The role of health literacy in simulation education: needs assessment and call to action

Abstract

Understanding health literacy is crucial to improve health and reduce disparities. Simulation is an effective active learning strategy to teach health literacy. Our aim was to perform a needs assessment of health literacy education using simulation, to guide faculty development for simulation educators. Utilizing Kern’s curricular development process, problem identification, general and targeted needs assessments were performed. PubMed, CINAHL and PsycINFO searches were conducted using terms for health literacy and ‘prioritized health literacy competencies’ (PHLCs). Abstracts and full texts were screened. Simulation events that could feasibly incorporate health literacy were included. Data were collected regarding learners, type of event and incorporation of PHLCs. A targeted needs assessment used electronic survey to identify knowledge, attitudes and beliefs of local simulation educators regarding health literacy. Health literacy components of local simulation events (2018–2019) were assessed using a tool developed by the investigative team. Literature search identified 614 published articles, and 67 were included in analysis. ‘Avoidance of jargon’ (14/67) and ‘patient-centred approaches’ (11/67) were the most commonly cited PHLCs. No articles mentioned ‘delivery of information in 1–3 need-to-know elements’. Of the 57/881 local simulation events that could feasibly incorporate health literacy, 17/57 did so. ‘Jargon’ and ‘patient-centred’ care were the PHLCs most often present in learning objectives. Survey response rate was 77%. Only 18% (3/17) of local simulation educators demonstrated ‘comprehensive understanding’ of health literacy. Educators reported understanding ‘using universal precautions in written and oral communication’ (mean Likert 3.3) and ‘need-to-know/need-to-do concepts’ (3.4) least well. The majority felt including health literacy was important in simulation and believed they did this. There is a critical need to formalize and standardize language used when creating and studying simulations involving health literacy. An interprofessional faculty education program may assist faculty understanding of PHLCs when designing focused simulations for future healthcare providers.