How can we involve the populations that we serve in improving the health literacy environment of health care organizations?

1
How can we involve the populations that we serve
in improving the health literacy environment of
health care organizations?

• Nadia Ali, M.D, M.BB.S, MPH, FACP
• Associate Program Director,
• Internal Medicine Residency Program
• Clinical Assistant Professor,
• School of Medicine of Temple University,
• Crozer Chester Medical Center, Upland, PA.
• www.healthliteracynow.org

2
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  

3
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.

4
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

5
Outline(cont)

• What structures are needed for community
  involvement?
• What processes are needed for community
  involvement?
• Challenges in involving communities.

6
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

7
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.

8
Figure 1 Hospital Health Literacy Environment
-human resources
Skills
Expectations
Social worker
Doctors
Case Manager
Nurse
Staff
???
Intern
Med student
Resident
Preferences
9
Figure 2 Hospital Health Literacy Environment
-Material resources
Skills
Expectations
Technology
Consents
signs
Rights Res
Advance directives
Info Booklet
Payment calculation
Preferences
10
What are the components of the health literacy
environment?

• Navigation
• 2. Print Communication
• 3. Oral Exchange
• 4. Technology
• 5. Policies Protocols

11
Navigation

• Telephone System
• Entrance
• Lobby
• Staff Assistance
• Hallways Navigation Ease
• Service and specialty areas

12
Print Communication

• Writing style
• Organization and design
• Type Style, Size of Print, and contrast with
  Paper
• Photographs, Illustrations, Symbols, and
  Diversity

13
Oral Exchange

• Provision of assistance
• Translation services
• Use of plain language
• Use of audio and/or video tapes for patient
  education.

14
Technology

• Televisions
• Telephones
• Computers
• Kiosks

15
Policies Protocols

• Use of Print
• Oral exchange
• Staff orientation
• Staff skills building (print communication and
  oral exchange)

16
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.

17
Relationship between population and HL
environment.
Navigation
Print Communication
expectations
Resources
Needs
Oral Exchange
Beliefs
Values
Technology
Preferences
Language
Policies
18
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.

19
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.

20
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

21
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.

22
Level 1 Raising Awareness

• Basic level
• Specific examples of patients with poor outcomes
  secondary to HL barriers.
• Main objective is raising awareness

23
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.

24
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

25
Example cont.

• Audio

26
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.

27
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

28
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

29
Example of Level 1 HL task force for a community
Hospital

• Stake holders identified
• Residents-Noon conference
• Nurses-Monthly nurse managers meeting and floor
  nurse assemblies
• Senior Leadership- Director for patient safety
• Culture committee and patient education
  committee- representation
• Librarian

30
Level 2 Population involvement Assessment of HL
Environment

• Essential to determine the populations
• Needs
• Expectations
• Preferences
• Perceptions of our services
• Resources
• Values

31
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.

32
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)

33
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.

34
Example of Level 2 Assessment of Hospitals
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

35
Example of Level 2 Assessment of Hospitals
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.

36
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

37
Example of Level 3 New Medication Form

• Development of the form
• Piloting the form
• Post intervention follow-up

38
What structures are needed for population
involvement?

• Review organizational structure to identify
  existing resources
• Volunteers
• Students
• Community Organizations
• Patient families

39
What processes are needed for population
involvement?

• Identify interested stakeholders
• Involve them from the beginning
• Lay down ground rules
• Follow-up at regular intervals

40
Activity 2

• How would you involve your target population in
  assessing and improving the HL environment?

41
Target Areas

• A. 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

42
Challenges..brainstorm

• What challenges do you expect during the process
  of population involvement?

43
Challenges

• Involvement of stake holders
• Common ground
• follow-up
• Incentives for stake holders
• time
• material incentive
• recognition

44
Challengescontinue

• Choice of the HL barrier.
• Low hanging fruit
• Short steps
• feasibility
• Realistic timeline

45
Thank you