Workforce Development: Advancing Health Literacy at the Minnesota Department of Health (MDH)

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Workforce Development:

Advancing Health Literacy at the

Minnesota Department of Health

(MDH)

November 21, 2013

Don Bishop, Genelle Lamont, Charity Kreider

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Overview

• What is health literacy to public health?

• Barriers to and opportunities for Health Literacy in

Minnesota

• What is our role and capacity as a State Public Health • What is our role and capacity as a State Public Health

Agency to address health literacy?

• National Assessment of Adult Literacy (1992, 2003) • Importance

• March 2013 CHP Health Literacy Workshop • Evaluation Results

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Health Literacy…

“…is the degree to which individuals have the

capacity to obtain, process, and understand basic information and services needed to make

information and services needed to make

appropriate decisions regarding their health.” -National Academies of Sciences, Institute of Medicine (2004)

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Transition

• The scope of health literacy should be expanded

to include the ability to access, understand, to include the ability to access, understand,

evaluate, and communicate information on the

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Public Health Literacy…

“…the degree to which individuals and groups can obtain, process, understand, evaluate, and act on

information needed to make public health decisions information needed to make public health decisions that benefit the community.”

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Barriers to Health Literacy

• Complexity of written health information in print/web. • Lack of health information in languages other than

English and inadequate translations.

• Lack of cultural appropriateness of health information. • Inaccuracy or incompleteness of information in mass • Inaccuracy or incompleteness of information in mass

media.

• Low-level reading abilities, especially among

undereducated, elderly and some segments of ethnic minority populations.

• Lack of empowering content that targets behavior

change as well as direct information (social marketing strategies).

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Barriers to Health Literacy in Minnesota

• By 2030 number of Minnesotans over age 65 expected

to double - will then comprise 20% of population

• Schools increasingly segregated

Ø Rapidly changing demographics

Ø Rapidly changing demographics

Ø Growth in charter schools

Ø School choice option

• Home ownership gap: Of Color – 38.6%; White –

non-Hispanic – 76.2%

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Barriers to Health Literacy in Minnesota

• Roughly 25% of foreign born (any race) lack high

school degree or GED compared to 6% of native-born

• Of all black children in state, 35% have foreign-born

parent parent

• For children age 0-19, 1 in 6 is the child of an immigrant;

for children age 0-4, 1 in 5 is child of an immigrant.

• Four year high school graduation rate in 2012: Of Color

– 57%; White (non-Hispanic) – 84%

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Percent of Minnesota residents under 65

without health insurance in 2011

• American Indian 23.1

• Asian 12.4

• Black (U.S. born) 12.6

• Black (foreign born) 24.8

• White 8.6

• Hispanic 29.3

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Impact of ACA on Minnesota’s

Uninsured

• In 2010 485,200 in Minnesota were uninsured

• By 2016 expected that uninsured will be reduced

to between 159,000 and 254,000.

• Eligibility

– Medicaid < 138% federal poverty level – MinnesotaCare 138-200% federal poverty level – Private Coverage > 200% of fed poverty level

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U.S. Adult Health Literacy

88% of American adults do not have proficient health literacy skills

needed to make

important individual important individual and family health choices.

Source: 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.

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Percent of Adults in

Below Basic

Health

Literacy NAAL Population: 2003

Characteristic % in Below Basic

% in total population

Did not graduate from high school 51 15 Did not speak English before starting school 39 13

Adults reporting poor health 10 4

Adults reporting poor health 10 4

Hispanic adults 35 12

Age 65+ 31 15

No medical insurance 36 18

Did not obtain information over internet 80 43

Black adults 19 12

One or more disabilities 48 30

Source: U.S. Dept. of Education, Institute of Education Sciences, National Center for Education Statistics, 2003 National Assessment of Adult Literacy (NAAL)

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Risk Factors for Low Health Literacy

• Older adults (65+ years)

• Limited English Proficiency (LEP) • Socioeconomically disadvantaged • Socioeconomically disadvantaged

• Lower educational attainment • Lower income level

• Higher percent minorities

• Medicare/Medicaid recipients or uninsured • Chronic and severe health conditions

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by Census Tract in Minnesota, 2007-2011

Saint Paul Minneapolis

Twin Cities by Census Tract in Minnesota,

2007-2011

Saint Paul Minneapolis

Twin Cities

Source: 2007-2011 American Community Survey Minnesota/prepared by the U.S. Census Bureau, 2012.

Composite measure of 0-6 points defined as 1 point for a) Non Hispanic White <25%, b) >15% Speaking English Less than "Very Well"; c) >20% Foreign Born; d) >16% Living in Poverty; e) >23% Age 65 or Over; f) <75% with High School education or more

Map by James Peacock, MDH Heart Disease & Stroke Prevention Unit, June 2013

Low Health Literacy Composite

0 1 2 3 4 5

Saint Paul

Source: 2007-2011 American Community Survey Minnesota/prepared by the U.S. Census Bureau, 2012.

Composite measure of 0-6 points defined as 1 point for a) Non Hispanic White <25%, b) >15% Speaking English Less than "Very Well"; c) >20% Foreign Born; d) >16% Living in Poverty; e) >23% Age 65 or Over; f) <75% with High School education or more

Map by James Peacock, MDH Heart Disease & Stroke Prevention Unit, June 2013

Low Health Literacy Composite

0 1 2 3 4 5

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Importance

• “Adults with limited health literacy have less

knowledge of disease management, report poorer health status, and are less likely to seek preventative care.” (IOM, 2004)

• “Low health literacy costs the U.S. healthcare industry

$73 billion per year in misdirected or misunderstood healthcare services (Vernon, 2009; Friedland, 1998; Howard, 2005)

• Public health has ethical and legal obligation to

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Purpose

Create a public health workforce at MDH

fluent in health literacy principles and

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Methodology

• Conducted comprehensive literature review

• Developed workshop learning objectives and content • Arranged guest speakers, facilitators and panelists

• Arranged workshop venue and catering service • Arranged workshop venue and catering service

• Advertisements and invitations sent via MDH Intranet

and MS Outlook Calendars

• Assessed participant learning needs for break-out

group activity: CDC Training Module and Simply Put Checklist

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Learning Objectives

1. Define health literacy and describe conceptual models. 2. Discuss the individual, medical, public health, economic,

and political importance of health literacy.

3. Identify populations vulnerable to low health literacy rates. 4. Describe effective use of theory-based models in design 4. Describe effective use of theory-based models in design

and evaluation of culturally sensitive health literate materials.

5. Give examples of basic concepts for communicating with a diverse audience (e.g. cultural competency, participatory action and learning).

6. Apply lessons learned from the workshop to current public health work for improvement and use in future work.

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CDC Online Health Literacy Course

• Course Title: Health Literacy for Public Health

Professionals

Ø http://www.cdc.gov/healthliteracy/training/index.html

• Simply Put: A guide for creating easy-to-understand

materials

Ø http://www.cdc.gov/healthliteracy/pdf/simply_put.pdg (see Appendix D: Checklist for easy to understand print materials)

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Pre-Workshop Homework Assignment

• Assemble work team from your program area

(heart disease, stroke, diabetes, oral health, LEP, obesity, tobacco, injury & violence, etc.)

• Complete online training: CDC Health Literacy for • Complete online training: CDC Health Literacy for

Public Health Professionals

• Team members review CDC Health Literacy

checklist and core health literacy articles

• Team members meet and apply concepts from

CDC health literacy online course to a current project

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Pre-Workshop Homework Assignment:

Project Description Content

1. Target/main audience 2. Goals/objectives

3. Main activities and project deliverables

4. Does your project currently address health literacy? If so, please describe how:

5. Will your project include an evaluation?

6. Does this evaluation have a health literacy component? If so, please describe:

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Pre-Workshop Homework Assignment:

Final Step: Create Health Literacy Plan

If your project and project evaluation currently

addresses health literacy, please describe areas for improvement.

If not, please create a brief plan on how your group could address health literacy in your project and project evaluation.

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Health Literacy Workshop Agenda

Morning

• Health literacy overview - Don Bishop, PhD, Minnesota Dept. of

Health

• Using health behavior theory to target, design, and evaluate

health messages – Marco Yzer, PhD, University of Minnesota health messages – Marco Yzer, PhD, University of Minnesota

• Implementing health literacy in a state public health

department – Jennifer Dillaha, MD, Arkansas Dept. of Health Lunch

• Video Screening: Say It Visually! – Stan Shanedling, PhD,

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Health Literacy Workshop Agenda

Afternoon

• Break-out group activity building on pre-workshop homework

applying health literacy tools/strategies to existing MDH activities: led by Alisha Elwood, MA, LMFT, Minnesota Health Literacy

led by Alisha Elwood, MA, LMFT, Minnesota Health Literacy Partnership, Blue Cross Blue Shield Minnesota

• Panel Discussion: Communicating with a diverse audience [Panel:

Genelle Lamont, Moderator, MPH, DHPE Fellow; Maria Veronica Svetaz, MD, MPH, Hennepin County Medical Ctr; Sara Chute, MPP, Minn. Dept. of Health; Mary Beth Dahl, RN, Stratis Health]

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Resources

Participants received • Welcome letter • Agenda • Learning objectives • Speaker bios • Speaker bios • Presentation slides • Directory of resources • MDH Communication policies/resources • Panel questions

• Copies of pre-workshop assignment

Ø These and additional health literacy resources were made available online through MDH Intranet to participants

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Participants

• ~85 attended

Required

• Center for Health Promotion (CHP)

Invited

• Health Promotion & Chronic Disease (HPCD) • Health Promotion & Chronic Disease (HPCD)

• Office of Statewide Health Improvement (OSHII) • Office of Communications

• Refugee Health Program

• Office of Minority & Multicultural Health • Executive Office

• U of MN School of Public Health and Journalism graduate

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Evaluation Results (51 of 85 attendees)

90% 86%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Very/Somewhat likely to attend another health literacy workshop. Understood the objectives of this workshop.

84% 82% 78% 70%

61%

Workshop content was relevant to my work.

Folder packet provided me with useful resources & tools.

The presentations and panel discussion were engaging. Overall I learned a lot from this workshop.

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Evaluation Results (continued)

• More information requested:

– Culture-specific communications and health literacy – Applying health behavior models to project planning – Web design and videos that address health literacy – Web design and videos that address health literacy – How to apply health literacy principals into RFPs and

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Advancing Health Literacy at MDH

(1) Create a MDH Health Literacy Committee

(2) Create a full-time Health Literacy Coordinator (3) Develop MDH Health Literacy Guidance

Document Document

(4) Develop and formalize MDH staff training curricula in health literacy

(5) Develop staff competencies and performance measures & monitor written and oral

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Looking Forward

• Health Literacy as a part of Health Equity

• Upcoming Health Equity Report to state legislature: advancing health

equity in Minnesota

• Culture change and a transitioning workforce

• Working more closely with low health literacy populations with a

better health literacy lens better health literacy lens

• Regional health literacy workshops for local public health agencies

and communities

• Development of a State Health Literacy Action Plan with Minnesota

partners

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Health Literacy Intervention Points

Culture & Society

Health System

Education System

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Acknowledgements

Center for Health Promotion Leadership

• Mark Kinde, Injury & Violence Prevention Supervisor

• Stan Shanedling, Heart Disease & Stroke Prevention Supervisor • Gretchen Taylor, Diabetes Program Supervisor

• Merry Jo Thoele, Oral Health Program Supervisor • Jim Bluhm, Assistant Section Manager

Minnesota Department of Health

• Mary Manning, Promotion & Chronic Disease (HPCD) Director

• Jose Gonzalez, Office of Minority & Multicultural Health (OMMH) Director • Jim Peacock, Epidemiologist Senior Heart Disease & Stroke Prevention

Directors of Health Promotion & Education

• Steve Owens, Director of Health Equity

• Karen Thompkins, Internship & Fellowship Manager • Liz Traore, Evaluation & Epidemiology Manager • Cheryl Welbeck, Executive Assistant

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Don Bishop don.bishop@state.mn.us Genelle Lamont genelle.lamont@state.mn.us Charity Kreider charity.kreider@state.mn.us www.health.state.mn.us/divs/hpcd/chp/

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