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Health Literacy Recipe Toolkit Adapted from materials on FMDRL by Amanda Kost and Daniel Ruegg A. Method A: Asynchronous and then discussion Duration: 60 min Student to Faculty ratio: 30/1-2 OBJECTIVES: 1. Learn definitions and levels of health literacy 2. Identify patients at high risk for low health literacy 3. Understand some of the ramifications for health and health care of low health literacy 4. Review tools that can be used to assess health literacy 5. Practice ways to improve health literacy of your patients through written and verbal communication and modifications of the clinical environment. 6. Utilize the teach-back method Why this topic: It is important for students to understand how health literacy can impact our patients’ ability to fully participate in their care and ultimately their outcomes. Student pre-class preparation/Required out of class resource: Students will complete the Health Literacy module which is in the Module section of the Underserved Pathway. https://depts.washington.edu/fammed/online/course/view.php?id=124 Ask the students to bring the materials they used and modified Faculty pre-class preparation: Faculty will review the module (20 minutes) Faculty will review this guide (10 Min) Materials: Case 1 and case 2 (enough copies for each group of two to have one of each) Teaching Plan: (modify as you wish) Suggested Time Goal and Description Introduction (5 min) Goal: to get a number of lessons identified right away. Ask Students to introduce themselves and say one thing they learned doing the module. Discussion about health Literacy Goal: reinforce the concepts from the (15 min) module Review 1. % of persons basic or below. 2. High risk groups 3. Three ways to modify health literacy: ensure printed materials are 5th grade of below, slow down and draw pictures, use the teach back Ask students to comment about someone they have seen at their primary care preceptorship where there might have been an issue of low health literacy Teach Back (20 min) Goal: have the students practice a teach back: Divide in groups of two. Give out the cases 1 and 2 to each group (each student gets one). Have the first student sum up the visit and give the plan and ask the “pt” to tell what is understood. At 5 min: switch roles At 5 min: bring the group back together and ask for comments. Summation (5-10 min) Reinforce Teach Back, summarize again why this is important and get comments from the group B: Method B: all in-person session Duration: 60 min (is more fun and less rushed with 90) Student to Faculty ratio: 30/1-2 OBJECTIVES: 1.Learn definitions and levels of health literacy 2. Identify patients at high risk for low health literacy 3. Understand some of the ramifications for health and health care of low health literacy 4. Review tools that can be used to assess health literacy 5. Experience health illiteracy through the recipe exercise as a way of really understanding what our patients encounter. 6. Utilize the teach-back method Why this topic: It is important for students to understand how health literacy can impact our patients’ ability to fully participate in their care and ultimately their outcomes. Student pre-class preparation/Required out of class resource: none Ask the students to bring the materials they used and modified Faculty pre-class preparation: Faculty will review the powerpoint (10 min) Faculty will review this guide (10 Min) Materials: Powerpoint Recipes Facilitator role: The role of the facilitator is to introduce the topic of health literacy, facilitate a low literacy interaction, explore what this means to the participants, and identify ways to improve our communication and our patients’ understanding. The goal of this activity is to create a low literacy moment for health care professionals by taking them out of their comfort zone and into the kitchen. As a facilitator, you are here to push participants to describe how they feel about the volume of information given, identify ways they cope with not being fully literate on the topic, test their recall of information and draw parallels between their experience and that of their patients. This exercise works best as an interactive conversation between the facilitator and the participants, so please deviate from the script as you feel necessary. Teaching Plan: (modify as you wish) Suggested Time Goal and Description Introduction (5 min) Goal: to get a number of lessons identified right away. Ask Students to introduce themselves and share something they know or think about health literacy Introduction about health Literacy Goal: introduce the concepts (5-8 min) Show the powerpoint up to slide 13 First round recipes teaching Goal: have the students experience low literacy. Introductory script by facilitator (3 min) Divide into groups of three (chef, 7 min for the teaching learner, observer). Show slide 14. Read the introductory script below Gauging Understanding Goal: to have students talk about how it felt. (15-20 min) Key is to keep it light and humorous!!! Ask for a volunteer learner. If no one volunteers, call on someone. Take the recipe and quiz them on the 4 points to be reinforced. Look in the facilitators cc of recipes below for other questions you can ask that link this back to what our patients encounter. Thank this person for going first. Pick another recipe and do this with a second learner and recipe. If time also a third. Identifying emotions: Ask the learners how they felt as low literacy learners? Ask the teachers how they felt trying to teach in that limited time? Ask the observers what they observed that seemed to slow down learning and what seemed to help. Show slides 15 and 16 The Teach Back Demonstration Show slide 17 on Teach Back ad why this 5 minutes is important Demonstrate it. See the Teach Back Demonstration script below Recipe Exercise Round 2: Goal: to practice the Teach Back. Teach Back practice 7 minutes Switch roles. Trade recipes Repeat the teaching but the chef will use Teach Back Reflections Ask observers what they observed. 5 min Ask learners and teachers their thoughts Final Summation Finish the slides that review the evidence (5 min) Final questions (5 min) Script for Introducing Recipe Exercise Round 1 Many aspects of a recipe are surprisingly similar to that of a medical interaction - a considerable amount of information squeezed into a short time, specific ingredients, precise measurements and often an esoteric language. As health care providers we underestimate the amount of information that we present in the course of a visit while overestimating what we expect patients to understand. The concepts presented in the just the treatment plan may include several prescriptions, instructions on labs or other tests, warning signs for follow- up and finally return visit instructions. A recipe, much like a prescription, requires several instruction that are key to it effectiveness - the ingredient (medication), the amount (dose), how it is prepared and cooked (the sig). In the recipe exercise, you are trying to mimic this high volume, low literacy interaction through a role play where the teacher reads an entire recipe (which may contained up to 40 discrete instruction) and from this teach 3-4 key concepts (name of the dish, ingredients, baking time) to the learner in a 5-7 minute period. We are going to have a great dinner, prepared by you! Each group is responsible for bringing a dish to our dinner tonight. Their roles are fairly self explanatory; the learner is responsible for listening to the recipe and learning key concepts. The observer is there as someone to reflect on the overall experience, the learner’s responses, the teacher’s methods. The teacher has the bulk the responsibility; they are given the paper instructions and recipe and instructed to read the recipe and teach the key concepts. Tips for the Gauging Understanding 1. Quiz learners about the key ingredients. It may help to begin by asking the specific learners few closed questions we often use in visits to assess understanding – Did you understand the recipe? Get it? Then press the learners to give the details on their key ingredients. Often coping mechanism, misunderstandings, difficulties with teaching methods organically will emerge when the learners are asked about the key ingredients. Examples of coping mechanism often seen during the exercise are: . Saying yes so not to feel wrong, but not really knowing the details . Being vague . Asking a companion (in this case, the observer) . Frustration 2. Discuss the ramifications of misunderstood ingredients or instructions - undercooked, burned, over salted food to draw parallels to the consequences of mistaking medications or treatments. 3. Observers and learners can be asked the types of assessments of understanding the teachers used while they were teaching the material. These fall into four categories: . A request for a teach-back is the most effective assessment of understanding. “Please tell me what you understand the plan to be.” For the recipe exercise this could be “Please tell me what ingredients you will bring.” . Open-ended questions such as “What questions do you have?” can be effective because they invite the patient to ask questions or share concerns. Closed-ended questions such as “Does this make sense? Or “Do you have any questions?” . Least effective statements are the “Ok?” or “Alright?” questions because they are ambiguous and closed-ended. 4. Beyond the ingredients, assess the learners’ understanding of some of the terms and key concepts of cooking and draw parallels of the assumptions that we make in medicine about the foundation knowledge out patients have about disease and treatments. For example, examine learners’ understanding (or lack thereof) of concepts behind a gratin which is similar to many patients’ background understanding of hypertension.

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