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CLAMs for diverse populations can overcome language barriers Culturally & Linguistically Appropriate Materials

US residents speak at least 329 languages. In some US cities less than 60% of the population speaks English. About 32 million of us speak a language other than English at home. If your service population is not diverse now, it will be soon.  Pew Research projects the US Spanish speaking population will triple by 2050, and the Asian population will double. Success in improving the health of ethnic populations will substantially influence the future health of America as a whole.
 
Healthcare organizations have been working to develop their capacity to address language barriers and cultural differences, but it’s hard to make progress when the challenge is increasing along with the complexity of treatments and healthcare delivery and financing systems. Non-English speakers still face substantial communication barriers at almost every level of the health care system.
 
Studies show that communication barriers have a negative impact on health, discourage use of preventive services, and increase costs of treatment through unnecessary testing, delayed diagnosis, extended treatment times, and misinterpreted instructions. Without information that they can understand and use in their everyday lives, patients cannot engage in self-care or self-management. In short, they cannot take responsibility for their health and be partners in treatment, as effective care now requires.
 
In most cases, provider organizations and insurers have the means to overcome language barriers. But current practice in most communities still reflects an assumption that it is the patients' obligation to make themselves understood, to ask appropriate questions and to correctly interpret and comply with instructions. In most instances, this assumption is wrong as a matter of law. Federal and state civil rights laws and Medicaid regulations require access to linguistically appropriate care. These laws are the basis for accreditation standards that require providers and insurers to position themselves for our multicultural future.  

Studies show that print materials, particularly in combination with brief counseling, can increase recall, compliance, and behavior changes; and reduce consultations regarding discomforts that could be self-managed. Health information is increasingly available and accessed online, through mobile devices and virtual patient educators. Still a clear message from research participants is that written information should always be available, even in the presence of multiple other media.

While they are not a total solution, CLAMs remain the necessary foundation for a comprehensive communication effort, and an obvious starting place to promote health literacy. Organizations serving diverse populations will need to hone a process to develop and test English language materials, and to adapt essential proven materials for non-English speakers.  More on that next time. Stay tuned.
 
 
 
 
 

 

Critical Health Literacy: The mind’s strongest glue?


Previously in this space, we talked about the identified consequences of health literacy. I argued that the documented presence of those consequences in a mother’s (or other’s) life would be evidence that she  possesses and used health literacy skills to produce those consequences.  Now we look specifically at critical health literacy and its consequences.
 
Nutbeam (2000, 2008) followed literacy scholars Freebody and Luke (1990) to name levels, or, more accurately, categories of health literacy: functional/technical skills (ability to read and use numbers); interactive/social skills (listening, speaking) and critical health literacy, critical thinking skills that enable a person to apply information in new circumstances (Nutbeam 2000) in one’s own life (Kickbush 2001).
 
While critical skills are commonly considered advanced or higher level skills, some literacy scholars (Charner-Laird, Fiarman, Park, Soderber & Nunes, 2003) have argued that critical  thinking, especially reflection, is so essential to making meaning from information and using it in context, that it should be considered a basic skill. They describe reflection as the “mind’s strongest glue” for making connections essential to understanding any subject.  Maternal health literacy includes all three categories of health literacy skills, which mothers use in various combinations according to the task and the context. Strong skills in one category (say listening and remembering) can compensate for lesser skill in another category (like reading).
 
Is Critical Health Literacy different from Health Literacy?
Sykes and colleagues (2013) wanted to know if critical health literacy is really different from associated concepts like health literacy and empowerment. So they analyzed the literature on critical health literacy and interviewed UK health literacy experts. They concluded that critical health literacy is indeed a unique concept differentiated from related concepts by its consequences: confidence or self-efficacy,  improved quality of life,  increased social capital, and improved health outcomes.  The unique consequences of critical heath literacy suggest that critical thinking is the active ingredient in health literacy that leads to action and outcomes. This adds weight to our operating theory at Beginnings Guides and the Center for Health Literacy Promotion that reflection is a key lifeskill for mothers taking responsibility for family health.
 
The Active Ingredient in Health Literacy: critical thinking skills
My friend and colleague, home visiting expert Linda Wollesen has been saying for decades that mothers make progress when home visitors, parent educators (I’ll add patient educators and health educators) stop giving answers and instead ask questions that make mothers think. In the process of working out answers to reflective questions mothers learn to look objectively, critically at a situation to make sense of it and choose a purposeful response, to formulate their own questions for information seeking, to interpret information and use it for practical purposes in their everyday lives. 
 
Basic health literacy, described as reading and numeracy skills used to understand basic information needed to make appropriate health decisions (Monday I will quit smoking) is insufficient to affect outcomes. Action is required for outcomes, often sustained and difficult action. And critical thinking skills are required to plan action, progress in the face of barriers, and produce desired outcomes. So to be health literate, mothers and others need skills in all three categories: functional, interactive and critical health literacy. And the greatest of these is critical health literacy — thinking skills to respond intentionally to the health challenges and opportunities of everyday life.
 
 
References
Nutbeam D. (2000)Nutbeam, D. (2000). Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st Century. Health Promotion International, 15, 259267.
 
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67, 2072-2078.
 
Kickbush,IS. (2001).Health Literacy: addressing the health and education divide. Health Promotion International 16 (3), 289-297.

Sykes S, Willis J, Rowlands G & Popple K. (2013). Understanding critical literacy: a concept analysis. Biomed Central Public Health:13:150. http:www.biomedcentral.com1471

Measuring Health Literacy by its Consequences

Let’s welcome the new year with some new thinking about measuring health literacy.
 
It’s hard to say exactly what electricity is, but if the lights are on, we know we’ve got it. And we measure electricity by the light it produces. So it is with health literacy. It is hard to say just what health literacy is, but we know it by its consequences, and we can measure those consequences.
 
Services utilization, behaviors, self-care
Two recent systematic reviews and concept analyses (Sykes 2013, Sorenson 2012) identified the consequences of health literacy.  Both studies found the most frequently reported consequences of health literacy are improved use of services, behaviors, and self-care. These consequences reflect how people use their health literacy skills in everyday life and what they   actually do for health with the information and support available to them.  Although these consequences are supposed or anticipated rather than evidence-based (Sykes 2013), the documented presence of these consequences would indicate that the person possesses and has used health literacy skills to produce them. Studies using the Life Skills Progression instrument to assess maternal heath literacy are building the evidence base.
 
The LSP  Maternal Health Literacy Scales rate mothers health literacy by their health and healthcare-related actions practices and behaviors. Sequential measures show change —improvement or regression.  The LSP Healthcare Literacy Scale uses 9 items to rate mothers’ use of information, emergency services, medical and dental care and preventive services for herself and her child. The Selfcare Literacy Scale uses five items to assess risk behaviors and selfcare practices.  Three  published studies using LSP data on three different cohorts of mother-child dyads  provide evidence that mothers supported by home visitors trained to promote maternal heath literacy produced the consequences of health literacy at increasing levels over 12-18 months.  So the recent analyses of the consequences of health literacy confirm earlier findings that the LSP can be used as  meaningful measure of MHL.
 
Next: the recently identified unique consequences of critical health literacy add weight to our theory that critical thinking skill, particularly reflection, is the active ingredient in health literacy  that enables mothers (and others) to transform their decisions into health promoting actions and outcomes. Stay tuned
 
 
References
Sorenson K. Van den  Broucke S, Fullam J, Doyle G, Pelikan J, et. al. (2012). Health Literacy and Public Health: A systematic review and integration of definitions and models. BMC Public Health12:80. http://www.biomedcentral.com/1471-2458/12/80.
 
Sykes S, Willis J, Rowlands G & Popple K. (2013). Understanding critical literacy: a concept analysis. Biomed Central Public Health:13:150. http:www.biomedcentral.com1471-2458/13/150

Smith, S. A., & Moore, E. J. (2012). Health literacy and depression in the context of home visitation. Maternal and Child Health Journal16, 1500-1508. 

Carroll LN, Smith SA & Thomson NR. (2014). The Parents as Teachers Health Literacy Demonstration Project: Integrating an Empowerment Model of Health Literacy Promotion into Home-Based Parent Education. Health Promotion Practice pii: 1524839914538968. [Epub ahead of print]. Available on Internet at: http://hpp.sagepub.com/content/early/2014/06/23/1524839914538968.abstract

Mobley S, Thomas S, Sutherland D, Hudgins, J, Ange B & Johnson M. (2014) Maternal Health Literacy Progression Among Rural Perinatal Women. Maternal Child Health J 18: 1881-1892. 
Sandra Smith, PhD, MPH sandras@u.washington.edu

Reflections on 2014

Beginnings Pregnancy Guide 9th Edition Sold Out  
The second printing of the 2014 is underway. The scan code that instantly links Beginningsreaders to additional prescreened information via the Internet on a mobile device has proved popular. In a survey of pregnant women in SC, we found that respondents rarely use toll free numbers; while nearly all reported finding health information online.  The entire website is available on your mobile device. 
 
Websites Continue to Grow
Beginnings Guides had 155,00 visitors in 2014.  The Center for Health Literacy Promotion had 55,000 visitors. The blogs were read by 100,00 including 6900 reads in the last 30 days.  And we have 1310 Twitter followers. Kudos to Beginnings Webmother, Simone Snyder. 
 
Most read blogs 
On Healthliteracypromotion.com
      (this one was on the most-read list for 2013, too)
 
On BeginningsGuides.com:
 
Promoting Maternal Health Literacy Nationally & Internationally 
Free Health Literacy Training Videos
We produced a series of training videos in collaboration with the National Network of Libraries of Medicine Pacific Northwest Region. This from the National Libraries Website:
 
Center for Health Literacy Promotion offers free training
Together with the National Network of Libraries of Medicine, the Center for Health Literacy Promotion has put together three short training sessions on understanding and promoting health literacy designed for social and health services providers and programs. Each session includes a short video, a pre- and post-test (with answer key), a handout, and a facilitator's guide. All three sessions and their resources are available to download or view for free online.
To view these resources, visit the Center for Health Literacy Promotion:

Published Article:  Parents As Teachers Health Literacy Demonstration Project 
Carroll LN, Smith SA & Thomson N (2014). Integrating an Empowerment Model of Health Literacy Promotion into Home-Based Parent Education. Health Promotion Practice pii: 1524839914538968. [Epub ahead of print] Read the article
 
Guest editor, Curationis Special Edition: 
This turned out to be a monumental work and an inspiring labor of love. It was a joy and a challenge to work with a dozen authors whose work is at the foundation of efforts in southern and eastern African countries to develop professional education curricula and build a workforce of nurses dedicated to care of children. With health systems only about 20 years old, this work is underway to differentiate care of children from care of adults. Therefore, the articles focus on issues in professional education and practice. There are many lessons we in the US can learn from their work to build a healthcare system grounded in child rights, and to effect systems change in the face of racism and limited resources.  Curationis, a South African nursing journal has published the special edition online with free access for all. It will appear in print in 2015. 
  
HARC VI Washington DC Nov 4-5
Family transitions precluded my travel to DC this year. But I was not totally absent. Linda Wollesen, developer of the LSP presented in my stead results of a study conducted in collaboration with Anne Turner and colleagues at University of Washington Northwest Center for Public Health Practice. Conclusion: parents can and do manage child oral health, even in the face of poverty, low education and limited English proficiency where service and supports to use them are in place. This is on the list to publish in 2015.
 
New & Contintuing in 2015
Worldwide Universities Health Literacy Network
Last year in Sydney I worked with an awesome group scholars/practitioners/patient representatives to instigate an international collaboration on promoting health literacy as a personal and community asset. The group has joined with others who began similar talks in 2012 at the first Worldwide Universities Health Literacy Network meeting in Southampton, and expanded to include representatives of countries in Europe, Asia, Africa , South America (and me). The collaborators have been holding monthly meetings via Skype and are developing funding proposals to address maternal health literacy globally.
 
CenteringPregnacy Health Literacy Trial
This project continues. I got to visit the site of the comparison group, Greenville Health System, Greenville, SC.  We're searching for a second site. Want to be an intervention site? Contact me!
 
Maternal Health Literacy: Untangling the "Web of Interaction"
The research project for 2015 is funded by the National Library of Medicine. The study addresses an urgent need to determine what promotes maternal health literacy, especially in historically underserved poverty populations. We are identifying factors in the home and family context that influence mothers'health literacy, and how those factors interact. Understanding the context in which mothers use information and services for personal and child health can guide intervention design, tailoring and evaluation. We are looking for ways to visualize data to suggest points of intervention and help home visitors to answer the ever-vexing question: where to begin?
 

Toward an Integrated Approach to Promoting Health Literacy

Previously in this Space,
I suggested that efforts to promote health literacy are better guided by a salutogenic model that asks, What enables a person to move toward health? or what enables a person to take action for health? That’s true in health promotion. But a person uses the health literacy skill set in various combinations to accomplish different health task in multiple health contexts. No single approach will get us to our envisioned health literate society.
 
Need for an integrated Approach
A new salutogenic perspective and approach to health literacy needs to complement rather than replace the dominant pathogenic approach.  Nearly everyone will at some time find themselves in need of care that only hospitals and healthcare organizations can provide. The pathogenic approach is appropriate and necessary in healthcare contexts.
In addition, with chronic disease/disability steadily increasing and accounting for nearly half of all health loss (Lytton, 2013), and nearly 80% of all health costs in the US (Budenheimer 2009) continuing attention to risk factors and preventive practices is necessary and will remain so. 
 
Still, the number and variety of risks, and the number and variety of conditions that constrain health choices, are so vast that achieving health literacy as defined in the pathogenic model is nearly implausible (Lytton 2013). A salutogenic approach is needed to clarify where, when, and how mothers, and others, can take effective action to achieve, maintain and enhance good health.
 
Domains of Health Literacy
Sorenson et al (2012) integrated the pathogenic and salutogenic approaches represented in 17 definitions and 12 models of health literacy. The authors described three domains of health literacy focused on disease treatment, disease prevention (both pathogenic) and health promotion (salutogenic).
 
Maternal Health Literacy Crosses Domains
A mother uses health literacy skills to function in each of these domains. She functions in the healthcare system when she is an out-patient in prenatal care or oral healthcare, when she is an in-patient in obstetric care, and when she obtains health services for her child. She functions in the prevention domain when she engages in preventive parenting practices (e.g. using a car seat) and avoids risky behaviors (e.g. smoking). In the health promotion domain, a health literate mother engages in self-care practices (e.g. exercise) and actively supports healthy child development (e.g. reads to the child).  This integrated model is potentially a giant leap for health literacy research. Stay tuned.
 
References
Budenheimer T, Chen E & Bennett H. (2009). Confronting the Growing Burden of Chronic Disease: Can the US Health Care Workforce Do the Job? Health Affairs 28 (1). 65-74. Available online:
 
Sorenson K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, et. al. (2012). Health Literacy and Public Health: A systematic review and integration of definitions and models. BMC Public Health12:80. Available online: www.biomedcentral.com/1471-2458/12/80.
 

Lytton M. (2013). Health Literacy: An Opinionated Perspective. American Journal of Preventive Medicine 45,e35-e40.

Health Literacy: Time for a new question

What causes disease?
For 200 years,  Western medicine has worked from the idea that health is the absence of disease. 
The overarching question for medicine and healthcare has been What causes disease?  And despite
the name, healthcare has always been about treating disease. Early on, care and research focused 
on germs and infectious disease; later , following the research, focus shifted to genes and risk factors 
for chronic disease. Although it is now widely accepted that health is more than the absence of 
disease,  Public Health, and even the relatively new field of Health Promotion, still maintain a steady 
focus on reducing disease risk factors. It’s time for a new question.
 
  Prerequisite for Health:
  • Peace
  • Shelter
  • Education
  • Food 
  • Income
  • Stable eco-system
  • Sustainable resources
  • Social justice
  • Equity
                      Ottawa Charter
Research has answered, in broad terms, the centuries old question. 
The roots of disease grow deeper and earlier than germs or genes and 
risky lifestyles. It is well-established that health and disease originate in early development, in the “zero to three”, prenatal to preschool period. The 
combination of Nature (genes & germs) and nurture (early parenting and environment) in the earliest months and years of life establish the foundation
for all that follows:  how susceptible we are to disease, how resilient we are,  
and further, how we learn, make friends, cope with challenges, and get
what we want. 
 
Research breakthroughs have  given health a new broader meaning that is
 expressed and accepted more internationally than in the US.  See the
Ottawa Charter  and the World Health Organization’s Health Promotion Glossary (1998)
 
It is now clear that health and disease originate in early development; and that health, like disease,
develops over time and its trajectory can be influenced, especially during fetal and early child 
development and other critical periods of development. That understanding demands that we flip 
the overarching question to ask, What causes health? And to flip the concentration of resources from
end of life care to maternal and child health promotion.
 
What causes health literacy?
Most health literacy research has taken place in US academic medical centers under the old overarching 
question asking, What is the role of low literacy in disease? It is important to note  that this research
also uses an outdated understanding of literacy as reading ability. This line of research has established
that few Americans understand medical terminology and nearly all of us have difficulty following complex
medication regimens and navigating the complexities of healthcare and insurance. 
 
If we start with the new overarching question: What causes health?, then a more actionable  question for 
health  literacy promotion is What will empower this person to use information and services for health?  
The answer, that which empowers a person to use information and services for health, is health literacy.   
Better information is necessary, but rarely sufficient. Look to the Prerequisites for Health (above) to see 
other factors necessary to develop  health and health literacy.
 
 
References
 
Antonovsky A. (1996). The salutogenic model as a theory to guide health promotion Health Promotion
International 11 (1);11-18
 
Halfon N, Larson K, Lu M, Tullis E & Russ S. (2014). Lifecourse Health Development: Past, Present and Future.
Maternal Child Health Journal 18:344-365.
 
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67, 2072-2078.
Shonkoff, J. P., & Phillips, D. (2000). From neurons to neighbourhoods. The Science of Early Childhood 
Development,: National Academy Press: Washington DC.
 
 
 
 

 

Stay strong, Mothers

Today I am sending love and light and courage to all mothers of black sons; their hearts must be in their throats. Every day. All day. But especially today.  Because racism in America is so not not a thing of the past.
 
The American justice system has again declared that its okay for an adult white man with a gun to kill an unarmed black teenager because the adult is afraid.  It is one highly questionable shocking thing for an untrained, self-appointed vigilante alone in the dark to claim a level of fear that justifies killing - and have the courts uphold that claim. The Ferguson incident is something  different, more frightening, dangerous and depressing.
 
I don’t know what happened in Ferguson.  But one must question how a trained police officer, pledged to protect citizens, inside his vehicle with a gun and backup on the way,  facing a teenager with only cigarillos in his hand,  whose crimes are lifting a handful of tobacco products from a convenience store and walking in the street —  how can that officer be so afraid and so without options that he must shoot to kill. Multiple times. Before backup arrives.
 
We have to ask, why are the Ferguson police so afraid of those it is their duty to protect?  Do they receive no training in race relations, or conflict resolution, in take down and control, in any form of self-defense that does not rely on lethal weapons?
 
Racism is fear of someone who does not look like you.  Fear as a legal justification for police shooting down citizens in the streets institutionalizes racism. Fear as justification for transforming a grand jury into a secret trial for the killer further institutionalizes the racial divide.
 
Divided we fall. A people living in fear of each other cannot achieve optimum health, or high productivity, or spiritual advancement, and certainly not liberty and justice for all. 
 
My hope lies with the mothers and fathers and spiritual leaders in Ferguson and across America who call upon themselves, their sons  and their neighbors —yet again— to be the ones to demonstrate restraint under pressure, to practice non-reaction when provoked,  to keep thinking in the face of fear,  to live up to being an American.  Stay strong, Mothers.

 

Health Literacy for the Third Era


The third era of healthcare
It started in the 1980s. Epidemiologists —they study how disease is distributed and controlled— 
realized that events and experiences we have in the womb —before we are even born—influence 
our health in middle age.  Discovery of the “Developmental Origins of Health and Disease (DOHAD) 
is what they mean by landmark research; it marks a turn that requires a new way of defining 
and measuring health, and a second transformation of healthcare services.
 
Halfon and colleagues trace the evolution of healthcare from the first era —1900-1950— 
when medical and health systems focused on germ theory and acute care of infectious disease. 
Around 1950,  gene theory and social research led to bio-behavioral theories that said disease 
results from the interaction of genetic make-up and adult health behaviors.  So the second 
era of healthcare refocused thinking and resources on chronic disease. Health promotion 
tried in vain to change adults’ risky behaviors.  Later researchers recognized that gene 
networks interact with each other and the environment in complex and dynamic ways that 
influence how our bodies and minds are engineered and re-engineered to function in our 
environments. This is when we started talking about the social determinants of health. 
 
Developing Health
By 2000, the synthesis of biological, behavioural and social sciences led to the slowly emerging
third era of healthcare where your doctor will focus less on chronic disease diagnosis and treatment 
and more on lifecourse health development.  The goal of Medicine will be to optimize your health
trajectory — the way your health plays out across your lifecourse, from preconception through infancy, 
childhood and on to old age.
 
Redefining Health
Thought leaders now are talking about health as a capacity—an ability or power to understand, experience 
of do something.  Health is used to achieve one’s potential and accomplish one’s goals.
 
Clarifying the Health-Literacy Link
The evolved concept of health is strikingly similar to current descriptions of literacy as an ability used
to achieve ones potential and accomplish one’s goals, to function in some social context. In other 
words, you’re healthy and literate when you function — interact successfully— with your environment. 
We could say further, you are health literate when you interact with your environment in ways that 
optimize your health.
 
Context Matters. Embrace Complexity
Transition to the third era of health care requires refocusing heath literacy research and practice on 
the environment in which health and disease develop, that is, on the context in which people make 
meaning from  information and use it for health and healthcare decision making and action. The  
goal of health literacy promotion for the third-era is to optimize a person’s or a community’s health 
trajectory. That means we need to be promoting maternal health literacy earlier —preconception. 
 
Repositioning Maternal-child Heath
Further, the rapidly increasing understanding of DOHAD —the developmental origins of health and 
disease— positions maternal-child health at the foundation of personal and public health and at the
center of an evolved third-era healthcare system. It makes maternal health literacy the foundation
 
That’s why I am working on ways to use data to understand the contexts in which maternal-infant
health and maternal health literacy develop.  Successful efforts to untangle the web of interactions 
that influence the health trajectories of a mother and her child may answer the health literacy 
promoter’s essential question: Where to begin?  Stay tuned.
 

Halfon N, Larson K, Lu M, Tullis E & Russ S. (2014). Lifecourse Health Development: Past, Present 
and Future. Maternal Child Health Journal 18:344-365.

Health Literacy & Maternal Health Literacy: What’s the difference?

Start with measurement
What we measure and how we measure it matters because it determines what we
find out about what works and what’s worth doing and who should do it.* Measurement
remains the most crucial issue for health literacy research; because we need to find 
out what works for whom,  and what’s worth doing and who should do it.
 
Im especially interested in what works for mothers in the prenatal to preschool 
period. Because they are the foundation of personal and public health. Healthy mother… 
healthy baby… healthy population. What mothers learn about health and healthcare
during pregnancy and early parenting can benefit entire families across their lifespans, 
and extend benefits to the healthcare, education and justice systems, and to the economy.

Health literacy focuses on patients understanding healthcare information
Health literacy research assesses patients health literacy by their scores on a single 
administration of a reading test using medical terms. Patients are marked poor, marginal 
or adequate. An adequate score means you will probably not need assistance to make 
meaning from information  about your diagnosis or to follow treatment instructions.  If 
you cannot pronounce most of the words,  you are assumed to have poor health literacy 
and to be unable to “obtain, process and understand basic information needed to make 
appropriate health decisions”. 

What we find out from health literacy-reading test scores is that almost everybody has 
limited medical vocabulary and difficulty making sense of information from the healthcare
system. We find out that information needs to be simplified and its delivery needs to be
improved. We find that patients score better when we give them better information and
conclude that what’s worth doing is improving information and its delivery.  Since most 
studies originate in academic medical centers, it is not surprising that studies position health 
professionals as the keepers and dispensers of health and medical knowledge and so it falls
to them to reduce the risk and mitigate the negative impacts of low [health] literacy on 
patients and the system.

Maternal health literacy focuses on parents using information for health
Maternal health literacy research assesses periodically what parents do with information, 
how they integrate it into their lives and households. Changes in parent’s health- and
healthcare-related actions, practices and behaviors provide evidence of progress (or 
regression) in developing the knowledge and social and cognitive skills needed to participate 
in healthcare and preventive practices. This approach captures effects of systems efforts to
improve information as well as public health efforts to directly assist parents to make meaning
from the information and apply it in real life.

By monitoring what parents actually do for health with the information available to them, we
find out that direct assistance to use information and services for health is most beneficial to 
lower functioning parents, while also benefitting higher functioning parents. We find that social
workers, parent educators, health educators, and trained paraprofessionals working in homes 
and communities can enable parents to better manage family health and healthcare, even with
the added challenges of poverty, limited education and limited English proficiency. 

Both approaches are needed
The dominant clinical approach to patient’s health literacy and the public health approach to 
maternal health literacy are complementary rather than exclusive. Patients and parents need 
quality information, accessible services, and assistance to use them effectively.

*    lisabeth schorr Common Purpose: Strengthening Families and Neighborhoods to Rebuild America. http://lisbethschorr.org   Read this book!

Health Literacy Month: Time to think about your furnace

The morning was chilly, definitely fall in the air.  I turned on the furnace.  It seemed to take a while but the house warmed up.  Just as I noticed my nose was no longer cold, a  contractor doing repairs on the exterior reported with some alarm the smell of gas around the furnace exhaust. I turned off the heat. Two days later the scene repeated itself. The previous residents could not recall any problem with the furnace,  or ever having it checked.
 
I called a local heating company.
 
The tech walked in the door, sniffed the air, and immediately pulled out his hand-held CO - carbon monoxide - monitor.  His eyebrows went up. He ordered all the windows and doors opened.  Then he went outside to get a reading at the exhaust vent. He left the area when the reading got to 260 - more than 10x the standard.
 
What you dont know can hurt you
Would this explain my headache that won’t go away, I asked. Yes. And dizziness, drowsiness or a lightheaded sort of flu-like feeling - early signs of carbon monoxide poisoning. That’s what kills a person who sits too long in a car in the garage with the motor running.
 
Turns out the furnace heat exchangers - whatever those are - had cracked, probably years earlier causing the furnace to leak moisture and over heat. It had been deteriorating, gradually producing less and less heat with more and more gas.
 
I’d never thought about the furnace beyond the thermostat. I took for granted that it protected my health by providing  heat in the winter. It never occurred to me that it could be health hazard.
 
Use information and services in ways that enhance health.
That’s the definition of health literacy. With many households switching to affordable gas heating and appliances, keeping healthy requires new awareness. Here’s information I learned about maintaining gas appliances that you, and families you serve, can use to protect and enhance health this winter.
 
1.    Get a CO monitor. If you have any gas appliances get a monitor. Building codes now squire them in new construction. If you have a gas furnace put one in each bedroom.  I got a model that’s guaranteed for 10 years for $23 at WallMart. It plugs in to any outlet. The alarm sounds if the CO level reaches 70 ppm -parts per million - the point when most people start to feel symptoms.  For a little more money you can get a monitor that shows the ppm . For a bit less, there are battery powered monitors, but you have to monitor the battery.
 
      If the alarm sounds, get to fresh air and call 911.
 
2.    Have the furnace checked annually- a great way to mark Health Literacy Month each October. The local heating company charges $109 to check the system including the ducts. The new furnace I bought cost $4500. If the furnace had been checked annually for the last 20 year that would have cost a total of $2180.
 
3.    Change the filter every six months. My local heating company provides free filters and will change them at no charge 2x a year. Does yours?
 
4.    If you smell gas,  do not ignore it. Turn off the appliance. Open doors and windows. Call for service to the appliance. Do not wait for the alarm to sound.
 
5.    Useful numbers. CO level at the furnace’s exterior exhaust should be < 24ppm (parts per million).  The level in front of a gas fireplace should be <  9ppm. My fireplace tested at 30ppm. It is off. It will be serviced tomorrow.
 
 
 
 
 
 

 
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