Education Matters: Education and Health Outcomes

1. Education Matters: Education and Health Outcomes Julie Miller-Cribbs, Ph.D., MSW Associate Professor, Assistant Director, Anne & Henry Zarrow School of Social Work Michael Miller, RPh, DrPH Associate Professor, College of Pharmacy SUMMER INSTITUTE ANCHORING LECTURE August 4, 2011

2. Objectives • Examine the connection between education and health literacy • Review the concept of health literacy and its relationship to health outcomes • Raise awareness of national standards for health literacy • Discuss literacy based tools and interventions that can be integrated into clinical practice

3. Background • Most patient/health education materials are developed by HIGHLY educated individuals. • Patient understanding/ comprehension of materials are RARELY assessed or considered • Most American adults have NEVER had a human anatomy/biology course (including those with a college degree). • Most students take ONE health/wellness class during high school (usually taught by a teacher with a limited health background). Credit: Wallace

4. How Does Education Influence Health? Three interrelated pathways Health Knowledge and Behavior Employment and Income Social and Psychological Factors

5. How does education influence health?

6. How does education influence health? PATHWAY ONE: HEALTH KNOWLEDGE, LITERACY & BEHAVIORS

8. Education and Health Behaviors

9. Health Behaviors Continued

10. Education and Health Outcomes

12. Education and Health Calculator • http://www.commissiononhealth.org/Calculator.aspx

13. Parent’s education is linked to children’s health

14. Education, Income & Children’s Health From http://www.commissiononhealth.org/Documents/ChildrensHealth_Chartbook.pdf

15. How does education influence health? PATHWAY TWO: EMPLOYMENT AND INCOME

16. Income & Health

17. Income & Children’s Health

18. Gaps in Infant Mortality Rates by Mother’s Education

20. Working Conditions & Resources • Working long hours has been linked with cardiovascular disease, diabetes, subjective health complaints, fatigue, and depression • Safety and Health hazards: Hotel cleaners • Ergonomic hazards (bending, pushing carts, and making beds) • Trauma hazards that include slips, trips, and falls • Respiratory, dermal, and possibly carcinogenic hazards from chemicals in cleaning products • Mold and microbial contaminants • Infectious agents • Occupational stress due to heavy workloads, lack of adequate supplies, job insecurity, low pay, and discrimination • Part time, seasonal, and temporary employment & insurance coverage

22. Percent of Nonelderly Women Reporting No Doctor Visit in Past Year Due to Cost, by Race/Ethnicity US 28.1% OK Hispanic 38.5% 12% HI US 27% American Indian/ Alaska Native 43.3% SC AR 11.9% US 23% 33.7% IA Black 12.4% RI 14.7% US White 22.7% WV 6.9% MA US 12.7% Asian and NHPI GA 22.5% 6.1% CT Data: BRFSS, 2006-2008.Note: Data reflect the U.S. average and the states with the highest and lowest percentages.Source: The Kaiser Family Foundation, Putting Women’s Health Care Disparities on the Map, available at: www.kff.org/womensdisparities/.

23. How does education influence health? PATHWAY THREE: SOCIAL AND PSYCHOLOGICAL FACTORS

24. Work, Stress and Control

25. Social Support • Sense of belonging • Increased sense of self-worth • Security • Increased access to resources through network (emotional, instrumental)

26. Focus: Health Literacy “…the constellation of skills, including the ability to perform basic reading and numerical tasks required to function in the health care environment.” Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, AMA, 1999 “…the ability to understand and use health-related printed information in daily activities at home, at work, and in the community to achieve one's goals and to develop one's knowledge and potential” National Assessment of Adult Literacy, 2006

27. Demographic Correlates of Health Literacy The Health Literacy of America’s Adults. Results from the 2003 National Assessment of Adult Literacy. 2006. http://nces.ed.gov/pubs2006/2006483.pdf

28. Recognized Priority Populations • Racial/Ethnic Minorities • Low Income Groups • Women • Age <18 years • Age ≥ 65 years • Residents of rural areas • Individuals with disabilities or special health care needs USDHS. 2009 National Healthcare Disparities Report 2009. AHRQ Publication No. 10-0004. March 2010. www.ahrq.gov/qual/qrdr09.htm

29. Components of Health Literacy – Skills Vs Demands

30. Interpreting Literacy Levels Literacy Proficiency Level The Health Literacy of America’s Adults. Results from the 2003 National Assessment of Adult Literacy. 2006. http://nces.ed.gov/pubs2006/2006483.pdf

31. The Health Literacy Problem The Health Literacy of America’s Adults. Results from the 2003 National Assessment of Adult Literacy. 2006. http://nces.ed.gov/pubs2006/2006483.pdf

32. How many polio vaccinations should children have received by the time they are 7 years old? Credit: Wallace

33. What does the label say a person should do in case of an overdose? Credit: Wallace

35. Common Misunderstanding of Warning Labels “Chew pill and crush before swallowing.” “Just for your stomach.” “Use extreme caution in how you take it.” “Medicine will make you feel dizzy.” “Take only if you need it.” “Don’t take medicine if you’ve been in the sunlight too long.” “Don’t leave medicine in the sun.” “Don’t leave [medicine] in sunlight but a cool place.” Davis et al. (2006). J Gen Intern Med.

36. What messages do we send to our patients with varying literacy? Higher Literacy “ I love these sheets… they tell me exactly what is happening in my body.” Lower Literacy “I think they make my baby look ugly.” Credit: Wallace

37. Readability of AAFP and ACOG Patient Education Materials Average reading level of materials=9.4 • Average reading level • of materials=≈9.0 Wallace et al. (2004). Fam Med. Freda. (1999). Obstet Gynecol. 800+ published studies confirm these findings.

38. Are Home Blood Glucose and Pressure Monitor Guides Readable? • Blood Glucose Monitors • Average reading grade level was 10th grade. • Font and graphic size • were small throughout. • Blood Pressure Monitors • Average reading grade level was 9th grade. • Most instructions did NOT emphasize key points. Wallace et al. (2008). Diabetes Techn Ther. Wallace et al. (in press). Blood Pressure Monit.

39. Survey of Sooner Care Parents

40. Survey of Young Oklahomans N=519, Young Oklahomans 18-34 41% report medical debt 39 % report using pay day lender for medical costs/debt Young Oklahomans with High Health Literacy  Completed more education Valued Health insurance covered more Rated the quality of their health care services higher Had fewer health worries Had less medical debt As compared to those with lower levels of health literacy

41. Examples from Oklahoma Data: Tulsa Photovoice (preliminary)

43. PhotoVoice: Communication Errors • finishing participants’ sentences • upon asking a question, answer it themselves without giving the participant time to answer • correcting the respondent • talking over the respondent • becoming sidetracked during the interview • judgmental

44. References • America’s Health Starts with Health Children From http://www.commissiononhealth.org/Documents/ChildrensHealth_Chartbook.pdf • Oklahoma data RWF http://www.commissiononhealth.org/State.aspx?State=54348 • National Poverty Center, Education and Health Policy Brief http://www.npc.umich.edu/publications/policy_briefs/brief9/ • Work Hazards resources: http://www.cdc.gov/niosh/docs/2004-143/table3(large).html