IHA Health Literacy conference 2004

The Institute for Healthcare Advancement (IHA) is a California-based not-for-profit private operating foundation dedicated to advancing healthcare delivery through demonstration of innovative healthcare practices and education of healthcare professionals and consumers.

Founded in 1993, IHA publishes and designs education materials and programs in health literacy, operates freestanding medical and dental clinics for disadvantaged children, consults on a variety of healthcare issues, and organizes seminars and other educational programs for healthcare professionals and consumers. IHA has organized an annual health literacy conference since 2001.

The conference offers high quality presentations and discussions with invited “faculty” who are engaged with cutting edge research or practice. Two presentations from the 2004 conference are summarized on this and the next page.

Information and summaries of all 2004 conference presentations: www.iha4health.org

Research, Education, Practice and Policy

Dean Schillinger, M.D., associate professor of medicine at the University of California, San Francisco, and a primary care physician at San Francisco General Hospital, is a pioneer in health literacy research who contributed to the IOM Report. His presentation first focused on communication, specifically, on some research on screening, jargon, and medication discordance.

Diabetes patients with limited health literacy experience lower quality communication, though he noted that the results of several randomized controlled trials had been “somewhat paradoxical.” In one study, for example, he and colleagues found that patient-directed interventions could improve satisfaction and functional status among diabetes patients, yet they also found lower diabetes knowledge, higher body mass index, and no difference in blood pressure or HbA1c levels. Although drawing attention to low health literacy can be stigmatizing, 96% of patients in the intervention group and 97% in the control group felt that informing their doctor of their reading abilities would be useful. However, Dr. Schillinger and colleagues concluded that informing physicians was unlikely to change patient health outcomes in the short run.

Another study suggested that patients had trouble understanding jargon even when the terms were clarified. Visual aids, however, may help. In a study involving atrial fibrillation patients who used warfarin (a blood thinner that requires close monitoring and frequent dose adjustments), visual aids improved concordance; when clinicians pointed to pictures of the drug while taking patient reports, concordance improved among non-English speakers and those with limited health literacy.

Dr. Schillinger described promising results from the IDEALL (Improving Diabetes Efforts Across Language and Literacy) Project at San Francisco General where they are tracking the use of an automated telephone disease management system in the patient’s preferred language as well as group medical visits designed to encourage patients to become active in self-care through participatory learning and peer education. Both the automated system and the group visits appear to generate significant levels of engagement and clinical activity, and could be used as adjuncts to traditional care in a public health setting.

He concluded by stressing that health professionals need further training and support. He called for accreditation bodies to become more engaged, and posed some questions about public policy. “How can we ensure that the current focus on those with limited literacy does not get diluted?” he asked.

“Can we develop quality measures that capture the experience of those with limited health literacy? Can we use quality measures to generate standards to improve care for those with limited health literacy?”

Improving health outcomes among Head Start families:
Calculating the return on investment

Ariella D. Herman, Ph.D., senior lecturer of operations and decisions at The Anderson Graduate School at the University of California, Los Angeles (UCLA), presented an ongoing research project, a cooperative effort between UCLA and Johnson & Johnson that has shown a promising return on investment using both qualitative and quantitative measures.

In a pilot study, Dr. Herman and colleagues set out to create and evaluate training programs that teach Head Start parents how to best manage the health care needs of their children. Initially, over 400 English- and Spanish-speaking parents at four Head Start agencies were administered pre- and postsurveys and were interviewed. A control group received IHA’s easy-to-read self-help health book, What to Do When Your Child Gets Sick, with no training, while an intervention group received the book with training in how to use it. A train-the-trainer component prepared on-site coordinators to run the parent program.

Pre-training surveys revealed that although parents claimed to be confident and know how to take of their sick children, 74% did not have a book on child health in the house, and of the remaining group, 3% had a handbook from an insurer, 4% had a magazine or a flyer, and the rest could not recall the name of the book. When asked what they did if their child had a fever of 99.5 F, 44% said they went to a clinic or called a doctor, 26% kept the child home from school, and 7% called 911 or went to an ER.

After the training, confidence among parents and coordinators increased significantly. Two-year follow-up data indicated a reduction in missed work and school days by parents and children, fewer clinic and emergency department visits for non-emergency conditions, and other benefits. Using Medicaid costs, Dr. Herman estimated an average annual savings of $198 per family trained. By training 10,000 families, Medicaid could save almost $2 million dollars annually just in ER and clinic visits.

“But it’s more than just quantitative results,” she said. “The qualitative impact of this kind of training is powerful both for parents and children.”

After the training, parents can keep better track of immunizations, provide better well-child care, resist panicking when their children become sick, and even offer some minor health care to family members.

Herman’s research team has developed an education and research model based on continuous improvement. The trainer’s component ensures that every agency involves a team of six, including its health services and social services director/coordinator as well as family literacy specialist and community partners.

“Our objective for the end of next year,” Dr. Herman told attendees, “is to train 11,000 parents in 74 Head Start families [representing] all of the regions of Head Start.” The ten-year goal is to serve 400,000 parents, reaching approximately half of all Head Start agencies in the United States.

“I’m a dreamer,” she said, “but hopefully we’ll get there.”