A'vision'for'health'literacy'development'

Health'literacy:''
Innova1ve'approaches'to''
improving'the'quality'of'care

We&...
Does Health
Literacy
make a
person’s
world go
around?

The
basics

•  Housing
•  Money
•  Support
•  Wellbeing
•  Advice
•...
Informa1on@rich'Health'Literacy'Ques1onnaire'
1.'Feeling'understood'and'supported'
by'healthcare'providers''

6.'Ability't...
Ophelia’s Principles
1.  Outcomes focused
–  Improved health and reduced health
inequalities
2.  Equity driven
–  All acti...
Health'literacy'Needs'
Not'a'single'High'/'Low'concept'

Health'literacy'profiles'–'‘nick'names’''
1.  High&health&literacy...
Health literacy needs assessment
Question asked of front line
practitioners/managers:

CRICOS&Provider&Code:&00113B&

Resp...
Grounded approach to HL intervention development
(Osborne, Batterham, Elsworth, Buchbinder)

Health&Literacy&Response&Fram...
The
basics

•  Housing
•  Money
•  Support
•  Wellbeing
•  Advice
•  Coaching
•  Other
Organisational
HL
interventions

He...
Thank you

Richard.Osborne@deakin.edu.au

www.ophelia.net.au
Note: PhD scholarship available in 2014!

CRICOS&Provider&Cod...
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Health literacy: Innovative approaches to improving the quality of care. Professor Richard Osborne

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School of Health and Social Development, Deakin University
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.

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Health literacy: Innovative approaches to improving the quality of care. Professor Richard Osborne

  1. 1. A'vision'for'health'literacy'development' Health'literacy:'' Innova1ve'approaches'to'' improving'the'quality'of'care We&need&research&and&development&programs&to&generate& new&insights&into:&& –  What&is&Health&Literacy?& •  How&can&it&be&opera<onalised& –  What&determines&an&individual’s&health&literacy?& –  What&are&the&consequences&of&low&health&literacy?& –  How&do&we&ensure&delivery&of&fair&and&equitable&health& services…&irrespec<ve&of&the&level&of&health&literacy?& –  How&do&we&make&the&system&responsive&to&people&with& low&health&literacy&in&day&to&day&prac<ce?& Professor Richard Osborne BSc, PhD Chair of Public Health Head, Public Health Innovation Co-Director, Population Health Strategic Research Centre School of Health and Social Development Deakin University, Melbourne, Australia 26th November 2013 WUN, Sydney CRICOS&Provider&Code:&00113B& Public&Health&Innova<on,&Deakin&University,&Australia& CRICOS&Provider&Code:&00113B& Inclusive Health Literacy organizing framework © Richard Osborne, Alison Beauchamp 2013 Supportive & determining structures Public&Health&Innova<on,&Deakin&University,&Australia& Does Health Literacy make a person’s world go around? The basics (Trust, faith, emotional, cultural, environmental) Healthy choices Basics (absence of catastrophic health problems, absence of poverty, safety) •  Housing •  Money •  Support •  Wellbeing •  Advice •  Coaching •  Other •  Informed •  Enabled •  Healthy productive lives
  2. 2. Does Health Literacy make a person’s world go around? The basics •  Housing •  Money •  Support •  Wellbeing •  Advice •  Coaching •  Other Does Health Literacy make a person’s world go around? Health literacy The basics •  Housing •  Money •  Support •  Wellbeing •  Advice •  Coaching •  Other Health literacy Healthy choices •  Informed •  Enabled •  Healthy productive lives Healthy choices •  Informed •  Enabled •  Healthy productive lives Interven1on'development' (interven1on'mapping)' 1.  Needs'assessment''(fine&grained&health&literacy&needs)' •  Needs&of&pa<ents&& •  Needs&of&system&(prac<<oners,&planners/managers,& policymakers)& 2.  From&the&needs&assessment&to&create&a&matrix&of&proximal& program&objec<ves& If you get this wrong, everything else is wrong 3.  From&the&target&users,&select&interven<ons,&methodologies&and& prac<cal&strategies&and&sugges<ons& 4.  CoZdesign&and&plan&interven<ons&with&all&stakeholders& 5.  Priori<sa<on,&adop<on&and&implementa<on&of&interven<ons& 6.  Monitoring&and&program&evalua<on.& If one is truly to succeed in leading a person to a specific place, one must first and foremost take care to find him where he is and begin there. Søren Kierkegaard: “Synspunktet for min Forfatter-Virksomhed. En ligefrem Meddelelse, Rapport til Historien”, C.A. Reitzels Forlag, 1859. CRICOS&Provider&Code:&00113B& Public&Health&Innova<on,&Deakin&University,&Australia&
  3. 3. Informa1on@rich'Health'Literacy'Ques1onnaire' 1.'Feeling'understood'and'supported' by'healthcare'providers'' 6.'Ability'to'ac1vely'engage'with' healthcare'providers'' 2.'Having'sufficient'informa1on'to' manage'my'health'' 7.'Naviga1ng'the'healthcare'system' •  I&can&rely&on&at&least&one&healthcare&provider& Development&of&the&& Health&Literacy&Ques<onnaire&(HLQ)&& for&interven<on&development •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& •  I&am&sure&I&have&all&the&informa<on&I&need&to& manage&my&health&effec<vely&& 3.'Ac1vely'managing'my'health' •  I&spend&quite&a&lot&of&<me&ac<vely&managing&my& health&& 4.'Social'support'for'health' •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.'Appraisal'of'health'informa1on'' •  When&I&see&new&informa<on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa<on&from&different& sources&& •  Discuss&things&with&healthcare&providers&un<l& you&understand&all&you&need&to&& 8.'Ability'to'find'good'health' informa1on' •  Get&health&informa<on&in&words&you& understand&& •  Find&informa<on&about&health&problems& 9.'Understand'health'informa1on'well' enough'to'know'what'to'do'' •  Read&and&understand&all&the&informa<on&on& medica<on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.'Beliefs'and'values' Geang&sick&is&part&of&geang&old& CRICOS&Provider&Code:&00113B& Health'literacy'interven1ons'to'improve' health'and'equity'@'innova1on'needed' •  Problem – We can not go to the literature to get Health Literacy interventions – There is (almost) nothing there that will fit my community/clinic/culture •  Realization Australian'Research'Council'(ARC)'' Linkage'Grant'(2012@2015)' – There is nothing new in health literacy, it is what GREAT frontline practitioners do each day •  It is also a part of good health policy •  Solution – Use information from (usual) patients, (great) practitioners, (great) managers and the literature •  Focus first on the insights of the best frontline practitioners …then&reflect&on&previous&theory& CRICOS&Provider&Code:&00113B& Public&Health&Innova<on,&Deakin&University,&Australia& •  Inves1gators' – Richard&Osborne& – Rachelle&Buchbinder& – Alison&Beauchamp& – Roy&Bacerham& – Sarity&Dodson& – Gerald&Elsworth& CRICOS&Provider&Code:&00113B& •  Partner'–'Victorian'Government' – Home&and&Community&Care&(HACC)& – Primary&Health& – Hospital&Admissions&Risk&Program&(HARP)& •  PhD'Scholars'(more'welcome)'
  4. 4. Ophelia’s Principles 1.  Outcomes focused –  Improved health and reduced health inequalities 2.  Equity driven –  All activities at all stages prioritise disadvantaged groups and those experiencing inequity in access and outcome 3.  Co-creation approach –  In all activities at all stages, relevant stakeholders engage in co-creation of solutions 4.  Needs-diagnostic approach –  Participatory assessment of local needs using local data 5.  Driven by local wisdom –  Intervention development and implementation is grounded in local experience and expertise. 6.  Sustainable –  Optimal health literacy practice becomes normal practice and policy 7.  Responsiveness –  Recognise that HL needs and the appropriate responses vary across individuals, contexts, countries, cultures and time 8.  Systemically applied –  A multi-level approach in which resources, interventions, research and policy are organised to optimise health literacy The'overarching+aims'of'the'project'are'to'improve'health' outcomes'and'reduce'health'inequali1es'for'people'with' long@term'condi1ons'through:' – Understanding&the&health&literacy&of&individuals;& – Tailoring&service'provider&response&to&individuals’&different&health& literacy&needs;&& – Targe<ng&the&health'system'response&to&a&community’s&health& literacy&needs;&and&& – Developing&a&comprehensive&recommended&framework&for& Victoria/Thailand/etc& www.ophelia.net.au www.ophelia.net.au CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& Health'Literacy'Ques1onnaire'–'needs'assessment' 1.'Feeling'understood'and'supported' by'healthcare'providers'' 6.'Ability'to'ac1vely'engage'with' healthcare'providers'' 2.'Having'sufficient'informa1on'to' manage'my'health'' 7.'Naviga1ng'the'healthcare'system' •  I&can&rely&on&at&least&one&healthcare&provider& •  I&am&sure&I&have&all&the&informa<on&I&need&to& manage&my&health&effec<vely&& 3.'Ac1vely'managing'my'health' •  I&spend&quite&a&lot&of&<me&ac<vely&managing&my& health&& 4.'Social'support'for'health' •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.'Appraisal'of'health'informa1on'' •  When&I&see&new&informa<on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa<on&from&different& sources&& •  Discuss&things&with&healthcare&providers&un<l& you&understand&all&you&need&to&& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& Administered to the see&& 8.'Ability'to'find'good'health' usual people informa1on' / trying to engaging •  Get&health&informa<on&in&words&you& engage with your understand&& •  Find&informa<on&about&health&problems& healthcare service 9.'Understand'health'informa1on'well' enough'to'know'what'to'do'' •  Read&and&understand&all&the&informa<on&on& medica<on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.'Beliefs'and'values' Geang&sick&is&part&of&geang&old& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B&
  5. 5. Health'literacy'Needs' Not'a'single'High'/'Low'concept' Health'literacy'profiles'–'‘nick'names’'' 1.  High&health&literacy& 2.  Overall&high&health&literacy&but&not& confident&about&finding&trustworthy& info& 3.  Overall'high'health'literacy'but'not' very'engaged'in'managing'or' thinking'about'health' 4.  Moderate&high&health&literacy&Z&some& difficul<es&understanding& informa<on& 5.  Moderately&high&health&literacy&but& low&social&support&and&some&difficulty& naviga<ng&health&services& 6.  Difficult'finding'informa1on'and' knowing'what'should'be'believed' 7.  Average&everything&Z&not&geang& quite&enough&informa<on&and&not& very&ac<ve& 8.  Average&everything&Z&but&insufficient& informa<on& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& 9.  Low'reading'and'wri1ng'ability'but'works' well'with'health'professionals' 10.  Moderately&low&health&literacy& (Informa<on&needs&increasing&complexity& with&mul<ple&condi<ons)& 11.  Not'gebng'the'informa1on'they'need'or' knowing'what'to'trust'(young,'diabetes' and'depression/anxiety)' 12.  Moderately&low&health&literacy,&not& geang&need&met&by&health&professionals,& low&social&support&Z&main&problem&is& others& 13.  Moderately'low'health'literacy,'not' gebng'needs'met'but'reasonable' rela1onships'with'Health'Profession'and' social'support'@'main'problem'is'their' own'abili1es' 14.  I'm&OK,&everyone&else&is&not&OK& 15.  It’s&all&awful&
  6. 6. Health literacy needs assessment Question asked of front line practitioners/managers: CRICOS&Provider&Code:&00113B& Response: CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& Ac#on&orientated&health&literacy&ques#onnaire& CRICOS&Provider&Code:&00113B& 1.&Feeling&understood&and&supported& by&healthcare&providers&& 7.&Naviga#ng&the&healthcare&system& Person level: What can be done to help them? Tailoring of interventions to the level of health literacy of the target groups Organisation level: What services and reorganisation of services are needed to serve them better? Service reorganisation to be responsive to specific / diverse needs Cannot&do—Very&easy& 6.&Ability&to&ac#vely&engage&with& healthcare&providers&& 2.&Having&sufficient&informa#on&to& manage&my&health&& Strongly&Agree—Strongly&disagree& CRICOS&Provider&Code:&00113B& •  I&can&rely&on&at&least&one&healthcare&provider& •  I&am&sure&I&have&all&the&informa?on&I&need&to& manage&my&health&effec?vely&& 3.&Ac#vely&managing&my&health& •  I&spend&quite&a&lot&of&?me&ac?vely&managing&my& health&& 4.&Social&support&for&health& •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.&Appraisal&of&health&informa#on&& •  When&I&see&new&informa?on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa?on&from&different& sources&& •  Discuss&things&with&healthcare&providers&un?l& you&understand&all&you&need&to&& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& 8.&Ability&to&find&good&health& informa#on& •  Get&health&informa?on&in&words&you& understand&& •  Find&informa?on&about&health&problems& 9.&Understand&health&informa#on&well& enough&to&know&what&to&do&& •  Read&and&understand&all&the&informa?on&on& medica?on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.&Beliefs&and&values& GeLng&sick&is&part&of&geLng&old& CRICOS&Provider&Code:&00113B& Ac#on&orientated&health&literacy&ques#onnaire& 1.&Feeling&understood&and&supported& by&healthcare&providers&& Cannot&do—Very&easy& 6.&Ability&to&ac#vely&engage&with& healthcare&providers&& 2.&Having&sufficient&informa#on&to& manage&my&health&& 7.&Naviga#ng&the&healthcare&system& Strongly&Agree—Strongly&disagree& •  I&can&rely&on&at&least&one&healthcare&provider& •  I&am&sure&I&have&all&the&informa?on&I&need&to& manage&my&health&effec?vely&& 3.&Ac#vely&managing&my&health& •  I&spend&quite&a&lot&of&?me&ac?vely&managing&my& health&& 4.&Social&support&for&health& •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.&Appraisal&of&health&informa#on&& •  When&I&see&new&informa?on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa?on&from&different& sources&& •  Discuss&things&with&healthcare&providers&un?l& you&understand&all&you&need&to&& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& 8.&Ability&to&find&good&health& informa#on& •  Get&health&informa?on&in&words&you& understand&& •  Find&informa?on&about&health&problems& 9.&Understand&health&informa#on&well& enough&to&know&what&to&do&& •  Read&and&understand&all&the&informa?on&on& medica?on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.&Beliefs&and&values& GeLng&sick&is&part&of&geLng&old& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& Grounded approach to HL intervention development Grounded approach to HL intervention development (Osborne, Batterham, Elsworth, Buchbinder) (Osborne, Batterham, Elsworth, Buchbinder) Across%10%disparate%centres Health literacy needs assessment Question asked of front line practitioners/managers: CRICOS&Provider&Code:&00113B& Response: CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& Patient level: What are the capabilities and resources of an individual? How do you help them? Tailoring of interventions to the level of health literacy of the target groups Organisation level: Who are our patients / citizens? What services are needed, how can services be reorganised? Service reorganisation to be responsive to specific / diverse patient needs CRICOS&Provider&Code:&00113B& Ac#on&orientated&health&literacy&ques#onnaire& CRICOS&Provider&Code:&00113B& Strongly&Agree—Strongly&disagree& 1.&Feeling&understood&and&supported& by&healthcare&providers&& Cannot&do—Very&easy& 6.&Ability&to&ac#vely&engage&with& healthcare&providers&& CRICOS&Provider&Code:&00113B& •  I&can&rely&on&at&least&one&healthcare&provider& 2.&Having&sufficient&informa#on&to& manage&my&health&& •  I&am&sure&I&have&all&the&informa?on&I&need&to& manage&my&health&effec?vely&& 3.&Ac#vely&managing&my&health& •  I&spend&quite&a&lot&of&?me&ac?vely&managing&my& health&& 4.&Social&support&for&health& •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.&Appraisal&of&health&informa#on&& •  When&I&see&new&informa?on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa?on&from&different& sources&& •  Discuss&things&with&healthcare&providers&un?l& you&understand&all&you&need&to&& 7.&Naviga#ng&the&healthcare&system& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& 8.&Ability&to&find&good&health& informa#on& •  Get&health&informa?on&in&words&you& understand&& •  Find&informa?on&about&health&problems& 9.&Understand&health&informa#on&well& enough&to&know&what&to&do&& •  Read&and&understand&all&the&informa?on&on& medica?on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.&Beliefs&and&values& GeLng&sick&is&part&of&geLng&old& CRICOS&Provider&Code:&00113B& Ac#on&orientated&health&literacy&ques#onnaire& Strongly&Agree—Strongly&disagree& 1.&Feeling&understood&and&supported& by&healthcare&providers&& Cannot&do—Very&easy& 6.&Ability&to&ac#vely&engage&with& healthcare&providers&& •  I&can&rely&on&at&least&one&healthcare&provider& •  Discuss&things&with&healthcare&providers&un?l& you&understand&all&you&need&to&& •  I&am&sure&I&have&all&the&informa?on&I&need&to& manage&my&health&effec?vely&& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& 2.&Having&sufficient&informa#on&to& manage&my&health&& 3.&Ac#vely&managing&my&health& •  I&spend&quite&a&lot&of&?me&ac?vely&managing&my& health&& 4.&Social&support&for&health& •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.&Appraisal&of&health&informa#on&& •  When&I&see&new&informa?on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa?on&from&different& sources&& 7.&Naviga#ng&the&healthcare&system& 8.&Ability&to&find&good&health& informa#on& •  Get&health&informa?on&in&words&you& understand&& •  Find&informa?on&about&health&problems& 9.&Understand&health&informa#on&well& enough&to&know&what&to&do&& •  Read&and&understand&all&the&informa?on&on& medica?on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.&Beliefs&and&values& GeLng&sick&is&part&of&geLng&old& CRICOS&Provider&Code:&00113B& Development' and' validation'of' a'HL'tool' using' systematic' grounded' consultation' processes Health Link%HLQ%to: assessment literacy needs Question asked of front line Patient'experience'and'Response: practitioners/managers: their'view'of'solutions Tailoring of CRICOS&Provider&Code:&00113B& HL'needs' assessment'(ie,' apply'HLQ'in' targeted' communities) CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& Ac#on&orientated&health&literacy&ques#onnaire& CRICOS&Provider&Code:&00113B& Strongly&Agree—Strongly&disagree& 1.&Feeling&understood&and&supported& by&healthcare&providers&& Cannot&do—Very&easy& 6.&Ability&to&ac#vely&engage&with& healthcare&providers&& CRICOS&Provider&Code:&00113B& •  I&can&rely&on&at&least&one&healthcare&provider& 2.&Having&sufficient&informa#on&to& manage&my&health&& •  I&am&sure&I&have&all&the&informa?on&I&need&to& manage&my&health&effec?vely&& 3.&Ac#vely&managing&my&health& •  I&spend&quite&a&lot&of&?me&ac?vely&managing&my& health&& 4.&Social&support&for&health& •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.&Appraisal&of&health&informa#on&& •  When&I&see&new&informa?on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa?on&from&different& sources&& Patient level: What are interventions to the capabilities and Clinician/practitioners' the level of resources of an health literacy of individual? experience'and'broad' the target How do you help them? groups history'of'solutions •  Discuss&things&with&healthcare&providers&un?l& you&understand&all&you&need&to&& 7.&Naviga#ng&the&healthcare&system& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& 8.&Ability&to&find&good&health& informa#on& •  Get&health&informa?on&in&words&you& understand&& •  Find&informa?on&about&health&problems& 9.&Understand&health&informa#on&well& enough&to&know&what&to&do&& •  Read&and&understand&all&the&informa?on&on& medica?on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.&Beliefs&and&values& GeLng&sick&is&part&of&geLng&old& CRICOS&Provider&Code:&00113B& Ac#on&orientated&health&literacy&ques#onnaire& Strongly&Agree—Strongly&disagree& 1.&Feeling&understood&and&supported& by&healthcare&providers&& Cannot&do—Very&easy& 6.&Ability&to&ac#vely&engage&with& healthcare&providers&& Organisation level: Who Health%Literacy% Response% Framework Service re- are our patients / citizens? Managers/policymakers' organisation to What services are needed, be responsive to how can services be diverse experience'and'views' specific / needs reorganised? patient of'what'is'possible. •  I&can&rely&on&at&least&one&healthcare&provider& •  Discuss&things&with&healthcare&providers&un?l& you&understand&all&you&need&to&& •  I&am&sure&I&have&all&the&informa?on&I&need&to& manage&my&health&effec?vely&& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& 2.&Having&sufficient&informa#on&to& manage&my&health&& 3.&Ac#vely&managing&my&health& •  I&spend&quite&a&lot&of&?me&ac?vely&managing&my& health&& 4.&Social&support&for&health& •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.&Appraisal&of&health&informa#on&& •  When&I&see&new&informa?on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa?on&from&different& sources&& 7.&Naviga#ng&the&healthcare&system& 8.&Ability&to&find&good&health& informa#on& •  Get&health&informa?on&in&words&you& understand&& •  Find&informa?on&about&health&problems& 9.&Understand&health&informa#on&well& enough&to&know&what&to&do&& •  Read&and&understand&all&the&informa?on&on& medica?on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.&Beliefs&and&values& GeLng&sick&is&part&of&geLng&old& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& Outcomes  costs'(short' term)  costs'(long' term)  Productivity' (long'term) Optimised'health healthy'behaviour Earlier'engagement positive'and'active' engagement'in'life System%response Prioritisation'of' services Skill'set'clarification' and'development communities'of' practice
  7. 7. Grounded approach to HL intervention development (Osborne, Batterham, Elsworth, Buchbinder) Health&Literacy&Response&Framework& Across%10%disparate%centres Development' and' validation'of' a'HL'tool' using' systematic' grounded' consultation' processes Link%HLQ%to: Health literacy needs assessment HL'needs' assessment'(ie,' apply'HLQ'in' targeted' communities) Matrix'of'interven1ons'and'intended'outcomes' Patient'experience'and'Response: Question asked of front line practitioners/managers: their'view'of'solutions CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& Ac#on&orientated&health&literacy&ques#onnaire& CRICOS&Provider&Code:&00113B& Strongly&Agree—Strongly&disagree& 1.&Feeling&understood&and&supported& by&healthcare&providers&& •  Discuss&things&with&healthcare&providers&un?l& you&understand&all&you&need&to&& •  I&am&sure&I&have&all&the&informa?on&I&need&to& manage&my&health&effec?vely&& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& 2.&Having&sufficient&informa#on&to& manage&my&health&& 3.&Ac#vely&managing&my&health& •  I&spend&quite&a&lot&of&?me&ac?vely&managing&my& health&& 4.&Social&support&for&health& •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.&Appraisal&of&health&informa#on&& •  When&I&see&new&informa?on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa?on&from&different& sources&& 7.&Naviga#ng&the&healthcare&system& 8.&Ability&to&find&good&health& informa#on& •  Get&health&informa?on&in&words&you& understand&& •  Find&informa?on&about&health&problems& 9.&Understand&health&informa#on&well& enough&to&know&what&to&do&& •  Read&and&understand&all&the&informa?on&on& medica?on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.&Beliefs&and&values& GeLng&sick&is&part&of&geLng&old& CRICOS&Provider&Code:&00113B& Patient level: What are the capabilities and resources of an individual? How do you help them? Clinician/practitioners' experience'and'broad' history'of'solutions Cannot&do—Very&easy& 6.&Ability&to&ac#vely&engage&with& healthcare&providers&& CRICOS&Provider&Code:&00113B& •  I&can&rely&on&at&least&one&healthcare&provider& Tailoring of interventions to the level of health literacy of the target groups Target'group+ Prac1ce'gap+ Health%Literacy% Response% Framework Interven1on+ Intended' outcomes+ Person'' Strongly&Agree—Strongly&disagree& 1.&Feeling&understood&and&supported& by&healthcare&providers&& •  I&can&rely&on&at&least&one&healthcare&provider& 2.&Having&sufficient&informa#on&to& manage&my&health&& •  I&am&sure&I&have&all&the&informa?on&I&need&to& manage&my&health&effec?vely&& 3.&Ac#vely&managing&my&health& •  I&spend&quite&a&lot&of&?me&ac?vely&managing&my& health&& 4.&Social&support&for&health& •  WI&have&at&least&one&person&who&can&come&to& medical&appointments&with&me&&& 5.&Appraisal&of&health&informa#on&& •  When&I&see&new&informa?on&about&health,&I& check&up&on&whether&it&is&true&or&not&& •  I&compare&health&informa?on&from&different& sources&& Cannot&do—Very&easy& 6.&Ability&to&ac#vely&engage&with& healthcare&providers&& •  Discuss&things&with&healthcare&providers&un?l& you&understand&all&you&need&to&& 7.&Naviga#ng&the&healthcare&system& •  Work&out&what&is&the&best&care&for&you&& •  Decide&which&healthcare&provider&you&need&to& see&& 8.&Ability&to&find&good&health& informa#on& && && && && Prac11oner' Organisation level: Who Managers/policymakers' Service re-to are our patients / citizens? organisation What services are needed, be responsive to experience'and'views' specific / diverse how can services be reorganised? patient needs of'what'is'possible. Ac#on&orientated&health&literacy&ques#onnaire& && && && && && && && && •  Get&health&informa?on&in&words&you& understand&& •  Find&informa?on&about&health&problems& 9.&Understand&health&informa#on&well& enough&to&know&what&to&do&& •  Read&and&understand&all&the&informa?on&on& medica?on&labels& •  Understand&what&healthcare&providers&are& asking&you&to&do&& 10.&Beliefs&and&values& GeLng&sick&is&part&of&geLng&old& CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B& Outcomes  costs'(short' term)  costs'(long' term)  Productivity' (long'term) System%response Prioritisation'of' services Optimised'health Skill'set'clarification' and'development communities'of' practice healthy'behaviour Earlier'engagement Level'of' interven1on+ Organisa1on/' ' policy' Partnerships/' inter@agency' positive'and'active' engagement'in'life www.ophelia.net.au • Australia • Asia – Partnerships across SE Asia and Western Pacific •  Thailand and Taiwan leadership •  Indonesia current discussions – WHO endorsement and support • EU • Africa • South America CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B&
  8. 8. The basics •  Housing •  Money •  Support •  Wellbeing •  Advice •  Coaching •  Other Organisational HL interventions Health literacy Health literacy Healthy choices •  Informed •  Enabled •  Healthy productive lives Applica1ons'of'health'literacy'assessments' 1.  Needs'assessment'/'interven1on'development' – Who&are&our&pa<ents?& – What&is&needed&to&meet&needs?& – What&are&the&characteris<cs&of&those&who&do&not&engage&in&health?& 2.  Benchmarking'/'Quality'' – Do&people&leave&your&health&services&with&higher&health&literacy&compared&with& when&they&enter?& – Is&there&varia<on&in&health&literacy&across&health&services?& 3.  Outcomes'assessment' – Did&your&health&literacy&interven<on&work?&& 4.  Understand'mechanisms' – Who&complies&with&treatments&/&health&interven<ons&and&why?& – Is&low&health&literacy&linked&to&medical&errors&or&iatrogenic&deaths?&& 5.  Management'/'treatment'burden'Assessment' – How&challenging&is&the&clinical&load&/&complexity&of&the&people&we&treat?& 6.  Educa1on'and'training' 7.  and'more…' CRICOS&Provider&Code:&00113B& The basics •  Housing •  Money •  Support •  Wellbeing •  Advice •  Coaching •  Other Healthy choices Individual HL interventions •  Informed •  Enabled •  Healthy productive lives Reflections: Why much of our research and programs go nowhere! An idea RCT Application An idea Co-creation Testing/PDSA Implementation Optimisation RCT Application CRICOS&Provider&Code:&00113B&
  9. 9. Thank you Richard.Osborne@deakin.edu.au www.ophelia.net.au Note: PhD scholarship available in 2014! CRICOS&Provider&Code:&00113B&
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