front of the materials.
Make written communication look easy to read._-5
Use at least 12-point font. Avoid using all capital letters, italics, and fancy script. Keep line length between 40 and 50 characters. Use headings and bullets to break up text. Be sure to leave plenty of white space around the margins and between sections.
Improve the usability of information on the Internet.
Studies show that people cannot find the information they seek on Web sites about 60 percent of the time.6 This percentage may be significantly higher for persons with limited literacy skills.

For print communication, use captions or cues to point out key information.3

Remember
Refer to the Office of Management and Budget (OMB) Policies for Federal Public Websites for further guidance.

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Improve the Usability of Health Information
Many of the elements that improve written and oral communication can be applied to online information, including using plain language, large font, white space, and simple graphics.7 Other elements are specific to the Internet. These include:
• Enhancing text with video or audio files
• Including interactive features and personalized content
• Using uniform navigation
• Organizing information to minimize searching and scrolling
• Giving users the option to navigate from simple to complex information ?A critical way to make information on the Internet more accessible to persons with limited literacy and health literacy skills is to apply user- centered design principles and conduct usability testing.

Usability is a measure of several factors that affect a user’s experience interacting with a product, such as a Web page. These factors include:
• How fast can the user learn how to use the site?
• How fast can the user accomplish tasks?
• Can the user remember how to use the site the next time he or she visits?
• How often do users make mistakes?
• How much does the user like the site? ?To learn more about usability, visit www.usability.gov.

Are you speaking clearly and listening carefully?
Ask open-ended questions.
Ask questions using the words “what” or “how” instead of those that?can be answered with “yes” or “no.” For example, “Tell me about your problem. What may have caused it?” 3 Try asking “What questions do you have?” instead of “Do you have any questions?”
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Use a medically trained interpreter.
Plain English will not necessarily help individuals who do not speak English as their primary language and who have limited ability to speak or understand English. To better ensure understanding, health information for people?with limited English proficiency needs to be communicated plainly in their primary language, using words and examples that make the information relevant to their potentially different cultural norms and values.
Check for understanding.
The “teach-back” method is a technique that healthcare providers and consumers can use to enhance communication with each other. The person receiving the health information is asked to restate it in their own words??"not just repeat it??"to ensure that the message is understood and remembered. When understanding is not accurate or complete, the sender repeats the process until the receiver is able to restate the information needed.8 Consumers also can be asked to act out a medication regimen.3

Tip: Checking for understanding
Summarize what the patient needs to do. Consider using a handout or written brochure in plain language. Explain what each medication is for, along with the dosage and side effects. Make sure the patient knows where the information is written down.
Then check for understanding:
“I want to be sure I didn’t leave anything out that I should have told you. Would you tell me what you are to do so that I can be sure you know what is important?”
(Source: Doak CC, Doak LG, Root JH. 1996. Teaching Patients With Low Literacy Skills. JB Lippincott Company: Philadelphia, PA.)
Participate in plain language and cultural competency training.
Encourage colleagues to do the same. Consider organizing a training for health professionals and staff in your organization.

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Improve the Usability of Health Information
Example:

developed by the Centers


Easy-to-read flyer

for Disease Control and Prevention. The flyer was developed in multiple
?languages.



??








?

























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Improve the Usability of Health Information

Checklist for Improving the Usability of Health Information
??????????the intended users ?????pre- and post-tests ???????the number of messages ?????plain language???????????respect
???????on behavior????????for understanding????"??????????with pictures??????a medically trained interpreter or translator

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1 National Cancer Institute. Making Health Communication Programs Work. Washington, DC.?2 National Institute of Deafness and Other Communication Disorders. Improving Health Literacy.
Available at http://www.nidcd.nih.gov/about/what.asp.
3 Doak C, Doak L, Root J. 1996. Teaching Patients With Low Literacy Skills. 2nd Edition. JB Lippincott Co.: Philadelphia, PA.
4 Plain Language Action and Information Network. Available at www.plainlanguage.gov. Accessed on October 21, 2005.
5 American Institute for Research. 1981. Guidelines for Document Designers. Washington, DC. 6 U.S. Department of Health and Human Services. Usability Basics. Available at http://www.
usability.gov/basics/index.html. Accessed on October 13, 2005.
7 Baur CE. 2005. Using the Internet To Move Beyond the Brochure and Improve Health Literacy. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 141-154.
8 Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. 2003. Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine. 163(1): 83-90.

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Strategies

Improve the Usability of Health Services

Navigation of healthcare and public health systems requires being familiar with the vocabulary, concepts, and processes needed to access health services and information. This includes understanding insurance coverage and eligibility for public assistance, filling out patient information forms, scheduling appointments and follow-up procedures, and locating services.
Strategies to improve the usability of health services include:
• Improve the usability of health forms and instructions
• Improve the accessibility of the physical environment
• Establish a patient navigator program ?Improve the usability of health forms and instructions ?Healthcare and public health systems rely heavily on printed materials, including:
• Medical history forms
• Insurance forms
• Informed consent forms
• Patients’ rights and responsibilities
• Test results
• Directions to the lab or pharmacy
• Hospital discharge and home care instructions
• Clinical research protocols and announcements ?These documents, particularly forms which contain blank spaces to be filled in by the user, are often more difficult to understand than regular prose. 1 ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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Consent forms and other legal documents related to patients’ rights often contain long sentences and difficult legal terms. It is critical that these forms be translated into plain language. According to recent guidelines prepared by the National Quality Forum, healthcare providers should ask each patient to recount what he or she has been told during the informed consent process to check for understanding.2
Tips for improving the usability of health forms and instructions:
• Revise forms to ensure clarity and simplicity.
• Test forms with intended users and revise as needed.
• Provide plain language forms in multiple languages.
• Provide clear information about eligibility for public assistance.
• Train staff to give assistance with completing forms and scheduling follow-up care.

Sample informed consent language
Voluntary participation:
“You don’t have to be in this research study. You can agree to be in the study now and change your mind later. Your decision will not affect your regular care. Your doctor’s attitude toward you will not change.”
New information about risks:
“We may learn about new things that may make you want to stop being in the study. If this happens, you will be informed. You can then decide if you want to continue to be in the study.”
(Source: Paasche-Orlow MK. 2005. The Challenges of Informed Consent for Low-Literate Populations. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 119-140.)

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Improve the Usability of Health Services
Improve accessibility of the physical environment1
Settings with a large number of signs and postings have a high literacy demand. Maps, directions, signs, schedules, and instructions are posted throughout the healthcare setting to help consumers locate services and information. Many of these signs contain unfamiliar phrases and symbols. This environment can be intimidating and overwhelming for persons with limited health literacy skills. Too often, confusing signs and postings create more work for healthcare staff and cause embarrassment for patients.
Tips for improving the physical environment:
• Include universal symbols and clear signage.
• Promote easy flow through healthcare facilities.
• Train staff to create and maintain a respectful and shame-free environment. ?Establish a patient navigator program ?Patient navigators can help consumers access services and appropriate health information. Patient navigators are health professionals, community health workers, or highly trained patient liaisons who coordinate health care for patients and assist them in navigating the healthcare system. Patient navigators can help patients evaluate their treatment options, obtain referrals, find clinical trials, and apply for financial assistance.


Hablamos Juntos,?with support from?the Robert Wood Johnson Foundation, has developed a set of Universal Symbols in Health Care. Visit www.hablamosjuntos.org to learn more.


Did you know?
Congress recently passed the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005. The bill authorizes $25 million in grants over 5 years to establish patient navigator programs in low-income and rural communities nationwide.
(Public Law 109-18)

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1 Rudd RE, Renzulli D, Pereira A, Daltroy L. 2005. Literacy Demands in Health Care Settings: The Patient Perspective. In Understanding Health Literacy. Schwartzberg JG, VanGeest JB, Wang CC, Editors. AMA Press, 69-84.
2 Wu HW, Nishimi RY, Page-Lopez CM, Kizer KW. 2005. Improving Patient Safety Through Informed Consent for Patients With Limited Health Literacy. National Quality Forum. Available at http://www. qualityforum.org/docs/informed_consent/webinformedconsentMember+public09-13-05.pdf. Accessed October 13, 2005.

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Strategies

Build Knowledge to Improve Health Decisionmaking

Being an informed consumer of health information requires more than reading ability. People with limited health literacy often lack knowledge or have misinformation about the body and the causes of disease. Without this knowledge, they may fail to understand the relationship between lifestyle factors such as diet and exercise and health outcomes. People with limited health literacy skills may not know when or how to seek care.
Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated, forgotten, or is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.
Strategies to build knowledge and improve health decisionmaking include:
• Improve access to accurate and appropriate health information
• Facilitate healthy decisionmaking
• Partner with educators to improve health curricula ?Improve access to accurate and appropriate health information ?Create mechanisms for sharing and distributing plain language materials among health professionals. ?Healthcare and public health professionals can develop plain language health education materials that can be easily shared among practitioners. Health education materials should be both scientifically accurate and culturally appropriate. Develop partnerships among and across regions, audiences, and fields of interest to facilitate dissemination. ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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Build Knowledge to Improve Health Decisionmaking
Health professionals and researchers may want to examine the impact of participatory action and empowerment research strategies for effective diffusion of health information at the community level.1
Work with the media.
Working with the media to improve health literacy involves:
1. Increasing the media’s awareness of health literacy issues. Many health stories already have a health literacy angle, but it goes unreported.
2. Making scientific and medical information easier to understand. Be sure the information you give journalists is written in plain language and is suitable for a public audience. When you are working with journalists, emphasize that the provision of health information, especially when it fosters stress and anxiety in the public, does not by itself promote public understanding.
Develop new methods for information dissemination.
Health information seeking on the Internet demonstrates the public’s interest in finding health information someplace other than brochures. Personal electronic devices (e.g., cell phones, palm pilots) and talking kiosks could be new methods for delivering health information. Before you create another brochure, consider whether alternate methods for information dissemination could improve communication with your intended users.

Message channels
Channels are the routes of message delivery (such as individual, group, organizational, community, and mass media). Select channels that fit your communication objectives, your budget, and your timeline.
For more information, refer to CDCynergy.

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Build Knowledge to Improve Health Decisionmaking
Facilitate healthy decisionmaking
Research suggests that more information does not necessarily improve decisionmaking and often may undermine it.2 People process and use a limited amount of information when making a decision. As the choice becomes more complex, people adopt simplifying strategies that allow them to consider only some of the information. As a result, they may ignore or limit their search for information.
We know that obtaining accurate, appropriate health information is only one element of healthy decisionmaking. Increased self-efficacy, that is, a person’s belief in his or her ability to accomplish a desired task, is a key factor in decisionmaking.3 A high self-efficacy for a task may mean that a person is more likely to try it. The way we “package” health information and services can greatly increase self-efficacy.
What you can do:
• Use short documents that present “bottom-line” information, step-by-step instructions, and visual cues that highlight the most important information.
• Align health information and recommendations with access to services, resources, and support. ?Partner with educators to improve health curricula ?Co-develop adult basic education lessons on health content. ?Adult education includes the instruction of people 16 years of age and older who are not regularly enrolled full-time students. Lessons include reading, writing, arithmetic, and other skills required to function in society. Health professionals can work with adult educators to identify the specific skills needed to support health literacy.

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Build Knowledge to Improve Health Decisionmaking
Adult education theory maintains that people want information that is relevant to their lives. According to national surveys, health-related content is likely to engage adult learners.4
Health professionals can partner with adult educators to develop and deliver health lessons, which simultaneously builds health knowledge and reaches adults who may not connect with traditional health outreach methods. Construct lessons in which students use health-related texts like prescription labels, consent forms, health history forms, and health content from the Internet.
Partner with K??"1_ educators to improve health education in schools.
The U.S. educational system is a critical point of intervention to improve health literacy.1 Educators can take advantage of existing skill development and curricula to incorporate health-related tasks, materials, and examples into lesson plans. Many states already have standards for health education that can be enriched to incorporate health literacy skills.
Health professionals can support educators by speaking to elementary and secondary students or helping to organize health-related field trips with local schools.
1 Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. National Academies Press: Washington, DC.
2 California HealthCare Foundation. 2005. Consumers in Health Care: The Burden of Choice. Available at www.chcf.org/.
3 U.S. Department of Health and Human Services. Making Health Communication Programs Work. National Cancer Institute: Washington, DC.
4 U.S. Department of Health and Human Services. 2003. Communicating Health: Priorities and Strategies for Progress. Washington, DC.


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Strategies

Advocate for Health Literacy in Your Organization


Health professionals must commit to advocating for improved health literacy in our respective organizations. We must embed health literacy in our programs, policies, strategic plans, and research activities.
You can advocate for health literacy in your organization.
• Make the case for health literacy improvement
• Incorporate health literacy into mission and planning
• Establish accountability for health literacy activities ?Make the case for health literacy improvement ?Include health literacy in staff training and orientation. ?Training staff will increase awareness of the need for addressing health literacy and improve their skills for communicating with the public. ?• Include information on health literacy in staff orientation. ?• Make a presentation on health literacy at your next staff meeting. ?• Circulate relevant research and reports on health literacy to colleagues. ?• Post and share health literacy resources.?Identify specific programs and projects affected by low ?health literacy. ?How can addressing health literacy improve the effectiveness of these programs? What existing or ongoing organizational activities contribute to the improvement of health literacy? How can these activities be recognized and supported? ?U.S. Department of Health and Human Services ?Office of Disease Prevention and Health Promotion
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Advocate for Health Literacy in Your Organization
Target key opinion leaders with health literacy information.
Brief senior staff and key decisionmakers on the importance of health literacy. Explain how health literacy relates to the organization’s mission, goals, and strategic plan and how it can be incorporated into existing programs. Be specific!
Use the following talking points to make the case for health literacy improvement:
1. Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy. In other words, nearly 9 out of 10 adults may lack the skills needed to manage their health and prevent disease.
2. Furthermore, 14 percent of adults (30 million people) have Below Basic health literacy. These adults were more likely to report their health as poor (42 percent) and more likely to lack health insurance (28 percent) than adults with Proficient health literacy.
3. There is a mismatch between the reading level of health information and the reading skills of the public. In addition, there is a mismatch between the communication skills of lay people and health professionals.
4. Adults with limited literacy skills are less likely to manage their chronic diseases and more likely to be hospitalized than people with stronger literacy skills. This leads to poorer health outcomes and higher healthcare costs.
5. People’s ability to understand health information is related to the clarity of the communication. Health professionals’ skills, the burden of medical jargon, and complicated healthcare delivery systems affect health literacy.
6. The benefits of health literacy improvement include improved communication, greater adherence to treatment, greater ability to engage in self-care, improved health status, and greater efficiency and cost savings to the health system as a whole.
7. Enhancing health literacy does not always require additional resources. It is a method for improving the effectiveness of the work we are already doing.

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Advocate for Health Literacy in Your Organization
Incorporate health literacy into mission and planning
Include specific goals and objectives related to improving health literacy in strategic plans, performance plans, programs, and educational initiatives. Goals and objectives may be population based (for example, achieving Healthy People 2010 Objective 11-2) or specific to the mission of the organization.
Convene a work group to develop a health literacy agenda for your organization.
Seek input and collaboration from a broad cross-section of employees.
Include health literacy in grants, contracts, and memorandums of understanding.
Recommend that all products, including educational materials, forms, and questionnaires, be written in plain language and tested with the intended users. Encourage contractors, grantees, and partners to indicate and evaluate how their activities contribute to improved health literacy.
Incorporate health literacy into Funding Opportunity Announcements (FOAs). These include requests for proposals (RFPs), applications (RFAs), corrections (RFCs), and program announcements (PAs). In addition, provide proposal reviewers with basic health literacy information and training when appropriate.

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Advocate for Health Literacy in Your Organization
Establish accountability
Include health literacy improvement in program evaluation.
Incorporate health literacy objectives into evaluation criteria for programs and projects.
Include health literacy improvement in budget requests.
Designating funding for health literacy activities will hold staff and management accountable and encourage evaluation.
Implement health literacy metrics.
Implementing metrics or measurable objectives for your organization will help establish accountability for health literacy activities. Below are examples of health literacy metrics.
Our organization will:
1. Apply user-centered design principles to 75 percent of new Web pages.
2. Ensure that all documents intended for the public are reviewed by a plain language expert.
3. Provide all new employees with training in cultural competency and health literacy within 6 months of their date of hire.

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Resources

@
To Learn More About Health Literacy

Health Literacy: A Prescription to End Confusion
Released in 2004 by the Institute of Medicine (IOM), this report examines the body of knowledge that applies to the field of health literacy and recommends actions to promote a health-literate society. Available at: www.iom.edu/report.asp?id=19723
Healthy People 2010
Healthy People 2010 is a comprehensive set of disease prevention and health promotion objectives developed to improve the health of the nation. Objectives 11-2 and 11-6 specifically address health literacy. Available at: www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm
The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NAAL) This report is the first release of the NAAL health literacy results. The results are based on assessment tasks designed specifically to measure the health literacy of adults living in the United States. Health literacy was reported using four performance levels: Below Basic, Basic, Intermediate, and Proficient.
Available at:
http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483
Communicating Health: Priorities and Strategies?for Progress?This publication provides in-depth action plans for each of the six Healthy People 2010 Health Communication Objectives, including Objectives 11-2 and 11-6 on health literacy.?Available at: http://odphp.osophs.dhhs.gov/projects/HealthComm/
U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion
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To Learn More About Health Literacy
Literacy and Health Outcomes
This report from the Agency for Healthcare Research and Quality (AHRQ) provides a systematic review of the literature on literacy, its relationship to various health outcomes and disparities, and the effectiveness of health literacy interventions.
Available at: www.ahrq.gov/clinic/epcsums/litsum.htm
Bibliography Understanding Health Literacy and?Its Barriers?The National Library of Medicine’s (NLM) bibliography provides a comprehensive list of health literacy citations from varying disciplines and publications. The bibliography is divided into specific topic areas. Available at: www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html
To learn more about improving the usability of health information:
Scientific and Technical Information: Simply Put
This guide from the Centers for Disease Control and Prevention (CDC) will help you translate complicated scientific and technical information into material that captures and keeps the interest of your intended audience.
Available at: www.cdc.gov/communication/resources/simpput.pdf
CDCynergy (CD-ROM)?A multimedia CD-ROM used for planning, managing, and evaluating public health communication programs. The planning model is designed to guide the user through systematically conceptualizing, planning, developing, testing, implementing, and evaluating health communication activities, while promoting accountability and the importance of evaluation.?Available at: www.cdc.gov/communication/cdcynergy.htm

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Making Health Communication Programs Work
(the “Pink Book”)
The planning steps in this guide from the National Cancer Institute (NCI) can help make any communication program work, regardless of size, topic, intended audience, or budget. The Pink Book describes a practical approach for planning and implementing health communication efforts.
Available at: www.cancer.gov/pinkbook
Plainlanguage.gov
Designed to improve communication from the Federal Government to the public, this Web site contains excellent tools and examples of plain language.?Visit www.plainlanguage.gov
A Family Physician’s Practical Guide to Culturally Competent Care?This guide, developed by the Office of Minority Health (OMH), includes cultural competency curriculum modules designed to equip family physicians with awareness, knowledge, and skills in cultural competency to better treat the increasingly diverse U.S. population. Available at: http://cccm.thinkculturalhealth.org/
National Standards for Culturally and Linguistically Appropriate Services in Health Care?OMH has developed comprehensive standards on culturally and linguistically appropriate services (CLAS) in health care. The CLAS standards provide definitions of culturally and linguistically appropriate services and address organizational structures and policies that help healthcare professionals respond to cultural and linguistic issues presented by diverse populations.
Available at: www.omhrc.gov/assets/pdf/checked/finalreport.pdf

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To Learn More About Health Literacy
Policies for Federal Public Websites
The Office of Management and Budget issued the Policies for Federal Public Websites in 2004. The policies are designed to improve the usability of Federal Web sites.?Available at: www.firstgov.gov/webcontent/policies_and_implementation.shtml
Usability.gov
A resource for usable, useful, and accessible Web sites. This site contains information, guidelines, and checklists for conducting usability testing and user-centered design.?Visit www.usability.gov
To learn more about improving the usability of health services:
Improving Patient Safety Through Informed Consent for Patients With Limited Health Literacy?This report, from the National Quality Forum, is designed to provide an overview of major issues involved in providing informed consent for all patients, particularly those with limited health literacy. Available at: www.qualityforum.org/docs/informed_consent/webinformedc onsentMember+public09-13-05.pdf
Understanding Health Literacy
This comprehensive resource of health literacy research seeks to improve understanding of this public health challenge and to stimulate research focused on reducing or eliminating the literacy barrier?to effective medical diagnosis and treatment. The book includes a chapter on the literacy demands of healthcare settings.
Schwartzberg JG, VanGeest JB, Wang CC, Editors. Understanding Health Literacy. AMA Press. 2005.

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To learn more about building knowledge to improve health decisionmaking:
Consumers in Health Care: The Burden of Choice
This report by the California HealthCare Foundation presents the latest research on consumer decisionmaking, explores the methods consumers use to make choices, and looks at what influences affect consumer action. The research suggests important implications for the development of effective information tools for consumers. Available at: www.chcf.org/topics/view.cfm?itemid=115327
healthfinder®
healthfinder® is an award-winning Federal Web site for consumers, developed by the U.S. Department of Health and Human Services and other Federal agencies. Since 1997, healthfinder® has been recognized as a key resource for finding the best government and nonprofit health and human services information on the Internet. healthfinder® links to carefully selected information and Web sites from more than 1,500 health-related organizations.
Available at: www.healthfinder.gov

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Essay Instructions: The purpose of this paper is to describe HISPANICS living in Alabama and their health concerns. 1. Identify Hispanics living in Alabama. 2. Conduct literature review using a minimum of 10 references pertaining to their health concerns, health practices, and health agencies that serve to meet those health concerns. The research should address these questions: 1. For each of the following organizations, what role might they play in the health of Hispanics: World Health Organization (WHO), Pan American Health Organization (PAHO), U.S. Dept. of State, Centers for Disease Control and Prevention (CDC) 2. In the country of origin of Hispanics, what are the specific communicable disease health concerns of Hispanics? 3. In the country of origin of Hispanics, what are the food and vectorborne disease concerns? 4. In the country of origin of Hispanics, what are the occupational safety and disease concerns? 5.How might Hispanics impact the overall health of Alabama and the delivery of health services in Alabama? 6. Which subgroups within Hispanics would benefit the most from health education programs that already exist in Alabama that serve the general population? Specify the names of the health education programs (minimum three) that already exist in Alabama. Briefly describe the programs and briefly describe what subpopulation of Hispanics would benefit by their services. The format of the paper should be as follows: The paper should be a maximum length of 8 pages not including title page and references. The paper should be organized according to the following: Title Page, Introduction, Description of Hispanics, Role of health organizations in Hispanic health( answers question 1), Communicable diseases (answers question 2), Food and vector borne diseases (answers question 3), Occupational diseases and safety issues (answers question 4), Health impact of Hispanics in Alabama ( answers question 5), Existing health education programs in Alabama (answers question 6). Conclusion.

( Lisa L. Mathis ) California College for Health Sciences