Session B: What’s in a Word? The Translation of Information and the Client/Translator Relationship

Wilma Alvarado-Little, MA, MSW

Wilma Alvarado-Little, MA, MSW

Wilma Alvarado-Little, MA, MSW, Alvarado-Little Consulting, LLC

Wilma Alvarado-Little began her session with the following question: what is the difference between bilingual, interpreting, and translating?  She then followed with a discussion on the importance of understanding each when communicating and marketing.  The art of communication is a powerful tool. Alvarado-Little suggests seeking professional services when seeking a translator and/or interpreter expertise in order to ensure quality and consistency.

She recommended approaching the creation of materials with caution as the message could easily be confused depending on the audience.  Alvarado-Little spent time discussing cultural competency and how aspects of the community and target population should be integrated into materials creating documents that are sensitive to many perspectives and health literacy.

Alvarado-Little recommended including the following aspects to complete a successful translation project having a clear understanding of the project, making sure to plan ahead, having a final version of the document to be translated and revised for content before submission for translation, and allowing enough time for translation to be completed.


Session D: Easy-to-Understand Informed Consent and Advance Care Planning

Rebecca Sudore, MD

Rebecca Sudore, MD

Rebecca Sudore, MD, University of California, San Francisco

Dr. Sudore is a geriatrician and palliative care physician whose presentation outlined the health literacy issues related to informed consent and advance care planning and presented some lessons learned from creating these forms for patients. She also talked briefly about web design for advance care planning sites.

Dr. Sudore reviewed the basics of creating clear written materials, including use of white space, short sentences, avoiding jargon, grouping information, etc. She talked about design elements, such as use of pictures that improve comprehension. She also talked about various readability testing tools available. She reviewed the components of Informed Consent forms as set out in the AHRQ Toolkit.

Dr. Sudore went over some of the many factors that affect patient understanding of informed consent forms, such as visual or hearing impairment, number of medications, chronic disease burden, etc. She said, “Forms alone do not work, conversations do.” She recommended facing the patient, speaking slowly, and using a “Pocket Talker” when possible. She recommended the use of teach-back in the informed consent process. She also noted that informed consent forms needed to be available in the patient’s primary language and interpreters should be used for teach-back. Her three main guidelines for informed consent were:

  1. Plain language (< 8th grade; 4th-6th grade if possible)
  2. Form in patient’s native language
  3. Interactive teach-to-goal process using open-ended questions to gauge comprehension (only take about 3 minutes)

On the subject of HIPAA forms (and how to get your organization to allow you to change them), she recommended sharing examples of easy-to-read HIPAA forms being used by other healthcare organizations.

Dr. Sudore went on to talk about Advance Directives, “the ultimate informed consent forms.” She showed us the California Advance Health Care Directive form she participated in developing, which is currently available in 10 languages. She talked about how it was developed and how versions for other states are in development as well. She expressed interest in partnering with groups working in more states to develop these forms.

She cited studies of existing advance care directives that had shown that 70% of patients’ documented end-of-life wishes were wrong. In studies where the focus was on discussing the patients’ wishes, there was a 90% consistency of care with the patient’s goals, as well as greater satisfaction for the patient and their surrogate, and increased cost savings and quality of care. The studies showed that, just because someone signs something, it doesn’t mean they understand it, and that it is important to confirm understanding through discussion.

Dr. Sudore recommended that the first step in preparing the advance care directive is to find out what matters most to the patient. Most patients don’t care what the treatment is; they care what the outcome of the treatment will be. Family and religious values are important here, as well as other cultural factors. Visual images and stories make powerful teaching tools in bringing issues and questions to light. Video images and stories improve understanding, increase engagement, decrease decisional conflict, and help identify goals.

She introduced us to the PREPARE website, which her team developed. The team included health literacy, geriatrics and palliative care and behavioural experts, and used 13 separate focus groups for feedback. The team also conducted cognitive interviews with patients. The site uses simple, active language, high-contrast, video instructions for using the site, voice-overs and closed captioning, and lots of videos, many of which model behaviour, demonstrating how to plan for health care. (The site avoids the use of terms like “death” and “end-of-life,” which can be frightening for patients.) She emphasized the importance of pilot testing such a site with the target population, as well as improving it over time.

Dr. Sudore’s presentation was packed with useful insights about the difficulties patients and practitioners face in reaching “informed consent” and strategies for overcoming them. One of the most important take-aways was that written forms, no matter how well designed and written, cannot function to obtain truly informed consent on their own. Visuals, stories, and, most important, discussions with patients and families that include teach-back, are key to truly informed consent and advance care planning.


Session E: Tweets for Engagement and Health Messaging

Alisa Hughley, MPH and RV Rikard, PhD

From left to right: Alisa Hughley, MPH and RV Rikard, PhD

RV Rikard, PhD, North Carolina State University; Kathleen Hoffman, PhD, MS, MSPH, Medivizor; & Alisa Hughley, MPH, enBloom Media

The three presenters are the hosts of the Health Communication, Health Literacy & Social Science Tweet Chat (@hchlitss, #hchlitss), a weekly Twitter conversation about health literacy. The hchlitss tweet chat is in interview format and features guest “speakers.”

According to, a site that provides analytics for health-related Twitter activity, there are “1 million tweets relating to healthcare each day.” The presenters said that, when used well, Twitter “gives the opportunity to collaborate, connect, and share meaningful professional relationships.” Twitter was also presented as a way to reach the public with health messages. Alisa Hughley pointed out that even people in lower socio-economic groups are likely to have smartphones (possibly the only computer they do own).

The presenters talked about how to use Twitter to help a healthcare organization: Twitter can help drive traffic to your website, and it is an incredible resource for connecting with experts and stakeholder communities. By connecting with others who already have large followings, you can increase your own following.

The participants then broke up into groups and practiced crafting tweets centered around specific health care messages. We discussed some of the tweets participants created, talking about the value of language that is specific, engaging, and uses as few words and characters as possible. We also talked about Twitter “etiquette”: crediting the author when retweeting, etc. We learned that good tweets are those that add value to the community in which you are participating, including citing resources. HIPAA privacy and other standards of confidentiality should always be respected.
The presenters demonstrated a few online tools for tweetchatting, how their own Tweet Chat works, and how to use analytics to gauge one’s effectiveness on Twitter (how many users reached and how engaged they are, for example).

They offered several online resources, such as and

Equity and Health Literacy: Examining the Link, Exploring Solutions

From left to right: Robert Logan, Ph.D, Michael Paasche-Orlow, M.D, Winston F. Wong, M.D., M.S, and Michael Villaire, MSLM (Moderator)

From left to right: Robert Logan, Ph.D, Michael Paasche-Orlow, M.D, Winston F. Wong, M.D., M.S, and Michael Villaire, MSLM (Moderator)

Michael Villaire, MSLM (Moderator), Institute for Healthcare Advancement; Michael Paasche-Orlow, M.D., Boston University; Robert Logan, Ph.D, National Library of Medicine; Winston F. Wong, M.D., M.S,, Kaiser Permanente

Each renowned in their fields, Dr. Michael Paasche-Orlow, Dr. Robert Logan and Dr. Winston F. Wong discussed their perspectives of how health disparities, social determinants of health, and social disparities influence health literacy and overall health outcomes of not only individuals, but communities as well. Health equity is a state that we all want to reach. In order to achieve this vision, health literacy, research and policy elements must be incorporated into intervention strategies.

Health literacy plays a role in the burden of disease and can be used as a tool in prevention. The more competent an organization is in health literacy best practices, the better their outcomes will be. However, health literacy strategies need to go beyond “do you understand” to “what is important to you” as an individual or community. This shift allows us to invest in the influencers that have the capacity to result in better outcomes.

Dr. Paasche-Orlow shared some of his research and provided evidence from a study that initially seemed to identify a racial health disparity in patient outcomes, but upon further investigation found the difference to be attributable to a disparity in health literacy. In this instance and in other areas of his work, a clear link between health literacy and health equity could be drawn. Not all the experts agreed on the directionality of this link, but did support the strong connection between health literacy and health equity.

Incorporating health literacy principles can help eliminate health disparities, and improve how we navigate and communicate within our complex healthcare system.  Additional tools can be used to improve access, knowledge and an understanding of health literacy and health equity interventions. The development of an electronic health literacy tool shed was suggested. More research is still needed on health literacy and health equity, but the field is on the right path and further investigation can shed light on this connection and the root causes of health disparities.


Affordable Care Act and Health Literacy: Lessons Learned, Best Practices, and Recommendations

From left to right: Michael Villaire, MSLM (Moderator), Don Rubin, Ph.D., Catina O’Leary, Ph.D., Victor Wu, M.D, Doreena Wong

From left to right: Michael Villaire, MSLM (Moderator), Don Rubin, Ph.D., Catina O’Leary, Ph.D., Victor Wu, M.D, Doreena Wong

Michael Villaire, MSLM (Moderator), Institute for Healthcare Advancement;  Don Rubin, Ph.D., University of Georgia; Victor Wu, M.D, evolent Health; Catina O’Leary, Ph.D., Health Literacy Missouri; Doreena Wong, Asian Americans Advancing Justice

Summary session coming soon

Session K: Using the Universal Precautions Toolkit 2.0

Barry Weiss, MD

Barry Weiss, MD

Barry Weiss, MD, University of Arizona

The Universal Precautions Toolkit was developed by a team of physicians, public health nurses, researchers, and others based on the premise that everyone has trouble understanding difficult and complex information, and that all patients benefit from clear communication.

The AHRQ Universal Precautions Toolkit is a PDF document designed to help health care practitioners and organizations communicate more effectively with patients. It contains 21 tools for improving practice from a health literacy standpoint. The tools are split into groups under headings such as “Improving Spoken Communication” and “Improving Self-Management and Empowerment.”

Dr. Weiss conducted this workshop using the second edition of the toolkit. The purpose of the workshop was to familiarize participants with the toolkit for potential use in their own practices.

Before he started the hands-on part of the workshop, Dr. Weiss explained the AAFP Demonstration Project, which visited medical practices across the country and observed use of the first edition of the toolkit. He showed the example of the Medication Review tool, and how it improved medication review effectiveness in the practices they observed: patients brought in more medications, more problems were identified, more changes in medications made, etc.

The second edition of the toolkit was based on the results of the demonstration project.

Dr. Weiss split participants into groups and had each group choose one tool in the toolkit to explore. The goals were to become more familiar with the content of the tool, discuss how it might be used in participants’ settings, how patients might benefit, what parts of the tool might be harder to use, and how to overcome barriers to implementing the tool.

After working in small groups for about 15 minutes, each group reported back to the main group. Overall, the groups found the toolkit had great potential for use in their practices. They also found it useful to explore the toolkit using the embedded links.

Some teams expressed that certain activities appeared time-consuming and hard to incorporate into their practice. Dr. Weiss said that this observation reflected what they had learned in the demo project; but that practices found that, while it took a lot of upfront work to implement a tool, using it led to better results long-term; e.g., fewer return visits, better patient satisfaction, etc.

AHRQ Universal Precautions Toolkit:

Session L: Integrating Health Literacy into Your Organizational Structure

Emily Briglia, MA

Emily Briglia, MA

Emily Briglia, MA, Community Healthcare Network

Emily Briglia used her experience with Community Healthcare Network (CHN) to walk her attendees through the process of incorporating health literacy best practices into the operations of a healthcare agency. In 2011, CHN, not-for-profit FQHC with 11 health centers in New York City serving over 75,000 patients each year, launched an agency-wide health literacy initiative that aimed to improve patient outcomes by creating an organizational culture based on health literacy principles.

Briglia explained that CHN undertook this initiative because they see health literacy as the responsibility of all healthcare organizations. The traditional definition of health literacy applies to a patient’s own capabilities or skill set. For a health system to be effective, they need to evaluate how they engage consumers in the healthcare process and not put the oneness on the client.

To implement this agency-wide campaign, health literacy initiative leaders helped CHN staff learn and apply important health literacy universal precautions with patients, such as plain language and the teach-back method. Using plain language can increase patient understanding of health information, but its adoption in health organizations has been limited, partially due to a lack of provider training. When facilitated properly, the teach-back method can check for lapses in patient understanding, uncover health beliefs, reinforce health messages, and open a dialogue with patients. The employment of both of these strategies is crucial to ensure providers are communicating with patients effectively.

Participants completed various exercises including viewing teach back training videos, participating in teach back role plays, re-writing statements in plain language, and providing colleagues with constructive criticism on how to improve the facilitation of health literacy universal precautions. In 2014 alone, CHN’s health literacy leaders have presented for and/or trained over 1000 health care providers on health literacy. Upon completion of this session, participants were better prepared to incorporate these strategies into patient care, resulting in improved patient understanding.


Session M: Intergenerational Communication Preferences

Jill Clutter, Ph.D

Jill Clutter, Ph.D

Georgianna Sergakis, Ph.D & Jill Clutter, Ph.D, The Ohio State University

As part of the breakout sessions offered at the IHA Health Literacy Conference, Dr. Georgianna Sergakis and Dr. Jill Clutter of The Ohio State University College of Medicine facilitated a session entitled, “Intergenerational Communication Preferences.”   The session was filled with high energy; utilizing effective visuals to describe the importance of breaking down the barriers and building bridges between all individuals (regardless of differences) in order to achieve success in the workplace.

The session focused on the exploration of generational differences in the workplace, charting the foundations of generation-specific behaviors, and the creating strategies to use to optimize intergenerational interactions in the workplace of the healthcare industry.

Georgianna Sergakis, Ph.D

Georgianna Sergakis, Ph.D

Dr. Sergakis and Dr. Clutter explained how the current – and future healthcare system is now dominated by four generations of individuals:

  • The Veterans / Traditionalists (born 1922 – 1945)
  • Baby Boomers (Born 1946 – 1964)
  • Generation X (Born 1964 – 1982)
  • Millenials (Born 1982 – 2000)

The generation categories were described in brief detail, showing how each generation contributes to the shaping of “shared” history, beliefs, and behaviors.  It was also discussed how the unique experiences from one generation to another has influenced intergenerational interactions and communication preferences.

It is important that in order to have effective intergenerational communication, individual focus must be placed on the “value” that each generation brings to the table in order to create a positive and productive environment.  Intergeneration communication involves finding a “common ground” while respecting one another’s differences when working together.   Simply put, effective intergenerational communication will create “synergy” among everyone.