Promoting Health Literacy at Promoting Health Literacy at Hawthorne Education CenterHawthorne Education Center

Jennifer P. Rho, MD, MPHJennifer P. Rho, MD, MPH

Rochester Public School’s facility Rochester Public School’s facility dedicated to adult and family literacydedicated to adult and family literacy

Serves 3000 learners per year, 700 per Serves 3000 learners per year, 700 per dayday

Employs 60 teachers and staff membersEmploys 60 teachers and staff members 100 volunteers per week100 volunteers per week Highly committed learners, staff and Highly committed learners, staff and

volunteersvolunteers

Hawthorne Education Hawthorne Education CenterCenter

Rochester, MNRochester, MN

Hawthorne Education Hawthorne Education CenterCenter

Rochester, MNRochester, MN

Courses of study: English as a Second Courses of study: English as a Second Language, Adult Basic Education, GED, Language, Adult Basic Education, GED, High School Diploma, Hand in Hand, High School Diploma, Hand in Hand, Citizenship preparationCitizenship preparation

Ages 15-80+, average age 25-30Ages 15-80+, average age 25-30 Represents 30+ countries including U.S. Represents 30+ countries including U.S.

born learners born learners >80% living below federal poverty level>80% living below federal poverty level

Health at Hawthorne:Health at Hawthorne: A Challenge A Challenge

At least one ambulance per month at schoolAt least one ambulance per month at school prior to health promotion activities (pre-2005)prior to health promotion activities (pre-2005)

Obvious health disparities among learnersObvious health disparities among learners Pervasive problems with health care access Pervasive problems with health care access High uninsuranceHigh uninsurance

– 34% of Hawthorne learners are uninsured vs. 3% 34% of Hawthorne learners are uninsured vs. 3% uninsured in Rochester area (2007)uninsured in Rochester area (2007)

Low health literacyLow health literacy - many those who have - many those who have insurance act functionally uninsuredinsurance act functionally uninsured

Literacy LevelsLiteracy Levels

Health at Hawthorne:Health at Hawthorne:An OpportunityAn Opportunity

One of the main reasons One of the main reasons Hawthorne learners say Hawthorne learners say that they are learning that they are learning English is English is so that they so that they

can talk with their can talk with their doctor.doctor.

The Early DaysThe Early Days

Environment was Environment was ripe for health ripe for health promotion at promotion at HawthorneHawthorne

Eager public health Eager public health studentstudent

Helped in whatever Helped in whatever way I couldway I could

Hawthorne Health ServicesHawthorne Health Services Opened Sept 2005Opened Sept 2005 CollaborativeCollaborative among among

Hawthorne Education Hawthorne Education Center, Migrant Health Center, Migrant Health Services, Olmsted County Services, Olmsted County Public Health and Winona Public Health and Winona State UniversityState University

Open 4 days per weekOpen 4 days per week Free to Hawthorne learners Free to Hawthorne learners

and family members and family members 4 providers, public health 4 providers, public health

nurse, office assistant, nurse, office assistant, Americorps VISTA Americorps VISTA volunteervolunteer

Funded through donationsFunded through donations

Hawthorne Health Hawthorne Health ServicesServices

Promote health literacyPromote health literacy through: through: Providing health educationProviding health education Providing limited health services Providing limited health services

at Hawthorne at Hawthorne Identifying and accessing Identifying and accessing

sources for health insurance sources for health insurance and primary health care and primary health care

Collaborating with others in the Collaborating with others in the communitycommunity

Providing case management for Providing case management for learners with ongoing health learners with ongoing health concernsconcerns

What We Have AccomplishedWhat We Have Accomplished 5500 patient visits at the clinic 5500 patient visits at the clinic

since openingsince opening Additionally:Additionally:

– Annual health fair serves 400 Annual health fair serves 400 learners/yearlearners/year

– Annual flu shot clinic provides Annual flu shot clinic provides >200 vaccinations/year>200 vaccinations/year

– Multiple other community Multiple other community partnerships-Mayo Breast Clinicpartnerships-Mayo Breast Clinic

– Multiple health ed programsMultiple health ed programs– Introduced hundreds of health Introduced hundreds of health

professionals to health literacy professionals to health literacy – Jobs skills to community Jobs skills to community

members - medical members - medical interpretationinterpretation

Very few ambulance visits to Very few ambulance visits to Hawthorne since clinic openedHawthorne since clinic opened

Service-LearningService-Learning Provides opportunity for Provides opportunity for

reciprocal learningreciprocal learning about health about health literacyliteracy

Train the next generation to Train the next generation to provide patient-centered careprovide patient-centered care

Provides manpower to Provides manpower to implement health promotion implement health promotion activitiesactivities

Great opportunity to build Great opportunity to build relationshipsrelationships

>50 nursing students/yr>50 nursing students/yr Varying number of med Varying number of med

studentsstudents Health fair, flu shot, screenings, Health fair, flu shot, screenings,

exercise class, book clubexercise class, book club

Annual Health FairAnnual Health Fair 400+ learners400+ learners Great community Great community

participation participation Guide for participantsGuide for participants Follow-up surveyFollow-up survey

– NutritionNutrition– Weight lossWeight loss– ExerciseExercise– Dental CareDental Care– Blood pressureBlood pressure– (Stress)(Stress)

Annual Cold and Flu ClinicAnnual Cold and Flu Clinic

Education-Education-focusedfocused– Service-learningService-learning– Classroom basedClassroom based– VideoVideo– PostersPosters

Flu shot clinicFlu shot clinic

Health Literacy Book ClubHealth Literacy Book Club Taught by nursing Taught by nursing

students and medical students and medical studentsstudents

ESL level 5ESL level 5 Small groupsSmall groups Health Literacy Special Health Literacy Special

CollectionCollection– http://http://

www.healthliteracy.worldedwww.healthliteracy.worlded.org/.org/

– Staying Healthy Florida Staying Healthy Florida Literacy CoalitionLiteracy Coalition

– Culture and HealthCulture and Health– Ask Me 3Ask Me 3

Mayo Patient Ed PilotMayo Patient Ed Pilot

Field test Mayo Patient Ed materials with Field test Mayo Patient Ed materials with Hawthorne learnersHawthorne learners

Goals:Goals:– To increase the health literacy of Hawthorne learners To increase the health literacy of Hawthorne learners

through the process of systematically evaluating patient through the process of systematically evaluating patient ed materialsed materials

– To empower the Hawthorne learners to advocate for To empower the Hawthorne learners to advocate for themselves when they do not understand health info themselves when they do not understand health info that has been provided to themthat has been provided to them

– To utilize the expertise of the Hawthorne community To utilize the expertise of the Hawthorne community (teachers and learners) to improve the quality of Mayo (teachers and learners) to improve the quality of Mayo patient ed materials developed for Mayo patientspatient ed materials developed for Mayo patients

Participatory MethodsParticipatory Methods

Hawthorne teachers and administrators Hawthorne teachers and administrators participated in every aspect of participated in every aspect of development and implementationdevelopment and implementation– Classroom basedClassroom based– Picked topic and individual materials to Picked topic and individual materials to

reviewreview– Chose methodsChose methods– Gave input on the eval toolsGave input on the eval tools– ESL, GED, DiplomaESL, GED, Diploma

How we included everyone How we included everyone Initial meeting Initial meeting Chose topic - healthy livingChose topic - healthy living Chose items to review Chose items to review Chose evaluation methods (Doak & Doak)Chose evaluation methods (Doak & Doak)

– SAMSAM– Individual and group review for learnersIndividual and group review for learners

Met with teachers (ESL, Reading, GED, Diploma). Met with teachers (ESL, Reading, GED, Diploma). Reviewed items and SAM. Did SAM together on Reviewed items and SAM. Did SAM together on food pyramidfood pyramid

Teachers chose which items they wanted to Teachers chose which items they wanted to review with their classreview with their class

Reviewed 1 item per week for 4 weeks Reviewed 1 item per week for 4 weeks

Healthy livingHealthy living

Topic has been Topic has been consistently important consistently important to adult learnersto adult learners

8-10 classrooms per item 8-10 classrooms per item Lead by a patient educator Lead by a patient educator Introduction - Introduction - “This is your chance to be the “This is your chance to be the

teacher, to teach us how we can make health teacher, to teach us how we can make health information easier to understand for you and your information easier to understand for you and your family”family”

Individual EvaluationIndividual Evaluation– Read designated pagesRead designated pages– Circle words that they did not understandCircle words that they did not understand– Multiple choice questions to assess understanding of Multiple choice questions to assess understanding of

contentcontent Group review/teachingGroup review/teaching Debriefing with teachers, learner feedbackDebriefing with teachers, learner feedback

In The ClassroomIn The Classroom

ResultsResults

Teachers and learners were VERY engaged Teachers and learners were VERY engaged and motivated and motivated

Strong interest in healthy living infoStrong interest in healthy living info All of the materials were beyond the All of the materials were beyond the

literacy levels of the learnersliteracy levels of the learners Positives: mutually beneficial, Positives: mutually beneficial,

collaboration, community expertise, group collaboration, community expertise, group interaction, valuable informationinteraction, valuable information

Negatives: Too much data, too much timeNegatives: Too much data, too much time

RecommendationsRecommendations

Rewrite the 4 tested items to match ESL level Rewrite the 4 tested items to match ESL level 44

Establish process to selectively test pt ed Establish process to selectively test pt ed materials with adult learners during materials with adult learners during development development

Tie into CASAS - develop lesson planTie into CASAS - develop lesson plan

What have we learned over What have we learned over the past 6 years?the past 6 years?

Hawthorne learners utilize Hawthorne learners utilize available health services when available health services when health education is providedhealth education is provided

Hawthorne learners participate Hawthorne learners participate more when the health topic is more when the health topic is important to themimportant to them

Health activities should be guided Health activities should be guided by the community as much as by the community as much as possiblepossible

A Note about ResearchA Note about Research

Research has never been the Research has never been the guiding force behind our health guiding force behind our health activitiesactivities

Concerns about vulnerable Concerns about vulnerable populationpopulation

Community-led researchCommunity-led research Action-orientedAction-oriented Education-focusedEducation-focused Marcia Drew Hohn, Ed. D.Marcia Drew Hohn, Ed. D.

– Literacy Leader Fellow 1996-1997Literacy Leader Fellow 1996-1997

Why We Have Been Why We Have Been SuccessfulSuccessful

Health literacy has been a topic of mutual interestHealth literacy has been a topic of mutual interest Spirit of cooperationSpirit of cooperation Hawthorne remains in controlHawthorne remains in control Reciprocal learningReciprocal learning Individual agendas are minimized - careful Individual agendas are minimized - careful

selection of partnersselection of partners Efforts are a combination of civic engagement, Efforts are a combination of civic engagement,

community organizing, service learningcommunity organizing, service learning Grass roots, bottom up approach, flexible, Grass roots, bottom up approach, flexible,

responsiveresponsive No money to argue overNo money to argue over

Use existing community infrastructure when possible Use existing community infrastructure when possible Get involved in your community Get involved in your community Work with organizations not institutions-one exists to Work with organizations not institutions-one exists to

effect change, the other to maintain the status quoeffect change, the other to maintain the status quo Asset-mapping Asset-mapping

– Few organizations want another needs assessment Few organizations want another needs assessment Win-win situations - can help offset lack of funding Win-win situations - can help offset lack of funding Service-learning/Reciprocal learningService-learning/Reciprocal learning Face time is very importantFace time is very important ““The process is the product” The process is the product”

Community Community EngagementEngagement StrategiesStrategies

Tips for getting startedTips for getting started Look for unique opportunitiesLook for unique opportunities Be humble - be a leader without being “the Be humble - be a leader without being “the

expert”expert” Utilize the practical expertise of community Utilize the practical expertise of community

organizations and community members organizations and community members Relationships take time - start small and get to Relationships take time - start small and get to

know the community (all levels) know the community (all levels) Minimize agenda settingMinimize agenda setting Recognize that the community way is different Recognize that the community way is different

than the academic way than the academic way Plan to sustain the program Plan to sustain the program

Future PlansFuture Plans More collaborationMore collaboration

– Mayo Med School Mayo Med School – Mayo OphthalmologyMayo Ophthalmology– Mayo DermatologyMayo Dermatology– Public Health Public Health

ImmunizationsImmunizations Revamped health fairRevamped health fair Healthy eating classHealthy eating class Expand offerings for Expand offerings for

health literacy book clubshealth literacy book clubs Work with Mayo Pat Ed to Work with Mayo Pat Ed to

develop pt ed materialsdevelop pt ed materials PRECEDE-PROCEEDPRECEDE-PROCEED Hopefully some fundingHopefully some funding