Building a Foundation of Health Literacy with Ask Me 3™

Physiotherapist-targeted strategies and tools for recognising patients with limited health literacy and adapting physiotherapeutic communication: A scoping review

OBJECTIVE

To provide an overview of available strategies and tools that support physiotherapists to recognise patients with LHL and to adapt the physiotherapeutic communication during the diagnostic phase.

METHODS

PubMed, Embase, CINAHL and PsycINFO were searched for publications appearing between 2000 and June 2024. Additional grey literature was searched up till October 2022. Studies were included if they described strategies and tools aimed at supporting communication with patients with Limited Health Literacy in physiotherapy. Exclusion criteria focusing on general health literacy prevalence, behavioural interventions, or basic communication training.

RESULTS

Out of the 9960 unique studies identified by our literature searches, 314 full-text studies were assessed and 98 met the inclusion criteria. The data on strategies and tools were extracted into the following six categories: verbal communication (n = 3), written communication (n = 34), digital device (n = 9), questionnaire (n=19), interpreter (n = 22), and other media (n = 2). Within these categories, tools and strategies were further classified based on the communication aims. Some tools and strategies were uncategorisable.

CONCLUSION

While various strategies and tools exist for recognising patients with limited Health Literacy, they are often generic and not tailored to the physiotherapeutic context. This scoping review identifies a gab in physiotherapeutic approaches, particularly on those that go beyond information provision.

PRACTICE IMPLICATIONS

To improve communication in physiotherapy practice, there is a need for the development of tailored strategies and tools that reflect the specific dynamic of the physiotherapeutic process. We recommend engaging in design-based research that involves both patient and physiotherapist to co-create tools and strategies. In the meantime, physiotherapists are advised to use general communication strategies and tools and refer to our resources to select tools that best align with their specific goals.

Patient Engagement in Home Health: The Role of Health Literacy and “Ask Me Three®”

Health literacy has been identified as a barrier to patient engagement among older adults, especially within the home health care setting. This systematic literature review explores patient engagement; the relationship between patient engagement and health literacy; and finally, best practices for improving patient engagement through health literacy. Various interventions were explored but the “Ask Me Three®” tool created by the Institute for Healthcare Improvement and the National Patient Safety Foundation, was a best practice for improving patient engagement through increased health literacy. This educational intervention is a high-touch, low-cost, process designed to engage patients, and their informal caregivers in their own care through increased communication by asking three important questions: (1) What is my main problem?, (2) What do I need to do?, and (3) Why is it important for me to do this? These questions make the patient engage with their provider to identify their main health problem; what actions need to be taken to improve their health, and why those actions are important. Providers can potentially influence patient’s behavior through engagement and increased health literacy. The “Ask Me Three®” intervention is an example of how increased patient engagement and health literacy can lead to better health outcomes. The “Ask Me Three®” intervention may improve the quality of home health care.

Which criteria characterize a health literate health care organization? - a scoping review on organizational health literacy

BACKGROUND

Organizational health literacy (OHL) aims to respond to the health literacy needs of patients by improving health information and services and making them easier to understand, access, and apply. This scoping review primarily maps criteria characterizing health literate health care organizations. Secondary outcomes are the concepts and terminologies underlying these criteria as well as instruments to measure them.

METHODS

The review was carried out following the JBI Manual on scoping reviews. The databases CINAHL, Cochrane Library, JSTOR, PsycINFO, PubMed, Web of Science Core Collection, and Wiley Online Library were searched in July 2020. Three researchers screened the records and extracted the data. The results were synthesized systematically and descriptively.

RESULTS

The literature search resulted in 639 records. After removing duplicates, screening by title and abstract, and assessing full-texts for eligibility, the scoping review included 60 publications. Criteria for OHL were extracted and assigned to six main categories (with 25 subcategories). The most prevalent topic of organizational health literacy refers to communication with service users. Exemplary criteria regarding this main category are the education and information of service users, work on easy-to-understand written materials as well as oral exchange, and verifying understanding. The six main categories were defined as 1) communication with service users; 2) easy access & navigation; 3) integration & prioritization of OHL; 4) assessments & organizational development; 5) engagement & support of service users, and 6) information & qualification of staff. The criteria were based on various concepts and terminologies. Terminologies were categorized into four conceptual clusters: 1) health literacy in various social contexts; 2) health literate health care organization; 3) organizational behavior, and 4) communication in health care. 17 different assessment tools and instruments were identified. Only some of the toolkits and instruments were validated or tested in feasibility studies.

CONCLUSIONS

Organizational health literacy includes a significant number of distinct organizational criteria. The terminologies used in the OHL literature are heterogeneous based on a variety of concepts. A comprehensive, consensus-based conceptual framework on OHL is missing.

Development of a Clinical-Academic-Community Collaboration to Improve Health Literacy

Limited health literacy is associated with poor patient health outcomes and increased hospitalization rates. Patient-provider communication plays an important role in patient health literacy and the understanding of medical terminology. This study demonstrates how a collaboration between clinical, academic, and community partners was instrumental in the design and implementation of a clinic readiness assessment and a clinic-based pilot intervention to encourage patient-provider communication and improve patient health literacy. A state hospital association, academic research team, and community adult literacy center director collaborated to develop a 60-item clinic readiness assessment and an evidence-informed pilot intervention. The clinic readiness assessment captured clinics’ motivation and capacity for pilot implementation and providers’ current communication strategies. The intervention centered around AskMe3™ educational materials and involved 2 patient visits (initial and follow-up visits). Data collection instruments for the intervention were administered verbally and included questions about patient demographics and communication needs, and a single-item health literacy measure. Descriptive statistics (frequencies/percentages) were used to analyze results from the clinic readiness assessment and pilot intervention. Establishment of the partnership, and collaborative, iterative development of the clinic readiness assessment and pilot intervention are described. This pilot project resulted in important lessons learned which led to critical modifications that will inform future expansion of the intervention. Collaboration between healthcare leaders, researchers, and community partners is recommended for developing clinic-based health literacy initiatives.

Perspectives on health examination for asylum seekers in relation to health literacy - focus group discussions with Arabic and Somali speaking participants

BACKGROUND

Asylum seekers coming to most countries are offered a specific health examination. A previous study concluded that a considerable proportion of those taking part of it in Sweden had poor experiences of the communication in and the usefulness of this examination and had poor health literacy. The aim of this study was to explore in greater depth the experiences of the health examination for asylum seekers among Arabic- and Somali-speaking participants in Sweden. A secondary aim was to examine experiences and discuss findings using a health literacy framework.

METHODS

Seven focus group discussions were conducted with 28 Arabic and Somali speaking men and women that participated in a health examination for asylum seekers. Data were analyzed by latent content analysis.

RESULTS

One overarching theme - beneficial and detrimental - was found to represent the participants' experiences of the health examination for asylum seekers. Three categories were identified that deal with those experiences. The category of "gives some good" describes the examination as something that "gives support and relief" and "cares on a personal level." The category of "causes feelings of insecurity" describes the examination as something that "lacks clarity" and that "does not give protection." The category "causes feelings of disappointment" views the examination as something that "does not fulfil the image of a health examination" and "does not focus on the individual level."

CONCLUSION

The health examination for asylum seekers was experienced as beneficial and detrimental at the same time. The feelings were influenced by the experiences of information and communication before, during and after the examination and on how health literate the organizations providing the HEA are. To achieve more satisfied participants, it is crucial that all organizations providing the HEA become health literate and person-centered.

Health Literacy in Relation to Health Outcomes: A Concept Analysis

Health literacy is a concept discussed in the literature of many disciplines, but the definitions used are varied. Using the Walker and Avant method of concept analysis, the authors explore health literacy in relation to health outcomes-the defining attributes, antecedents, consequences, and empirical referents. In addition, cases are provided that illustrate health literacy in relation to health outcomes. This concept analysis allows for colleagues in nursing to have a better understanding of this concept and facilitates further development of tools to assess and improve health literacy and ultimately improve health outcomes overall.

Developing and pilot testing a comprehensive health literacy communication training for health professionals in three European countries

OBJECTIVE

Skills to address different health literacy problems are lacking among health professionals. We sought to develop and pilot test a comprehensive health literacy communication training for various health professionals in Ireland, Italy and the Netherlands.

METHODS

Thirty health professionals participated in the study. A literature review focused on evidence-informed training-components. Focus group discussions (FGDs) explored perspectives from seventeen professionals on a prototype-program, and feedback from thirteen professionals following pilot-training. Pre-post questionnaires assessed self-rated health literacy communication skills.

RESULTS

The literature review yielded five training-components to address functional, interactive and critical health literacy: health literacy education, gathering and providing information, shared decision-making, enabling self-management, and supporting behaviour change. In FGDs, professionals endorsed the prototype-program and reported that the pilot-training increased knowledge and patient-centred communication skills in addressing health literacy, as shown by self-rated pre-post questionnaires.

CONCLUSION

A comprehensive training for health professionals in three European countries enhances perceived skills to address functional, interactive and critical health literacy.

PRACTICE IMPLICATIONS

This training has potential for wider application in education and practice in Europe.

Contextualizing Health Literacy to Health Care Organizations

Parker, Ratzen and Lurie (2003) pointed out that a silent epidemic is affecting the health status of the American population, namely poor health literacy. Actually, inadequate health literacy is the main cause of the patients’ inability to navigate the health care environment, paving the way for inappropriateness in the provision of care as well as for poor health outcomes. Moreover, it has been esteemed that a third of the European population is not able to properly understand, process and use health information (HLS-EU Consortium, 2012). The same issue has been identified in several Asian countries (see, for example, Nakayama et al., 2015; Pednekar, Gupta & Gupta, 2011). What is striking is that—until today—the attention has been focused on the individual determinants of low health literacy, while studies concerning the organizational health literacy—that is to say, the ability of health care organization to establish friendly and comfortable relationships with the patients—are uncommon (Weaver, Wray, Zellin, Gautam & Jupka, 2012). This article is aimed at exploring the way health care organizations deal with patients living with inadequate health literacy. Drawing on the prevailing literature (Brach et al., 2012; DeWalt et al., 2013; Matthews & Sewell, 2002; Murphy-Knoll, 2007; Stableford & Mettger, 2007) the main approaches to improve organizational health literacy are examined. Then, a distinction between formal and informal tools to address organizational health literacy is suggested and the effectiveness of both of them is compared. The findings of the research suggest that informal tools are more common than formal tools, even though the former have lower perceived effectiveness as compared with the latter. Health care organizations seem to be still far from effectively activating comprehensive organizational health literacy pathways. There is a desperate need for systemic efforts to enhance the awareness of organizational health literacy and to encourage processes of change towards health literate organizational environments.

More than meets the eye: relationship between low health literacy and poor vision in hospitalized patients

Patient-centered care includes involving patients and their families in self-management of chronic diseases. Identifying and addressing barriers to self-management, including those related to health literacy and vision limitations, may enhance one's ability to self-manage. A set of brief verbal screening questions (BVSQ) that does not rely on sufficient vision to assess health literacy was developed by Chew and colleagues in the outpatient setting. The authors aimed to evaluate the usefulness of this tool for hospitalized patients and to determine the prevalence of poor vision among inpatients. In a prospective study, the BVSQ and the Rapid Estimate of Adult Learning in Medicine-Revised (REALM-R; among participants with sufficient vision, ≥ 20/50 Snellen) were administered to general medicine inpatients. Of 893 participants, 79% were African American, and 57% were female; the mean age was 53 years. Among 668 participants who completed both tools, the proportion with low health literacy was 38% with the BVSQ versus 47% with the REALM-R (p = .0001). Almost one fourth of participants had insufficient vision; participants with insufficient vision were more likely to be identified as having low health literacy by the BVSQ, compared with those with sufficient vision (59% vs. 38%, p < .001).