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
Outline • Background: Health literacy and Audiology • Evaluation of written materials • Evaluation of Apps 4. Clinical implications
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.
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
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)
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)
PhD Thesis Submission Title: Health Literacy, Instruction Materials, and Hearing Aid Management in Older Adults
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.
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)
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)
Page from the Modified Guide creatingsoundvalueTM
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
HAM Test: Scoring 2 points: task correct with no prompts 1 point: task correct with 1 prompt Maximum score = 14
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)
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.
Preferred User Guide Number of Participants
Useability of a Smartphone App for Hearing Aid Management Ms Andrea Caposecco, Prof Louise Hickson, Ms Barbra Timmer
Apps & Hearing Aid Management Can older adults configure and use an app for HA management and troubleshooting?
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
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.
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.
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).
How to Design Best Practice Materials • Content • Language • Layout and typography • Organization • Graphics
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)
Content Give priority to ‘how to’ information Emphasize small practical steps
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)
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
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)
Graphics 1. Pull the tube out of the hearing aid. Tube
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.
Acknowledgements Contact Information Andrea Caposecco: firstname.lastname@example.org Prof Louise Hickson: email@example.com Communication Research Registry
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