How can we involve the populations that we serve in improving the health literacy environment of

health care organizations?

Nadia Ali, M.D, M.B;B.S, MPH, FACPAssociate Program Director,

Internal Medicine Residency Program Clinical Assistant Professor,

School of Medicine of Temple University,Crozer Chester Medical Center, Upland, PA.

www.healthliteracynow.org

No conflicts of interest

No employment relationships outside of my primary affiliation

No memberships on a Board of Directors or other leadership position

No research funding received. No paid consultant positions or membership in an

advisory board or review panel No membership in a speaker's bureau No major stock or investments relevant to your

position No Other sources of income, including

relationships and company name  

Objectives

To identify the different levels of community participation in a health care organization.

To analyze the structures and processes needed to involve populations in identifying, assessing and eliminating health literacy barriers

To reflect upon potential challenges and opportinities in involving populations at the organizational level.

Outline

What is ‘Health Literacy Environment’? Components of ‘Health Literacy Environment

of a health care organization. Defining the characteristics of a population Relationship between population and health

literacy environment. Defining the different levels of community

involvement

Outline…(cont)

What structures are needed for community involvement?

What processes are needed for community involvement?

Challenges in involving communities.

What is ‘Health Literacy’?

Health literacy emerges when the expectations, preferences, and skills of individuals seeking health information and services meet the expectations, preferences, and skills of those providing information and services. Health Literacy: A Prescription to End Confusion. Institute of Medicine, 2004

What is ‘Health Literacy Environment’?

The health literacy environment of a healthcare facility represents the expectations, preferences, and skills of those providing health information and services.

Figure 1: Hospital Health Literacy Environment -human resources

Skills

DoctorsNurse

Staff

Social worker Case

Manager

InternMed student

Resident

???

Expectations

Preferences

Figure 2: Hospital Health Literacy Environment -Material resources

signs

Technology

Consents

Advance directives

Info

Booklet

Rights & Res

Payment

calculationPreferences

SkillsExpectations

What are the components of the health literacy environment?

Navigation 2. Print Communication 3. Oral Exchange 4. Technology 5. Policies & Protocols

Navigation

Telephone System Entrance Lobby Staff Assistance Hallways Navigation Ease Service and specialty areas

Print Communication

Writing style

Organization and design

Type Style, Size of Print, and contrast with Paper

Photographs, Illustrations, Symbols, and Diversity

Oral Exchange

Provision of assistance Translation services Use of plain language Use of audio and/or video tapes

for patient education.

Technology

Televisions Telephones Computers Kiosks

Policies & Protocols

Use of Print Oral exchange Staff orientation Staff skills building (print

communication and oral exchange)

Defining the characteristics of a population

A population is defined as a collection of human beings living in the same area.

The population being served by a health organization may consist of several communities.

Each community is characterized by its unique needs, risks, preferences, beliefs, values, language and resources.

Relationship between population and HL environment.

Navigation

Print Communication

Oral Exchange

Technology

Policies

Needs

Beliefs

expectations

Values

Preferences

Language

Resources

Activity 1

Each group will be assigned an at risk target population. Each group will come up with creation of an optimal health literacy environment for its target population in an office setting. How can each of the different component of the HL environment address the need of the target population. You have 10 minutes for discussion followed by a short presentation from each group.

Target Populations

A. Elderly population with difficult sight and hearing.

B. Chinese (Mandarin) speaking population consisting of large families.

C. African American population with limited reading and writing skills and less than high school education.

Defining Population Involvement

Inclusion of individuals who are adult learners or limited health literacy in the design, implementation and evaluation of health information and services.

Attributes of a health literate organization: IOM Roundtable on Health Literacy Jan 2012

Levels of Population Involvement

Level 1: Raising awareness about potential HL barriers.

Level 2: Assessment of HL barriers.

Level 3: Development of interventions to address HL barriers.

Level 1: Raising Awareness

Basic level

Specific examples of patients with poor outcomes secondary to HL barriers.

Main objective is raising awareness

Example:

36 year old African American female admitted second time with shortness of breath.

Patient recently delivered a normal baby about 1 months ago.

Post partum hospital stay for 2 weeks and diagnosed with post partum cardiomyopathy.

Example cont…

Visited her PCP 3 days post hospital discharge.

ED visit 1 week following the PCP visit. Sent out with same meds.

Second hospital admission with same symptoms as post discharge because family upset about symptoms not resolving and the first hospital not ‘good enough’

Example cont….

Audio

Level 1: Raising Awareness

Identifying key HL barriers through involvement of the population

Identifying key stake holders of organization

Meeting with key stake holders to specific examples indicating the need for improvement.

Level 1: Raising Awareness

Identify interested stakeholders and get their feedback on potential solutions.

Convene interested stake holders to

form a taskforce or an interest group to deal with the situation

Example of Level 1: HL task force for a community Hospital

Collection of specific patient examples pertinent to oral exchange component of the HL environment.

Supplementation with a survey that indicated low knowledge amongst residents and nurses regarding HL

Example of Level 1: HL task force for a community Hospital

Stake holders identified

Residents-Noon conferenceNurses-Monthly nurse managers meeting and floor nurse assembliesSenior Leadership- Director for patient safetyCulture committee and patient education committee- representationLibrarian

Level 2 Population involvement: Assessment of HL Environment

Essential to determine the populations

Needs Expectations Preferences Perceptions of our services Resources Values

Level 2 Population involvement: Assessment of HL Environment

Tools for assessment include

HL Environment Assessment Survey

HCAHPS

Staff, patients and their families, and community observations.

HCAHPS Questions

How often did staff explain about medicines before giving them to patients?

How often did hospital staff tell you what the medicine was for? (Q16)

How often did hospital staff describe possible side effects in a way you could understand? (Q17)

Level 2 Population involvement: Assessment of HL Environment

Identify community resources and partnering with them

Involve community members in identifying a barrier using available tools.

Use community input to get a better understanding of the HL barriers and population needs.

Example of Level 2: Assessment of Hospital’s navigation system

Pharmacy representation on the task force.

Use of new student volunteers to fill out the navigation assessment on Day 1

Collection of forms and data entry

Example of Level 2: Assessment of Hospital’s navigation system

Discussion of the results with the sign committee.

Discussion with senior hospital executives regarding budget.

Roll out of the intervention at the beginning of next year.

Level 3: Development of interventions to address HL barriers.

Involving the population in the design of the intervention.

Pilot testing in the population

Post intervention follow-up

Example of Level 3: New Medication Form

Development of the form

Piloting the form

Post intervention follow-up

What structures are needed for population involvement?

Review organizational structure to identify existing resources

Volunteers Students Community Organizations Patient families

What processes are needed for population involvement?

Identify interested stakeholders

Involve them from the beginning

Lay down ground rules

Follow-up at regular intervals

Activity 2

How would you involve your target population in assessing and improving the HL environment?

Target AreasA. Elderly population with difficult sight

and hearing –Providing consent for transfusions and surgical procedures

B. Chinese (Mandarin) speaking population consisting of large families- hospital to home discharge.

C. African American population with limited reading and writing skills and less than high school education- providing education about chronic diseases

Challenges…..brainstorm

What challenges do you expect during the process of population involvement?

Challenges

Involvement of stake holdersCommon groundfollow-up

Incentives for stake holderstimematerial incentiverecognition

Challenges…continue

Choice of the HL barrier.Low hanging fruitShort stepsfeasibilityRealistic timeline

Thank you