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Special Halloween Edition: Attribute 4

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We are thrilled to share a special Halloween installment of our series on the Ten Attributes of Health Literate Health Care Organizations in celebration of National Health Literacy Month.

In honor of this scary day, we learned from New York City Poison Control’s Director of Public Education Lauren Schwartz about why you should never be frightened of engaging the people you serve.

This series is meant both to inform and spark discussion. Please feel free to comment, ask questions, and contribute. Thank you!

Attribute 4:  A health literate health care organization includes populations served in the design, implementation, and evaluation of health information and services.

Say Ah!: Poison Control has been an early adopter of health literacy best practices. The Health Education Literacy Program was one of the first initiatives to engage a broader audience in both health literacy and medication safety. How did you engage target audiences in developing these materials?

Lauren: We were fortunate to collaborate with Literacy Partners on the Health Education Literacy Program (HELP). We developed the materials together and were able to field-test all of the curriculum components with their adult learners to ensure that the materials were engaging and understood by our target populations. This included the brochures and the lessons. In addition, we were able to observe a number of adult education instructors at the Queens Public Library use the materials with their English as a Second Language (ESL) students. Working with the adult education students, we were able to incorporate the feedback from focus groups. We then showed them the revised version of the materials. The students were able to again give feedback and stated how much the materials had improved and how much of their own suggestions they saw incorporated into the new versions.

Say Ah!: Your written materials are great models of plain language writing. Thank you. How do you handle and resolve conflicts of opinion when they arise between what professionals want to communicate and what patients and consumers want and need from the materials?

Lauren: I always sit down with the content experts at the Poison Control Center when beginning materials development to help establish the key messages and ensure that the content is rooted in clinical evidence. Materials are then field tested using a discussion guide that incorporates CeCi Doak and Len Doak’s Learner Verification and Revision technique, which asks questions of the target audience to ensure that the material is understood and allows any concerns or questions to be addressed before the piece is printed. See Chapter 10 (chapters 8, 9 and 10 appear in this link).

Say Ah!:  Do you have different models for evaluating information and services based on the many unique populations? If so, can you tell us about some and to what populations they apply? And if not, can you tell your process for evaluating the health literacy of the health information and services you design and implement?

Lauren: Any new program is piloted with a sample of the target population we are aiming to reach. For example, when we developed the medicine safety for parents program in English, Spanish and Chinese, our health educators piloted it with these audiences. We collected a pre-test from participants and then conducted follow-up calls two weeks after the session to obtain their feedback about the program and gather information about changes in knowledge, attitudes and behaviors. Building knowledge, attitude and behavior change questions into the assessments helps to evaluate outcomes. Knowledge based questions assess using a dosing instrument rather than a kitchen spoon and knowing the active ingredient; attitude is often measured through comfort calling the Poison Control Center after the workshop; and behavior often asks about using the medication management tools and saving the Poison Center number in the cell phone.

Say Ah!:  In the many years you have been doing this, what are the top 3 three lessons you have learned to better engage and empower populations served in the development of consumer-facing materials and services.

Lauren: First and foremost, always listen to the needs and feedback of those communities you are trying to reach. Ask about any barriers for accessing a service or engaging in a health behavior change. Focus groups conducted with parents at WIC showed that barriers for calling the Poison Control Center included a preference for 911, a fear of being reported to child welfare, and low self-efficacy when presented with a child’s poisoning. This led to creating programs that addressed these issues with caregivers (read more here).  Second, field test all new programs and materials developed in every language to ensure that the messages are understood and address any concerns. Third, be open to change and continue the learning process.

About Lauren Schwartz, MPH
Ms. Schwartz is the Director of Public Education at the New York City Poison Center, where she has worked since 1999. In her role, she coordinates the community education and outreach efforts for New York City and Nassau, Suffolk and Westchester counties. Ms. Schwartz is responsible for all aspects of the multilingual health education programs created to raise awareness about prevention of unintentional poisonings, medicine safety and utilization of the NYC Poison Control Center. She is also an Assistant Professor of Emergency Medicine at New York University School of Medicine. She received a master’s degree in Public Health from Hunter College.

The NYC Poison Control Center is available 24 hours a day, 7 days a week for treatment advice about exposures to poisons or questions about medicine safety. Pharmacists and nurses certified in poison information are there to give advice. All calls are free and confidential. Translator services are provided in more than 150 languages. Call any time at 1-800-222-1222 or 212-POISONS (212-764-7667).

Week 4, Health Literacy Attribute 5

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We are thrilled to share the fourth interview in our series on the Ten Attributes of Health Literate Health Care Organizations in celebration of National Health Literacy Month. This series is meant both to inform and spark discussion. Please join Health Literacy NY and be a part of the conversation! Thank you!

This week, we have jumped ahead and are featuring Attribute 5: Meets the needs of populations with a range of health literacy skills while avoiding stigmatization. Attribute 4 will be discussed during next week’s special Halloween edition.

Thankfully, we were able to catch the very busy Emelin Martinez, who manages three key health literacy-related initiatives at New York-Presbyterian Ambulatory Care Network. As the program manager for Health Education and Adult Literacy (HEAL), Waiting room As a Literacy and Learning Environment (WALLE) and Reach Out and Read, Emelin shared some important operational insights into how to meet the wide ranging health literacy needs of patients and caregivers.

Say Ah!: How do ensure awareness of – and sensitivity to – low health literacy on the provider side?

Emelin: New York-Presbyterian’s Ambulatory Care Network (NYP-ACN) works with the medically underserved population, with majority being an immigrant patient base. Therefore, within ACN, all the residents are trained in the tenets of health literacy by me. Dr. Dodi Meyer then trains all the residents on cultural competency. This way, we try to increase the providers’ ability to communicate in a health literate and culturally competent manner, or at least start to get them exposed to thinking that way. One thing I tell residents is to always recognize that the person in front of you did not go to medical school, so you have to be mindful of what you say and how you say it.

The volunteers that are part of any health education and adult literacy program initiatives are also trained how to approach patients, meet them where they are at, and communicate with them in a clear and non-didactic manner.

Say Ah!: How does each level incorporate clear communication in their daily interactions with the patient population that your organization serves?

Emelin: I can only speak from the trainings that are given, but the residents are trained in health literacy (especially teach back method). During the monthly medical home meetings, we try to re-emphasize these practices. Volunteers are also trained to communicate with the tenets of health literacy and cultural competency. Additionally, the hospital values putting patients’ needs and wants at the forefront when communicating and assessing. In developing patient materials as well as methods to teach volunteers and residents, we involve patients in the development of health education related materials to incorporate their feedback, which is very important.

Say Ah!: You create – and oversee the creation of – health literate materials What is your process to ensure these pieces meet the ability of your patient populations?

Emelin: For written patient material used at NYP-ACN sites, the steps to ensure suitability before production is as follows: (1) Present the material to the Multidisciplinary Committee at both Cornell and Columbia sites; and (2) Present the material to the Patient and Family Advisory Council to ensure we are meeting the needs of the people we treat.

About Emelin Martinez 

Emelin has provided direct health literacy support to thousands of patients and their families through her work as the Waiting room As a Literacy Learning Environment (WALLE) and Reach Out and Read (ROR) Program Manager for New York-Presbyterian’s Ambulatory Care Network’s Community Health Education and Outreach. She has implemented the ROR at NYP’s Columbia University Medical Center site, as well as at five community clinics serving Northern Manhattan. She has helped create patient-informed health education curricula and materials to better meet the needs and abilities of consumers; and she has trained more than 200 medical residents in health literacy best practices.

Emelin cites her work serving as the health literacy specialist for the ACN Multidisciplinary Patient Health Education Committee as a career highlight. Her collaborative efforts there helped result in a Clear Mark Award, an Award of Distinction from the Center for Plain Language, for “Healthy Eating — Spanish,” NYP’s Diabetes Self Management Education Booklets in 2016.

Week 3, Health Literacy Attribute 3!

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Say Ah! is celebrating Health Literacy Month with an interview and discussion series on the Ten Attributes of Health Literate Health Care Organizations. Below you will find the third interview of the series. This interview is meant both to inform and spark discussion. Please feel free to comment, question or contribute! Thank you!

Week 3’s Attribute: A Health Literate Health Care Organization Prepares the Workforce to be Health Literate and Monitors Progress.

We emailed Migna Taveras, Director of Cultural Competency and Health Literacy at Advocate Community Providers (ACP), to find out how ACP ensures a health literate workforce. 

Say Ah!: Even before you prepare your workforce to be health literate, how does health literacy factor into your hiring process both for patient facing – and non-patient facing – positions?

Migna: For all our positions, we look to recruit individuals who reflect our populations and understand the communities that we serve.  For example, many of the patients cared for by physicians in our network are Spanish-speaking Latinos, and that is reflected in our workforce in both patient and non-patient facing positions.  We recently hired two multi-lingual individuals who have both provider and patient-facing responsibilities to assist in supporting doctors from the South Asian community; our staff speaks Urdu, Bengali, Punjabi, and Hindi, the languages most widely spoken by patients in those practices.These staff members are key to facilitating collaboration within the South Asian communities and to further connect our local doctors to the greater community.

Say Ah!: What kind of health literacy training have you found to be effective and why? What have you tried that has not worked?

Migna: We like to use as many modes of communication as possible because people learn in different ways.  By offering learning opportunities in-person through workshops with applied practice, providing online resources to support learning, and hands-on-training, we find that people are better able to retain the information longer than just one-time activities.  By creating an online community, where Cultural Competency and Health Literacy issues can be raised via ticklers, videos, and animations, we will be able to more readily increase awareness and reinforce learning throughout the network.

Say Ah!: What have been your successes and challenges in establishing a “culture in which everyone works toward the unified goal of promoting successful communication.”

Migna: We train our doctors to use the “Teach Back” method in their clinical interactions to promote patient understanding.  We also train providers to encourage patients to ask questions. Through our direct patient interactions, we promote the “Ask Me 3” model for clear and concise communications.  This very week we are hosting remote trainings for our providers and practice staff on these tools and arming them with tool kits to enhance the patient experience within their practices.

About Migna Taveras
Migna focuses on improving communications between physicians and patients to promote understanding across ACP’s network of physicians, partners, and collaborators.  By promoting patient understanding, patients become empowered to learn healthy lifestyles which improves health and wellness; a fundamental key to transforming avoidable emergency room visits.

With 15 years of experience successfully managing and devising strategic public policy agendas and government affairs programs to produce positive results, Migna has served as an advisor to impactful leaders locally and nationally.  She has assisted in negotiating New York City’s $70-billion-dollar budget, managing appropriations programs for three NYC councilmembers, and generated over $20 million in revenues for the New York City Housing Authority including a small $50,000 multi-year grant from a private foundation to fund literacy programs in Harlem.

Migna currently serves as an adjunct professor in Health Education at the Borough of Manhattan Community College.  She is a Barnard graduate with a Bachelor of Arts in Political Science and Sociology, and a Masters in Advanced Management and Finance from Columbia University’s School of International and Public Affairs.