how can we involve the populations that we serve in improving the health literacy environment of...
TRANSCRIPT
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