Enhancing Health Literacy Across a Health System

From left,Terri Ann Parnell, DNP, RN, Joanne Turnier, MS

From left,Terri Ann Parnell, DNP, RN,
Joanne Turnier, MS

Terri Ann Parnell and Joanne Turnier focused on the optimization of health literacy programs and education in healthcare settings. The presenters shared strategies for improving patient-centered care using health literacy in the North Shore LIJ Health System.

Their campaign focused on diversity and developing patient-centered and individualized care, and it recognized that health literacy is a key component of improving their healthcare system. In 2010–2011, they conducted an in-depth needs assessment, and in 2013 they began to integrate programs and the process of outcome measurement. They engaged stakeholders across sectors, including clinicians, medical students, public health workers, administrators, and people in marketing and advertising.

The overall process of implementing a broad-scope health literacy intervention at the program level required the work of many dedicated individuals. Buy-in from stakeholders was key, and particular focus was paid to the inclusion of diverse cultures and health needs. The process started with a rigorous needs assessment and progressed by developing resources and standards. The resources were delivered to the appropriate people.

There was also a focus on teaching and training around health literacy. Training and practice of health literacy for patient care was made mandatory where possible, and subsequently taken to the bedside for integration. Measurement and assessment were initiated, and quality improvement is continuous.

Numeracy: Exploring Strategies to Convey Quantity, Time and Risk

Helen Osborne, MEd, OTR/L

Helen Osborne, MEd, OTR/L

Helen Osborne outlined overall strategies to increase understanding for patients who struggle with numeracy. They included:

  • Knowing the science (or the study design)
  • Knowing and understanding the data
  • Knowing what your audience may or may not know
  • It’s important to know why you are using numbers as well as to know that there can be multiple reasons to use them, to persuade, inform or compel recognition of danger or to make sense out of conflicting data. It might be possible that you don’t need to use numbers at all.

    Osborne offered specific strategies for conveying quantity, time, risk, and comparison data. When it comes to quantity, it’s important to confirm the measurement system you’re using. She mentioned a number of visual comparisons, including the compartmentalized plate and the Wong Baker Pain Scale, and comparisons with common objects like ping pong balls. She cautioned that mathematical symbols can be a form of jargon, and suggested that if you are meeting in person, you can actually do the math with the client. For conveying time, she suggested creating schedules that revolve around a person’s daily habits, rather than the clock, and including visuals representing time, such as sunrise and sunset, as exemplified by the AHRQ pill card.

    Osborne concluded the session with an exercise that paired a set of instructions requiring some kind of numeracy with an imagined client. The exercise gave participants the opportunity to employ some of the strategies and provoked lively discussion.

    How Do You Know They Know? Methods for Evaluating Teaching and Training

    Sabrina Kurtz-Rossi, MEd.

    Sabrina Kurtz-Rossi, MEd

    Education is a core component of health literacy. We routinely rely on health curricula that are valuable for students, but that also have measurable outcomes — a crucial tool for quality improvement and for seeking funding.

    This session helped attendees better understand the principles of adult education and demonstrated techniques that could be easily and readily measured. The application of these theories to curriculum development is two-fold. First, the pros and cons of various curriculum development methods should be assessed and the appropriate method chosen for the context. Second, the objective of the education needs to be identified. 

    In setting curriculum objectives, ask: what will participants know, and at what point will they know it? This question focuses on the audience, not on the curriculum.

    She provided steps to help create measurable observation criteria for evaluation:

    • Include action verbs in these objectives and target one expectation at a time.
    • Match the goals to the learning activities and the learning strategy.
    • Identify the indicator that the learning has been accomplished, making the objectives achievement based and measurable.
    • Be careful to include only one indicator at a time.

    There are two main types of evaluation that can be used: formative evaluation and outcome-based evaluation. It may include alternative assessments such as telling stories or “teach-backs,” portfolio review, self-assessment, or peer review. These are methods of goal-free program evaluation in which the evaluator does not know program goals, and are related in particular to Transformation Learning theory.

    Creating Unbiased, Understandable Shared Decision Materials: Is It Possible?

    Geri Lynn Baumblatt, MA

    Geri Lynn Baumblatt, MA

    Patient decision aids “prepare patients to make informed, values-based decisions with their practitioner,” said Geri Lynn Baumblatt, who works with decision scientists, clinicians, and patients to create multimedia decision aids. She gave a broad and detailed explanation of why they are being used now, what’s involved in creating them, and how to avoid bias.

    Shared decision making is a new practice. Patients may not be aware of multiple options, and understanding risk in the face of increasing amounts of data is a challenge. The patient’s quality of life may be significantly affected, and, as Baumblatt pointed out, practitioners are not particularly good at knowing what their patients want. Most patients now, 71% as opposed to 51% in 2000, want to be involved. 

    In order for shared decision making to happen, more than one reasonable option, including no treatment, needs to be in place, and values need to be recognized. Providers need to be open to the possibility that they may not agree with the patient’s choice. Allowing enough time for discussion is a factor, making the emergency room an inappropriate setting.

    Baumblatt finished with an in-depth and compelling set of strategies that can be used to create unbiased decision making aids. She feels it’s impossible to avoid influencing people’s choices. The goal when creating shared decision making tools is to create them in a way that’s most likely to help and least likely to inflict harm.

    Cultural Competency Training – A Collaborative Project

    Crystal Duran, MPH, MCHES

    Crystal Duran, MPH, MCHES

    Crystal Duran framed her session by noting that 25% of individuals choose not to seek care when sick or injured, and 76% of individuals don’t understand how the healthcare system works. For example, Rose doesn’t follow her treatment plan because she cannot read and is embarrassed to tell her doctor. Maria needs kidney dialysis treatments three times a week, but she doesn’t speak English and has trouble scheduling appointments. “These are the people we deal with every day, and it is a very confusing and frustrating system for patients to navigate themselves. That is why it is so important that patients can receive culturally competent care so that they better understand and can make informed decisions about their coverage and treatment plans.” 

    Unfortunately, she said, not everyone in your workplace will feel the same way. “There are a lot of people internally who will think it’s the patient’s problem and they need to figure it out. Sadly, we want them to have access to preventive care and to be healthy, but there is unwillingness on the part of physicians to want to be trained in this area. Sometimes they don’t understand and they don’t want to understand. It can be a lose-lose.”

    To combat internal opposition, she advised against calling it cultural competency training, but rather patient safety or equitable care training. “Cultural competency training tends to be a turn-off for doctors,” said Duran.

    There are also models for training that have already been done, and it would be beneficial to “expand your literature, research, and partnerships as you acquire ideas on how to develop your trainings.” When you think about partners, some of you may be reluctant to reach out to your competitors. But in this field, insurance companies are willing to come together for these values and mission,” assured Duran. “Step out of your comfort zone and make some time to phone one of your competitors to see what they have been doing for cultural competency health literacy training. You’ll be surprised!”