Useful Resources: Health Literacy

Health Literacy is key to individuals being able to access, understand, and fully use health information and services. For this reason, the Agency for Healthcare Research and Quality (AHRQ) has developed a listing of tools and other resources to help healthcare professionals in “making information easier to understand and systems easier to navigate.” The resource list is divided into the following topics:

Visit the AHRQ website to learn more about the available Health Literacy Resources.

Workers Who Give Care To The Homebound Often Can’t Afford To Get Their Own

From the article by Shefali Luthra on Kaiser Health News:

For more than two decades, Celeste Thompson, 57, a home care worker in Missoula, Mont., had not had regular contact with a doctor — no annual physicals and limited sick visits. She also needed new glasses.

Like many others who work in the lower rungs of the health care system, she has worked hard to keep her clients healthy by feeding them, dressing them and helping them navigate chronic conditions.

But because of the low wages and the hourly structure of this industry — which analysts estimate is worth nearly $100 billion annually and projected to grow rapidly — workers like Thompson often don’t have health insurance. Many home health agencies, 80 percent of which are for-profit, don’t offer coverage, or their employees don’t consistently clock enough hours to be eligible. They generally earn too much to qualify for public aid but too little to afford the cost of premiums.

“It’s a social justice issue. We have a workforce that is the backbone of long-term [care] services, and they themselves don’t have coverage,” said Caitlin Connolly, who runs a campaign to increase home care wages at the National Employment Law Project, an advocacy organization.

In 2015, Montana opted in to the 2010 health law’s expansion of Medicaid, the state-federal low-income health insurance program. Thompson, who was making about $10 an hour, immediately signed up.

Her vision care was among the first things she focused on. She had not visited an eye doctor in nine years — a problem because her job includes keeping track of patients’ pill bottles and making sure they take the right medications. “I had to use a magnifying glass to see small print,” said Thompson, who now wears bifocals. Her doctor has since warned her she may need a stronger correction soon.

…Thompson is part of a large population of home-based caregivers who might be affected by such changes. From 2010 to 2014, about half a million of these workers gained new health insurance through Obamacare, estimates PHI, a New York-based nonprofit that researches this slice of the labor force and advocates for improved working conditions, in a March issue brief.

Most home care workers’ gains came from living in states that, like Montana, expanded Medicaid. But even with Obamacare in place, many home health workers — perhaps 1 in 5 — remain uninsured. By contrast, about 8.6 percent of all Americans lack coverage.

Read the full article.

The Future of Health Care Is Outside the Doctor’s Office

From the article by Mattie Quinn on Governing:

Eastern Kentucky, with its small communities nestled in the Appalachian Mountains, is well known as one of the poorest pockets of the country. What’s sometimes forgotten, though, is how the region’s economic decline has gone hand-in-hand with a long history of poor health.

In the early 1990s, state policymakers began to grapple with what to do about the region’s high rates of cancer, diabetes and heart disease, as well as the apparent lack of such basic good health practices as preventive screenings. In many ways, the people in the region seemed to be living outside the health-care system. That’s why, in 1994, lawmakers and health officials raised a simple question: How do we get people into the system in the first place?

“We knew we needed to create a position that would work as a patient advocate,” says Fran Feltner, director of the Center of Excellence in Rural Health at the University of Kentucky. At the time, “lawmakers sort of joked that if there was money left after the legislative session, they would create a program that would include an advocacy position,” she says. “Surprisingly, there was money left, so the Kentucky Homeplace was born.”

Kentucky may have backed into the program, but Homeplace has become an innovative model for serving people in poor, rural areas. At its heart is the advocacy position. Those who enroll in the program are matched with a community health worker — usually someone born and raised in the community. The health worker can assist with any number of things that might affect a person’s well-being, from getting them eyeglasses to helping them with food assistance to making sure they make medical appointments. “Those may seem like small problems for many people,” says Deana George, a community health worker with Kentucky Homeplace, “but I know I’ve made the process that much easier for our clients.”

After just a year with the program, George has several positive stories to share. She notes one proud moment of getting free cancer medication for a client — a medication that can run up to $10,000 a month. “When I bump into [clients] at the grocery store and they introduce me to their family, I know I’ve made a difference,” she says.

Not only has the program helped get people into care, it has also seen improvements in diabetes outcomes and in cancer screening rates. Nearly 80 percent of participants receive colon cancer screenings, well above the 40 percent national average. The program, which now serves 36 counties in Kentucky’s Appalachia region, has also introduced a new low-dose screening for lung cancer.

Health policymakers outside Kentucky have taken note. Homeplace, which is run through the Center of Excellence in Rural Health, was recognized as an “outstanding rural health program” by the National Rural Health Association, and the U.S. Department of Health and Human Services applauded its work in colon cancer screening rates. Feltner, who oversees the program, has won numerous health awards throughout the state and region. As she sees it, the community health worker is the key to the program’s success. “We’ve discovered the missing link, and that’s a person on a health-care team that makes sure a client has what they need outside of the clinic,” she says. “If a mom doesn’t have shoes for her kids, she’s likely not getting a regular Pap smear.”

Read the full article.

Travel Ban Spotlights U.S. Dependence On Foreign-Born Doctors

From the article by Lauren Silverman on Kaiser Health News:

Patients in Alexandria, La., were the friendliest people Dr. Muhammad Tauseef ever treated. They’d drive long distances to see him, and often brought gifts.

“It’s a small town, so they will sometimes bring you chickens, bring you eggs, bring you homemade cakes,” he said. One woman even gave him a puppy. “That was really nice.”

Tauseef was born and raised in Pakistan. After going to medical school there, he applied to come to the U.S. to train as a pediatrician.

It’s a path thousands of foreign-born medical students follow every year — a path that’s been around for more than half a century. And, like most foreign-born physicians, Tauseef came on a J1 visa. That meant after training he had two options: return to Pakistan or work for three years in an area the U.S. government has identified as having a provider shortage. He chose to work with mostly uninsured kids at a pediatric practice in Alexandria, La.

“That was a challenge,” he said, “but it was rewarding as well, because you are taking care of people who there aren’t many to take care for.”

The U.S. medical system depends on doctors like Tauseef, said Andrew Gurman, president of the American Medical Association. He worries that President Donald Trump’s executive order on immigration, which is now on hold after a federal appeals court ruling.

“International medical graduates have been a resource to provide medical care to areas that don’t otherwise have access to physicians,” he said. “With the current uncertainty about those physicians’ immigration status, we don’t know whether or not these areas are going to receive care.”

According to the AMA, about 280,000 international medical graduates practice in the U.S. today — that’s about one in four doctors. Some are U.S. citizens who’ve gone abroad for medical school, but most aren’t.

“They don’t all have permanent visas and so a lot of them are concerned about what their status is going to be, whether they can stay, whether they can go home to visit family and still come back, and the communities they serve have similar questions,” he said.

And the care is top-notch. A study just published in the journal BMJ shows Medicare patients treated by doctors from foreign medical schools get just as good care — and sometimes better — than those treated by U.S. medical graduates.

Read the full article.


CDC task force recommends engagement with community health workers for diabetes prevention

From the article from Healio: Endocrine today:

Interventions that utilize community health workers for diabetes prevention, typically implemented in underserved communities, can improve health and reduce health disparities for adults with diabetes, according to a recent report released by a CDC task force.

The Community Preventive Services Task Force is recommending interventions that engage community health workers for diabetes prevention to improve glycemic control and weight-related outcomes among people at increased risk for type 2 diabetes. Some evidence suggests interventions may reduce rates of progression from prediabetes to type 2 diabetes, although more research is needed, the report noted. The task force finding is based on evidence from a Community Guide systematic review of 22 studies conducted through May 2015.

Community health workers are defined as front-line public health workers who serve as a bridge between underserved communities and health care systems. They typically are from or have a unique understanding of the community served, and they often receive on-the-job training and work without professional titles. Organizations may hire paid community health workers or recruit volunteers.

In the review, the task force evaluated the effectiveness of interventions in which community health workers connected with community groups or individuals who had one or more risk factors for type 2 diabetes. Included studies evaluated interventions that engaged community health workers as health education providers (n = 22); outreach, enrollment and information agents (n = 6); members of care delivery teams (n = 4); and patient navigators (n = 3).

Findings showed that interventions utilizing community health workers resulted in improved HbA1c, weight-related outcomes and rates of progression to type 2 diabetes, although the report noted that data on reduced progression came from three studies with small sample sizes.

Read the full article.

Study Offers Young Doctors Strategies To Deal With Discrimination

From the article by Carmen Heredia Rodriguez on Kaiser Health News:

n July 2013, a man arrived in the emergency room of a California hospital seeking treatment for his child. But when the intern on call walked in to see him, the father looked at her name tag and demanded another physician. As a Palestinian, he didn’t want his child treated by a Jewish doctor. The intern turned to her resident supervisor, Emily Whitgob, who told her colleagues about the incident.

The episode, Whitgob said, helped motivate her to study how doctors in training and their institutions should deal with patients’ prejudice and to publish a report that outlines strategies offered by the professionals she and the other authors consulted. The recommendations, published Wednesday in the Association of American Medical Colleges’ journal Academic Medicine, call for trainees to focus on their role as doctors by not taking hostile comments personally and meeting patients’ anxieties with empathy.

Researchers recruited 13 experienced faculty members from the pediatric department at Stanford University School of Medicine in California to review a series of scenarios illustrating patient discrimination against a medical trainee. Participants shared their reactions to the situation and outlined strategies for diffusing the tension in such encounters.

The issue has attracted national attention recently after Tamika Cross, a black physician from Houston, posted on social media that a flight attendant had dismissed her offer to help and disputed her credentials when looking for medical aid for a man who needed treatment mid-flight. Her Facebook post went viral, garnering over 48,500 shares as of Wednesday.

It’s not clear how often these episodes occur. But the journal article notes that a 2015 survey found 15 percent of pediatric residents at Stanford had experienced or witnessed mistreatment of medical residents by patients or families. Of those incidents, 67 percent involved discrimination by patients’ families. Half the people in the survey said they did not know how to respond to the discrimination and a quarter thought that the hospital was not likely to take any action against the patients’ families.

The situations can be complicated by the lack of racial and ethnic diversity in many hospitals. According to the most recent data available from the medical colleges association, black and Hispanics make up about 9 percent of U.S. doctors.

Whitgob, now a developmental behavioral pediatrics fellow at Stanford, said the results of her research can help create a set of guidelines to give hospitals and medical students a framework to handle patient discrimination in the field.

“I wanted to help create the tools so that they can cope with these events in the future,” she said.

The experienced doctors in the study noted that if the patient needs immediate medical attention, providers should ignore any hostile comments and quickly deliver that care.

When the need is not immediate, the study participants also recommend doctors speak honestly to patients about underlying emotional triggers, which may perhaps allow a more constructive dialogue that will get to the patient’s or family’s hostility and may allow both sides to work toward establishing enough trust for care to be given.

Formal training is needed to equip doctors with the skills to engage in these discussions, according to the report. By developing self-awareness and sensitivity, medical personnel can shift the focus away from the discriminatory remarks and emphasize patient care. The group also advised providers to set expectations early in medical training by communicating that discrimination can happen to anyone.

Many of these concepts should not be new to trainees. As part of their accreditation, medical schools already are required to teach students about culturally competent health care.

Read the full article.

October HDRG Recap: USA Faculty, Staff, and Students Serving the Community through Project Homeless Connect

The October 2016 meeting of the Health Disparities Research Group (HDRG), featured a team of faculty and students from the University of South Alabama (USA) who shared their experiences of as founders and participants in  Project Homeless Connect(PHC). This annual one day even provides various resources including medical services, legal services, dental and vision screenings, and access to housing assistance to homeless individuals and families in Mobile and Baldwin counties. The team from USA coordinates and provides all medical screenings and clinical services offered at the event.

Dr. Margaret Moore Nadler, USA College of Nursing, provided an overview of the experience of implementing PHC in Mobile and also the process through which the interprofessional team from the university became involved. The event began as a multi-agency and university partnership led by the Mobile-Baldwin Continuum of Care Board and Housing First (a local non-profit agency focused on advocacy and community collaboration to end homelessness). The original focus of the collaboration was to develop standards for counting the number of homeless individuals in the area in order to comply with Federal regulations that require “Point in Time” count every January. Through this collaborative process, the group learned that Birmingham and other cities across the nation put on annual service events often called Project Homeless Connect through which they provide a one day, one-stop opportunity for homeless individuals and families to access needed services and assistance under one roof. The Mobile collaborative group realized that such an event would be a great way to serve while also meeting the mandate of conducting the annual census.

During their presentation to HDRG, members of the interprofessional team focused on three key aspects of USA’s participation in PHC.

Benefits for the USA team

  • Working in an interprofessional team provides opportunities for developing understanding across disciplines and build relationships.
  • Through the service learning opportunities of PHC students are able to strengthen their cultural competency skills and are often challenged to expand their capacity for compassion and empathy. In demonstrating this point, Caleb Butler, a social work student, shared that while he was serving as an advocate at PHC he met someone who was his age, shared a similar family background, and came from the same hometown, yet he(Caleb), was a university student, while the other person was homeless. Caleb explained that through this experience his understanding of homelessness broadened, he developed more empathy, and he realized that anyone had the potential to become homeless.
  • Reciprocal learning between faculty and students occurs through the process of feedback and evaluation. Students from the College of Allied Health Professions, College of Medicine, and College of Nursing  run the medical clinic with backup support from faculty and community providers. After each PHC the teams debrief and discuss what worked and what didn’t in order to help all involved improve their skills and to make plans and adjustments for the future.

Improvement and Development

  • After reviewing three years of participation in Project Homeless Connect, the team is developing  a strategy for moving forward and improving care.
  • A 3-5 year strategic plan with the goal of expanding the health clinic portion of the PHC as a quarterly event. They plan to seek corporate sponsorships and grants to support this goal.
  • SMART objectives have been developed around providing better care, creating better health, and lowering costs.
  • Each area of clinical service will be evaluated to recognize what works and opportunities for improvement.
  • Marketing and advocacy strategies being developed to raise the profile of Project Homeless Connect both on campus and in the broader community. New partnerships are also being sought to enhance services offered.

Data Collection and Research

  • Through the forms that clients in Project Homeless Connect complete, an abundance of data is being collected and compiled in REDCap so that it can be that can be analyzed for trends and to inform performance improvement efforts. The goal is to have an accessible Homeless Health longitudinal data set that can be accessed by students, faculty and community partners who participate in Project Homeless Connect.
  • The team has identified research opportunities from this project:
    • Community Based Participatory Research
    • Readiness to change and patient referrals to community agencies
    • Use of motivational interviewing
    • Students participating in PHC: Attitudes towards the people who are homeless and now working
    • Needs assessment of USA student homelessness or risk factors for homelessness
    • Influence of  interprofessional education collaboration

The presentation team consisted of:

  • Dr. Margaret Moore Nadler, College of Nursing
  • Dr. Kathy Bydalek, College of Nursing
  • Ms. Clista Clanton, Biomedical library
  • Dr. Pam Johnson,College of Nursing
  • Ms. Mary Meyer, College of Nursing
  • Mr. Caleb Butler, Social Work Student in the Department of Sociology, Anthropology, and Social Work
  • Mr. William Crittenden, third year medical student in the College of Medicine

Download the presentation.

Watch the video:



September HDRG Recap: Sustaining Community Health Advocates for the Long-term

At the September 16, 2016, meeting of the Health Disparities Research Group, Ms. Sarah Wraight, graduate research assistant with the Center for Healthy Communities and Master’s candidate in the department of Sociology, Anthropology, and Social Work, together with

Ms. Candis Patterson, Health Education Specialist with the Center for Healthy Communities, presented “Will they stay or will they go? Long term commitment to a community health advocacy program.” Based on interviews with the several of the longest serving  and currently active Community Health Advocates (CHA), their presentation explored the factors that allowed this group of CHAs to continue working with the Center for Healthy Communities through the more than 10 years of the program’s history.

In describing the elements that have contributed to their continued relationship with the CHC, Ms. Wraight and Ms. Patterson discussed their findings with special emphasis on three key themes:

  • Spirituality and Community Trust
    • Support provided by individual pastors and churches
    • Key church ministries where CHAs can plug in the health advocacy work
    • Churches provide gathering place considered trustworthy and safe, providing an open space for health education activities
  • Self and Collective Efficacy
    • Pride in being able to give to their own community
    • Desire to pass the torch along to other individuals to continue the work
  • Professionalism and Networking
    • Professionalism comes from the support of the University staff in training and providing assistance with CHA events
    • Meetings and program activities provide opportunities to meet and brainstorm ideas for future projects

Ms. Wraight and Ms. Patterson also explained that in addition to describing the factors that kept them connected to the program, the CHAs interviewed shared their goals for future health advocacy efforts.  The strongest themes regarding future CHA work included:

  • Developing more partnerships with organizations and institutions in Mobile
  • Moving into advocacy to directly influence policy change
  • Addressing mental health issues

The presentation was based on a poster presentation given by Ms. Wraight, Dr. Roma Hanks (Co-Director of the Community Engagement Core with the Center for Healthy Communities and Chair of the Department of Sociology, Anthropology, and Social Work), and Ms. Patterson at the Women’s Health Update Conference held at UAB in August. Dr. Hanks, who was unable to attend the HDRG meeting, has directed the CHA work for several years and designed the project methodology used for the research presented in the poster. They are currently drafting a manuscript to further detail their research on the continuity of the CHAs.

Read more about the work of the CHA program.

Attending To The ‘Human Element’ Is Key To Keeping Patients Healthy

From the article by Shefali Luthra on Kaiser Health News:

Racial minorities and lower-income people typically fare far worse when it comes to health outcomes. And figuring out why has long been one of health care’s black boxes. Forthcoming research may help shed light on what’s driving those inequities — and how the system can fix them.

What is needed? Better bedside manner, so patients actually trust their doctors. Communication that is easily understood by everyday people. And transparency about what medical care costs, plus a willingness to discuss how price points fit into consumers’ health decisions.

Those ideas were highlighted in a white paper presented recently at a health communication conference sponsored by the Centers for Disease Control and Prevention. The findings, which will be published in full later this fall, are based on interviews with 100 health professionals and 65 “disadvantaged patients,” along with a nationally representative survey of 4,000 consumers. The examination is part of a larger project funded by the Robert Wood Johnson Foundation, a health-focused nonprofit. It was conducted by the Altarum Institute, a research and consulting organization.

The paper suggests that “implicit bias” — doctors and nurses subtly or subconsciously treating some patients differently than others — or patients’ perception of it could have consequences for people’s health. Patients who felt that they had experienced bias based on factors like race, income or insurance were less likely to follow advice about medication, for instance, and ended up sicker in the long run.

“We for a long time have neglected the human element,” said Chris Duke, director of Altarum’s Center for Consumer Choice in Health Care, and the white paper’s author. “The number one predictor of patient satisfaction is if your nurse listened to you. We neglect this at our great peril.”

Duke stressed that the research isn’t enough to draw conclusions about causality — that feeling disrespected causes worse health. But the study builds on years of investigation that suggests implicit bias and how patients perceive it could contribute to differences in health outcomes.

Insurance status was the largest predictor of how patients viewed their doctor-patient interaction, Duke said. People on Medicaid, the state-federal health insurance program for low-income people, or who were uninsured, were more likely to perceive disrespect than those with private insurance or Medicare, which provides coverage for senior citizens and some disabled people. Income was the next predictor for how well people felt they were treated. After that came race.

Meanwhile, racial minorities and low-income people also were more likely to be sensitive to concerns about a doctor’s bedside manner, and to seek out someone they thought would treat them well, Duke noted.

Often, these patients cue in on subtle behaviors, such as the doctor not making eye contact or not asking questions about their symptoms and health conditions, their lifestyle or their preferences on how to manage a disease. But that can be enough, Duke said, to keep people from seeking care, or following through on medical advice.

Read the full article.


Patient Navigators: The Missing Link to Increasing Minority Participation in Cancer Clinical Trials

From the  article on the NIMHD website:

A study conducted by the University of Alabama at Birmingham (UAB) and funded by the National Institute on Minority Health and Health Disparities that promotes the inclusion of minorities in cancer clinical trials has been selected by the American Society of Clinical Oncology to be featured in Clinical Care Advances 2016, an annual review of major advances in clinical cancer research.

The study, led by Mona Fouad, M.D., MPH, director of the UAB Minority Health and Health Disparities Research Center, focuses on the use of patient navigators as a liaison between medical staff and patients, to inform and enroll eligible African American cancer patients into clinical trials.

Dr. Fouad stated this model came as a result of the staggering disparities in clinical cancer research, currently fewer than 10 percent of patients enrolled in cancer clinical trials are minorities.

To achieve accurate results, cancer clinical trials require participation of individuals from all cultural and ethnic backgrounds, however enrollment and retention of minority groups often proves challenging.

“We started with the patient navigation model to assist under-resourced patients in our cancer center,” said Fouad. “We’ve been using patient advocates for the last two decades to promote cancer screening, but then we started thinking, ‘Well, what if they have a positive test?’ ‘How do we link them to the care needed to start treatment?’”

Patient advocates were trained to become patient navigators as a way to steer patients in the right direction to locate resources and enlist the best possible care to treat their cancer diagnosis.

“We were successful in providing this model to help patients comply and complete their cancer care, and when we accomplished that, the compliance rate was as high as 95 percent in low-income populations. So then we thought, why don’t we test this model to see not only if it helps patients to access care, but can it educate them about clinical trials as well,” said Fouad.

Fouad admitted that while many patients were reluctant at first, they came around to the idea once it was explained in detail and resources were provided to make clinical trial involvement easier for them.

“What we found by doing this is that a lot of minority patients are scared about therapeutic trials. They believe that they are experiments, and some were reluctant due to the times they’d have to be available for the trials, so the navigators were able to help with those reservations,” stated Fouad, explaining the navigators were trained to identify resources to aid trial participants.

“Navigators connected patients with social workers and did what they could to make sure all the patient had to focus on was their care and involvement in the clinical trial,” said Fouad.

While it is generally the job of medical staff to offer clinical trials to every eligible patient, the study revealed that protocol is not always followed with minority or lower socioeconomic patients.

“Sometimes, even the physician, if they know there is a patient coming from a rural area or having difficulty traveling, they tend to just not offer them clinical trials because they don’t want to increase the burden on the patient or they think the patient is not going to be a compliant participant, so, unintentionally, they just won’t offer them the trials,” said Fouad.

Read the full article.