Patient Safety Webinar – Health and Nutrition Literacy (December 4, 2018)

Welcome to the December patient safety series webinar Thank you again, everyone, for joining us This is our December session of the series that we have cosponsored by the NNLM south central region and SaferCare Texas which was formerly known as the UNTHSC Institute for Patient Safety designed to help health information professionals support the elimination of preventible harm and achieve the highest quality and health care possible I’m so excited to announce today’s speaker, Dr. Teresa Wagner Dr. Teresa Wagner graduated with a doctorate in public health from UNTHSC where she is now an assistant professor in the school of public health She is a registered and licensed dietician and a member of the Texas academy of nutrition and dietetics as well and as a community health worker instructor Dr. Wagger chose to do her public health doctoral residency focusing on health literacy at the university of Texas, center for health communication and literacy coalition of central Texas There she received the UT school of nursing community and academic collaborative research award and was hired as director of health literacy There she worked to making systemic health recommendations focusing on injury, illness and readmission prevent through health communication She received the distinguished scientist award for her work in modifying the health care environment in Texas regarding health literacy She currently works for SaferCare Texas as a senior fellow addressing health literacy in that role she has established aid multi-stakeholder collaborative in conjunction with the hospital council foundation and testified for health literacy legislation in Texas Her testimony helped with getting health literacy in the state health plan and she also recently received the 2018 health literacy hero award for her efforts to develop a culture of health literacy throughout Texas I’m so pleased to tell you Dr. Wagner is actually here in the room with us this afternoon I’m going to go ahead and pass things over to her and let her get started with her presentation Take it away, Dr. Wagner >> Good afternoon So today we’re going to be talking about health and nutrition literacy as the social determinants of patient safety, health and healing of So throughout the presentation we’re going to bring all of those together and bring them home so you have a better understanding on how your communication with patients actually makes an impact on whether or not they are able to get well and stay well once they leave the facility if you worked in health care And then if you don’t work in health care, I’m going to be talking to you about ways that in the community we can support people in staying healthy and well through improved health communication So in summary then, at the completion of the seminar you’ll be able to identify the issues related to health literacy, identify health literacy as a barrier to proper nutrition and health behavior, analyze how these impact health, healing and patient safety and develop solutions within your community and in partnership with the health care continuum So we start out by looking at the social determinants of health which we know as a major impact on whether or not people are able to stay healthy and well out in the community There’s five facets that were spelled out by healthy people 2020 And each of those facets, if you look, in my mind is related in some way to health literacy, and so as we go through this presentation, I’m going to show you that relationship So and normally I’m in an in-person situation, but in your mind you can raise your hand and indicate which of these you think is the strongest predictor of health status So do you think it’s income or do you think it’s literacy skills, education level, ethnic group or people’s average beer intake on the weekend, which we all know can say something about lifestyle but is actually supposed to be funny But looking at the other factors, you can, in your mind, go, yeah, that could impact people’s health status, whether it’s income, education All of these things can impair whether or not we’re healthy or not So the number one indicator is actually literacy skills and how that plays out we’ll see in the presentation So, again, I’m usually in person but I want you to think in your mind whether or not people will tell you if they have trouble reading, whether or not people will limited literacy

have low IQs and the number of years of schooling is a good guide to determine literacy levels, and we all know people who got through high school without having great literacy skills because sometimes the system just sets them on a track to get out without having achieved that And then I’ve also been presenting at senior citizen centers where the low income area and I was really expecting most of those attendees to have not only limited literacy but also possibly low IQ.s One couple was asking me questions Little elderly lady popped up and said there’s a pamphlet inside your medication, all you have do is take it out and read it I was like wow, she blew my bias out of the water So you can’t always tell by looking at people or because of your own biases or the things that you learned growing up whether or not they are going to have low literacy, much less low health literacy So that’s why it’s so important we communicate in a universal precautions way where we assume everyone has low health literacy and if we need to move up in scale on what type of information we provide them, we do so So I wanted to go through each of the different facets of the five social determinants of health that the healthy people 2020 spelled out and just kind of walk you through to look at what the breakdown is For health and health care, health literacy is actually listed there, but health literacy is also a barrier to access to health care and access to primary care My own daughter was trying to make an appointment with an OB/GYN And she went to the website on their phone and they had these complex diagnosis and she hands me her phone and says you pick, I can’t figure any of this out So that just shows you, it’s all interrelated Education, same thing, language and literacy right there R but can we get through — I know we can get through some, but we can get all the way through school and have a good education which then is going to lead into job opportunities and socioeconomic status without having good language and literacy skills, and it starts all the way in early childhood To have social cohesion, civic participation and to eliminate or reduce discrimination and incarceration, we have to have a good education We have to have good literacy skills, but if you think about hierarchy, we need to have those basic needs met which we can only meet by having these basic skills in order to move up MASlow’s hierarchy and doing other things that really brings society together and help us have good health care systems that people can navigate and staying healthy and well using the advice that they are given >>> And then neighborhood and built environment, do they VIN their neighborhoods access to food that’s one, they can access to be healthy, but, two, it’s a basic need Crime and violence If they don’t have access to food, is that not going to perpetuate crime and violence And then if low socioeconomic areas, then the environmental conditions are likely not good as well And then critic stability as we look at poverty, unemployment, they probably don’t have health insurance Again, food insecurity pops up and housing instability pops up here So, in my mind, of course I might be a little biased because I specialize in health literacy, but in my mind health literacy is the social determinant of health, not just part of the social determinants of health So what is health literacy? Health literacy is defined by healthy people 2020 and the institute of medicine as the degree to which individuals have the capacity to attain, process and understand basic health information and services needed to make appropriate health decisions Well, what’s wrong with that definition? And you can see it in the left-hand corner but when I — actually I’m doing a study right

now where I’m going and interviewing health care providers in different hospitals throughout north Texas, and one of the health care providers when I was asking him about the health literacy of his organization said to me wait, stop right there In my understanding people have health literacy, not organizations And so why are you asking us about your organization? And I was like, wow, it’s so interesting that people still have that old definition in their head when we know and a growing body of research is showing that health literacy as health care organizations is getting more and more important because we’ve made access to health care and health care in general and navigating health care so difficult that we now have to reach back and help patients navigate So thinking about it in health care and health care information, most of it is written at a tenth grade level or higher The average person in the U.S. reads at an eighth grade level and 20% read at the fifth grade level or bow low 40% of seniors read at or below the fifth grade level L 50% of African-Americans and Hispanics read at or below the fifth grade reading level, and at the same time those with the lowest reading ability are at the highest risk for health problems, so that leaves a lot of people with health problems that they don’t know how to manage because they don’t have the capacity to manage it and we as health care are not reaching back and trying to meet them where they are at So the key risk factors for low health literacy are the elderly, but there’s also disparities with young 20-year-olds that are just leaving their parents’ advocacy and having to evaluate for themselves, for one they haven’t built enough skills in self-advocacy but they are often not taken seriously by health care providers and they are used to having their parents do the advocating for them Members of minority groups, low income, people who did not graduate from high school and non-native English speakers So I want you at home or wherever you happen to be to read this passage, and again I usually have people in person but it’s a common nursery rhyme, and when you think of it or you figure it out, if you want to type it into the chat, we’ll see what we come up with Okay We have a partial answer There we go So the interesting thing about this slide is, first of all, when you first look at it, it’s overwhelming, looking at all those large words with all those syllables, but, two, you probably don’t know how to say or haven’t in a while said a lot of these words, so it might take you a minute to sound them out But if you think about him with low health literacy, they are going to have to go word by word, letter by letter to figure this out, and therein lies the problem because at the end of the day or the end of the sheet, they aren’t going to know what they just read So it’s up to us to provide that information in a way that is consumable and understandable by everyone So look how simple we could actually make that So just by using plain language or living room language, simple words, and putting pictures, we can expand the ability for people to understand the information that we’ve given them and make it very simple And then the point I guess too is that people with good literacy skills, we can skim over a paragraph and get the understanding, but people with low literacy skills are not going to be able to do that and when they walk away, they don’t understand what they’ve just read, but, two, if they are filling out a form at a health care establishment, they are going to quit and they are not going to give you all the information that you need in order to make sure that the treatment that you give them is completely accurate So when we look at different types of literacy, there’s what we call basic functional literacy which means that we have sufficient basic skills and reading and writing, interactive health literacy which is more advanced and requires that we have cognitive literacy skills because we kind of have to use that information that we’ve just read like on the label in

the picture like the young woman was reading to figure out like how much do I need to give my child Think about if she has low literacy skills and ends up giving her child more than her child actually needs and lastly is critical health literacy and that’s the ability to analyze information — negative external factors it might inhibit health promotion So that would be your doctor tells you you need to exercise more and eat more healthy For one, that’s not detailed enough but they can refer to a registered dietician or maybe a sports therapist or sports therapist that can help really bring that information home But at the same time it takes higher order thinking and we may not have clients that are able to do that higher order thinking So even if they have basic functional literacy skills, there’s still three different types of skills that they need to have in order to navigate health information, and that’s print literacy, they need to be able to read and understand text and locate and interpret information and documents, and that’s no use quantitative information So for example on medication labels where it gives you a range of ages and tells you a half tea spoon or three-quarters tea spoon based on the age and how many hours it’s been and all of these different things, and then oral literacy which is the ability to speak and listen effectively So if people don’t have good oral literacy either, they are not going to advocate for themselves and they are not going to have that open conversation with health care providers that we want them to be having and we want our health care providers to be resip indicating in that conversation So what does this mean? We know, we’ve talked about already, how literacy say strong predictor as a person’s health That poor health literacy is also stronger predictor of a person’s health than age, income, employment status, education level and race The AMia estimates 90 million low health literate Americans So health literacy and patient safety, what does that boil down to if we know that there’s that many people that have low health literacy Even if you have high education and high understanding, when you’re handed a catastrophic diagnosis, your ability to understand complex information immediately decreases So even if you’re highly educated, you can have poor health literacy if you’re handed a catastrophic diagnosis or even just trying to understand complex medical information if that’s not your specialty So when we look in the literature, low health literacy has been linked to poor outcomes which is reduced ability to understand labels and health messages, limited built to foam instructions, lower likelihood of receiving preventative care, worse overall health status, higher mortality among the elderly, shorter life expectancy, worse physical and mental health and greater use of emergency department Think about if you were the parent of that baby and you gave her the wrong dose how bad you would feel and hopefully nothing horrible would happen to the child, but again it’s a patient safety issue So what can be done? How do we solve this problem? Looking at the social determinants of health, there’s a variety of ways that we can intervene in our communities in order to improve these health outcomes and the situation in terms of people knowing how to stay healthy and well What we want to do is empower the neighborhoods that we serve, so make the healthy choice the easy choice Bring healthy foods into those neighborhoods that are food deserts, empower people with education that meets people where they live and what does that mean? It means culturally, geographically, all of these things So if we look at culture and literacy, we know culture affects how people communicate, understand and respond to health information And a different culture may come in with a whole different set of expectations and ways that they interact with the health care field So if you look at their cultural beliefs, values, language preferences, attitudes, traditions and health practices, you really have to be open-minded in order to achieve positive health outcomes So I have a story about Willy Ramirez who went into an emergency department and had

a brain bleed and had a really bad headache, but what he told his mom when he had gotten home before he went to the emergency department was he was inTOXICADo In Cuban that might have meant he had food poisoning But they never checked him or the brain bleed and he ended up being a quadriplegic and the hospital system had a $34 million lawsuit settlement on that case So we need to listen, we need to get interpreters, we need to speak in a way that’s culturally competent to understand people and really get to the root cause of whatever their issue is But cultural competency and how we’ve looked at culture in the past is we kind of memorized a set of cultural tenets that we thought were assignedded to different groups, and really now we know, A, different groups are mixing their cultures but also that we can’t understand every nuance about where someone grew up and what their social determinants of health are So instead we want to start cultural humility and what that is is an openness to look at yourself So really accurately assess yourself and what your on biases and limitations are in understanding other people and really taking in information of where they are at and trying to apply whatever the advice is that you’re going to be giving them or you’re going to be work with them on a mutually acceptable solution to help with their health problems, and have you to embrace gaps in your own knowledge, so be willing to understand that you aren’t necessarily the be all to end all You are a tool that can help people achieve good health but only if you are willing to work with where they are at And in order to achieve that, you have to have openness to new ideas So when I lived in Austin, and if any of you live in Austin right now or have visited Austin, you know about Amy’s ice cream So one day I was sitting in Amy’s ice cream enjoying my ice cream and I hear a cat meow I thought okay, I’m the only woman in there except for this woman that walked in I thought does she have a cat with her, and I looked at her and I didn’t see a cat And she went behind the counter and meows her order She is happy and is walking out and he yells back to her, paws up which I guess means have a great day, but I thought to myself, that is cultural humility He was willing to meet her where she was at and provide service I think us as health care providers need to use that same lens Information in cultural competency so we know that if we aren’t culturally competent, if we don’t provide information where people are, it can actually disable people It must be accessible and relevant I did a study recently on websites for seniors and found that only 5% of the websites that I looked at had reading levels and font sizes that were senior-friendly They have to support autonomy and decision-making, so make it simple enough to where people can make informed decisions Providers must be willing to listen and hear So my daughter, when she was in her early 20s and in college was having problems with a health issue and kept going to her provider and telling them that she was constipated bought she knew that there was more to it than that They are like oh, no, you’re just constipated and they wouldn’t listen to her I don’t know if it was her age or whatever but they wouldn’t listen to her I kept telling her, no, you have to go back and kept making more appointments and they kept sending her home, saying the same thing and it wasn’t helping She won’t becoming unconstipated Finally two months later she went in for an MRI finally and was fasting for that MRI, left the appointment and was about to take a bite of a donut and they said you need to

get back here immediately We need to do emergency surgery for appendicitis She could have died and all because the providers wouldn’t take her seriously So we have to — it’s a patient safety issue U we have to listen and hear and be willing to take in that information no matter who it is that we’re working with We have to give information that’s person centered and we have to give care that’s person centered and share knowledge and information in a health literate manner Otherwise the information and the services were getting disabled, discriminate and apply barriers, and that’s where the culturally and appropriate services standards for health care came from I know Texas has adopted these Not all states have but the class standards address improved quality of care, access to care and elevate patient health outcomes by providing effective equitable understandable and respectful quality care and services that are responsive to diverse cultural, health beliefs and practices, preferred languages, health literacy and other communication needs, and then if we are the health care provider, we need to document that we’re doing that So this was a study that was done in a culturally and linguistically diverse community and it was focused on arabic, Chinese and Spanish and looked at what their information sources were, their access to information and information that was provided and the needs that were identified fall right in line with everything I’ve been saying is that there’s a more strategic and coordinated approach that needs to be developed, greater emphasis on supporting and enhancing the interpersonal aspects of informational provision Greater range of information for culturally and linguistically diverse communities and ensure the information resources and processes reflect the circumstances and needs of these communities So it’s not one size fits all We can’t just do plain language at fifth grade level and think it’s going to meet the needs of everybody So this is my little graph that I made in terms of if people have limited English pro givensie and therefore inability to communicate well at all in English Basically it severely limits their access to health information and health services But it’s not just language There are a lot of people who don’t have the education or the ability, the exposure to health care to understand health information or they have some type of impairment understanding health information and that could actually be mental health issues But this also impedes their ability to absorb health information and access health services So what we need to do then is communicate plainly in primary languages and use words and examples like little miss MUFFET to make words more understandable and then we complete the pry angle and make health information and health services more distinguishable and understandable Here’s the model of the journey of health and well-being, in my mind We collect health information from all these sources We get it from radio, family, friends, but we then have to use our cognitive brain to assimilate all that and we have to integrate that with what our family health history is, our ethnicity, our culture and then what are our social activities, what do our friends do? Do our friends encourage us to eat healthy Do we exercise as part of our hobbies Do we have the money, work and community where we can actually get out and do those things? When I worked for early childhood intervention and I would be talking to mothers about getting out and taking a walk, I had to be cognitive of the community than they live in and whether or not that was safe or not Sometimes they would call me and go, don’t come today, we just had a drive-by shooting So not all communities are conducive to the lifestyle that we need to be living to have health and well-being So that brings us to how do we learn about nutrition because when we talk about lifestyle, yes, it’s good to be active but probably equally importantly is good nutrition So if you look at nutrition information for disparate populations, how do we relate that to our own health? There’s a whole couple of generations who kind of go, oh, I have diabetes and, oh, but

I don’t relate that to the fact that I lay on the sofa and watch TV all day that it’s exacerbated, so we kind of have to connect that and really start with K-12 which is my recommendation for legislation, but we really have to look at the communities that people are brought up in to see if it’s conducive to building that foundation of knowing about good nutrition So a comprehensive conceptualization of literacy is needed that incorporate health literacy construct Otherwise, people don’t understand the importance of having that nutritional foundation and they go for what tastes good, what’s easy, what’s available in their neighborhood One time I was driving to go do a talk in rural Michigan and had to go like into farmland and all of that, and I got hungry because I had just been on a flight and had to drive two hours and I started looking for some place to eat and sure enough the only thing I could find was fast food and I was like oh, my God, this is real, so it does happen We call these food deserts A food desert is a low income area or neighborhood It could also be a rural area that lacks the proper source of healthy food These areas usually have many fast food chains and smaller convenient stores, but how do you learn about healthy nutrition in this environment? So who is affected? People in terms of not being able to empower people to stay healthy and well when they don’t have access to healthy foods Generally it’s the people who live in food desserts that have low income and no transportation and children who grow up eating unhealthy food as a result So if you look at the U.S. as a whole, this is a map that shows where those food desserts lie, where people have either no car and/or no supermarket store within a mile You can see there’s a lot in the south That’s where the really high prevalence is but also in rural areas throughout the country And that’s where we see these big pockets of these degenerative diseases or chronic diseases that need to be managed well but yet these people tend to have low health literacy And then advertisers get in on that — not that they are targeting to make people unhealthy but if you only have access to Mcdonald’s and then it’s oh, this is where we can have hey nice family dinner and I’m not criticizing Mcdonald’s in any way I think they have made great efforts to have healthier foods, but if you look in the picture, two sundaes signature in front of the girls, fried food, another sundae, sodas, very little nutritional value despite the fact that it is a nice family meal We just need to change the foods that are being served So the health issues are people who live in food deserts may develop health issues such as obesity, cardiovascular disease, cancer, diabetes and have premature death So are we looking at super heroes of the future looking like this? I don’t know But what can we do? From the health care perspective, I’m doing a study right now on, as I mentioned, where I’m interviewing health care facilities and talking to, because of the collaborative I’ve built here in the north Texas area, I’m able to talk to CEos and CNos and other leaders in the health care field which has been very hard to establish in the past Generally the people working on health literacy are those people that are in direct patient care and event no power to change despite the fact they are frustrated by the inability of their time or system to give the people good information that’s going to help them stay healthy and well when they get home As we look at the IOM attributes of a health literate organization, the most important is we have leadership that promotes health literacy and good education which means it needs to be embedded in a mission, vision or at least the strategic plan because that’s where we’re finding, at least in my experience, when those leaders that are advocates of health

literacy leave, the person whose job is health literacy inevitably gets fired or moves to another department where health lit riskie is very minimized So they also need to plan, evaluate and improve their health literacy so they should be looking at patient outcomes in relation to health literacy and patient safely in relation to health literacy and in terms of medication, all of these things Prepare the work force so they need to train the staff, the nursing staff, the front staff I once had one of my focus group patients tell me how rude the front desk staff was to her It made her never want to come back, and so then we wonder why people don’t want to follow-up and we label them non-compliant and we need to ensure that they have easy access, so patient navigators or some type of assistance with insurance, also that we are communicating effectively with basically my whole talk It explains coverage and costs and that’s one thing that we don’t do well in the health care system today, and one of my colleagues is a nurse and makes a good salary at one of the facilities that we interviewed and said there’s times when I don’t go, even though I have something wrong because I have no idea what it’s going to cost me and I’m afraid of what it’s going to cost me, and I’m like I do the same thing So think about people that have no money and no understanding, what that’s doing to them wanting to access health care or preventative services We need to target high risk populations and make sure that we have good informed consent If we’re having to rip somebody’s appendix out or do an emergency C-section, any of those things, making sure that people understand the procedures that they are agreeing to Design easy to use materials and I think that’s one of the hardest things to achieve in large health care systems and any doctor’s office for that matter because there’s so many materials and to have someone on staff that actually keeps on top of that and has the skills to produce health literate information, I know there’s a huge need of that area because there’s not a lot of people that are trained in health literacy We need to meet the needs of all so making sure that we have good cultural competency, that we have people that interpret all Hamilton these things that make health care welcoming and then also include consumers and it’s probably the one thing that we do — I won’t say one thing because there are a lot of things we’re not doing well But we tend to not include people and ask them are you able to understand this? If not, how could we make it better and what would be the need to know for you? So a lot of times we give all of this extra information which is not need to know and all it does is water down and/or discourage people from using the information that we need them to use So one of the stood I’m doing right now is on the term of mortality After weeding through it the information that we got from different hospital systems, kind of boil it down, need to know our next step is to actually go out and interview people that are recently postpartum and say what of this do you understand, what would have been useful for you, what it culturally competent, all of these things so that we can make these directions more useable and hopefully lower than maternal mortality rate in the state of Texas, if not the country So thinking outside of health care If you look at this chart, actually clinical care is only 20% of health outcomes, and all of the social determinants of health that we talked about really play a larger role and so we need to be able to reach out into the communities and either work with what we have to make it better and/or bring programs out that can help make things better You think physical environment, what can I do about that? I once did a program in Austin where we partnered with a housing authority and then also service that went in homes I think it was meals on wheels and we would have the meals on wheels people, if they saw unsafe things in the homes or asbestos or lead paint or all of these different factors, they would let us know and we would work with the housing program to come out and remove those factors So really having a look at the social determinants of health and some of the suggested solutions is bringing information out into the communities So partnering with these home-based services like meals on wheels, visiting nurses, home

health, early childhood intervention which I worked for at one point, promoting the healthy communities is a program of the public library association and the national network of library of medicine and, for example, in my mom’s little town, Georgetown, they have a wow mobile that brings information out to seniors that are home bound, and even young people who can’t get out into the library Also using Ehealth literacy interventions targeted at vulnerable populations that bring computers to population that’s don’t have computers and teaches them how to access information How we’ve just got to get all of the information that’s out there and credible into a health literate format It’s a big job We’ve got a lot to do in health literacy, but we can also use recreation centers as a way to get health information out Community groups such as churches have free health fairs, have mobile health care In Austin I worked with a dental bus that went out into the communities here at community health science center, we have the pediatric bus that goes out and does medical care for children out in disparate communities They go out into the neighborhood and they speak the language and they know the customs and they know the culture so they can carry those health messages out into the community And then workplace wellness programs make where we work a healthy place as well because, in my opinion, the work hours and culture of the U.S. is not conducive to good health So nutrition solutions Obesity is actually very expensive so why don’t we reinvest those costs in getting people healthier by providing healthy food access These are a couple of examples of healthy foods Oatmeal and then fruit and yogurt parfaits which come in really handy if you’re in the airport and you need to grab a snack I do that all the time Keep pushing fast food to evolve and offer better options education on healthy eating and food preparation out in the communities and through these revenge ups as well Have the market do well by doing well So Walgreen’s has an initiatives to turn 1,000 location news food oasis So if they are in a food dessert area, offer healthy food in their stores Healthy food financing initiative, incentivizing stores to open in food deserts through tax credits, below market and guaranteed loans and raise and enforce snap standards because we know there’s a lot of healthy foods that snap dollars can go towards that really shouldn’t be They should be going toward healthy foods Mobile options, we actually can do delivery, vending machines at work but also connecting with farmers that produce fruits and vegetables for people who live in food deserts through green carts and community gardens and then foundational support and micro finance So even the government can get involved New York City has probably been one of the entrepreneurs in terms handicap promoting health care through government support But they have food retail expansion of support health in their city and state Also there’s a healthy corners program in D.C. and then also putting pressure on snap to include farmers market because they often don’t count as a venue where as they could buy fruits and vegetables there and liquor, it doesn’t make sense This study shows if you give parents understandable knowledge about nutrition, that they will want more, that they really do want to know We just have to put it in a way that they understand that’s culturally applicable to them and we meet them where they are at And then lastly potential health literacy legislation which I always push for, despite the fact that health literacy is now in the Texas state health plan, I would love to see to have it mandated in K-12 education because how else are we goes to raise the next generation of people who do understand and do link their lifestyle to whether or not they have adult onset diabetes or high blood pressure, pre eclampsia, all of these things that are negative outcome Allocate funding for health lit riskie issues

That was one of my big concerns when I started health literacy work in Texas was I saw all this need and all of these, especially rural hospitals came to me like, yeah, we really need your help I was like yeah, but I got to get paid So I’m hoping that in some way we can start really bolstering funding for health literacy issues because it is important Actually if we just took the money off the back end from all of this poor outcome and put it on the front end to improve health literacy because improved health across the state and the country And then promote health literate communication and facilitating legislation to support infrastructure in services, health and wellness, reduce degenerative and chronic diseases and training our health care providers to use health literate practices coming up, and then also continuing education for providers who are already in practice So in summary, as I said, in my mind, health literacy is the social determinant of health but it interacts with all Hamilton these things that we talked about today, the health care system, cultures, society and access to health and education and all of that boil down to health care outcomes and costs which we all want to improve and we all want to lower costs So I now will take your questions >> Great Thank you so much, Dr. Wagner I want to remind everyone, you can put your comments into the chat box Your questions will be sharing them with Dr Wagner here We did have a question come in earlier Let me answer this one really quickly The slides are available We’ll have our support person put the link in the chat box once again for those, but the question that came in earlier was about why are the elderly so predisposed to lower health lit riskie levels? >> A lot of reasons but I guess if you want to just look at elderly in general, as we age our ability for cognitive efforts decreases, our dexterity decreases and our vision decreases, so all of those things put the elderly at more risk and I mean I just know from my parents and my friend’s parents who are in their 70s and 80s now that, you know, things progress and the way we give medications, the way we interact with the health care system, all of these things are now technology that they don’t understand or haven’t grasped and then on top of that, when we put information out there that’s not health literate, that even compounds the problem more Like I talked about with my study on the website and the font size and the readability >> A lot of issues facing that elderly population in particular Great question Any other questions, go ahead and please put them into the chat box We will also go ahead and share Dr. Wagner’s contact information I’m sure she would be happy to answer any questions if anyone has them at a later time I’ll give a couple more minutes in case anyone is typing out their questions now all right We have another great question that’s come in With so many obstacles, transportation access, costs, demographics, etc., how can librarians be of the most help? As a health science librarian in a medical university, I see so much disparity but I want to do more than just research So maybe my question is how can non-clinicians help? >> Partnering out in the community to help provide services as a librarian you are a huge, rich resource of health information So really looking out — I just did health literacy needs assessment for north Texas in collaboration with my hospital council group And really we looked at those things, and it’s all about what programs are out there to reach these people that are not able to reach out for themselves The more work to get that information out into the communities, like I said, where they are at, then definitely need to do that and I’d love to help brain storm with you and possibly connect you in your area >> I can say it’s certainly here at the south central region offices It’s one of the reasons we partner with the program and any way we can help them with our funding, with our knowledge and all of that is a really great opportunity for us as well

Another question Someone who is familiar with cultural competency and also a TCOM health literacy conference, do you know if there’s anything like this planned in the near future? >> We used to have one here We haven’t had one in a few years but there is a really great one that the health collaborative down in San Antonio puts on in October It’s usually the first weekend in October every year That would be a good resource for you Hopefully at some point we can have a TCOM health literacy conference but right now San Antonio’s doing a really great job at it, and I wouldn’t necessarily want to compete with their efforts In fact, we are starting to build a collaboration with them So hopefully this will be a nationwide effort >> Great >> I want to add is we just formed, so I’m connected with other health literacy professionals throughout the country, but we’ve just formed an international health literacy association, so our goal is to really tackle these issues from a global perspective So if you’re interested in joining that and then also learning about some of the other organizations that are available nationwide, feel free to reach out and I’ll help you get connected >> Great >> And do you have the name of that San Antonio program off the top of your head? >> They are called the health collaboratives It’s where I got the award from They also called it their health literacy program is called the San Antonio health literacy initiative So I’m not sure which website you would go to but you can try both of those >> Great I have another question here You mentioned snap What’s your experience with W.I.C. especially in rural areas, native American populations >> They still embrace culture and all of that, but limiting the unhealthy foods people can get and if they make them useable at farmer’s markets, then definitely that’s a great program >> Great And we’re having a lot of — I like this Someone said it’s not limiting It’s guiding >> Thank you >> And we have a lot of people sharing in the chat other resources for health literacy Thank you so much I do know that University of Arkansas for medical sciences has a center for health literacy as well If you’re part of a med school, you can work with students in the community and do outreach and set up and share information We do have the MedLine Plus English and Spanish resources That’s great All right If there’s no other questions at this time, I will go ahead and encourage everyone top write down Dr. Wagner’s information if you do think of a question at a later time but I’ll go ahead and thank her for a fabulous presentation as I finish up the recording and do our housekeeping Thank you >> Thank you >> I’ll ask everyone to stay on for just a couple more minutes as we do our final housekeeping