Developing a Health Literacy Universal Precautions Toolkit

1. 1 Developing a Health Literacy Universal Precautions Toolkit DeWalt DA, Hawk V, Broucksou K, Hink A, Brach C, Callahan LF AHRQ Annual Meeting 2009

2. 2 Project in Process Rationale Process Prototype Feasibility

3. 3 Rationale Low health literacy is common We do not have good strategies for knowing who is struggling with health information Health literacy universal precautions is structuring the delivery of care in the practice as if every patient may have limited health literacy

4. 4 Process Identify and review tools Identify gaps Develop plan for toolkit organization Create implementation guidance Test individual tools Create “toolkit” as unified approach Pilot test toolkit in practices

5. 5 Tool identification and review Searched the internet via Google (health literacy, health communication, health education materials) Directed inquiries: Advisory Board, Health Literacy List Serve, primary care practices in PBRN Conducted conference calls with practices in NC and across the country with a reputation for working on health literacy universal precautions

6. 6 Tool Review Catalogued tools Training for clinicians and staff System changes in practices Use of educational media Connections with community organizations Made assessment of how tool could be used in primary care Ease of use Documented experience or research on tool Format (book, internet, video, etc) Avoided creating a catalog of patient education materials

7. 7 Results This table is a summary of what we found. We identified 219 candidate tools. Many tools were focused on health literacy training for providers and were generally repetitive in terms of their content. a few tools had recommended system changes, many tools were different types of educational media for patients or instructions on how to improve educational media. A smaller number of tools were related to community linkages and other areas. In terms of the target audience, most tools were targeted for providers and staff to improve their attention toward health literacy issues. Some were targeted toward patients, and often these were tools to encourage patients to ask questions or specific educational materials. The other category often included policymakers or researchers that might be the target audience.This table is a summary of what we found. We identified 219 candidate tools. Many tools were focused on health literacy training for providers and were generally repetitive in terms of their content. a few tools had recommended system changes, many tools were different types of educational media for patients or instructions on how to improve educational media. A smaller number of tools were related to community linkages and other areas. In terms of the target audience, most tools were targeted for providers and staff to improve their attention toward health literacy issues. Some were targeted toward patients, and often these were tools to encourage patients to ask questions or specific educational materials. The other category often included policymakers or researchers that might be the target audience.

8. 8 Gaps to Fill Practice assessment for primary care Individual tools (form templates for practices, patient follow-up procedures, etc.) Implementation guidance

9. 9 Implementation Guidance How do we take an idea and get it implemented reliably and sustainably in practice? Steps for implementation Frame in the Model for Improvement (PDSA) Examples of how others have done it Ways to track progress

10. 10

11. 11

12. 12

13. 13 Test Individual Tools Each “tool” or “implementation guidance” was tested in 2-4 practices Practices reviewed the tool and attempted implementation on a small scale Reviewed feedback by conference call Received feedback from Advisory Board

14. 14 Create Prototype Toolkit Developed the framework for the toolkit Introduction Getting Started Form a team Assess your practice Raising awareness in your practice Built in tutorial for Model for Improvement Added examples of practices doing this work

15. 15 Toolkit Organization Introduction and getting started Assessment of practice Four Key Changes Effective Oral Communication E.g. teach back method Effective Written Communication E.g., forms, education materials Self-Management and Empowerment E.g., action plans, encouraging questions Supportive Systems E.g., community resources, supportive systems

16. 16 Final List of Tools Getting Started Forming a team Assessing your practice Raising awareness Effective Oral Communication Communicating Clearly with patients Using the teach back method Following-up with patients Improving telephone communication Using the brown bag review Addressing language differences Knowing your patients: understanding differences Effective Written Communication Designing easy to understand forms Using effective health education Making your practice easy to navigate Creating a welcoming front desk Self-Management and empowerment Encouraging questions Action plans Improving medication adherence Obtaining patient feedback Supportive systems Providing support for patients Getting patients the medications they need Using health resources in your community Using Literacy Resources in your community

17. 17

18. 18 Feasibility Testing in Process 8 practices (pediatrics, family medicine, internal medicine) Each practice performs an assessment Each practice chooses 5 tools to try to implement in 3 months Follow-up phone calls to be completed end of September

19. 19 What are we learning? Practices start from very different levels Health literacy expertise Practice change expertise Need to grab the attention of practices Video helps Get entire practice involved (not just clinicians) Assessment results helpful Practices want “real life” examples Quick start guide Volume of tools is a bit overwhelming Must be easy to navigate the toolkit

20. 20 Conclusion Conducted a thorough search for tools Juxtaposed toolkit with chronic care model/medical home Designed from perspective of making incremental changes Overwhelming for some practices Requires close attention and hard work, just like any reliable practice change

21. 21 Acknowledgements Authors Darren DeWalt, MD, MPH Leigh Callahan, PhD Victoria Hawk, RD, MPH Kimberly Broucksou, MSW, MPA Ashley Hink, MPH Rima Rudd, ScD Cindy Brach, MPP Advisory Panel Michael Barr, MD, MBA Toni Cordell Gail Neilsen, RTR, BSHCA, SAHRA Michael Paasche-Orlow, MD, MPH Ed Wagner, MD, MPH North Carolina Network Consortium