and other clinical training programs need to make these sorts of opportunities available.

Finally, Dreyer said, changes are needed in the health system in order to improve health literacy because focusing on these systematic changes is more important than a misguided attempt at labeling the patient and trying to implement change at that level. But the workshop also affirmed the need to effectively help patients by empowering them to be able to take responsibility for their health care and to ask questions and interact in an empowered way with the healthcare system. Dreyer said the most effective way to improve patient knowledge is by reaching him or her through community outreach and not via the healthcare system. Health providers must work with community partners in a transdisciplinary fashion to achieve success.

Culbert mentioned that the work of Health Literacy Missouri takes place both inside and outside the healthcare system. He cited the importance of focusing on the individual, not in a way that points the finger at them, but rather one that empowers them. It is very important to begin early with individuals, whether they are new mothers, children, or medical students. Reinforcement must take place continuously throughout the life cycle. The state of health literacy will likely take a generation to make advances. Culbert said that progress can be made if there is a commitment to health literacy and efforts are based on good evidence. Knowledge is improving regarding what works at the community level and how to empower individuals so they can make good health decisions.

Roundtable member Winston Wong discussed the implementation of the Patient Protection and Affordable Care Act (ACA) and how health literacy may or may not be a mitigating factor toward the success of its implementation. The ACA will have its impact at the local level. Patient empowerment takes place both in clinicians’ rooms and in the community, such as within Head Start programs. There is a need to identify competencies of providers in terms of their ability to empower patients. More functional healthcare encounters would take place if patients were assertive and comfortable specifying their needs and expecting to be heard.

Wong mentioned that 90 percent of Americans do not see a physician or a nurse in any given year, and so much of the effort toward improving health literacy must be directed toward population management and wellness prevention efforts. Health literacy is a key element of how communities try to optimize health and wellness, aside from what happens during a clinical visit. There needs to be a focus on how health literacy is operationalized in terms of changing the trajectory of chronic disease and prospects for wellness and health in communities.

Roundtable member Cindy Brach mentioned that patient empowerment and self-management are focus areas of the AHRQ Health Literacy

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