Improving Health Literacy: what we know, what we dont know AND what - - PowerPoint PPT Presentation

▶
improving health literacy what we know what we don t know
SMART_READER_LITE
LIVE PREVIEW

Improving Health Literacy: what we know, what we dont know AND what - - PowerPoint PPT Presentation

Oct 23, 2023 114 likes •564 views

Improving Health Literacy: what we know, what we dont know AND what could make a difference Professor Kirsten McCaffery Sydney School of Public Health kirsten.mccaffery@sydney.edu.au @KirstenMcCaffer The University of Sydney Page 1 2

slide-1
SLIDE 1

The University of Sydney Page 1

Improving Health Literacy: what we know, what we don’t know AND what could make a difference

Professor Kirsten McCaffery Sydney School of Public Health kirsten.mccaffery@sydney.edu.au @KirstenMcCaffer

slide-2
SLIDE 2

The University of Sydney Page 2

What we know: Health Literacy

Individual health literacy Demand from health literacy environment

2

slide-3
SLIDE 3

The University of Sydney Page 3

Low health literacy is common (ABS 2006)

Individual HL 60% ‘inadequate’ HL

3

slide-4
SLIDE 4

The University of Sydney Page 4

Individual HL 60% ‘inadequate’ HL HL environment 60-95% of health info too complex

4

PROBLEM!

slide-5
SLIDE 5

The University of Sydney Page 5

HEALTH LITERACY ENVIRONMENT

Systematic review: 126 written info CKD (Morony et al 2015)

  • Readability (Flesh-Kincaid)
  • Lexile score (complexity and demand)

Results

  • 77% beyond average recommended lexile score
  • 66% beyond average readability score (grade 8 = 13-14 yo)
  • 95% beyond level for low literacy popn (grade 5 = 10 yo)
slide-6
SLIDE 6

The University of Sydney Page 6

Health literacy environment matters….

  • 24-36 hrs after ED discharge: 80% of patients did not

understand home care instructions (Engels et al 2012).

  • 40-80% of health information given by HCPs forgotten

immediately (review by Kessels et al 2013).

  • Review of medication errors found 19-59% of patients make

errors – highest in patients with low literacy, elderly and with young children (Mira et al 2015).

slide-7
SLIDE 7

The University of Sydney Page 7

Health literacy costs billions…..

  • UK HL accounts for 3-5% of ALL healthcare costs –AUD$ 5-8

billion per year (2013-14).

  • Australia: increased out of pocket costs $143-$7798 per

person/ year.

  • Cost to health and quality of life is huge
slide-8
SLIDE 8

The University of Sydney Page 8

What can we do about health literacy?

slide-9
SLIDE 9

The University of Sydney Page 9

Use evidence-based interventions that work

slide-10
SLIDE 10

The University of Sydney Page 10

Improved Health Literacy

Written health information Prescription Drug labels Verbal communic- ation Risk communic- ation Shared Decision Making Engage with education sector

slide-11
SLIDE 11

The University of Sydney Page 11

Improved Health Literacy

Written health information Prescription Drug labels Verbal communic- ation Risk communic- ation Shared Decision Making Engage with education sector

slide-12
SLIDE 12

The University of Sydney Page 12

Improved Health Literacy

Written health information Prescription Drug labels Verbal communic- ation Risk communic- ation Shared Decision Making Engage with education sector

slide-13
SLIDE 13

The University of Sydney Page 13

Improved Health Literacy

Written health information Prescription Drug labels Verbal communic- ation Risk communic- ation Shared Decision Making Engage with education sector

slide-14
SLIDE 14

The University of Sydney Page 14

Improved Health Literacy

Written health information Prescription Drug labels Verbal communic- ation Risk communic- ation Shared Decision Making Engage with education sector

slide-15
SLIDE 15

The University of Sydney Page 15

Improved Health Literacy

Written health information Prescription Drug labels Verbal communic- ation Risk communic- ation Shared Decision Making Engage with education sector

slide-16
SLIDE 16

The University of Sydney Page 16

Improved Health Literacy

Written health information Prescription Drug labels Verbal communic- ation Risk communic- ation Shared Decision Making Engage with education sector

slide-17
SLIDE 17

The University of Sydney Page 17

  • Use of plain language improves understanding (Syst Rev: Sheridan

et al 2011, 2013) Eg. CDC

https://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf

Improving written health information

  • Information needs to be actionable ie. clear what steps should be

taken

  • Pay attention to images

‘Eat a palm size piece of meat’ ‘Avoid salty foods’

slide-18
SLIDE 18

The University of Sydney Page 18

Example: Increasing readability of discharge summaries

(Choudry et al 2018)

  • Prospective observational study n=1072 patients
  • Reduced reading level of DS from grade 10 to grade 8

Results:

  • Patient calls after discharge reduced 21.9% to 9% P<0.0001
  • Readmission reduced by 50% per 100 pts discharged

(P=0.002)

  • Calling and readmission for pain control decreased by >50%,

(P<0.02). Enhancing HL simultaneously reduced burden on health staff

slide-19
SLIDE 19

The University of Sydney Page 19

Prescription drug labels

slide-20
SLIDE 20

The University of Sydney Page 20

Prescription drug labels

take 1 at 6am and 1 at 6pm every day OR take 1 with breakfast and 1 with dinner take twice daily OR take every 12 hours

YES x NO

If instructions are precise and explicit drug label errors reduced from 50% to 11% lower literacy populations (Davies et al 2008)

slide-21
SLIDE 21

The University of Sydney Page 21

Verbal communication: Use Teach Back

21

slide-22
SLIDE 22

The University of Sydney Page 22

Verbal communication: Use Teach Back

Teach-back

  • HCP asks patient to explain in own

words what they need to know or do, in a caring way to ensure accurate understanding

  • Clinicians do not use it in practice

without specific training

22

Patients forget 40-80% of what clinicians say (Ley, 1998;

Kessels, 2013)

slide-23
SLIDE 23

The University of Sydney Page 23

RISK COMMUNICATION: use format that improve understanding (Trevena et al 2013)

  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●

5 out of 100 women will experience side effects or 5%....

slide-24
SLIDE 24

The University of Sydney Page 24

RISK COMMUNICATION: use format that improve understanding (Trevena et al 2013)

10 20 30 40 50 60 70 80 90 100
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●
  • ● ● ● ● ● ● ● ● ●

5 out of 100 women will experience side effects or 5%....

NOT

20% less women will experience side effects

slide-25
SLIDE 25

The University of Sydney Page 25

Shared Decision Making

slide-26
SLIDE 26

The University of Sydney Page 26

Shared Decision Making

In >100 RCTs SDM using DA improves pt

  • utcomes:
  • Knowledge, risk perceptions, uncertainty
  • Participation in DM; ‘positive’ Dr-patient communication
  • Impact may be greatest in lower literacy/ socially

disadvantaged patients

Stacy D et al Cochrane Review PtDAs (2017); Durand et al PLOS one (2014)

slide-27
SLIDE 27

The University of Sydney Page 27

Engage with the education sector

  • Adult and community based education e.g. TAFE Health

Literacy Program (McCaffery et al HLRP; Muscat et al HLRP

accepted); AMEP; Skilled for Health (UK).

  • Schools
slide-28
SLIDE 28

The University of Sydney Page 28

How well are we doing in Australia?

  • Use of plain language materials
  • Prescription drug labels

X

  • Teach-back
  • Risk communication formats
  • Shared decision making

X X X X

slide-29
SLIDE 29

The University of Sydney Page 29

Behaviour change required….

slide-30
SLIDE 30

The University of Sydney Page 30

Health Literacy Hub community

  • f practice
slide-31
SLIDE 31

The University of Sydney Page 31

Sydney Health Literacy Lab research group Health Literacy Hub community of practice

slide-32
SLIDE 32

The University of Sydney Page 32

Sydney Health Literacy Lab: a behavioural science

and communication research group

  • Director: Prof Kirsten McCaffery
  • Deputy Director: A/Prof Jesse

Jansen

  • Westmead Lead: Dr Danielle

Muscat

slide-33
SLIDE 33

The University of Sydney Page 33

Our work seeks to build partnerships and educational opportunities in health literacy research and practice:

  • 1. Understand the diverse needs of the community and health care

services

  • 2. Develop and test new knowledge, skills or solutions to address

those needs

  • 3. Help implement new strategies to improve health literacy

effectively and sustainably in the community and health system AIM: to create a body of evidence to reduce the burden of low health literacy that can translate into practice

Sydney Health Literacy Lab:

slide-34
SLIDE 34

The University of Sydney Page 34

Sydney Health Literacy Lab

Dr Danielle Muscat, Westmead Health Literacy Lab Lead

slide-35
SLIDE 35

The University of Sydney Page 35

The Health Literacy Lab: exemplar collaborative research projects

  • 1. RCT of a TAFE health literacy education program (McCaffery et

al 2018 accepted)

  • 2. Health Direct & SHLLab trial of Teach back (Morony et al 2018)
  • 3. Parenting Plus HL program (Danielle Muscat, Lyn Trunchon, Dipti

Zacchariah, Anne Harris et al)

  • 4. CKD HL App (Danielle Muscat, Angela Webster et al)
  • 5. Diabetes App with Western Sydney Diabetes (Julie Ayre, Carissa

Bonner, Glen Maberly et al)

slide-36
SLIDE 36

The University of Sydney Page 36

– Partners: TAFE, CEC, NSW Health, NPS MedicineWise, USYD – Health literacy education program – 23 TAFE sites, 308 low literacy students – Guided lesson plan and resources

  • Teaching manual
  • Worksheets / exercises
  • Teaching resources

36

  • 1. TAFE Health Literacy program trial
slide-37
SLIDE 37

The University of Sydney Page 37

TRIAL DESIGN

37

Adult learners n=308 23 adult education colleges Intervention: HL program Standard LLN program

End of course assessment* 6 month follow-up

*Quantitative Measures Functional HL skills (temp, labels: medicine + nutrition) HLQ – generic scale Confidence Question asking/ SDM Involvement preferences HLQ scale, self-reported question asking, DM involvement Baseline assessment* Qualitative interviews: 30 students All teachers (n=37) All CHW 18 weeks

SDM program

Muscat et al

slide-38
SLIDE 38

The University of Sydney Page 38

Key Findings:

HL program improved health literacy (immed post & 6mths follow-up):

  • Ability to read nutrition labels (6.03 vs 5.49/10; P=0.022)
  • Confidence understanding health information (0.34 vs 0.06;

P=0.014).

  • HLQ subscale: ability to actively manage health (P=0.01)
  • Shared Decision Making knowledge & skills (QA, numeracy)
  • Health knowledge, confidence & SDM sustained at 6 months.
  • Course was very popular with students and staff (68% students

rated ‘excellent’ or ‘very good’).

  • Learnings shared with family and friends (84.2%).
slide-39
SLIDE 39

The University of Sydney Page 39

  • 2. Teach-Back telehealth intervention

Collaboration Sydney HL Lab, Health Direct, RDNS Trial of Teach-Back (n=637 callers) with Health Direct Parenting Baby and Birth Helpline. Teach-Back skills training to nurse telephone staff Stepped wedged cluster RCT

slide-40
SLIDE 40

The University of Sydney Page 40

Teach-Back telephone helpline trial

  • 637 callers, 87% female and 13% (n=127) inadequate health literacy
  • A consistent pattern suggests Teach-Back helped callers with

inadequate health literacy – Improved understanding (OR 2.3; P=0.06) – Reduced caller anxiety (OR 2.44; P=0.06) – Increased confidence ‘to know what to do next’ (OR 2.68; P=0.06)

  • Nurses felt their communication was more effective (OR 2.31;P<0.001)
  • 2 hours staff training & self-reflection tasks - feasible to implement

teach-back in a telephone health service

  • S. Morony, K Weir, C Bell, J Biggs, G Duncan, D Zialtis, D Nutbeam, K. McCaffery. Plos One (2018)
slide-41
SLIDE 41

The University of Sydney Page 41

Sydney Health Literacy Lab and Health Literacy Hub: research focused education program

  • Program of research placements for staff and students on

applied projects

  • Summer research scholarships
  • PhD scholarships and stipends
  • Research consultancy advice and support
  • Seminar series in collaboration with the Health Literacy Hub
slide-42
SLIDE 42

The University of Sydney Page 42

Sydney Health Literacy Lab research group Health Literacy Hub community of practice

slide-43
SLIDE 43

The University of Sydney Page 43

Working together we can make a difference….

slide-44
SLIDE 44

The University of Sydney Page 44

Thank you

Professor Kirsten McCaffery Sydney School of Public Health kirsten.mccaffery@sydney.edu.au @KirstenMcCaffer