User:Gabbyblandino/sandbox

Picking Articles
Sector Article: Health Literacy

Article Review:


 * "Improvement" Section:
 * doesn't mention the relationship between Nutrition and Health Literacy
 * Add: paragraph, talk about review regarding nutritional health literacy and its affects


 * "History" -- "Biomedical approach"
 * low health literacy levels correlating with lower socio-economic standing
 * Add: paragraph, giving statistics and go more in depth on impact it has on health disparities of at risk communities

How Health Literacy relates to my PE: improve the health literacy of at-risk individuals/communities in order to prevent disease and promote overall health and nutrition


 * Focus: health literacy as it pertains to nutrition for housing-insecure individuals
 * health literacy and health behavior

Chosen Contribution: Improvements


 * add methods in which low health literacy is improved based on systematic reviews

Area Article: Health Literacy

Article Review:


 * "Patient safety and outcomes"
 * talks about how a lack of health literacy disproportionately affects some groups, but doesn't mention housing-insecure individuals
 * Add: section, "At-risk communities"

How Health Literacy relates to my PE: add further detail about the status of at-risk individuals and how low health literacy affects them more so than individuals with high health literacy

Chosen Contribution: Risk-Identification + Cost (New Section)


 * Risk Identification:
 * Cost:
 * Cost:

Area: Risk Identification + Cost
Source: Gaps in Mental Health Care for Homelessness

Discharges of homeless individuals from psychiatric services often left patients referred to additional services--including housing. This leaves homeless individuals in San Francisco at a greater risk of further medical issues as they continue life on the streets with mental illnesses. I would like to add information regarding the number of individuals using psychiatric services in the San Francisco county. By sharing the number of unhoused patients being seen for mental health issues alongside the number of patients that were then referred to additional services after discharge, one may see the discrepancy between these statistics. This may highlight what efforts are being made to help alleviate conditions of homeless individuals, and what efforts still need work. Some may see this statistic as a success in that many homeless people are at least in contact with medical professionals regarding their mental illnesses and that some are even able to get additional services in the process. Others may see that there is a lack of services being offered upon discharge and thus view these statistics as an avenue in which SF county may improve its help of homeless individuals. Thus this source may shed light on the case of homeless individuals seeking psychiatric care while in need of other services--such as housing.


 * 4,666 discharges of 6,704 emergency psychiatric discharges involved a homeless person


 * 38.2% of patients were not given referrals to additional services after receiving emergency psychiatric services

Source: Ending Chronic Homelessness in San Francisco

The number of chronically homeless individuals in SF has recently risen and now bring about additional strain on institutions in the SF county--including jails, and hospitals. This collection of statistics is used to highlight what interventions may be done to lessen, and hopefully end, chronic homelessness and the issues it poses for the county. This source provides statistics regarding the difference in cost, in relation to mental health and substance abuse services, between homeless and chronically homeless individuals in San Francisco county. The current article about homelessness in the Bay Area does not currently highlight the difference between homeless and chronically homeless individuals, so these statistics might be able to shed light on the severity of the situation of chronically homeless individuals and how it affects SF. This sources will be helpful to use in conversation with Source 1 above to further explore the use and need of psychiatric services by unhoused individuals.


 * 72% of the total cost of emergency services may be attributed to the top 13% of homeless users


 * A non-chronically homeless individual averages $14k in mental health services, while a chronically homeless individual averages $33k in mental health services 31% of homeless individuals are chronically homeless, a larger percentage than in 2015

Source: Performance Audit of the Department of Public Health and Behavioral Services

Massive amounts of money have gone towards the Department of Public Health and Behavioral Services to provide mental health and substance use disorder treatment for unhoused individuals. Funding for these services comes from multiple sources and in recent years, the budgets for services have not been fully used. It is important, again, to show how much funding and from what sources goes into providing mental health services for the homeless in San Francisco county--as a model for how issues regarding homelessness are attempted to be solved. This report shows a steadily increasing budget for mental health and substance use disorder services recently due to underfunding in past years. It also shows that despite this increased budget sent out to contractors, not all the money is used. This may show that there is room to improve and grow the current services available for homeless individuals in San Francisco, or. This source also follows the changing demographic of age groups seeking behavioral health services as compared to previous years. Also, I would like to share what particular treatments within service groups were needed more than others; this may showcase what issues homeless individuals face most often in the SF county.


 * $370 million dollars used to provide mental health and substance use disorder services to over 30,000 patients


 * 3-8% of budget isn't spent on services, which equals $10.5-27 million dollars not going towards services

Sector
Source: Health Literacy Interventions and Outcomes

Health Literacy varies among individuals for a number of reasons, including age, education status, and language barriers. This study aims to show the differing health outcomes associated with lower levels of health literacy. This study shows the particular actions (ie. less review of prescription information, less ability to interpret that information, poorer ability to take medications, etc.) practiced by individuals with poorer health literacy and the health outcomes that often accompany these practices. Thus this source illustrates how low health literacy plays into all health related aspects of an individual’s life (from doctors appointments, to prescription taking, to nutrition information). The current Wikipedia page on Health Literacy lacks this information that links the ways in which low health literacy may increase the risk of disease and overall poor health outcomes described the current page. This information would highlight the importance of health literacy and the severity of the outcomes that come about for those who have low levels of health literacy.

Source: The Cost of Limited Health Literacy

Low levels of health literacy among some individuals has resulted in additional costs to the health care system. This study quantifies the number of individuals who live in the United States with the lowest levels of health literacy--a number that is truly shocking and scary. This gives context to the extra costs on the healthcare system that are associated with individuals with poor health literacy. This shows that even though money is going into programs that aim to improve levels of health literacy, there is room for improvement. This source highlights a different way to look at health literacy--a perspective of the issue through the additional costs it causes. Also, the Health Literacy Wikipedia site dedicates a large portion of its page to recommendations of how to improve poor health literacy, and showing the cost that poor health literacy has on individuals and health institutions strengthens the recommendations section by further validating the need for improvements.


 * 59% of Americans have the lowest 2 levels of health literacy


 * Additional costs of limited Health literacy: 3-5% of total healthcare cost; $143-7,798 per person

Source: Consumer understanding of nutrition labelling

Nutrition labelling proves confusing for many individuals in this review of research regarding the topic. This source describes the particular parts of a nutrition label that are difficult to understand due to low nutrition related health literacy. The lack of a nutrition literacy as it relates to health literacy gives me the opportunity to put the two into conversation on the Health Literacy Wikipedia page. The ability to read a label, whether it be on a food item or on prescription medication, is a vital skill often lacking of individuals experiencing low levels of health literacy. This source describes a variety of behaviors that are shown to be lacking or done without proper knowledge, such that readily available nutrition information is being overlooked. This directly ties into health as it pertains to food intake, and will highlight the depth to which there is a lack of nutrition literacy and how it may affect the health of individuals.

Drafting
Area:

The lack of health literacy affects all segments of the population. However, it is disproportionate in certain demographic groups, such as the elderly, ethnic minorities, recent immigrants, individuals facing homelessness, and persons with low general literacy.

Outcomes of low levels of health literacy also include relative expenditures on health services. Because individuals with low health literacy are more likely to have adverse health statuses, their use of health services is also increased. This trend is compounded by other risk factors of low health literacy, including poverty. Homelessness and housing insecurity can hinder good health and recovery in attempts to better health circumstances, causing the exacerbation of poor health conditions. In these cases, a variety of health services may be used repeatedly as health issues are prolonged. Thus overall expenditures on health services is greater among populations with low health literacy and poor health. These costs may be left to individuals and families to pay which may further burden health conditions, or the costs may be left to a variety of institutions which in turn has broader implications for government funding and health care systems.

A review of studies that focused on health literacy and its associated costs concluded that low levels of health literacy is responsible for 3-5% of healthcare cost--approximately $143 to 7,798 per individual within the healthcare system. For example, studies have shown that the increased prevalence of poor health and low health literacy has resulted in a greater use of emergency services by homeless individuals. A study conducted in San Francisco showed that “72% of the total cost of emergency services may be attributed to the top 13% of homeless users”. In this way, low health literacy produces financial outcomes as well as those of health.

Homelessness:

Individuals facing homelessness constitute a population that holds intersectional identities, is highly mobile, and is often out of the public eye. Thus the difficulty of conducting research on this group has resulted in little information regarding homelessness as a condition that has increased risk of low health literacy levels among individuals. Nonetheless, studies that do exist indicate that homeless individuals experience increased prevalence of low health literacy and poor health--both physical and mental--due to vulnerabilities brought on by the insecurity of basic needs among homeless individuals. The combination of poor health and homelessness has been found to increase the risk for further decline in health status and increased housing insecurity, all of which is highly affected--and in many cases perpetuated--by low levels of health literacy.

Sector:

In the creation of a program aimed to improve health literacy, it is also important to ensure that all parties involved in health contexts are on the same page. To do this, programs may choose to include the training of case managers, health advocates, and even doctors and nurses. Due to the common overestimations of health literacy levels of patients, the education of health literacy topics and training in the identification of low health literacy in patients may be able to create significant positive change in the understanding of health messages. The Health Belief Model has been used in the training of health professionals in order to share insight on the knowledge that is has been shown to most likely change health perceptions and behaviors of their patients. The use of the health belief model can provide basis for which patient health literacy may grow. The training of health workers may be seen as a “work around intervention” but is still a viable option and opportunity for mediating the negative outcomes of low health literacy. Effective health literacy programs are created with cultural competency, and individuals working within health institutions can support individuals with low health literacy by being culturally competent themselves.

In working to improve the health literacy of individuals, a multitude of approaches may be taken. Systematic reviews of studied interventions reveal that one works to improve health literacy in one patient may not work for another patient. In fact, some interventions were found to worse health literacy in individuals. Nonetheless, studies have illuminated general approaches that help individuals understand health messages. A review of 26 studies concluded that “intensive mixed-strategy interventions focusing on self-management” and “theory basis, pilot testing, emphasis on skill building, and delivery by a health professional” do aid in increasing levels of health literacy among patients. Another study revealed that programs aimed at targeting more than one behavior through increased health literacy are no less successful than programs with a single focus. The importance of dignity and respect is emphasized when creating programs for increasing health literacy of vulnerable individuals. In intervention programs created for homeless individuals in specific, it has been found that “successful intervention programs use aggressive outreach to bring comprehensive social and health services to sites where homeless people congregate and allow clients to set the limits and pace of engagement”. A social justice model is recommended for homeless individuals which is based on shared support of the community and their health literacy needs by those who provide services for this underserved group as well as the professionals who create and implement health literacy interventions.