Promoting Health Literacy at Hawthorne Education Center

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Promoting Health Literacy at Hawthorne Education
Center

• Jennifer P. Rho, MD, MPH

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Hawthorne Education CenterRochester, MN

• Rochester Public Schools facility dedicated to
  adult and family literacy
• Serves 3000 learners per year, 700 per day
• Employs 60 teachers and staff members
• 100 volunteers per week
• Highly committed learners, staff and volunteers

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Hawthorne Education CenterRochester, MN

• Courses of study English as a Second Language,
  Adult Basic Education, GED, High School Diploma,
  Hand in Hand, Citizenship preparation
• Ages 15-80, average age 25-30
• Represents 30 countries including U.S. born
  learners
• gt80 living below federal poverty level

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Health at Hawthorne A Challenge

• At least one ambulance per month at school prior
  to health promotion activities (pre-2005)
• Obvious health disparities among learners
• Pervasive problems with health care access
• High uninsurance
• 34 of Hawthorne learners are uninsured vs. 3
  uninsured in Rochester area (2007)
• Low health literacy - many those who have
  insurance act functionally uninsured

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Literacy Levels
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Health at HawthorneAn Opportunity
One of the main reasons Hawthorne learners say
that they are learning English is so that they
can talk with their doctor.
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The Early Days

• Environment was ripe for health promotion at
  Hawthorne
• Eager public health student
• Helped in whatever way I could

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Hawthorne Health Services

• Opened Sept 2005
• Collaborative among Hawthorne Education Center,
  Migrant Health Services, Olmsted County Public
  Health and Winona State University
• Open 4 days per week
• Free to Hawthorne learners and family members
• 4 providers, public health nurse, office
  assistant, Americorps VISTA volunteer
• Funded through donations

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Hawthorne Health Services

• Promote health literacy through
• Providing health education
• Providing limited health services at Hawthorne
• Identifying and accessing sources for health
  insurance and primary health care
• Collaborating with others in the community
• Providing case management for learners with
  ongoing health concerns

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What We Have Accomplished

• 5500 patient visits at the clinic since opening
• Additionally
• Annual health fair serves 400 learners/year
• Annual flu shot clinic provides gt200
  vaccinations/year
• Multiple other community partnerships-Mayo Breast
  Clinic
• Multiple health ed programs
• Introduced hundreds of health professionals to
  health literacy
• Jobs skills to community members - medical
  interpretation
• Very few ambulance visits to Hawthorne since
  clinic opened

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Service-Learning

• Provides opportunity for reciprocal learning
  about health literacy
• Train the next generation to provide
  patient-centered care
• Provides manpower to implement health promotion
  activities
• Great opportunity to build relationships
• gt50 nursing students/yr
• Varying number of med students
• Health fair, flu shot, screenings, exercise
  class, book club

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Annual Health Fair

• 400 learners
• Great community participation
• Guide for participants
• Follow-up survey
• Nutrition
• Weight loss
• Exercise
• Dental Care
• Blood pressure
• (Stress)

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Annual Cold and Flu Clinic

• Education-focused
• Service-learning
• Classroom based
• Video
• Posters
• Flu shot clinic

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Health Literacy Book Club

• Taught by nursing students and medical students
• ESL level 5
• Small groups
• Health Literacy Special Collection
• http//www.healthliteracy.worlded.org/
• Staying Healthy Florida Literacy Coalition
• Culture and Health
• Ask Me 3

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Mayo Patient Ed Pilot

• Field test Mayo Patient Ed materials with
  Hawthorne learners
• Goals
• To increase the health literacy of Hawthorne
  learners through the process of systematically
  evaluating patient ed materials
• To empower the Hawthorne learners to advocate for
  themselves when they do not understand health
  info that has been provided to them
• To utilize the expertise of the Hawthorne
  community (teachers and learners) to improve the
  quality of Mayo patient ed materials developed
  for Mayo patients

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Participatory Methods

• Hawthorne teachers and administrators
  participated in every aspect of development and
  implementation
• Classroom based
• Picked topic and individual materials to review
• Chose methods
• Gave input on the eval tools
• ESL, GED, Diploma

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How we included everyone

• Initial meeting
• Chose topic - healthy living
• Chose items to review
• Chose evaluation methods (Doak Doak)
• SAM
• Individual and group review for learners
• Met with teachers (ESL, Reading, GED, Diploma).
  Reviewed items and SAM. Did SAM together on food
  pyramid
• Teachers chose which items they wanted to review
  with their class
• Reviewed 1 item per week for 4 weeks

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Healthy living

• Topic has been consistently important to adult
  learners

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In The Classroom

• 8-10 classrooms per item
• Lead by a patient educator
• Introduction - This is your chance to be the
  teacher, to teach us how we can make health
  information easier to understand for you and your
  family
• Individual Evaluation
• Read designated pages
• Circle words that they did not understand
• Multiple choice questions to assess understanding
  of content
• Group review/teaching
• Debriefing with teachers, learner feedback

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Results

• Teachers and learners were VERY engaged and
  motivated
• Strong interest in healthy living info
• All of the materials were beyond the literacy
  levels of the learners
• Positives mutually beneficial, collaboration,
  community expertise, group interaction, valuable
  information
• Negatives Too much data, too much time

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Recommendations

• Rewrite the 4 tested items to match ESL level 4
• Establish process to selectively test pt ed
  materials with adult learners during development
• Tie into CASAS - develop lesson plan

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What have we learned over the past 6 years?

• Hawthorne learners utilize available health
  services when health education is provided
• Hawthorne learners participate more when the
  health topic is important to them
• Health activities should be guided by the
  community as much as possible

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A Note about Research

• Research has never been the guiding force behind
  our health activities
• Concerns about vulnerable population
• Community-led research
• Action-oriented
• Education-focused
• Marcia Drew Hohn, Ed. D.
• Literacy Leader Fellow 1996-1997

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Why We Have Been Successful

• Health literacy has been a topic of mutual
  interest
• Spirit of cooperation
• Hawthorne remains in control
• Reciprocal learning
• Individual agendas are minimized - careful
  selection of partners
• Efforts are a combination of civic engagement,
  community organizing, service learning
• Grass roots, bottom up approach, flexible,
  responsive
• No money to argue over

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Community Engagement Strategies

• Use existing community infrastructure when
  possible
• Get involved in your community
• Work with organizations not institutions-one
  exists to effect change, the other to maintain
  the status quo
• Asset-mapping
• Few organizations want another needs assessment
• Win-win situations - can help offset lack of
  funding
• Service-learning/Reciprocal learning
• Face time is very important
• The process is the product

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Tips for getting started

• Look for unique opportunities
• Be humble - be a leader without being the
  expert
• Utilize the practical expertise of community
  organizations and community members
• Relationships take time - start small and get to
  know the community (all levels)
• Minimize agenda setting
• Recognize that the community way is different
  than the academic way
• Plan to sustain the program

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Future Plans

• More collaboration
• Mayo Med School
• Mayo Ophthalmology
• Mayo Dermatology
• Public Health Immunizations
• Revamped health fair
• Healthy eating class
• Expand offerings for health literacy book clubs
• Work with Mayo Pat Ed to develop pt ed materials
• PRECEDE-PROCEED
• Hopefully some funding