Implementation of a standardised health education in a local context. A case study

Patient and public involvement in health literacy interventions: a mapping review

PLAIN ENGLISH SUMMARY

If people can read, understand and act on health information to better their health and reduce illness, they are thought to have "adequate" health literacy. Poor health literacy can mean people are less able to access health care and manage their health. Health literacy tends to worsen as adults get older, and is especially poor in adults age 65 and over. Ideally, health literacy interventions target people before age 65, to establish good skills and habits before people have many health problems associated with ageing. It is also good if researchers consult ordinary people, including patients and the public (PPI) when planning a programme to try to improve health literacy. This may help ensure individual needs are catered for.We therefore looked for studies that described any role of patient or public representatives in the research planning stages. We explored how the representatives contributed to each project. We found only 20 studies that included people other than the research team. Lack of reporting and consultation with patient and public representatives may contribute to less success when public health programmes are undertaken.

BACKGROUND

Health literacy is the ability to understand, access and use health care and is a critical mediating factor that affects the health of older adults. Patient and public involvement in health and social care research, policy and design of care delivery is one mechanism that can promote production of better health literacy. This mapping review looks for and describes practices, concepts and methods that have been reported involving patients and public in the development and design of health literacy interventions for older people.

METHODS

Studies for the present review were selected from an inventory of health behaviour studies published between 2003 and 2013. The inventory was created by systematic searches on bibliographic databases (Medline, CINAHL, Scopus, Google) for health literacy interventions involving older people (50+ years) and resulted in screening of 5561 articles, of which 1097 met study inclusion criteria. For the research described in this article 96 of the 1097 studies specifically focused on health literacy and were independently screened by two reviewers to assess involvement of stakeholders other than investigators and participants.

RESULTS

Twenty studies included patient and/or public involvement in at least one research domain: design, management or evaluation. Involvement included volunteers, older people, patients, and/or community representatives.

CONCLUSIONS

Patient and public involvement were rarely reported in studies on health literacy interventions for older people. Future intervention development needs high quality PPI, which is well reported to develop the evidence base and inform practice.

User involvement as sharing knowledge - an extended perspective in patient education

Background

Patient education is undergoing a paradigm shift in which the perspectives of patients are increasingly being incorporated into learning programs. Access to the users’ experience is now considered a prerequisite for the development of quality health services, but how this user experience is incorporated is somewhat unclear. The inclusion of experiential knowledge and user involvement can challenge professional authority, roles, and working methods because knowledge sharing is different from persuasion, professional explanation, and consent. Dialogue and collaboration between professionals and users are essential to effective user involvement; however, little is understood about the characteristics of their collaboration.

Objective

To describe characteristics of the collaboration between users and health professionals in developing, implementing, and evaluating patient education courses in hospitals.

Design, setting, and methods

A field study was conducted in three different hospitals. Data collection comprised open observations in meetings of 17 different collaboration groups with a total of 100 participants, and 24 interviews with users and professionals. The data analyses included both thematic and the Systematic Data Integration approach.

Results

Two contrasting types of collaboration emerged from the analyses; knowledge sharing and information exchange. The first was characterized by mutual knowledge sharing, involvement, and reciprocal decision making. Characteristics of the second were the absence of dialogue, meagre exploration of the users’ knowledge, and decisions usually made by the professionals.

Conclusion

Collaboration between users and health personnel takes place in an asymmetric relationship. Mutual knowledge sharing was found to be more than the exchange of information and consultation and also to be a prerequisite for shared decision making. In developing patient education when users are involved the health professionals have the power and responsibility to ensure that knowledge sharing with users takes place.