Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Acknowledgements.                    Innovations in Health literacy:                  from measurement to intervention    ...
Health Literacy: several definitions                           Use of the Health Education                           Impac...
How has health literacy been measured?                                                                                    ...
Steps in instrument development               Development.of.the.                                 .       Health.Literacy....
Concept mapping    Structured conceptualisation process grounded in                the real world of individual       citi...
Scales.of.difficulty….                                                                                      Find health info...
28%.of.                                                                                            people.                ...
Applications of a comprehensive                                                                              Applications ...
Health promotion:                                                                                          Prevention     ...
Upcoming SlideShare
Loading in …5
×

2012 World University Network Northampton Health Literacy - International perspectives

560 views

Published on

An overview of some of the most innovate and person-, practitioner-, and policymaker-centered thinking about health literacy

  • Be the first to comment

  • Be the first to like this

2012 World University Network Northampton Health Literacy - International perspectives

  1. 1. Acknowledgements. Innovations in Health literacy: from measurement to intervention MonashUniversity,Australia .Prof.Rachelle.Buchbinder. DeakinUniversity,Australia Richard Osborne .Mr.Roy.Ba;erham,.Prof.Gerald.Elsworth. Visiting Professor, Copenhagen University TaiwanNa8onalNormalUniversity,Taiwan Professor of Public Health .Prof.Annie.Chieh@Hsing.Liu. Director, Population Health Strategic Research Centre HealthSystemsResearchIns8tute,Thailand Deakin University .Dr.Charay.Vichathai. Australia VictorianGovernment,DepartmentofHealth,Australia WUN, Southampton, 22nd May2012© Richard Osborne 2012, Deakin University, Australia. Components of the Health Education Impact Questionnaire (heiQ) •  From the patient, practitioner and policymaker perspective, what should self-management impact on? 1.  Positive and Active Engagement in Life 2.  Health-Directed Activities 3.  Skill and Technique Acquisition 4.  Constructive Attitudes and Approaches 5.  Self-Monitoring and Insight 6.  Health Service Navigation 7.  Social Integration and Support 8.  Emotional Distress
  2. 2. Health Literacy: several definitions Use of the Health Education Impact Questionnaire (heiQ) •  Health.literacy.represents.the.cogniFve.and.social.skills.which.determine. the.moFvaFon.and.ability.of.individuals.to.gain.access.to,.understand.and. use.informaFon.in.ways.which.promote.and.maintain.good.health ..(World. Health.OrganizaFon). •  An.individual s.overall.capacity.to.obtain,.process.and.understand.basic. health.informaFon.and.services.needed.to.make.appropriate.health. decisions .(US.InsFtute.of.Medicine). •  The.capacity.of.an.individual.to.obtain,.interpret.and.understand.basic. health.informaFon.and.services.in.ways.that.are.health.enhancing .(UK. NaFonal.Consumers.Council). •  Health.literacy.is.the.ability.to.make.sound.health.decisions.in.the.context. of.everyday.life.–.at.home,.in.the.community,.at.the.workplace,.the. healthcare.system,.the.market.place.and.the.poliFcal.arena .(Kickbusch,. 2001). •  People s.competences.to.access,.understand,.appraise.and.apply. informaFon.to.make.health.decisions.in.everyday.life.throughout.the.life. course.(Sorensen.2011). The association between Lower health literacy associated with: Health Literacy and Health Outcomes –  inadequate knowledge about health and healthcare system –  increased hospitalisation –  poor access and utilisation of health services •  People with lower health literacy ~ 1.5 to 3 times more likely to experience poor health event •  Based on blunt measures of health literacy De Walt DA, et al. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med 2004:12:1228-39.© Richard Osborne 2012, Deakin University, Australia. © Richard Osborne 2012, Deakin University, Australia.
  3. 3. How has health literacy been measured? Application of existing•  Mostly.been.assessed.through.measuring.reading. measures of health literacy ability,.comprehension.and.word.recogniFon.skills. •  Key.tools.used.with.paFents:. 1..Rapid.EsFmate.of.Adult.Literacy.in.Medicine.(REALM). •  Prevalence of low health literacy in Australia 2..Test.of.FuncFonal.Health.Literacy.in.Adults.(TOFHLA). 3..Newest.Vital.Sign.(NVS). Barber M, Staples M, Osborne RH, Clerehan R, Elder C, Buchbinder R. Up to a quarter of the population may have suboptimal health 4..Audit.of.wri;en.materials./.signage.. literacy: a population-based survey. Health Promotion International 5..NaFonal.Literacy.Surveys. 2009; 24:252-261. Prevalence of low health literacy (N = 310)Grade 4-6 May need low-literacy materials; may not be able to read 6 (2%) prescription labelsGrade 7-8 May struggle with most currently available patient 35 (11%) education materials National survey (NAAL)High school Should be able to read most patient education materials 269 (87%) suggested that ~60% of Australians have low (N = 309) health literacy.Inadequate May be unable to read and interpret health texts 8 (3%)Marginal Would have difficulty reading/interpreting health texts 13 (4%)Adequate Could read and interpret most health texts 288 (93%) Tests fail to meet Will the real level of fundamental health literacy please (N = 308) The definition of measurement0-1 Suggests highly likely (50% or more) limited literacy 22 (7%) Health Literacy: stand up?. does not match criteria2-3 Indicates possibility of limited literacy 58 (19%) what current tools4-6 Almost always indicates adequate literacy 228 (74%) measure!
  4. 4. Steps in instrument development Development.of.the. . Health.Literacy.QuesFonnaire.(HLQ) 1.  Purpose and conceptualisation – grounded approach based on widespread consultation, our preferred method is concept mapping 2.  Draft item development – strict item writing rules, cognitive interviews 3.  Administration to a ‘construction sample’ – 600+ general population, 400 in each special group 4.  Psychometric analysis and refinement – structural equation modelling (Cluster analysis to identify groups of people with different health literacy profiles) 5.  Administration to a ‘validation sample’ – 600+ general population, 400 in each special group 6.  Finalization of the tool 7.  Develop a web of evidence of the value of the tool in target settings A grounded approach to conceptualization health literacy from the individual’s perspective •  Maximum heterogeneity •  Interviews and Concept Mapping workshops: If one is truly to succeed in leading a person to a specific place, –  Individuals who had taken part in a chronic disease self-one must first and foremost take care to find him where he is and management program (n=20) begin there. –  General population (n=14) –  Individuals who recently presented to the Hospital Emergency Department (n=14) Søren Kierkegaard: “Synspunktet for min Forfatter-Virksomhed. En ligefrem Meddelelse, Rapport til Historien”, C.A. Reitzels Forlag, 1859. –  International workshop consultation (Borneo) –  Expert clinicians (n=15) –  Expert patients (n=12) –  Community services managers/policymakers (n=10) –  Many other people across fields
  5. 5. Concept mapping Structured conceptualisation process grounded in the real world of individual citizens, practitioners and policy makers Seeding statement: 1.  Brainstorming session Results Thinking about your 2. Sorting and rating experiences in trying to of statements look after your health (or the health of your family), 3. Multivariate what abilities does a person analysis (multi- dimensional scaling and need to have in order to get cluster analysis) and to use all of the 4. Interpretation of information they need? maps © Richard Osborne 2012, Deakin University, Australia. PersonIcentredhealthliteracyStrongly Agree—Strongly disagree Cannot do—Very easy1. Healthcare provider support 7. Agency in relationships with•  I have at least one healthcare provider who knows providers me well •  Discuss things with healthcare providers until you Breadth and depth•  I trust advice I get from healthcare providers understand all you need to2. Perceived adequacy of health •  Feel able to discuss your health concerns with a information healthcare provider•  I have all the information I need to manage my health properly 8. Navigating the healthcare system •  Each scale is an independent questionnaire and •  Work out what is the best care for you•  When I receive treatments I always understand what they are for •  Work out how to make an appointment to see a healthcare provider has items that measure a wide range of Health3. Taking responsibility for health•  I set my own goals about health and fitness 9. Ability to access health information Literacy status •  Get health information in words you understand•  There are things that I do regularly to make myself •  Find information about health problems more healthy 10. Reading & writing health4. Being health focused information•  My health is important to me •  Read and understand all the information on•  Despite other things in my life, I make time to be medication labels healthy •  Follow the instructions from healthcare providers5. Social support properly•  If I need help, I have plenty of people I can rely on6. Critical appraisal 11. Beliefs and values•  I know which places provide health information that I Getting sick is part of getting old can trust A quote from Primary Care…•  When I see new information about health, I check up on whether it is true or no “Richard… these are the things that doctors hate most about their patients” © Richard Osborne 2012, Deakin University, Australia.
  6. 6. Scales.of.difficulty…. Find health information from several different places Find information about health problems .© Richard Osborne 2012, Deakin University, Australia. 40%.of. people. Measurement across the full range of the cannot.do. this.or.find.it. construct through carefully written items very.difficulty.. Item Difficulty Ability to Access Health Information 1..Find.health.informaFon.from.several.different. 0.60. Hardest places. 5..Find.informaFon.about.health.problems. 0.78. Easiest© Richard Osborne 2012, Deakin University, Australia. © Richard Osborne 2012, Deakin University, Australia.
  7. 7. 28%.of. people. cannot.do. Distribution of scores Measurement across the full range of the this.or.have. construct through carefully written items great. difficulty.. Item Difficulty Agency with healthcare professionals 1. Make sure that healthcare providers 0.72 Hardest understand your problems properly 3. Ask healthcare providers questions to get 0.78 the health information you need 5. Feel able to discuss your health concerns 0.86 Easiest with a healthcare provider© Richard Osborne 2012, Deakin University, Australia. Applications of a comprehensive Applications of a comprehensive measure of health literacy measure of health literacy Obtain a profile of an individual’s health literacy Evaluation of an intervention aimed to empower a disadvantaged group in their self-management 2.Perceived adequacyof 4.Being 4.Being 1.Healthcare health healthfocused. healthfocused. provider informa8on. 3.Taking 3.Taking support. responsibility responsibility forhealth. forhealth. 10.Reading& 5.Social 5.Social wri8nghealth support.. support.. informa8on. 9.Abilityto accesshealth 7.Agencyin 7.Agencyin 6.Cri8cal informa8on. 8.Naviga8ng rela8onships rela8onships appraisal. thehealthcare withproviders. withproviders. system.© Richard Osborne 2012, Deakin University, Australia. © Richard Osborne 2012, Deakin University, Australia.
  8. 8. Applications of a comprehensive Applications of a comprehensive measure of health literacy measure of health literacy Evaluation of a program to improve communication To understand the needs of individuals through surveys of target populations 2.Perceived 2.Perceived adequacyof adequacyof 4.Being 1.Healthcare health 1.Healthcare health healthfocused. provider informa8on. provider informa8on. 3.Taking support. support. responsibility We.must. forhealth. 10.Reading& 10.Reading& 5.Social wri8nghealth understand.needs. support.. wri8nghealth informa8on. so.that.the. informa8on. 9.Abilityto 9.Abilityto accesshealth accesshealth intervenFons.we. 7.Agencyin 6.Cri8cal informa8on. informa8on. develop.can.meet. 8.Naviga8ng rela8onships appraisal. thehealthcare these.needs. withproviders. system.© Richard Osborne 2012, Deakin University, Australia. © Richard Osborne 2012, Deakin University, Australia. Needs assessment But can health What.about.children?. education improve health The$new$person+centred$health$literacy$ literacy in Tailoring.of. Strongly Agree—Strongly disagree children? Cannot do—Very easy Applications of a comprehensive measure of health literacy What.are.the.capabiliFes. intervenFons. 1. Healthcare provider support 7. Agency in relationships with A comprehensive understanding of an individual and.resources.of.an. to.the.level.of. I have at least one health provider who knows me well providers Equitable. Discuss things with healthcare providers until health. 2.#Perceived# 2. Perceived information 4.#Being# you understand all you need to adequacy#of# individual,.and.challenges. 1.#Healthcare# health# health#focused! health.literacy. provider# informa=on! 3.#Taking# responsibility# adequacy support! for#health! 8. Navigating the health system IntervenFons.healththe information I need to manage 10.#Reading#&# 5.#Social# Work out what is the best care for you outcomes./. wri=ng#health# support!! are.they.experiencing?.. I have all informa=on! 9.#Ability#to# of.the.target. access#health# 7.#Agency#in# informa=on! 8.#Naviga=ng# rela=onships# 6.#Cri=cal# appraisal! my properly to.improve.. Taking responsibility for 9. Ability to access health the#healthcare# informed.and. with#providers! system! 3. groups. information© Richard Osborne 2012, Deakin University, Australia. health Health.literacy.my own goals about health and fitness I set Get health information in words you understand empowered. 4. Being health focused in.children.My health is important to me 10. Reading, writing, understanding adults. 5. Social support Follow the instructions from healthcare If I need help, I have plenty of people I can providers properly rely on Applications of a comprehensive Who.are.our.paFents./. Service.re@ 6. Critical appraisal 11. Beliefs and values These are the measure of health literacy organisaFon.to. I know which places provide health Getting sick is part of getting old ciFzens?.How.are.they. A comprehensive understanding of an individual information that I can trust 1.#Healthcare# 2.#Perceived# adequacy#of# health# 4.#Being# health#focused! be.responsive. skills we need responding.to.our. provider# informa=on! 3.#Taking# support! responsibility# our children to for#health! 10.#Reading#&# 5.#Social# to.diverse. wri=ng#health# support!! informa=on! 9.#Ability#to# services,.educaFon?.. access#health# 7.#Agency#in# have as they 6.#Cri=cal# informa=on! 8.#Naviga=ng# rela=onships# appraisal! the#healthcare# with#providers! paFent.needs. system! © Richard Osborne 2012, Deakin University, Australia. enter adulthood© Richard Osborne 2012, Deakin University, Australia.
  9. 9. Health promotion: Prevention evidence pathway in schools (Taiwan) A.health. Is.health.literacy. ‘opportunity’. the.missing.link. ➡ Education Needto in.health. promoFon?. –  Distribution and quality of demonstrate school health education causallinks… I.have.a.health. ➡ Health literacy changeover problem. Choose new behaviour 8me. –  National survey Datacanthen . (n=170,000) inform I.might.have.a. ➡Risk factor survey health.problem… Choose to not do new behaviour prac8ceand policy one.day. –  National surveys . ➡Health status Remain unaware/ unable / Unaware./. disinterested –  National surveys disinterest.© Richard Osborne 2012, Deakin University, Australia. © Richard Osborne 2012, Deakin University, Australia. Why is health literacy important? 1.  Clinicians need to know a person’s capacity to process and Thank you understand health information to be able to communicate with them effectively Richard.Osborne@deakin.edu.au 2.  Policy makers need to understand the community’s capacity to gain access to and understand health information to be able to set appropriate policies and provide appropriate resources 3.  Researchers need to understand these issues to make correct judgments about research methods, processes, findings etc 4.  Health literacy is a fundamental element of self-care, and Release of HLQ… a matter of weeks! should be considered when developing and evaluating - enquiries very welcome interventions 5.  We cannot provide complete health education without Development of a e-Health Literacy tool understanding health literacy - Enquires very very welcome 6.  We cannot move the field of health literacy until a web of evidence is developed based on sound measurement that is based on sound theory © Richard Osborne 2012, Deakin University, Australia.

×