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

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&


Inclusive
Health
Literacy
organizing
framework
© Richard Osborne,
Alison Beauchamp 2013

Supportive
&
determining
structures


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

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.



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&

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&



•  Inves1gators'
– Richard&Osborne&
– Rachelle&Buchbinder&
– Alison&Beauchamp&
– Roy&Bacerham&
– Sarity&Dodson&
– Gerald&Elsworth&

•  Partner'–'Victorian'Government'
– Home&and&Community&Care&(HACC)&
– Primary&Health&
– Hospital&Admissions&Risk&Program&(HARP)&
•  PhD'Scholars'(more'welcome)'

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



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&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'


5.'Appraisal'of'health'informa1on''

•  When&I&see&new&informa<on&about&health,&I&
•  I&compare&health&informa<on&from&different&
sources&&

•  Discuss&things&with&healthcare&providers&un<l&
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&
asking&you&to&do&&

10.'Beliefs'and'values'

Geang&sick&is&part&of&geang&old&


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&





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&

Health literacy needs assessment
Question asked of front line
practitioners/managers:


Response:




Ac#on&orientated&health&literacy&ques#onnaire&

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&



•  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&


5.&Appraisal&of&health&informa#on&&

•  When&I&see&new&informa?on&about&health,&I&
•  I&compare&health&informa?on&from&different&
sources&&

•  Discuss&things&with&healthcare&providers&un?l&
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&
asking&you&to&do&&

10.&Beliefs&and&values&

GeLng&sick&is&part&of&geLng&old&




manage&my&health&&






health&&




sources&&

see&&

informa#on&

understand&&

medica?on&labels&
asking&you&to&do&&









Grounded approach to HL intervention development


(Osborne, Batterham, Elsworth, Buchbinder)

Across%10%disparate%centres



Response:



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








manage&my&health&&



health&&




sources&&



see&&

informa#on&

understand&&

medica?on&labels&
asking&you&to&do&&










see&&

manage&my&health&&

health&&




sources&&

informa#on&

understand&&

medica?on&labels&
asking&you&to&do&&




Development'
and'
validation'of'
a'HL'tool'
using'
systematic'
grounded'
consultation'
processes

Health Link%HLQ%to: assessment
literacy needs
Patient'experience'and'Response:
their'view'of'solutions Tailoring of


HL'needs'
assessment'(ie,'
apply'HLQ'in'
targeted'
communities)










manage&my&health&&



health&&




sources&&


interventions to

Clinician/practitioners' the level of
resources of an
health literacy of
individual?
experience'and'broad' the target
groups
history'of'solutions



see&&

informa#on&

understand&&

medica?on&labels&
asking&you&to&do&&








Health%Literacy%
Response%
Framework

Service re-

Managers/policymakers'
organisation to
be responsive to
how can services be
diverse
experience'and'views' specific / needs
reorganised?
patient
of'what'is'possible.




see&&

manage&my&health&&

health&&




sources&&

informa#on&

understand&&

medica?on&labels&
asking&you&to&do&&






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


Health&Literacy&Response&Framework&

Across%10%disparate%centres
Development'
and'
validation'of'
a'HL'tool'
using'
systematic'
grounded'
consultation'
processes

Link%HLQ%to:


HL'needs'
assessment'(ie,'
apply'HLQ'in'
targeted'
communities)

Matrix'of'interven1ons'and'intended'outcomes'

Patient'experience'and'Response:
their'view'of'solutions










see&&

manage&my&health&&

health&&




sources&&

informa#on&

understand&&

medica?on&labels&
asking&you&to&do&&




resources of an
individual?

Clinician/practitioners'
experience'and'broad'
history'of'solutions




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''



manage&my&health&&



health&&




sources&&




see&&

informa#on&

&&

&&

&&

&&

Prac11oner'

Managers/policymakers' Service re-to
organisation
be responsive to
experience'and'views' specific / diverse
how can services be
reorganised?
patient needs
of'what'is'possible.


&&

&&

&&

&&

&&

&&

&&

&&

understand&&

medica?on&labels&
asking&you&to&do&&





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


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…'

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


Thank you

Richard.Osborne@deakin.edu.au

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


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

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