Health Literacy in Practice

Healthdirect Australia’s strategic approach

• Our initial outcomes:

Building ‘assets’ that supports greater empowerment (Nutbeam 2008)

Reducing ‘risk factors’ through telephone and digital services

• Stop describing the problem

• Putting equity at the heart of what we do

• Take a systems approach

24/11/2016

Starting our journey

Building (and integrating into) a systems solution

• Get Executive buy-in

• Prepare workforce to be health literate and monitor progress

• Integrate health literacy into planning, evaluation, safety and quality improvement across services

• Apply evidence-based practices to meet the needs of the population

• Complement face to face (or other) services

• Make sustainable change

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Our approach

Applying implementation science to health literacy efforts

Bringing together quality improvement and evidence-based practices

Building Healthdirect staff health literacy

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Introducing teach back intotelephone services

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Improving health communication through website information

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Improving health communication through social media

Development of a question builder

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Activity 1: Prepare the workforce to be health literate and monitor progress

• Introduced

• Settings based health promotion program

• Offers on-site health checks

• Offers health education

• Aligns to Work Health and Safety Agenda

• Joint NSW Health/Healthdirectevaluation: including a re assessment of the HLQ – in 2017

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Understand the baseline and introduce a suitable intervention

• Staff undertook the Health Literacy Questionnaire (Deakin University)

High level results showed:

A range of clusters were found

• Age, education status and living situation

Clusters of low HL

• Some groups didn’t feel their health needs were understood or supported

• Or, had enough information to manage their own health

• Staff born overseas struggle to navigate the health system

Activity 2: Introduce an evidence-based activity to telephone services

• Align to safety and quality standards

• Evidence-based approach

• Used in face to face practices

• Tested feasibility to use via the telephone

What are the training needs of staff?

• Support cultural change – its OK to ask

questions, its OK not to fully understand health advice

first time round

24/11/2016

Trialling teach back

Activity 3: Improving health communication through website information

Three stages:

1. Assessed the domains of health literacy

2. Conducted qualitative research – PBB and Healthdirect Australia websites (Aboriginal and Torres Strait Islander people, CALD and low SES)

3. Collected informal feedback from Healthdirect Australia staff

24/11/2016 For Office Use Only

Methods of collecting baseline data

Activity 3: Improving health communication through website information

• 15 pages from PBB were reviewed (Nov 15):

Readability:

3/15 were at the recommended reading level (grade 6)

Understandability:

Half distracted from the purpose

Actionability:

80% had pages with at least one action

Nearly 20% provided a tangible tool to help users take action

Useability:

Some jargon

multiple messages

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Results from assessing health literacy domains

Activity 3: Improving health communication through website information

Qualitative research

• Trustworthy source of information

• Some consumers find a lot of information difficult to digest

• Need to reflect different cultures to engage consumers

• Greater use of instructional images

Staff insights

• Uncertainly of health literacy principles

• Not sure what’s relevant and what’s not

• Not sure what health literacy guidelines to use

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High level findings from consumer and staff feedback

Initial step in this quality improvement activity

• 42 national or international HL guidelines/articles/tools were found with a focus on writing health information

• Relevant themes were identified from documents

• Gathered evidence from qualitative research (users)

• Drew upon broader health literacy principles

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Using existing evidence and the great work from other organisations

Identifying and understanding the implementation gap

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EVIDENCE PRACTICEIMPLEMENTATION

Designing the implementation process

Transformative process

• Clear about how to change practice (or

confirmation of good practices)

• Practice orientated: comprehensive,

applied, contextualised, responsive,

adaptive and ‘how-to

• Staff offered the same opportunity to

access learning

• Enables reflection and putting concepts

into practice

• Build into local policy/guidelines

Informative process

• Learning as acquiring facts, skills and

methods that can be retained and used as

necessary

• Little support describing the process of

conducting change within context

• Inconsistently used

• Varying degrees of translation from

information to knowledge

• Build into local policy/guidelines

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Building the capacity of health writers

Building an online learning tool

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Minimal Viable Product

Good communication: writing wellMain principles

Universal appeal

Actionable

Understandable

Readable | Active voice | Well structured | Culturally appropriate

|

Audience needs

Top up module

Writing for social media

Top up module Use of images and videos to support

narratives

Top up moduleTesting health literacy with

consumers

Online learning toolGood communication: writing well

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Interactive –

opportunities to

have a go!

Use as a learning

tool AND a

resourceTailored for

writers /editors

Not scored (pass or

fail)

Completion is

measured

User’s can return to

it multiple times

Evaluating the online learning tool

Population effect

• Building the evidence that these changes make a difference

• Reassess domains

• Re assess consumer perspectives

• Assess how information is used to support self management.

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Impact on the health system

Practice change

• Measuring likability and useability

• Measuring the adoption, implementation and sustainability of knowledge, skills and resources into routine practice

The Healthdirect Team

Maureen Robinson, GM Clinical Governance (Sponsor)

Andrew Bryant, GM Consumer Services

Camilla Stevsson, Senior Digital Producer

Joshua Rodriguez, Digital Producer

Dianne Zalitis, Clinical Lead PBB

Gayle Cowey, Learning and Development Manager

Francis Wilkins, Sub Editor

Anthony Fallick, Senior Product Manager

Michael Araco, Medical Advisor

Lyn West, HR administrator

Melissa Phang and Aoife McEldowney, Legal Counsel 24/11/2016

healthliteracy@healthdirect.org.au

Learning together!