Page 34 - Small Animal Clinical Nutrition 5th Edition

34 Small Animal Clinical Nutrition

informed consent forms, social services forms, public health
VetBooks.ir Box 3-2. Health Literacy and Language information, medical instructions and health education materi-
als often use jargon and technical language that make them too
Barriers.
difficult to use (Rudd et al, 2000).
Patients with inadequate health literacy and chronic illness
Almost 50 million Americans (~19% of U.S. residents) speak a have less knowledge of illness management than those with
language other than English at home. A total of more than 22
million have limited English proficiency, speaking less than high health literacy (Kalichman and Rompa, 2000). Public
“very well” by their own admission. The decade leading up to hospital patients with inadequate health literacy had higher
2000 experienced a 47% (more than 15 million people) rates of hospitalization than those with adequate health litera-
increase in the number of people who spoke a language other cy (Baker et al, 1996). Adults with limited health literacy have
than English at home. less knowledge of disease management and of health-promot-
Many patients who need medical interpreters have no ing behaviors, report poorer health status and are less likely to
access to them. Results of one study showed that no inter- use preventive services (IOM, 2004).
preter was used in 46% of emergency department cases Adverse drug events are another aspect of inadequate health
involving people with limited English proficiency. Furthermore, literacy. One report found that 10% of adverse drug events were
few clinicians receive instructions with how to work with inter- linked to errors in the use of the drug as a result of communi-
preters. cation failure (Leape et al, 1993).
Language barriers and deficits can cause great harm.
Patients are often nonadherent to medications, less likely to Where do Patients Receive Health Care
return for follow-up visits and have higher rates of hospitaliza-
tion and drug complications. Two cases follow: Information?
Case 1: A two-year-old girl was diagnosed with an inner ear Socioeconomic status, education level and primary language all
infection and was prescribed an antibiotic. Her mother under- affect whether consumers will seek out health information,
stood that her daughter should receive the prescribed medica- where they will look, what type of information they prefer and
tion twice daily. After carefully studying the label on the bottle how they will interpret that information (IOM, 2004).There is
and deciding it didn’t tell how to administer the medication, the no single reliable answer.
mother filled a teaspoon and poured the antibiotic into her Between 62 and 69% of adults at all literacy levels reported
daughter’s painful ear. obtaining information from family and friends. Between 94
Case 2: A young Spanish-speaking man stumbled into his and 97% of adults at all skill levels reported using radio and tel-
girlfriend’s house and said he was “intoxicado.” The Spanish-
speaking paramedics took the work to mean “intoxicated.”The evision to obtain information. Individuals with lower literacy
patient’s intended meaning was “nauseous.” After 36 hours of levels were less likely than those with higher skills to use news-
being worked up for a drug overdose, the patient was reeval- papers and magazines for health information (69.5 vs. 90%).
uated and found to have an intracerebellar hematoma with The National Cancer Institute conducted the Health
brainstem compression and a subdural hematoma. The young Information Trends Survey (HINTS), one of the nation’s first
man became a quadriplegic. national surveys of health information sources in 2003 and
Family members, friends and untrained members of the 2005. HINTS databases are designed to provide information
support staff are often used in these encounters, but commit regarding pattern of information use and opportunities to
more errors than those with more training. Much work needs inform Americans about cancer.
to be done in this area given the changing dynamics of the In a Gallup survey, the proportion of people who reported
U.S. population.
getting “a great deal” or “moderate” amount of health or med-
ical information from these sources follows: doctors (70%), tel-
The Bibliography for Box 3-2 can be found at
www.markmorris.org. evision (64%), books (56%), newspapers (52%), magazines
(51%), nurses (49%) and the Internet (37%).The proportion of
people who reported a great deal or moderate amount of trust
and confidence in the health or medical information from the
ment (Williams et al, 1995). sources follows: doctors (93%), nurses (83%), books (82%),
Racial and ethnic differences can contribute to communica- newspapers (64%), magazines (62%), the Internet (62%) and
tion breakdowns (Box 3-2). As many as 20% of Spanish-speak- television (59%) (Gallup Organization, 2002).
ing Latinos say they do not seek medical advice due to language People have more ways than ever to get information, includ-
barriers (IOM, 2002). A 2001 survey of 6,722 adults found that ing telephone, fax, e-mail, the Internet, television, radio, print
minority populations are more likely to have difficulties com- media, family and friends, etc. More sources will be available in
municating with their health care providers compared with the future, including automated monitoring of vital signs and
whites (Collins, 2001). markers, increased use of wireless technology, among others.
Even highly skilled individuals may find the health care sys- But how do people access information today and how accurate
tem too complicated to understand, especially when poor is that information? The National Cancer Institute sought to
health, anxiety, effects of medication, etc. make them more vul- answer some of these questions through HINTS. Some results
nerable. Directions, signs and official documents, including follow (Hesse, 2004):