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Connecting with Clients Beyond the Clinic: Lessons from Health Literacy Research

Connecting with Clients Beyond the Clinic: Lessons from Health Literacy Research Ms Andrea Caposecco, Prof Louise Hickson, Dr Carly Meyer, Dr Asad Khan, Ms Barbra Timmer British Society of Hearing Aid Audiologists, May 2015. creating sound value TM. www.hearingcrc.org. Outline.

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Connecting with Clients Beyond the Clinic: Lessons from Health Literacy Research

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  1. Connecting with Clients Beyond the Clinic: Lessons from Health Literacy Research Ms Andrea Caposecco, Prof Louise Hickson, Dr Carly Meyer, Dr Asad Khan, Ms Barbra Timmer British Society of Hearing Aid Audiologists, May 2015 creatingsoundvalueTM www.hearingcrc.org

  2. Outline • Background: Health literacy and Audiology • Evaluation of written materials • Evaluation of Apps 4. Clinical implications

  3. Health Literacy creatingsoundvalueTM Health literacy is the ability to obtain, process, and understand health information and services in order to make appropriate health decisions. (Ratzan and Parker, 2000). It is dependent on both individual and systematic factors. For example: Communication skills of both the client and the audiologist. Demands of the situation or context.

  4. Why is Health Literacy Important? creatingsoundvalueTM Health literacy affects people’s ability to: Navigate the healthcare system Share health information with providers Adopt health-promoting behaviors, such as exercising and eating a healthy diet Engage in self-care and chronic disease management

  5. Outcomes of Low Health Literacy • Poorer health status • Higher morbidity • Increased use of hospital and emergency services • Poorer health-related knowledge • Lower receipt of screening services • Poorer management of chronic health conditions (e.g., Berkmanet al., 2011; DeWalt, Berkman, Sheridan, Lohr, & Pignone, 2004)

  6. Edmonton Literacy Coalition

  7. In Appointments People with Low Health Literacy: creatingsoundvalueTM • Tend to think in concrete / immediate terms. • Often interpret information literally. • Have difficulty comprehending and applying information. • Tend to ask few questions. • Have difficulty knowing what • information the audiologist needs and • what is irrelevant. • Often communicate information in a • jumbled order. • (Mayer & Villaire, 2007)

  8. At least 30%of older people have low health literacy

  9. PhD Thesis Submission Title: Health Literacy, Instruction Materials, and Hearing Aid Management in Older Adults

  10. Hearing Aid User Guides • Analysed the content, design, and readability of 36 hearing aid (HA) user guides to determine their suitability for older adults. • Suitability Assessment of Materials (SAM) to measure content and design. • Readability tools (eg. Flesch Kincaid) to measure reading grade level.

  11. Hearing Aid User Guides • 69% were rated not suitable • High reading grade level • Uncommon vocabulary & jargon • Low contrast between text and paper • Small font size • Small graphics • Inclusion of extensive technical • information (Caposecco, Hickson, & Meyer, 2014)

  12. Hearing Aid User Guides

  13. User Guides & Aid Management Does a HA user guide revised using best practice guidelines superior ability to perform HA management and troubleshooting tasks? (Caposecco, Hickson, Meyer, & Khan, submitted)

  14. Page from the Modified Guide creatingsoundvalueTM

  15. Method Test of Functional Health Literacy Original User Guide 89 participants *No HA experience *>55 years old User guide survey Montreal Cognitive Assessment HA Management Test HA Troubleshooting Test Grooved pegboard Test Modified User Guide Screening Audiogram

  16. Hearing Aid Management Test

  17. HAM Test: Scoring 2 points: task correct with no prompts 1 point: task correct with 1 prompt Maximum score = 14

  18. HAM Test: Scores Obtained Modified User Guide Mean score = 10.3 (SD = 2.75, range = 3 to14) Original User Guide Mean score = 7.1 (SD = 2.57, range = 0 to13)

  19. HAM Test: Regression Analysis

  20. HAM Test: Findings creatingsoundvalueTM • Participants with the modified guide performed significantly better on the five complex tasks. • Putting the HA on • Holding the phone with the HA • Turning up the volume on the HA • Switching the HA to program 2 • Cleaning the tube • Took significantly less time on each task. • Required significantly fewer prompts.

  21. Preferred User Guide Number of Participants

  22. Useability of a Smartphone App for Hearing Aid Management Ms Andrea Caposecco, Prof Louise Hickson, Ms Barbra Timmer

  23. Best Practice Guidelines for Apps

  24. Apps & Hearing Aid Management Can older adults configure and use an app for HA management and troubleshooting?

  25. Method Test of Functional Health Literacy 30 participants No HA experience >60 years old App experience Montreal Cognitive Assessment App Useability Questionnaire HA Management Test for Apps HA Troubleshooting Test for Apps Grooved pegboard Test Audiogram

  26. Findings creatingsoundvalueTM • Majority of participants (93%) could find the appropriate screen and complete each task correctly. • No single variable was associated with ability to use the app. • Majority (93%) found the app either very easy or easy to use. • Main aspects liked ease of use, layout & contents of the home page, inclusion of high quality videos. • Main difficulty navigation.

  27. Clinical Implications creatingsoundvalueTM • It is strongly advocated that all hearing healthcare • professionals and organizations develop their • materials based on best practise guidelines for • health literacy.

  28. Health Literacy Interventions • In the past the focus was on patients’ deficits and their lack of knowledge and skill (Koh et al., 2013). • But the growing complexity of modern day health care challenges virtually all patients (Brach et al., 2012; Koh et al., 2013). • “Health care organizations need to make health information and services less complex for everyone” (U.S. Department of Health and Human Services, 2010a).

  29. How to Design Best Practice Materials • Content • Language • Layout and typography • Organization • Graphics

  30. Content • Give priority to ‘how to’ information (Seligman et al., 2007) • Highlight the positive (Wilson & Park, 2008) • Emphasize small practical steps (Centres for Disease Control and Prevention, 2009) • Personalise the information (Bull, Holt, Kreuter, Clark & Scharff, 2001)

  31. Content Give priority to ‘how to’ information Emphasize small practical steps

  32. Positive Effects of Personalization Personalized health-care material Improved willingness to open & use Increased likelihood of success & satisfaction Increased willingness to show to significant other Involvement of significant other Increased likelihood of success & satisfaction (Bull, Holt, Kreuter, Clark, & Scharff, 2001; Hickson, Meyer, Lovelock, Lampert, & Khan, 2014)

  33. Organization Quick Guide……...……………………………… 1 Your hearing aid Your hearing aid details …...………… 3 Diagram of your hearing aid…………. 4 Left & Right aid markings……...……... 5 Using the hearing aid Turning On & Off…………………….... 6 Batteries………………………..………. 7 Putting on the hearing aid………….…. 9 Removing the hearing aid……..……... 11 Volume control ……………………....… 12 Changing sound programs ………..…. 13 Telephone use ……………………….... 15 Cleaning and Maintenance Daily care tasks………………………… 17 Cleaning the tube…………………..….. 19 Replacing the tube …………………..… 21 Cleaning the dome…………………..… 22 Replacing the dome…………………… 23 Avoiding moisture & heat ……………… 25 Warnings …………………………..…… 27 Repair & Warranty……………..……….. 29 Trouble shooting guide………..…………….. 30

  34. Graphics • Use simple line drawings with a simple text caption • Include prompts arrows, labels etc • Avoid photographs except to gain attention • Ensure the reader understands all elements in graphic (Houst, Doak, Doak, & Loscalzo, 2006)

  35. Graphics 1. Pull the tube out of the hearing aid. Tube

  36. Take Away Messages Message #2 Older adults are better able to perform hearing aid management tasks with a best practice user guide Message #3 Adherence to best practice guidelines in the clinic will facilitate successful rehabilitation outcomes. Message #1 Current user guides are not suitable for older adults.

  37. Acknowledgements Contact Information Andrea Caposecco: a.caposecco@uq.edu.au Prof Louise Hickson: l.hickson@uq.edu.au Communication Research Registry

  38. References Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97-107. doi:10.7326/0003-4819-155-2-201107190-00005 Bull, F. C., Holt, C. L., Kreuter, M. W., Clark, E. M., & Scharff, D. (2001). Understanding the effects of printed health education materials: Which features lead to which outcomes? Journal of Health Communication, 6, 265-279 Caposecco, A., Hickson, L., & Meyer, C. (2014). Hearing aid user guides: Suitability for older adults. International Journal of Audiology, 53(S1), S43-S51. doi:10.3109/14992027.2013.832417 Caposecco, A., Hickson, L., & Meyer, C. (submitted). Evaluation of a modified user guide on hearing aid management. Ear and Hearing. Centers for Disease Control and Prevention. (2009). Simply Put: A guide for creating easy-to-understand materials. Retrieved from www.cdc.gov/healthmarketing/pdf/Simply_Put_082010.pdf Cordasco, K. M., Asch, S. M., Franco, I., & Mangione, C. M. (2009). Health literacy and English language comprehension among elderly inpatients at an urban safety-net hospital. Journal of Health and Human Services Administration, 32(1), 30-50 DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N., & Pignone, M. P. (2004). Literacy and health outcomes - A systematic review of the literature. Journal of General Internal Medicine, 19(12), 1228-1239. doi:10.1111/j.1525-1497.2004.40153x Doak, C. C., Doak, L. G., & Root, J. (1996). Teaching patients with low literacy levels. Philadelphia: J.B. Lippincott Company. Hickson, L., Meyer, C., Lovelock, K., Lampert, M., & Khan, A. (2014). Factors associated with success with hearing aids in older adults. International Journal of Audiology, 53 (S1), S18-S27. doi: 10.3109/14992027.2013.860488

  39. Houts, P. S., Doak, C. C., Doak, L. G., & Loscalzo, M. J. (2006). The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Education and Counseling, 61(2), 173-190. doi:10.1016/j.pec.2005.05.004 Koh, H. K., Baur, C., Brach, C., Harris, L. M., & Rowden, J. N. (2013). Toward a systems approach to health literacy research. Journal of Health Communication, 18, 1-5. doi:10.1080/10810730.2013.759029 Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington DC: US Department of Education Mayer, G. G., & Villaire, M. (2007). Health literacy in primary care: A clinician’s guide. Springer Publishing Company: New York. Ratzan, S. C., & Parker, R. M. (2000). Introduction. In C. R. Selden, M. Zorn, S. C. Ratzan & R. M. Parker (Eds.), National Library of Medicine current bibliographies in medicine: Health literacy (NLM Pub. No. CBM 2000-1). Bethesda, MD: National Institutes of Health Seligman, H. K., Wallace, A. S., DeWalt, D. A., Schillinger, D., Arnold, C. L., Shilliday, B. B., . . . Davis, T. C. (2007). Facilitating behavior change with low-literacy patient education materials. American Journal of Health Behavior, 31 Suppl 1, S69-S78. US Department of Health and Human Services. (2010). National action plan to improve health literacy. Retrieved from http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf Wilson, E. A. H., & Park, D. C. (2008). A case for clarity in the writing of health statements. Patient Education and Counseling, 72(2), 330-335. doi: 10.1016/j.pec.2008.02.008

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