Session N: Creating a Technology-Based Health Literacy Toolkit

From left to right: Anupama Kapadia, BA, Sara Noble, MA, and Melanie Stone, MPH

From left to right: Anupama Kapadia, BA, Sara Noble, MA, and Melanie Stone, MPH

In this interactive workshop, Melanie Stone, Sara Noble, and Anupama Kapadia guided participants through the process of creating a technology-based health literacy toolkit based on their experiences with Access Care, Texas: ACT Together for Health (ACT). ACT is a community service learning project and interprofessional initiative at The University of Texas Health Science Center at San Antonio. Stone, Noble and Kapadia shared how ACT team collaborated with community partners, the San Antonio Health Literacy Initiative and the Enroll SA coalition, to create a health insurance literacy toolkit app that educates community members and health professionals on how to access and utilize health insurance.

The presenters took the participants through the step-by-step process of creating a technology-based health literacy toolkit. First, they presented a scenario based on the health insurance literacy need they identified in the San Antonio community and described how they determined their target population.

Participants were then guided through the process of establishing community partnerships to address a health literacy need.  Participants broke into small groups to brainstorm each step of the process of creating and evaluating a health literacy toolkit. Then they reconvened in a large group discussion to share their insights and ideas. As each step was presented, the shared how ACT approached this part of the process for the development of their health insurance app. They found success in using health professional students as an innovative way to address community needs, the creation of two academic-community partnerships and building a diverse community health coalition.

Noble, Stone, and Kapadia created and shared a workbook with their participants. It was used as an interactive tool throughout the workshop and a post-session resource for participants. Cultural competency was a major factor in the creation of the toolkit and participants were encouraged in small and large group activities to consider literacy level and cultural appropriateness of their messaging and health communication.

Evaluating and disseminating the toolkit was also discussed in both small groups and together as a class. The presenters emphasized the importance of community feedback and promoting the toolkit on a grassroots level. All three presenters actively engaged participants and answered questions about their health literacy programs and initiatives.


Session O: Teach-back: Make It an Always Event

Mary Ann Abrams, MD, MPH

Mary Ann Abrams, MD, MPH

Mary Ann Abrams, MD, MPH; Nationwide Children’s Hospital

Dr. Abrams began her workshop by showing a true-life video of a mother who had overmedicated her son because she had misunderstood the doctor’s instructions. While the story ended without serious injury to the child, it still effectively illustrated the danger of miscommunication. Dr. Abrams then solicited stories of provider/patient misunderstandings from the audience.

With everyone thus actively engaged, Dr. Abrams set out her objectives for participants of the workshop:

  1. Advocate for health literacy and teach-back as key elements of patient safety and quality care
  2. Incorporate the Always Use Teach-back! Toolkit into initiatives to become a more health literate health care organization
  3. Support colleagues in changing individual provider and organizational behaviour to increase use of teach-back

Dr. Abrams then showed a video of a doctor explaining to a mother and son how to use an inhaler for the boy’s exercise-induced asthma. The doctor used technical jargon, rushed through the explanation, and at the end, asked only if the mother and patient had any questions. Participants then discussed the possible results of the doctor’s poor communication, and how he could have handled things differently.

Dr. Abrams talked about teach-back as a quality and safety factor in health care practice and cited a growing body of research that supports the use of teach-back in various settings and populations. She explained what teach-back is:

  • Asking people to explain in their own words what they need to know or do, in a friendly way
  • NOT a test of the patient, but a measure of how well you explained something
  • A way to check for understanding and, if needed, re-explain, then check again

Dr. Abrams introduced participants to the Always Use Teach-back! Toolkit and its two modules: the first for training oneself to use teach-back, and the second for coaching others.

Dr. Abrams described teach-back as in investment, not an add-on to healthcare. She showed various tools within the toolkit for gauging conviction and confidence among providers in their use of teach-back. She emphasized that it is important to circle back to staff trained in teach-back, to observe how they are doing, to encourage and reward their efforts.

Dr. Abrams recommended incorporating teach-back into training, processes, intakes, order sets, and documentation of visits. She gave some additional tips for using teach-back well:

  • “Chunk and Check” when teaching more than one topic. That is, teach the 2-3 main points of the first topic; check for understanding with teach-back; then go on to the next topic.
  • Support teaching with reader-friendly materials.
  • Use teach-back for all key patient education and communication.
  • Document the use of, and response to, teach-back.

The workshop ended with participants splitting up into small groups to either practice teach-back role-playing or discuss how to implement teach-back in their organizations, followed by a group discussion of the exercise.

Always Use Teach-back! Toolkit:


Closing Keynote

From left to right: Michael Villaire, MSLM and Rima Rudd, Sc.D

From left to right: Michael Villaire, MSLM and Rima Rudd, Sc.D

Rima Rudd, Sc.D., Harvard T.H.Chan School of Public Health & Michael Villaire, MSLM, Institute for Healthcare Advancement

Dr. Rima Rudd and Michael Villaire closed the conference with their final thoughts and major takeaways. Rudd’s first observation was that the conference goers, speakers, and poster presenters have taken a leap outside and we are clearly working outside some of the boxes created in the early years of health literacy.

We are no longer myopically focused on the skills of patients but are taking a clear look at the skills and abilities of health professionals and the characteristics of health and healthcare institutions that erect literacy related barriers to information and care. We are also no longer solely focused on the activities within the clinical encounter or taking place with the hospital or medical setting. Instead, we are engaged in public health work with a clear link to issues of disparities and equity, access to information, access to care and services, and the availability of usable and accessible tools for action.

In spite of this progress, we still tend towards a focus on disease management and will need to look at more distant horizons related to the health of our communities, occupational health and safety, environmental health and climate change, disaster preparedness and management. Additionally, we need to be attentive to the voices here calling on us to be aware of discrimination and bias, and calling out for attention to social justice. Rather than label groups of people as hard to reach, we must improve our skills to reach out to people our society has ignored for too long.

At this year’s conference several speakers and presenters highlighted the ways in which academia and clinicians have worked together to implement health literacy best practices to create better health outcomes for their patients. We clearly know and value the scientific insistence on research based practice – putting into practice the findings from well designed research studies. However, the oddity for us is that practice is ahead of the curve and many research studies are still a bit stuck.

Many studies are still focused on who has or who does not have strong literacy skills. Others are still examining the capabilities of patients without considering the other key variables in the equation, such as the communication skills of the health professionals, the context of institutional environments, the writing skills of those who construct key information, forms, and documents, or the missing rigor in the design, development, and piloting of our health tools and texts.

Practice – as represented here in panels and talks, and on posters – is well ahead of the curve and people present here have been moving ahead:

  • to improve communication skills of health providers despite the lack of tools to measure their skills;
  • to train and provide interpreters and navigators to help people through the difficult waters of poorly delivered and poorly designed information and web sites;
  • to translate messages and key information for actual use by the lay public; and
  • to explore how to make up for the missing components related to caring outreach and dignified exchange.

Many of these efforts are accompanied by rigorous evaluation studies. Dr. Rudd articulated the need to shift the bias in publishing from academia to practitioners who are getting at the deeper causes of low health literacy and disparate health outcomes.