Development and evaluation of a health literacy training program for allied health professionals: A pre-post study assessing impact and implementation outcomes.

Abstract

We developed and evaluated a health literacy training program for allied health professionals, and explored the feasibility of a train-the-trainer model to support dissemination. The program combined didactic and experiential teaching methods and behaviour change techniques, with a focus on teach-back and developing easy-to-understand written materials. Outcomes included participant reactions, confidence (range: 6-30), behavioural intentions (range: 6-42), and dissemination of training content. Implementation outcomes were evaluated using the Normalization MeAsure Development (NoMAD) tool, assessing the constructs of coherence (range: 4-20), cognitive participation (range: 4-20), collective action (range: 7-35) and reflexive monitoring (range: 5-25). Of the 29 allied health professionals who participated, 90% rated the program as 'excellent'/'very good', and 97% said the information was 'extremely'/'very' helpful for their everyday practice. We observed increases in confidence (mean difference [MD]=6.3, standard deviation [SD]=2.7, t25 =11.87, P<.001) and intentions (MD=3.6, SD=8.1, t23 =2.2, P=.04) related to health literacy practices after 6weeks. Improved confidence was retained over 6months (MD=7.1, SD=5.2, t18 =5.96, P<.001). After 6months, 95% of participants (n=19) reported using teach-back and 50% (n=10) reported having used a readability formula. Eight-five per cent of participants (17/20) had trained others in health literacy, reaching n=201 allied health professionals and students. NoMAD scores were highest in relation to cognitive participation (/20) (M=18.2, SD=2.1) and lowest in relation to collective action (/35) (M=25.4, SD=3.0). A train-the-trainer model appears to be a feasible method to disseminate health literacy training, but additional work may be needed to improve the collective work done to enable health literacy practices in real-world clinical contexts. Staff training is particularly important in highly diverse areas where patients are disproportionately affected by low health literacy.