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How to improve patient-communication? Impact of organisational health literacy in Ireland and the Netherlands


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Marise Kaper
Health Literacy Conference: Making Life Better
Belfast 2018

Published in: Health & Medicine
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How to improve patient-communication? Impact of organisational health literacy in Ireland and the Netherlands

  1. 1. How to improve patient-communication? Impact of organisational health literacy interventions in Ireland and the Netherlands Marise Kaper, MSc Jane Sixsmith, Louise Meijering, Janine Vervoordeldonk, Priscilla Doyle, Margaret Barry, Andrea de Winter, Menno Reijneveld
  2. 2. Communication barriers for low health literacy
  3. 3. Organisational health literacy interventions • Organisational Health Literacy Interventions (OHLIs) assess barriers and plan actions to improve communication (Brach et al., 2012): – navigation (complex signage) – written (leaflets, forms, out patient letters) – digital (web pages) – oral (patient – provider interaction) • Mixed findings on short term period (6 months): – more awareness and reduction of barriers – actions can be difficult to implement in complex settings
  4. 4. Study aim & framework We aimed to evaluate the implementation, moderators and outcomes of two OHLIs in Ireland and the Netherlands over 16 months; using the framework of Carroll et al. (2007), modified by Hasson et al. (2010). Implementation of OHLIs Adherence regarding: 1. Content 2. Intervention dose Outcomes following implementation of OHLIs Moderators: 1. Recruitment 2. Intervention complexity 3. Facilitation strategies 4. Participant responsiveness 5. Quality of delivery 6. Context
  5. 5. Methods Health care settings & Participants: • One Irish hospital setting & three Dutch settings (hospital & rehabilitation) • Staff (N=24): management, nurses, communications, IT. • Health service users via adult literacy service Implementation of two OHLIs: • IRL: Literacy Audit for Health Care Settings Adult Literacy Toolkit (Lynch, 2009) • NL: Quickscan Health Literacy Toolbox (Bax, 2014) Evaluation of implementation by questionnaires and interviews: 1. Planning and assessment - 6 months 2. Action planning - 8 months 3. Long term outcomes - 16 months
  6. 6. Overview of results Implementation fidelity • Fidelity to chosen components • Tailoring of OHLI delivery • Longer duration of activities Moderators • + HSUs identified unique barriers • Contextual moderators: • + Anticipation of staff • + Commitment of management+ • - Lack of time/resources • - Difference in procedures & structures Range of Outcomes • +Awareness of health literacy and barriers • + Improved written and digital communication • - Navigation and oral communication not improved
  7. 7. Moderators Moderators enhanced or hindered OHLI implementation: - Intervention complexity: “My experience is, is that it is a lot. That it would be nicer if it [the OHLI tools] were digitally better available". (NL participant 13, interview) + Context: anticipation of staff: “See where you can reinforce each other. A stand-alone project has less chance of success. It is nice that you link it to, self-management, patient-centeredness, hospitality. It will give you more opportunities to implement”. (NL participant 1, follow up) + Context: management commitment: “It’s very good! The general manager, the director of nursing, they are very committed to this. And like that it’s a patient experience initiative as well”. (IRL, participant 23, follow up)
  8. 8. Outcomes 1. More awareness of health literacy communication barriers: • “We said in advance, everyone scrolls, when you go to the website. I saw this with those low-literate people, nobody scrolls. And then there is a lot of information underneath”. (NL, participant 6, interview) 2. Structural improved quality of written and digital communication: health literacy policies, plain language training, improved leaflets, letters and webpages. • “The health literacy policy for the hospital? So that people have a process to follow when they are developing information leaflets, (but also) any kind of (patient) information”. (IRL, participant 21, follow up)
  9. 9. Conclusions & implications Conclusion: • High implementation fidelity of OHLI components. • OHLIs can contribute to improved communication when (contextual) moderators are considered. • Similar findings can promote transfer in EU. Recommendations: • Choose OHLI components: impact on patients and relevant for organisation. • Format: concise, digital, user friendly. • Implement OHLIs stepwise: enough time, committee, involve health service users.
  10. 10. References Bax, J. (2014). Quickscan Health Literacy Toolbox. Dutch Institute for Healthcare Improvement (CBO), Utrecht, the Netherlands. Brach, C., Keller, D., Hernandez, L. M., Baur, C., Parker, R., Schyve, P., Schillinger, D. (2012). Ten Attributes of Health Literate Health Care Organizations. Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science : IS, 2, 40. Hasson, H. (2010). Systematic evaluation of implementation fidelity of complex interventions in health and social care. Implementation Science : IS, 5, 67. Lynch, J. (2009). Literacy Audit for Health Care Settings. Retrieved from _settings.pdf
  11. 11. Questions & Discussion Persons to contact: • Research: Marise Kaper - • Irish OHLI: Jane Sixsmith - • Dutch OHLI: Janine Vervoordeldonk -