Evaluation of a Longitudinal Medical School Health Literacy Curriculum

Beyond the tip of the iceberg: Health literacy in older people.

Introduction: Health literacy is an essential component of efficient communication in the health system, influencing the health of individuals and society. Primary care physicians and administrative staff in primary care clinics and hospitals are important players as sources of health information and navigators of patients in the health system. Little is known of the association between the health literacy of providers and their performance with regard to health literacy of their patients. The objective of the study was to examine the correlation between the level of health literacy of service providers, their awareness of and attitudes towards health literacy promotion, and how they communicate with patients with low health literacy. Methods: A cross-sectional analytic research study was conducted among 50 physicians and 50 administrative staff members working in primary care community clinics in the Maccabi Health Maintenance Organization (HMO) in Israel. The level of health literacy was measured using the HLS-EU Q16 tool previously validated in Israel. Awareness of health literacy, of health and economic ramifications of low health literacy, attitudes towards health literacy promotion and the appropriateness of communication related to low health literacy, were measured using validated self-administered tools. Results: Among physicians, the level of awareness was higher than among administrative service staff. Over 42% of the providers showed good level of awareness regarding the effects of low health literacy, once defined, while 67% had never heard of the term health literacy, 26% heard of health literacy but were not familiar with its meaning. Significant positive associations were found (p ＜ .05) between the providers’ health literacy, their attitudes towards health literacy promotion and their use of communication techniques. Significant associations were found (p＜ .01) between awareness and the attitudes about health literacy promotion, and the degree to which communication techniques were adopted. No mediation variables were found between the research variables. Conclusions/Implications: This is the first research study of its kind in Israel that examined health literacy among health service providers. The results indicate gaps in health literacy which can be narrowed through guidelines for improving providers' understanding about health literacy, and for improving processes in health systems, focusing on the medical and administrative staff for promoting health literacy, and for using recommended tools for health communication. The health literacy of health services providers has implications for the degree of awareness of the importance of health literacy in treating and serving patients.

Health literacy: An opportunity for nurses to lead by example

Introduction: Health literacy plays a vital role in health education and health promotion and has received increasing attention as a means to improve health outcomes and reduce health inequality. The students’ awareness of health literacy and their weaknesses in this area are essential for educational planning. Objective: This study aimed to investigate the health literacy of non-medical college students and it’s affecting factors. Materials and Methods: This is a correlational study conducted on 250 non-medical students at the Islamic Azad University of Rasht branch, Rasht City, Iran in the academic year 2018-2019. They were selected using a random sampling method. The data collection tool was the Health Literacy For Iranian Adults (HELIA) questionnaire. The collected data were analyzed using the descriptive and analytical statistics (t-test, the Pearson correlation test, and the Chi-square test). Results: The Mean±SD of the HELIA score was 68.44±12.72 (out of 100). About 6.8% of students had inadequate health literacy, 29.6% problematic health literacy, 54.4% adequate health literacy, and 9.2% excellent health literacy. Students had the highest score in the dimensions of understanding Mean±SD (77.11±15.82) and access Mean±SD (72.35±16.73), while in decision-making and applying health information Mean±SD (55.62±15.01) they had the lowest score. There was no statistically significant correlation between students’ age and health literacy scores, but a statistically significant relationship was reported between their gender and health literacy levels (P=0.049). The Internet (54.8%) and physicians and health workers (27.2%) were the most important sources of information about health for students. Conclusion: Many students lacked sufficient health literacy. Since most of them received information about health issues through the Internet, educational health programs and contents can be provided to them through the Internet and social networks.

Health literacy (HL) is considered as an interaction between the demands of health systems and the skills of individuals. Considering that HL is a global epidemic, current global approach demands health professionals and organizations to be more accountable for universal precautions approach and improve communication skills, and employ strategies to confirm patient's understanding. There are limited number of studies that reveal the HL perception of healthcare professionals (HCPs) and their communication skills. The aim of this study is to evaluate HCPs' awareness of HL and compare the findings among the subgroups of HCPs. Moreover the frequency of using several universally accepted communication skills was evaluated. An online survey involving 29 items was developed and the link was distributed by physicians' and nurses' professional societies. Among the 277 participants who answered the questions, 184 were physicians and 78 were nurses. More physicians (38.0%) than nurses (18.4%) declared that the first time they heard about the term ＂HL＂ was through this survey. Although most of the participants did not receive any HL-related training, 92.7% of nurses and 77.3% physicians stated their willingness to receive information/training on the subject. The frequency of using methods that improve communication with patients and whether the participants' think that the health system/work environment does not support the use of such method were also evaluated. Methods like providing ＂information specifically designed according to patients' HL level＂ (8.6%), ＂individualized, condensed health education session＂ (10.5%), and ＂transferring a patient with difficulty to an education centre＂ were stated as not supported by the health system. Both the frequency and the variety of the communication methods were more for nurses than physicians. Factors obstructing effective communication with patients were lack of time, complexity and amount of the medical information, and language differences. These results emphasize the urgent need of initiatives to be taken to improve the awareness of HCPs on HL. The current structure of the roles and responsibilities of the HCPs needs to be improved to make it more HL-sensitive. HCPs' education, skills, workload, and the infrastructure of their institutions may not comply with the requirements of these initiatives. A global change is needed in the mind-set of the decision makers and educators, job definitions of HCPs, and their work environment. With a national multidimensional approach, results will be achieved and the problems caused by low HL will be diminished.

University of California, San Francisco School of Medicine

Low health literacy leads to poor knowledge and understanding of health information, delayed diagnosis, lower use of preventative medicines/health services, increased likelihood of hospitalisation, and increased patient anxiety. Effective communication facilitates patient understanding and helps patients to manage the adverse side-effects associated with treatment. It is not yet known whether radiation therapists in Ireland tailor their communication to match a patient's health literacy level. The purpose of this research was to investigate radiation therapists' knowledge and awareness of health literacy and perceptions of their role in supporting patients with low health literacy. Semi-structured interviews were conducted with sixteen radiation therapists working in four radiotherapy departments in Ireland. Data were analysed using the framework approach. Through discussions with participants, it was apparent that radiation therapists had limited knowledge of the concept of health literacy. Common themes arose from the interviews with four key themes identified: 1. Strategies used to identify patients' health literacy 2. Perceived effect of low health literacy 3. Obstacles faced when addressing low health literacy 4. Recommendations to support lower health literacy groups CONCLUSION: Currently, radiation therapists show some knowledge and awareness of health literacy, but an increased awareness of the prevalence of low health literacy and a structured approach to supporting patients would allow radiation therapists to more effectively communicate with patients, thus improving their treatment experience and reducing the risk of adverse outcomes.

Health literacy courses for health professionals have emerged in response to health professionals' perceived lack of understanding of health literacy issues, and their failure to routinely adopt health literacy practices. Since 2013 in Victoria, Australia, the Centre for Culture, Ethnicity and Health has delivered an annual health literacy demonstration training course that it developed. Course development and delivery partners included HealthWest Partnership and cohealth. The courses are designed to develop the health literacy knowledge, skills and organisational capacity of the health and community services sector in the western metropolitan region of Melbourne. This study presents key learnings from evaluation data from three health literacy courses using Wenger's professional educational learning design framework. The framework has three educational learning architecture components (engagement, imagination and alignment) and four educational learning architecture dimensions (participation, emergent, local/global, identification). Participatory realist evaluation approaches and qualitative methods were used. The evaluations revealed that the health literacy courses are developing leadership in health literacy, building partnerships among course participants, developing health literacy workforce knowledge and skills, developing ways to use and apply health literacy resources and are serving as a catalyst for building organisational infrastructure. Although the courses were not explicitly developed or implemented using Wenger's educational learning design pedagogic features, the course structure (i.e. facilitation role of course coordinators, providing safe learning environments, encouraging small group work amongst participants, requiring participants to conduct mini-projects and sponsor organisation buy-in) provided opportunities for engagement, imagination and alignment. Wenger's educational learning design framework can inform the design of future key pedagogic features of health literacy courses.

Serving Culturally and Linguistically Diverse Patients in Audiology-Part 2: Promoting Health Literacy

Health literacy (HL) is considered as an interaction between the demands ofhealth systems and the skills of individuals. The current global approachdemands health professionals to be more accountable for universal precautionsapproach and improve communication skills, and employ strategies to confirmpatients’ understanding. The aim of this study is to assess the knowledge andattitude of health care professionals (HCPs) about HL and their communicationskills, and its effect on their practices, and to compare the findings amongsubgroups of HCPs. An online cross-sectional survey involving 29 items wasdeveloped for sociodemographic and professional characteristics and knowledge,attitude, and practices evaluation. Health care professionals reached byoccupational organizations and social media platforms. Among the 277participants that answered the questions, 184 were physicians and 78 werenurses, and 37.99% of physicians and 18.42% nurses heard about the term “HL”through this survey. Most of the participants stated their willingness toreceive information/training on the subject and that knowing HL level wouldchange their approach to and outcomes of the patients. Nurses were using avariety of methods that improve communication with patients and considered HCPs’lack of knowledge of the concept of “HL” and their neglect of HL as obstacles toits evaluation more than physicians. These results emphasize the urgent need ofinitiatives to be taken to improve the awareness of HCPs of HL and thesubsequent incorporation of these initiatives into the daily health careservices they provide. Nurses’ awareness of HL is higher and they are alreadybetter at incorporating HL-sensitive items into their practices. Both graduateand continuing education programs need to be modified to improve HL knowledge ofall HCPs and its positive effects on health care. The current structure of theroles and responsibilities of these professions needs to be improved to make itmore HL sensitive.

Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient’s autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students’ competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations.

Introduction: 60% of Australian adults do not have the level of health literacy needed to understand and act on day to day health information. Low health literacy is linked to poorer health status, low use of preventive health services and higher rates of preventable hospitalisation. Faced with a growing and aging population and increasing rates of chronic and complex conditions, Northern NSW health services and health professionals must provide clear, accessible information that empowers patients, families and carers to understand and manage health conditions. Practice change implemented: The Northern NSW Health Literacy Project empowers people to understand and manage health conditions by: Developing health information that is easy to access, understand and act upon. Partnering with consumers to develop health information, assess service design and deliver health education. Building the capacity of the health workforce to improve communication with people in their care. Aim and theory of change: The Project aims to improve health communication and engage the community to empower people to be partners in their health care and understand and manage health conditions. Improving health literacy in this way can improve health outcomes and health service quality, safety and efficiency. Targeted population and stakeholders: The target population are people with chronic and complex conditions, their families and carers. Key stakeholders are the Northern NSW Local Health District (NNSW LHD) and North Coast Primary Health Network (NCPHN). Timeline: The Project commenced in July 2016. Highlights: The Project is jointly funded and implemented by NNSW LHD and NCPHN, allowing a unique whole of health system approach. The Health Literacy Website is the first of its kind in Australia. It contains information, resources and an online library of patient resources developed to meet health literacy standards. Visit http://healthliteracy.nnswlhd.health.nsw.gov.au/. Health Literacy Awareness and Workshops have been designed and delivered to over 700 health professionals and community members with significant impact on heath literacy knowledge and skills. 100% of surveyed attendees intended to implement at least one health literacy strategy. Health professionals are now developing and reviewing resources and communication practices in partnership with consumers to ensure health information is easy to access, understand and act on. Community members engaged in these processes report greater health literacy as a result of their involvement. Sustainability: The Project has resulted in systemic changes, building the foundations for a culture of health literacy. Health literacy is embedded in policy, and there is an increase in health literacy knowledge, confidence and skills among patients and workforce. The Website ensures sustainability, already continually expanding and improving. Transferability: The Website is easily transferable and accessible across health settings and geographical boundaries. Utilising digital technologies allows transferability within and outside NNSW. Conclusions: Improving the health literacy of health services and health professionals and empowering people to understand and manage their health can improve health outcomes and health service quality, safety and efficiency. The NNSW Health Literacy Project has demonstrated significant progress towards these aims and continues to build on these achievements.

We assessed the general knowledge of health literacy and the impact of limited health literacy on patients and to society in United States (US) audiologists and speech-language pathologists in Arkansas. A 10-item survey was completed by 198 professionals and students in communication sciences and disorders in Arkansas. The 10-items were divided into one demographic question, six patient-related health literacy questions, and three systems-related health literacy questions. Most professionals and students were aware that limited health literacy can be an obstacle for patients, but they were only somewhat or not aware of existing data on the average US adult reading grade level, the readability of clinic forms, or the estimated economic healthcare cost as a result of low health literacy. Increasing the awareness of health literacy and the impact of limited health literacy among all healthcare providers would be a worthwhile endeavor. More work is needed to study health literacy in various patient populations and to develop effective approaches to combat low health literacy in the field of communication sciences and disorders, as well as other healthcare disciplines, across the globe. This study suggests that health literacy awareness training may be needed, not only in Arkansas, but also throughout the US and other countries. The outcome should bridge the health literacy and communication gap between providers and their patients.

Health literacy awareness training for healthcare workers: Improving knowledge and intentions to use clear communication techniques

Introduction: Health literacy education, for health professionals, has been identified as having the potential to improve patient outcomes and has been recognized as such in policy developments. Health literacy, as a relational concept, encompasses individuals’ skills and how health information is processed in relation to the demands and complexities of the surrounding environment. Focus has been predominantly on the dimension of functional health literacy (reading, writing and numeracy), although increasing emphasis has been placed on interactive and critical domains. Such dimensions often guide the development of health professional education programmes, where the aim is to enhance the patient-practitioner relationship, and ultimately reduce the health literacy burden experienced by patients navigating health services. Currently little is known about qualified health professionals’ education in health literacy and communication skills, and development, implementation or evaluation of such interventions.Aim: To identify and map current educational interventions to improve health literacy competencies and communication skills of qualified health professionals.Methods: A scoping review will be conducted drawing on methods and guidance from the Joanna Briggs Institute, and will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. This study will retrieve literature on health professional education for health literacy and communication skills through a comprehensive search strategy in the following databases: CINAHL; Medline (Ovid); the Cochrane Library; EMBASE; ERIC; UpToDate; PsycINFO. Grey literature will be searched within the references of identified articles; Lenus; ProQuest E-Thesis Portal; RIAN and OpenGrey. A data charting form will be developed with categories including: article details, demographics, intervention details, implementation and evaluation methods.Conclusion: Little is known about the extent and nature of the current evidence base therefore a scoping review will be conducted, in order to identify programme characteristics in relation to health literacy competencies and communication skills.