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Empowerment through health literacy

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Over the last 20 years, the UCLA/Johnson & Johnson Head Start Management Fellows Program has trained over 1,400 Head Start directors to be better managers and has expanded a successful low literacy health education approach to tackle other health issues facing the Head Start community.

While working with the Head Start Fellows, Professor Ariella Herman of the UCLA Anderson School of Management realized that many of their families were not making full use of the programs and resources available to them. The reason, she learned, was their lack of knowledge about basic health care.

Leveraging the trust and rapport the Fellows Program had developed with Head Start, Dr. Herman, with the support of Johnson & Johnson, embarked on a health literacy initiative. The results were impressive. There was a huge decrease in ER and clinic visits and parents were feeling more empowered and self-confident after the training.

The results of the study led to the creation of the UCLA/Johnson & Johnson Health Care Institute (HCI) in 2001 under Dr. Herman’s leadership. Using a “Train the Trainer” approach and low literacy tools, HCI has touched over 60,000 families in multiple languages in 42 states and demonstrated in numerous peer reviewed publications that giving parents the advantage of knowledge empowered them to make choices that had major implications on workforce productivity, school attendance and on rising health care costs.

UCLA/HCI surveys done with participants over the years have shown a 29 percent decrease in school days missed and a 42 percent decrease in work days missed. After families were trained, there was a 42 percent decrease in doctor/clinic visits and a 58 percent decrease in emergency room (ER) visits. This was an average cost of just $80 per family. Furthermore, studies suggest that training 10,000 families using this model can lead to a total cost savings of nearly $5.1 million to Medicaid in direct costs associated with unnecessary ER and clinic visits annually.

Encouraged by these results, HCI expanded the low literacy health education approach beyond common childhood illnesses to tackle other health issues facing the Head Start community, such as oral health, and most recently, obesity.

Results from the Eat Healthy, Stay Active program to improve nutrition and physical activity habits among Head Start parents, staff and children suggest that the intervention was effective in improving knowledge and behavior for parents and key to the formation of healthy eating habits for the whole family.

Seventy percent of children participating in the program knew the difference between foods they should eat more often, or less often. There was a 66 percent increase in physical activity among parents and Head Start staff. Body Mass Index (BMI) ranges for parents and staff saw a downward shift (from 30.11 to 29.2), and the number of children classified as obese decreased significantly by 32 percent.

The learning process, Dr. Herman points out, continues beyond the training sessions. HCI tracked about 500 families who graduated from Head Start and have seen that behaviors, such as not rushing to the ER for childhood illnesses that could be treated at home, have continued.

Being a community-based program, Head Start agencies have been able to engage their communities into this learning process as well. “They do it in innovative ways,” notes Dr. Herman. It could be getting a pharmacy to donate digital thermometers or getting the attention of a local hospital.

When the program was implemented in Seattle a few years ago, Dr. Herman recalls, they invited medical residents from the Swedish Medical Center to attend the training. “The goal was to raise awareness. Now, year after year, more and more residents and doctors come to see how the training works. The medical community gets to know the families and how to communicate with them, and the families are very appreciative for this first step of communication between provider and patient.”

Health literacy is now a lifelong mission for Dr. Herman, and her efforts have not gone unnoticed. The United States Department of Health and Human Services has partnered with HCI to launch an action plan to improve health literacy in partnership with HCI. Dr. Herman is also working with the American Academy of Pediatrics to improve health literacy.

According to the 2003 National Assessment of Adult Literacy, more than 90 million Americans lack the necessary health literacy skills to effectively utilize the health care system.

“Health literacy is not just for Head Start, it’s a major national issue,” she points out.

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