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

CRICOS&Provider&Code:&00113B&Public&Health&Innova<on,&Deakin&University,&Australia&

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

Health'literacy:''Innova1ve'approaches'to''

improving'the'quality'of'care


A'vision'for'health'literacy'development'

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?&

Inclusive Health Literacy organizing framework

Supportive &

determining structures (Trust, faith, emotional,

cultural, environmental)

Basics (absence of catastrophic health problems, absence of poverty, safety)

© Richard Osborne, Alison Beauchamp 2013

Healthy choices

•  Informed •  Enabled •  Healthy

productive lives

The basics

•  Housing •  Money •  Support •  Wellbeing •  Advice •  Coaching •  Other

Does Health Literacy make a person’s world go around?

Healthy choices


productive lives

The basics



Health literacy

Healthy choices


productive lives

The basics



Health literacy

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&

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 you get this wrong, everything else is wrong


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.

Development&of&the&&Health&Literacy&Ques<onnaire&(HLQ)&&

for&interven<on&development

CRICOS&Provider&Code:&00113B&

Informa1on@rich'Health'Literacy'Ques1onnaire'1.'Feeling'understood'and'supported'

by'healthcare'providers''•  I&can&rely&on&at&least&one&healthcare&provider&2.'Having'sufficient'informa1on'to'manage'my'health''

•  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&&

6.'Ability'to'ac1vely'engage'with'healthcare'providers''

•  Discuss&things&with&healthcare&providers&un<l&you&understand&all&you&need&to&&

7.'Naviga1ng'the'healthcare'system'•  Work&out&what&is&the&best&care&for&you&&•  Decide&which&healthcare&provider&you&need&to&see&&

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

– 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&


Australian'Research'Council'(ARC)''Linkage'Grant'(2012@2015)'

•  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

www.ophelia.net.au CRICOS&Provider&Code:&00113B&

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


Health'Literacy'Ques1onnaire'–'needs'assessment'1.'Feeling'understood'and'supported'

by'healthcare'providers''•  I&can&rely&on&at&least&one&healthcare&provider&2.'Having'sufficient'informa1on'to'manage'my'health''

•  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&&

6.'Ability'to'ac1vely'engage'with'healthcare'providers''

•  Discuss&things&with&healthcare&providers&un<l&you&understand&all&you&need&to&&

7.'Naviga1ng'the'healthcare'system'•  Work&out&what&is&the&best&care&for&you&&•  Decide&which&healthcare&provider&you&need&to&see&&

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&


10.'Beliefs'and'values'Geang&sick&is&part&of&geang&old&

Administered to the usual people

engaging / trying to engage with your healthcare service



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&

CRICOS&Provider&Code:&00113B& CRICOS&Provider&Code:&00113B&







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

Response:

Tailoring of interventions to

the level of health literacy of the target groups

Service re-organisation to be

responsive to specific / diverse

needs

Organisation level: What services and

reorganisation of services are needed to serve them better?


Ac#on&orientated&health&literacy&ques#onnaire&Strongly&Agree—Strongly&disagree&1.&Feeling&understood&and&supported&

by&healthcare&providers&&•  I&can&rely&on&at&least&one&healthcare&provider&2.&Having&sufficient&informa#on&to&manage&my&health&&

•  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&•  WI&have&at&least&one&person&who&can&come&to&medical&appointments&with&me&&&

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

Cannot&do—Very&easy&6.&Ability&to&ac#vely&engage&with&

healthcare&providers&&•  Discuss&things&with&healthcare&providers&un?l&you&understand&all&you&need&to&&

7.&Naviga#ng&the&healthcare&system&•  Work&out&what&is&the&best&care&for&you&&•  Decide&which&healthcare&provider&you&need&to&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&


10.&Beliefs&and&values&GeLng&sick&is&part&of&geLng&old&

Person level: What can be done to help them?
























Grounded approach to HL intervention development (Osborne, Batterham, Elsworth, Buchbinder)



Response:


the level of health literacy of

the target groups

Service re-organisation to

be responsive to specific / diverse

patient needs

Organisation level: Who are our patients / citizens? What services are needed,

how can services be reorganised?


















Patient level: What are the capabilities and

resources of an individual?

How do you help them? CRICOS&Provider&Code:&00113B&
























Link%HLQ%to:

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

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

Managers/policymakers'experience'and'views'of'what'is'possible.

System%response costs'(short'term) Optimised'health Prioritisation'of'

services costs'(long'term) healthy'behaviour Skill'set'clarification'

and'development Productivity'(long'term) Earlier'engagement communities'of'

practicepositive'and'active'engagement'in'life

Development'and'

validation'of'a'HL'tool'using'

systematic'grounded'

consultation'processes

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

communities)

Health%Literacy%Response%Framework

Across%10%disparate%centres

Outcomes



Response:



the target groups



patient needs














































Link%HLQ%to:

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

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

Managers/policymakers'experience'and'views'of'what'is'possible.

System%response costs'(short'term) Optimised'health Prioritisation'of'

services costs'(long'term) healthy'behaviour Skill'set'clarification'

and'development Productivity'(long'term) Earlier'engagement communities'of'

practicepositive'and'active'engagement'in'life

Development'and'

validation'of'a'HL'tool'using'

systematic'grounded'

consultation'processes

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

communities)

Health%Literacy%Response%Framework

Across%10%disparate%centres

Outcomes



Response:



the target groups



patient needs













































Matrix'of'interven1ons'and'intended'outcomes'Target'group+ Prac1ce'gap+ Interven1on+ Intended'

outcomes+

Level'of'interven1on+'

Person'' && && && &&

Prac11oner' && && && &&

Organisa1on/'policy'

&& && && &&

Partnerships/'inter@agency'

Health&Literacy&Response&Framework&


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

Healthy choices


productive lives

The basics


Health literacy

Healthy choices


productive lives

The basics


Health literacy

Organisational HL

interventions

Individual HL

interventions


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…'


Reflections: Why much of our research and programs go

nowhere!

An idea Co-creation Testing/PDSA Implementation Optimisation RCT Application

An idea RCT Application


Thank you

[email protected]

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

Health & Medicine

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