Building organisation health literacy with Canterbury Hospital

Project Status
Current

Investigators
Dr Jane Lloyd, Prof Mark Harris, Dr Sarah Dennis, A/Professor Elizabeth Harris, A/Prof Marilyn Wise, Dr Nicola Dunbar

Project Rationale

Health literacy has historically been conceived as a patient problem, however, more recent research recognises that system changes are also needed to align health care delivery better with public health literacy skills and abilities. The health care system can effectively address health literacy by ensuring health services are easier to navigate, access and understand. 

Project Aims

•             Train and support Bilingual Community Educators to conduct patient experience and walking interviews to identify the strengths, weaknesses and opportunities for enhancing organisational health literacy

•             Facilitate a reflective process with patients, staff and managers to identify three concrete strategies for building organisational health literacy based on the findings from the needs assessment

•             Develop an organisational health literacy intervention to support the process of setting and implementing concrete strategies for change, based on the needs assessment

•             Support implementation of changes to structures and policies, team processes, provider communication practice and community education and confidence.

Background

Why health literacy is an important concept for the Australian healthcare system

Health literacy is increasingly recognised as a pillar for improving the health of populations.  It is important because it affects access to and use of health care, the quality of patient–provider communication and patients ability to manage their chronic conditions (1).

In 2014, building health literacy was identified as a national priority with the publication of the National Health Literacy Statement (2). It has been defined as the knowledge, skills, confidence and networks that are necessary for staying healthy, accessing preventive screening, deciding on treatment options, self-management and effective communication (3, 4).

Historically conceived as a patient problem, more recent research recognises that system changes are also needed to align health care delivery better with public health literacy skills and abilities. The health care system can effectively address health literacy by ensuring health services are easier to navigate, access and understand (5).

Health literacy is also an important concept for improving equitable access to health care. Sixty percent of Australians have health literacy below what is necessary to access appropriate health care (6). Low health literacy disproportionally affects disadvantaged Australians which, in turn, impacts on mortality and burden of disease as well as health service use and costs (7-9).

The characteristics of the social groups with low levels of health literacy are: immigrants whose English language skills are limited; immigrants from countries without comprehensive, trustworthy health care systems; members of low socioeconomic groups with limited education (6).

Therefore the challenge for health care organisations and providers becomes to communicate in health literate ways that meet the cultural and linguistic needs of patients. These organisations ‘must expect and prepare for diversity in the way they communicate about health care, train providers, and organise workflow’ (10). 

Organisation health literacy strategies for change will require a multilevel response from individual patients, healthcare professionals, managers and organisations and policy makers (11).  Some of the strategies may include recognising health literacy in organisations mission statements and policies, health professional training, quality improvement, tailoring of patient information, navigation support. 

Objectives

The project will pilot and evaluate the implementation and impact of an intervention to address organisational health literacy from the perspective of patients from culturally diverse backgrounds.

The objectives include:

  • Train and support Bilingual Community Educators to conduct patient experience and walking interviews to identify the strengths, weaknesses and opportunities for enhancing organisational health literacy
  • Facilitate a reflective process with patients, staff and managers to identify three concrete strategies for building organisational health literacy based on the findings from the needs assessment
  • Develop an organisational health literacy intervention to support the process of setting and implementing concrete strategies for change, based on the needs assessment
  • Support implementation of changes to structures and policies, team processes, provider communication practice and community education and confidence.

Methods

This is a mixed method study that will identify the impact of an organisational health literacy intervention on improving:

  • administrative staff and health professionals knowledge, confidence, attitudes and practice;
  • processes of care (arranging referrals, patient follow up and navigation support) and
  • community knowledge and confidence to know where and when to access health care.

The methods will include adapting the First Impressions Walking Interview assessment process (12) for use in Canterbury Hospital.  Four Bilingual Community Educators (BCEs) will be invited to participate. Training will be provided to the BCEs, service providers and department heads on organisational health literacy and walking interview.  The adaptation process will be facilitated by the researchers and the BCEs in collaboration with the participating health services. 

The assessment will include BCEs conducting the walking interview with patients from culturally diverse backgrounds to assess the strengths and weaknesses of the organisation’s health literacy and feedback the findings to the researchers.  In addition the BCEs will interview patients from diverse cultural groups to seek their feedback on their previous experiences communicating with clinicians.

The quality improvement process will include the following steps:

  • Synthesise the findings of the walking interviews in collaboration with the BCEs
  • Facilitate a workshop with the participating services to feedback the findings from the walking interviews and identify three concrete priorities and strategies for change
  • Draft and implement the health literacy environment needs assessment and action plan.

The evaluation will include the following steps:

  • Interviews with BSEs, service providers and department heads on the effectiveness of the walking interviews in identifying the organisations health literacy strengths and weakness and concrete strategies for change
  • Thematic analysis of the interviews
  • Preparation and distribution of the final report for the SLHD executive and to the participating service providers.

 

References

1.         von Wagner C, Steptoe A, Wolf M, Wardle J. Health litearcy and health actions: a review and a framework from health psychology. Health Education and Behaviour. 2009;36(5):860-77.

2.         Australian Commission on Safety and Quality in Health Care. Health Literacy National Statement: Taking action to improve safety and quality. Sydney: ACSQHC, 2014.

3.         Brega AG, Barnard J, Mabachi NM, Weiss BD, DeWalt DA, Brach C, et al. AHRQ Health Literacy Universal Precautions Toolkit: Second Edition. In: Services USDoHaH, editor. Rockville, MD: Agency for Healthcare Research and Quality; 2015.

4.         Rudd R, Comings JP, Hyde JN. Leave no one behind: improving health and risk communication through attention to literacy. Journal of Health Communication. 2003;8(S1):S104-S15.

5.         Brach C, Keller D, Hernandez L, Baur C, Parker R, Dreyer B, et al. Ten attributes of health literate organizations. Washington, DC: Institute of Medicine, 2012.

6.         Australian Bureau of Statistics. Adult literacy and life skills survey, summary results. Canberra: ABS; 2006 (2008 Reissue).

7.         Dewalt DA, Berkman ND, Sheridan S. Literacy and Health Outcomes. A Systematic Review of the Literature. J Gen Intern Med

2004;19:1228-39.

8.         Greenhalgh T. Health literacy: towards system level solutions. Journal of General Internal Medicine. 2012;27:173-8.

9.         Joshi C JU, Parker S, Del Mar C, Russell G, Lloyd J, Mazza D, Denny-Wilson E, van Driel M, Taylor R, Harris MF,. Does health literacy affect patients' receipt of preventive primary care?  A multilevel analysis. BMC Family Practice. 2014;15(171).

10.       Alper J. Integrating Health Literacy, Cultural Competence, and Language Access Services: Workshop Summary. Washington: The National Academies Press, 2016.

11.       DeWalt DA, Callahan LF, Hawk VH, Broucksou KA, Hink A, Rudd R, et al. Health Literacy Universal Precautions Toolkit. (Prepared by North Carolina Network Consortium, The Cecil G. Sheps Centre for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF, Rockville, MD. Agency for Healthcare Research and Quality. 2010.

12.       Rudd R. The Health Literacy Environment Activity Packet:  First Impressions and Walking Interview. Online tools: Harvard University, 2010.