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Barnes LAJ, Rolfe MI, Barclay L, McCaffery K, Aslani P. Demographics, health literacy and health locus of control beliefs of Australian women who take complementary medicine products during pregnancy and breastfeeding: A cross-sectional, online, national survey. Health Expect 2021; 25:667-683. [PMID: 34951097 PMCID: PMC8957740 DOI: 10.1111/hex.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Pregnant and breastfeeding women's use of complementary medicine products (CMPs) is common, and possibly associated with autonomous health care behaviours. However, the health literacy levels and health locus of control (HLOC) beliefs of women who use CMPs in pregnancy and lactation have not been previously assessed in a large Australian sample. Aim The aim of this study is to determine the health literacy levels and HLOC beliefs of women who use CMPs in pregnancy and lactation and determine the types of CMPs used. Methods A cross‐sectional, national, online survey of Australian pregnant or breastfeeding women aged 18 years and older, and currently using CMPs was conducted. Results A total of 810 completed surveys (354 pregnant and 456 breastfeeding women) were analysed. Most had adequate functional health literacy levels (93.3%). Health care practitioners (HCPs) HLOC mean scores were the highest for the sample, followed by Internal HLOC beliefs mean scores. Almost all (n = 809) took at least one dietary supplement, the most popular being pregnancy and breastfeeding multivitamins, iron supplements and probiotics. Use was generally in line with clinical recommendations, except for low rates of iodine supplementation. Herbal medicine use was lower for the total sample (57.3%, n = 464), but significantly higher (p < .0001) for the breastfeeding cohort, with consumers taking one to four herbal medicines each. The most popular herbs were raspberry leaf, ginger, peppermint and chamomile (pregnant respondents) and chamomile, ginger and fenugreek (breastfeeding respondents). Conclusions Respondents were health literate, with high scores for Internal and HCP HLOC scales, suggesting that they are likely to demonstrate self‐efficacy, positive health behaviours and work well in partnership with HCPs. HCPs can facilitate discussions with pregnant and breastfeeding women using CMPs, while considering women's health literacy levels, health beliefs and goals.
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Affiliation(s)
- Larisa A J Barnes
- Faculty of Medicine and Health, School of Pharmacy and University Centre for Rural Health, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University Centre for Rural Health and School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Margaret I Rolfe
- Faculty of Medicine and Health, University Centre for Rural Health and School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Lesley Barclay
- Faculty of Medicine and Health, University Centre for Rural Health and School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Kirsten McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Parisa Aslani
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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Sørensen K, Levin-Zamir D, Duong TV, Okan O, Brasil VV, Nutbeam D. Building health literacy system capacity: a framework for health literate systems. Health Promot Int 2021; 36:i13-i23. [PMID: 34897445 PMCID: PMC8672927 DOI: 10.1093/heapro/daab153] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The human and social implications of poor health literacy are substantial and wide-ranging. Health literacy represents the personal competencies and organizational structures, resources and commitment that enable people to access, understand, appraise and use information and services in ways that promote and maintain good health. A large-scale societal improvement of health literacy will require political buy-in and a systematic approach to the development of health literacy capacity at all levels. This article builds the case for enhancing health literacy system capacity and presents a framework with eight action areas to accommodate the structural transformation needed at micro, meso and macro levels, including a health literate workforce, health literate organization, health literacy data governance, people-centred services and environments based on user engagement, health literacy leadership, health literacy investments and financial resources, health literacy-informed technology and innovation, and partnerships and inter-sectoral collaboration. Investment in the health literacy system capacity ensures an imperative and systemic effort and transformation which can be multiplied and sustained over time and is resilient towards external trends and events, rather than relying on organizational and individual behavioural change alone. Nevertheless, challenges still remain, e.g. to specify the economic benefits more in detail, develop and integrate data governance systems and go beyond healthcare to engage in health literacy system capacity within a wider societal context.
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Affiliation(s)
| | - Diane Levin-Zamir
- Department of Health Education and Promotion,
Clalit, Tel Aviv and School of Public Health, University of Haifa,
Haifa, Israel
| | - Tuyen V Duong
- School of Nutrition and Health Sciences, Taipei
Medical University, Taipei, Taiwan
| | - Orkan Okan
- Interdisciplinary Centre for Health Literacy
Research, Bielefeld University, Germany
| | | | - Don Nutbeam
- Sydney School of Public Health, University of
Sydney, Sydney, Australia
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Conquest JH, Skinner J, Kruger E, Tennant M. Oral Health Profiling for Young and Older Adults: A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179033. [PMID: 34501621 PMCID: PMC8431107 DOI: 10.3390/ijerph18179033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to trial the suitability of an oral health promotion toolkit in a chair-side setting to determine: an individual's knowledge; understanding of oral and general health behaviour and evaluate the commitment of dental practitioners to undertake an assessment of the individual's attitude and aptitude to undertake a home care preventive plan. All participants were 18 years and over and came from low socio-economic backgrounds in rural New South Wales, Australia. The study evaluated 59 case studies regarding their knowledge of oral and general health. The study included an oral health profiling questionnaire, based on validated oral health promotion outcome measures, a full course of dental care provided by a private dental practitioner or a dental student. Out of the 59 participants, 47% of participants cleaned their teeth twice per day, 69% used fluoride toothpaste and 47% applied the toothpaste over all the bristles. The questionnaire, based on Watt et al. (2004) verified oral health prevention outcome measures was a sound approach to determine an individual's knowledge, understanding of oral and general health behaviour. However, dental practitioners' commitment to assessing the individual was low.
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Affiliation(s)
- Jennifer Hanthorn Conquest
- School of Human Sciences, University of Western Australia, Perth 6009, Australia; (E.K.); (M.T.)
- Correspondence: ; Tel.: +61-427-708-619
| | - John Skinner
- Poche Centre for Indigenous Health, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia;
| | - Estie Kruger
- School of Human Sciences, University of Western Australia, Perth 6009, Australia; (E.K.); (M.T.)
| | - Marc Tennant
- School of Human Sciences, University of Western Australia, Perth 6009, Australia; (E.K.); (M.T.)
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Serbim A, Paskulin L, Nutbeam D. Improving health literacy among older people through primary health care units in Brazil: feasibility study. Health Promot Int 2021; 35:1256-1266. [PMID: 31821454 DOI: 10.1093/heapro/daz121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are only a small number of reported intervention studies to improve health literacy among older populations. This paper reports on a study designed to investigate the feasibility and potential impact on health literacy and health practices of embedding an intervention programme to improve health literacy with older people through established primary health care units (PHCUs) in a disadvantaged urban community in Brazil. This investigation utilized a quasi-experimental design, with 42 participants recruited for the intervention group and comparison group. The Alfa-Health Program was offered by a nurse in a PHCU as part of the public universal health system over a period of 5 months, and was compared for its impact on a range of health literacy and self-reported health outcomes with routine health care available for older people. The intervention achieved relatively high levels of participation, and positive feedback from participants. Some improvements in vaccination rates, health literacy and reported health behaviours related to food choices and physical activity were observed. The intervention made good use of existing facilities; the content and methods were well received by the participants. However, there were some difficulties in recruitment and in retention of participants. The study has demonstrated the practical feasibility of delivering a comprehensive health education programme designed to improve health literacy in a PHCU in Brazil.
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Affiliation(s)
- Andreivna Serbim
- Nursing School, Federal University of Alagoas (UFAL), Arapiraca Campus, Brazil
| | - Lisiane Paskulin
- Nursing School, Nursing Graduate Program, Federal University of Rio Grande do Sul (UFRGS), Brazil
| | - Don Nutbeam
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
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Gibney S, Bruton L, Ryan C, Doyle G, Rowlands G. Increasing Health Literacy May Reduce Health Inequalities: Evidence from a National Population Survey in Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5891. [PMID: 32823744 PMCID: PMC7459493 DOI: 10.3390/ijerph17165891] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/16/2022]
Abstract
Background. Health literacy has been separately associated with socio-economic status and worse health status and outcomes. However, the magnitude of the associations between health literacy and health status and outcomes may not be evenly distributed across society. This study aims to estimate and compare the associations between health status, health behaviours, and healthcare utilisation within different levels of social status in the Irish population. Materials and methods. Data from Ireland collected as part of the 2011 European Health Literacy Survey were analysed. General health literacy was measured on a 0-50 scale, low to high. There were four binary outcomes: long-standing health conditions, smoking, hospital visits in the last 12 months, and self-rated health status. Logistic regression analysis was conducted to estimate the likelihood of each health outcome. Health literacy was treated as the main independent variable. Marginal effects were calculated using the delta method to demonstrate the change in likelihood of each outcome associated with a 5-point increase in health literacy score. The sample was grouped into tertiles based on self-reported social status, and models were replicated and compared for each tertile. Models were adjusted for known correlates of health literacy and health: age, gender, and education. Analysis was conducted using Stata V14. Results. Higher health literacy scores were associated with a lower probability of having a limiting illness within the low social status group only. Higher health literacy scores were associated with a lower probability of three or more hospital visits in the past 12 months in the low and middle social status groups. For people in the low and middle social status groups, higher health literacy levels were associated with a lower probability of being a current smoker. The associations between health literacy and self-rated health status were similar in each social status group. Conclusions: Improvement in population health literacy may reduce the prevalence of long-term chronic health conditions, reduce smoking levels, and result in fewer hospital visits. Whilst improved health literacy should improve behaviours and outcomes in all groups, it should have a more marked impact in lower social status groups, and hence contribute to reducing the observed social disparities in these health outcomes.
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Affiliation(s)
- Sarah Gibney
- Department of Health, Dublin 2, DO2 XW14, Ireland; (S.G.); (L.B.); (C.R.)
| | - Lucy Bruton
- Department of Health, Dublin 2, DO2 XW14, Ireland; (S.G.); (L.B.); (C.R.)
| | - Catherine Ryan
- Department of Health, Dublin 2, DO2 XW14, Ireland; (S.G.); (L.B.); (C.R.)
| | - Gerardine Doyle
- UCD College of Business, University College Dublin, Dublin 4, D04 V1W8, Ireland;
- UCD Geary Institute for Public Policy, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Gillian Rowlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Muscat DM, Ceprnja D, Hobbs K, Gibson JA, Blumenthal C, Milad R, Burns C, Lau T, Flood V. Development and evaluation of a health literacy training program for allied health professionals: A pre-post study assessing impact and implementation outcomes. Health Promot J Austr 2020; 32 Suppl 1:88-97. [PMID: 32320505 DOI: 10.1002/hpja.350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/16/2020] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED We developed and evaluated a health literacy training program for allied health professionals, and explored the feasibility of a train-the-trainer model to support dissemination. METHODS The program combined didactic and experiential teaching methods and behaviour change techniques, with a focus on teach-back and developing easy-to-understand written materials. Outcomes included participant reactions, confidence (range: 6-30), behavioural intentions (range: 6-42), and dissemination of training content. Implementation outcomes were evaluated using the Normalization MeAsure Development (NoMAD) tool, assessing the constructs of coherence (range: 4-20), cognitive participation (range: 4-20), collective action (range: 7-35) and reflexive monitoring (range: 5-25). RESULTS Of the 29 allied health professionals who participated, 90% rated the program as 'excellent'/'very good', and 97% said the information was 'extremely'/'very' helpful for their everyday practice. We observed increases in confidence (mean difference [MD] = 6.3, standard deviation [SD] = 2.7, t25 = 11.87, P < .001) and intentions (MD = 3.6, SD = 8.1, t23 = 2.2, P = .04) related to health literacy practices after 6 weeks. Improved confidence was retained over 6 months (MD = 7.1, SD = 5.2, t18 = 5.96, P < .001). After 6 months, 95% of participants (n = 19) reported using teach-back and 50% (n = 10) reported having used a readability formula. Eight-five per cent of participants (17/20) had trained others in health literacy, reaching n = 201 allied health professionals and students. NoMAD scores were highest in relation to cognitive participation (/20) (M = 18.2, SD = 2.1) and lowest in relation to collective action (/35) (M = 25.4, SD = 3.0). CONCLUSIONS A train-the-trainer model appears to be a feasible method to disseminate health literacy training, but additional work may be needed to improve the collective work done to enable health literacy practices in real-world clinical contexts. SO WHAT Staff training is particularly important in highly diverse areas where patients are disproportionately affected by low health literacy.
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Affiliation(s)
- Danielle M Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Kim Hobbs
- Western Sydney Local Health District, Sydney, Australia
| | | | | | - Rula Milad
- Western Sydney Local Health District, Sydney, Australia
| | - Chris Burns
- Western Sydney Local Health District, Sydney, Australia
| | - Timothea Lau
- Western Sydney Local Health District, Sydney, Australia
| | - Victoria Flood
- Western Sydney Local Health District, Sydney, Australia.,Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Muscat DM, Ayre J, Nutbeam D, Harris A, Tunchon L, Zachariah D, McCaffery KJ. Embedding a Health Literacy Intervention Within Established Parenting Groups: An Australian Feasibility Study. Health Lit Res Pract 2020; 4:e67-e78. [PMID: 32160305 PMCID: PMC7065833 DOI: 10.3928/24748307-20200217-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/22/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A significant proportion of new parents in high-income countries have lower health literacy, but few health literacy interventions exist for this group. OBJECTIVE This study investigated the feasibility of delivering health literacy content within existing postnatal parenting groups. METHODS Multicenter feasibility study using a seven-group pre-test post-test design. Parents older than age 16 years with children between age 4 and 26 weeks with sufficient English fluency were invited to participate in a 4-week health literacy program (four 2-hour sessions) delivered by trained facilitators (e.g., child and family health nurses). Mixed-methods evaluation was used, with quantitative data analyzed descriptively and qualitative data (e.g., focus groups, observations, interviews) analyzed using the Framework approach. KEY RESULTS Our health literacy program was successfully delivered at six sites in New South Wales, Australia, in 2018. Our recruitment strategy was successful in reaching diverse learners (N = 73), many who were born in a country other than Australia. However, few had limited health literacy as assessed by a subjective, single-item measure, and only half completed the follow-up questionnaires. High baseline knowledge, skills, and confidence among participants limited the potential for change in these quantitative outcomes but shed light on the utility of different measurement instruments in this context. Qualitative analyses suggested that the health literacy program aligned well with the institutional objectives of child and family health services and was acceptable to learners from diverse cultural backgrounds. However, in its current form, it may be perceived as too simple for learners with higher levels of education and literacy. CONCLUSIONS Our study has offered practical insights into the feasibility of embedding a health literacy intervention into established postnatal parenting groups and shown how program resources and facilitator training could be adapted to make the program more suitable for a range of learners and better support facilitators. [HLRP: Health Literacy Research and Practice. 2020;4(1):e67-e78.] PLAIN LANGUAGE SUMMARY: This study looked at the feasibility of delivering a 4-week health literacy program to new parents using existing postnatal parenting groups in New South Wales, Australia. Although the program was generally acceptable to learners and facilitators, this study offers several strategies to further improve the program so that it better supports facilitators and suits a wider range of learners.
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Affiliation(s)
| | | | | | | | | | | | - Kirsten J. McCaffery
- Address correspondence to Kirsten J. McCaffery, PhD, 128B Edward Ford Building (A27), The University of Sydney, 2006, New South Wales, Australia;
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Champlin S, Hoover DS, Mackert M. Family Health in Adult Education: A Missing Piece of the Health Literacy Puzzle. Health Lit Res Pract 2019; 3:S75-S78. [PMID: 31687659 PMCID: PMC6826759 DOI: 10.3928/24748307-20190624-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/24/2019] [Indexed: 11/20/2022] Open
Abstract
Previous research and interventions define health literacy as an individual-level concept. Although it is necessary to design programs aimed at individual people, not all health decisions are made by patients themselves, and calls have been made to expand health literacy work beyond the individual. This brief report stems from a larger study in which personnel working for adult literacy coalitions identified family health as a priority topic for health-focused lessons, yet often felt ill-equipped to teach students in this area. This brief report examines adult educators' perspectives on the types of content needed for a family health module designed for the adult education curriculum. Personnel from adult literacy coalitions offered qualitative insights on their desires for health literacy content in the context of family care. Adult literacy coalition educators and staff can provide important insights regarding the health literacy needs of adults in vulnerable populations. Three key themes emerged: American Family Health, Nutritious Eating, and Identify and Act. Rather than using a personal approach, a program that frames health literacy as family health and offers a holistic view on caring for others may serve to provide important context for health decisions and communication for adults at literacy centers. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S75–S78.]
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Affiliation(s)
- Sara Champlin
- Address correspondence to Sara Champlin, PhD, The University of North Texas, 1155 Union Circle, Denton, TX 76203;
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McCaffery KJ, Morony S, Muscat DM, Hayen A, Shepherd HL, Dhillon HM, Smith SK, Cvejic E, Meshreky W, Luxford K, Nutbeam D. Evaluation of an Australian Health Literacy Program Delivered in Adult Education Settings. Health Lit Res Pract 2019; 3:S42-S57. [PMID: 31687657 PMCID: PMC6826892 DOI: 10.3928/24748307-20190402-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Adult education targeting health literacy (HL) may bring added value in the form of improved health. Objective: This study evaluated the effects of a HL program as part of an adult education curriculum for adults with low literacy and numeracy. Methods: This was a partial-cluster randomized controlled trial among 308 adults enrolled in basic education programs in Australia. Of the 308 participants, 141 (46%) were randomized to either the standard program (language, literacy, and numeracy [LLN]), or the HL intervention (LLN with embedded health content); the remainder (n = 167) were allocated to standard intervention programs by the education provider at the class level. The main outcomes were functional HL, self-reported confidence, patient activation, generic HL (ie, HLQ, health knowledge, and self-reported health behavior). Data were collected at baseline, immediately after, and at 6 months post-intervention. Key Results: Of the 308 participants, 71% had limited literacy and 60% spoke a language other than English at home. Both interventions benefited participants, with improvements from baseline to immediate follow up on individual-level functional HL (e.g., reading a thermometer; HL group 18.4% vs. standard group 7.2%; p = .001), confidence (HL group 0.34 vs. standard group 0.06; p = .014) and health literacy questionnaire (HLQ) subscales. At 6 months, improvements in confidence (p < .001) and some HLQ measures were retained. A consistent pattern of increased improvement in the HL program was observed compared to the standard program, although only some measures reached statistical significance: reading a food label (HL group 6.03/10 correct vs. standard group 5.49/10 correct; p = .022); confidence (p = .008); ability to actively manage health (HLQ) (p = .017), and health knowledge at 6 months (HL group 68% vs. standard group 60% correct, p = .052). HL participants reported being more likely to share course information and rated the program more useful to understand their health. Conclusions: Improving language, literacy, and numeracy generally has potential public health benefits that are retained at 6 months. Integrating health content adds further value to adult basic learning, is feasible, and potentially scalable. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S42–S57.] Plain Language Summary: We compared the effect of an adult education-based health literacy (HL) program versus a standard language, literacy, and numeracy program on students' HL skills and psychosocial outcomes. Although students in both trial arms improved their skills, students in the HL program had better outcomes with higher HL, greater confidence, and higher health knowledge scores at 6 months.
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Affiliation(s)
- Kirsten J. McCaffery
- Address correspondence to Kirsten J. McCaffery, PhD, Sydney School of Public Health, Room 128B Edward Ford Building, The University of Sydney, NSW 2006, Australia;
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Muscat DM, Morony S, Trevena L, Hayen A, Shepherd HL, Smith SK, Dhillon HM, Luxford K, Nutbeam D, McCaffery KJ. Skills for Shared Decision-Making: Evaluation of a Health Literacy Program for Consumers with Lower Literacy Levels. Health Lit Res Pract 2019; 3:S58-S74. [PMID: 31687658 PMCID: PMC6826761 DOI: 10.3928/24748307-20190408-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/05/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Shared decision-making (SDM) has been found to be significantly and positively associated with improved patient outcomes. For an SDM process to occur, patients require functional, communicative, and critical health literacy (HL) skills. Objective: This study aimed to evaluate the impact of a program to improve health literacy skills for SDM in adults with lower literacy. Methods: An HL program including an SDM component (HL + SDM) and teaching of the three “AskShareKnow” questions was delivered in adult basic education settings in New South Wales, Australia. The program was evaluated using a partially cluster-randomized controlled trial comparing it to standard language, literacy, and numeracy (LLN) training. We measured the effect of these programs on (1) HL skills for SDM (conceptual knowledge, graphical literacy, health numeracy), (2) types of questions considered important for health decision-making, (3) preferences for control in decision-making, and (4) decisional conflict. We also measured AskShareKnow question recall, use, and evaluation in HL + SDM participants. Key Results: There were 308 participants from 28 classes enrolled in the study. Most participants had limited functional HL (71%) and spoke a language other than English at home (60%). In the primary analysis, the HL + SDM program compared with the standard LLN program significantly increased conceptual knowledge (19.1% difference between groups in students achieving the competence threshold; p = .018) and health numeracy (10.9% difference; p = .032), but not graphical literacy (5.8% difference; p = .896). HL + SDM participants were significantly more likely to consider it important to ask questions that would enable SDM compared to standard LLN participants who prioritized nonmedical procedural questions (all p < .01). There was no difference in preferences for control in decision-making or in decisional conflict. Among HL + SDM participants, 79% (n = 85) correctly recalled at least one of the AskShareKnow questions immediately post-intervention, and 35% (n = 29) after 6 months. Conclusions: Teaching SDM content increased participants' HL skills for SDM and changed the nature of the questions they would ask health care professionals in a way that would enable shared health decisions. [HLRP: Health Literacy Research and Practice. 2019;3(Suppl.):S58–S74.] Plain Language Summary: We developed a health literacy program that included a shared decision-making (SDM) section. The program was delivered in adult basic education classes by trained educators and compared to standard language, literacy, and numeracy training. Teaching SDM content increased participants' health literacy skills for SDM and changed the nature of the questions they would ask health care professionals.
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Affiliation(s)
- Danielle M. Muscat
- Address correspondence to Danielle M. Muscat, PhD, School of Public Health, The University of Sydney, 127A Edward Ford Building, NSW, 2006, Australia;
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Garvelink MM, Jillissen M, Knops A, Kremer JAM, Hermens RPMG, Meinders MJ. Implementation of the three good questions-A feasibility study in Dutch hospital departments. Health Expect 2019; 22:1272-1284. [PMID: 31560835 PMCID: PMC6882265 DOI: 10.1111/hex.12960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives To determine the feasibility of pragmatic implementation strategies for three good questions (in Dutch: Drie Goede Vragen; 3GV. What are my options; what are the risks and benefits related to these options; and what does this mean for my situation?) to increase shared decision‐making (SDM) efforts in Dutch secondary care, and identify barriers and facilitators of implementation. Methods Convergent mixed‐method design: pre‐post surveys with patients attending one of six clinical departments in a Dutch Hospital, post‐intervention interviews with patients and health‐care professionals. Primary outcomes: feasibility (reach, use of 3GV). Secondary outcomes: SDM, experiences with 3GV and decision making. Interviews focused on barriers and facilitators of 3GV use. Interviews were content coded and categorized into determinants of behaviour change. Results 35% of the respondents who had heard of 3GV (52%) used all three questions. 3GV use did not lead to more SDM (SDMQ9 M = Δ0.3;SE = 2.2) but patients felt empowered to decide (88%) and to SDM (86%). Barriers were as follows: time investment, other SDM projects and perception that the need to use 3GV differs per patient/consultation. Respondents preferred to use 3GV as they saw fit for the consultation, instead of literally asking them. Facilitators: easy, accessible information materials that can be flexibly used. Conclusion Implementation of 3GV seemed feasible, although influenced by contextual characteristics (eg type of decisions, patients, on‐going interventions). 3GV contributed to important elements of SDM, and respondents were willing to apply them in a way that suited their situation. Practice implications We recommend continuation of current and new implementation strategies to enable 3GV implementation in secondary care.
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Affiliation(s)
- Mirjam M Garvelink
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Quebec, QC, Canada.,Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marja Jillissen
- Radboud university medical center, Improvement & Implementation Group, Nijmegen, The Netherlands
| | - Anouk Knops
- Netherlands Patients Federation, Utrecht, The Netherlands
| | - Jan A M Kremer
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Bilodeau G, Witteman H, Légaré F, Lafontaine-Bruneau J, Voyer P, Kröger E, Tremblay MC, Giguere AMC. Reducing complexity of patient decision aids for community-based older adults with dementia and their caregivers: multiple case study of Decision Boxes. BMJ Open 2019; 9:e027727. [PMID: 31072861 PMCID: PMC6528048 DOI: 10.1136/bmjopen-2018-027727] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/19/2019] [Accepted: 03/14/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify patient decision aids' features to limit their complexity for older adults with dementia and their family caregivers. DESIGN Mixed method, multiple case study within a user-centred design (UCD) approach. SETTING Community-based healthcare in the province of Quebec in Canada. PARTICIPANTS 23 older persons (aged 65+ years) with dementia and their 27 family caregivers. RESULTS During three UCD evaluation-modification rounds, participants identified strengths and weaknesses of the patient decision aids' content and visual design that influenced their complexity. Weaknesses of content included a lack of understanding of the decision aids' purpose and target audience, missing information, irrelevant content and issues with terminology and sentence structure. Weaknesses of visual design included critics about the decision aids' general layout (density, length, navigation) and their lack of pictures. In response, the design team implemented a series of practical features and design strategies, comprising: a clear expression of the patient decision aids' purpose through simple text, picture and personal stories; systematic and frequent use of pictograms illustrating key points and helping structure patient decision aids' general layout; a glossary; removal of scientific references from the main document; personal stories to clarify more difficult concepts; a contact section to facilitate implementation of the selected option; GRADE ratings to convey the quality of the evidence; a values clarification exercise formatted as a checklist and presented at the beginning of the document to streamline navigation; involvement of a panel of patient/caregiver partners to guide expression of patient priorities; editing of the text to a sixth grade reading level; UCD process to optimise comprehensiveness and relevance of content and training of patients/caregivers in shared decision-making. CONCLUSIONS The revised template for patient decision aids is designed to meet the needs of adults living with dementia and their caregivers better, which may translate into fewer evaluation-modification rounds.
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Affiliation(s)
- Gabriel Bilodeau
- Laval University Research Centre on Primary Care and Services, Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Holly Witteman
- Laval University, Family and Emergency Medicine, Quebec City, Quebec, Canada
| | - France Légaré
- Knowledge Transfer and Health Technology Assessment Research Group, Research Center of Centre hospitalier universitaire de Québec (CRCHUQ), Quebec City, Quebec, Canada
- Family Medicine and Emergency Medicine, Universite Laval Faculte de medecine, Quebec City, Quebec, Canada
| | | | - Philippe Voyer
- Faculte des Sciences Infirmieres de l'Universite Laval, Quebec City, Quebec, Canada
| | - Edeltraut Kröger
- Laval University Research Center on Primary Care and Services, Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Marie-Claude Tremblay
- Laval University Research Centre on Primary Care and Services, Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Family Medicine and Emergency Medicine, Universite Laval Faculte de medecine, Quebec City, Quebec, Canada
| | - Anik M C Giguere
- Laval University Research Centre on Primary Care and Services, Centre integre universitaire de sante et de services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Family Medicine and Emergency Medicine, Laval University, Quebec City, Quebec, Canada
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Morony S, Weir KR, Bell KJL, Biggs J, Duncan G, Nutbeam D, McCaffery KJ. A stepped wedge cluster randomised trial of nurse-delivered Teach-Back in a consumer telehealth service. PLoS One 2018; 13:e0206473. [PMID: 30379942 PMCID: PMC6209310 DOI: 10.1371/journal.pone.0206473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the impact of Teach-Back on communication quality in a national telephone-based telehealth service, for callers varying in health literacy. DESIGN Cross-sectional stepped wedge cluster randomised trial with continuous recruitment, short (fixed) exposure and blinded outcome assessors. Nurses were stratified by hours worked and randomised into training groups using a computer generated sequence. SETTING An Australian national pregnancy and parenting telephone helpline. INTERVENTION Complex intervention involving a single 2-hour group Teach-Back training session, combined with ongoing nurse self-reflection on their communication following each call and each shift. PARTICIPANTS Participants were 637 callers to the telephone helpline aged 18-75 (87% female), of whom 127 (13%) had inadequate health literacy (measured with the Single Item Literacy Screener); and 15 maternal and child health nurses with 15 years' experience on average. MEASURES Primary outcome was a modified subscale of the Health Literacy Questionnaire, 'having sufficient information to manage health'. Secondary caller outcomes included caller confidence, perceived actionability of information and nurse effort to listen and understand. Nurse outcomes were perceptions of their communication effectiveness. RESULTS Over a 7 week period, 376 surveyed callers received usual care and 261 Teach-Back. Ratings on the primary outcome increased over time (OR 1.17, CI 1.01 to 1.32, p = 0.03) but no independent Teach-Back effect was observed. A consistent pattern suggests that, compared with usual care, Teach-Back helps callers with inadequate health literacy feel listened to (OR 2.3, CI 0.98 to 5.42, p = 0.06), confident to act (OR 2.44, CI 1.00 to 5.98, p = 0.06), and know what steps to take (OR 2.68, CI 1.00 to 7.17, p = 0.06). Nurse perceptions of both their own communication effectiveness (OR = 2.31; CI 1.38 to 3.86, p<0.0001), and caller understanding (OR = 2.56; CI 1.52 to 4.30, p<0.001) both increased with Teach-Back. No harms were reported. CONCLUSIONS Teach-Back appears to benefit telephone health service users with inadequate health literacy, but the extent of this is unclear due to smaller numbers of lower literacy participants. Improving caller ratings over time are likely due to increasing nurse communication competence.
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Affiliation(s)
- Suzanne Morony
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kristie R. Weir
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Katy J. L. Bell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Gregory Duncan
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Don Nutbeam
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten J. McCaffery
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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14
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Champlin S, Hoover DS, Mackert M. Health Literacy in Adult Education Centers: Exploring Educator and Staff Needs. Health Promot Pract 2018; 21:198-208. [PMID: 30070148 DOI: 10.1177/1524839918789690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective. Incorporating health content into adult education courses is promising for increasing health literacy skills among "hard-to-reach" populations. The purpose of this study was to gain previously untapped knowledge of adult education personnel (i.e., educators, staff) about the strategies and programs that would be beneficial for helping students learn about health. Method. Personnel (N = 53) from three literacy coalitions completed an online survey that assessed interest and preferences for developing a health literacy curriculum. Results. Personnel indicated general concepts such as health services and insurance as those of greatest priority. Additionally, tools designed for general use (completion of forms) were favored. Personnel preferred programs that focused on general skills over those designed to address specific health topics, χ2(1) = 11.52, p = .001. Conclusions. Adult education personnel find greatest value in health literacy programs aimed at increasing general skills rather than disease-/topic-specific content. There were several mismatches in topics noted as a "priority" and those for which personnel felt comfortable teaching. A focus on fostering general health skills will help all students-not just those with specific health concerns such as diabetes and asthma. Teaching health literacy through general skill development could make health programs exciting, engaging, and accessible for students.
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Gärtner FR, Bomhof-Roordink H, Smith IP, Scholl I, Stiggelbout AM, Pieterse AH. The quality of instruments to assess the process of shared decision making: A systematic review. PLoS One 2018; 13:e0191747. [PMID: 29447193 PMCID: PMC5813932 DOI: 10.1371/journal.pone.0191747] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/10/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies. METHODS In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397. RESULTS We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated. CONCLUSIONS Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument's content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.
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Affiliation(s)
- Fania R. Gärtner
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hanna Bomhof-Roordink
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ian P. Smith
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
| | - Anne M. Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Arwen H. Pieterse
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
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Muscat DM, Shepherd HL, Nutbeam D, Morony S, Smith SK, Dhillon HM, Trevenal L, Hayen A, Luxford K, McCaffery K. Developing Verbal Health Literacy with Adult Learners Through Training in Shared Decision-Making. Health Lit Res Pract 2017; 1:e257-e268. [PMID: 31294271 PMCID: PMC6607778 DOI: 10.3928/24748307-20171208-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background Health literacy skills are often assessed in relation to written health materials; however, many important communications are in other formats, especially verbal communication with health care providers. Objective This qualitative study sought to examine adult learners' experiences of developing verbal health literacy skills within an Australian adult basic education program, and to explore verbal communication and shared decision-making as a constituent domain of health literacy. Methods We conducted a semi-structured qualitative interview study between September and November 2014 with adult learners who had participated in a single-semester health literacy program that included an integrated shared decision-making component. We analyzed interviews using the Framework method; a matrix-based approach to thematic analysis. A hybrid process of inductive and deductive coding was used to interpret raw data. Key Results Interviewees were 22 students from six health literacy classes and ranged in age from 18 to 74 years (mean, 48.3). The majority were women (n = 15) and born outside Australia (n = 13). Health literacy was generally limited according to the Newest Vital Sign screening tool (n = 17). The health literacy program appeared to serve two key functions. First, it stimulated awareness that patients have the right to participate in decision-making concerning their treatment and care. Second, it facilitated verbal skill development across the domains of functional (e.g., communicating symptoms), communicative (e.g., asking questions to extract information about treatment options), and critical (e.g., integrating new knowledge with preferences) health literacy. Conclusions Our findings support the conceptualization of health literacy as a modifiable health asset that is subject to change and improvement as a result of deliberate intervention. Results reinforce verbal health literacy as an important component of health literacy, and draw attention to the hierarchy of verbal skills needed for consumers to become more actively involved in decisions about their health. We present a revised model of health literacy based on our findings. [Health Literacy Research and Practice. 2017;1(4):e257-e268.]. Plain Language Summary We developed a health literacy program for adults with lower literacy to help learners develop skills to talk to health care providers and share health decisions. The program was taught in Australian adult education settings. The article explores the range of health literacy skills needed for communication and decision-making in this study, and presents a model in which verbal skills are an important part of health literacy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kirsten McCaffery
- Address correspondence to Kirsten McCaffery, PhD, Room 128B, Edward Ford Building (A27), The University of Sydney, NSW, 2006, Australia;
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Muscat DM, Morony S, Smith SK, Shepherd HL, Dhillon HM, Hayen A, Trevena L, Luxford K, Nutbeam D, McCaffery KJ. Qualitative insights into the experience of teaching shared decision making within adult education health literacy programmes for lower-literacy learners. Health Expect 2017; 20:1393-1400. [PMID: 28678433 PMCID: PMC5689229 DOI: 10.1111/hex.12580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/28/2022] Open
Abstract
Background Enhancing health literacy can play a major role in improving healthcare and health across the globe. To build higher‐order (communicative/critical) health literacy skills among socially disadvantaged Australians, we developed a novel shared decision making (SDM) training programme for adults with lower literacy. The programme was delivered by trained educators within an adult basic education health literacy course. Objective To explore the experience of teaching SDM within a health literacy programme and investigate whether communicative/critical health literacy content meets learner needs and teaching and institutional objectives. Design and participants Qualitative interview study with 11 educators who delivered the SDM programme. Transcripts were analysed using the Framework approach; a matrix‐based method of thematic analysis. Results Teachers noted congruence in SDM content and the institutional commitment to learner empowerment in adult education. The SDM programme was seen to offer learners an alternative to their usual passive approach to healthcare decision making by raising awareness of the right to ask questions and consider alternative test/treatment options. Teachers valued a structured approach to training building on foundational skills, with language reinforcement and take‐home resources, but many noted the need for additional time to develop learner understanding and cover all aspects of SDM. Challenges for adult learners included SDM terminology, computational numerical risk tasks and understanding probability concepts. Discussion and conclusions SDM programmes can be designed in a way that both supports teachers to deliver novel health literacy content and empowers learners. Collaboration between adult education and healthcare sectors can build health literacy capacity of those most in need.
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Affiliation(s)
- Danielle M Muscat
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
| | - Suzanne Morony
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Heather L Shepherd
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia.,University of Sydney, Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Sydney, NSW, Australia
| | - Haryana M Dhillon
- University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia.,University of Sydney, School of Psychology, Sydney, NSW, Australia
| | - Andrew Hayen
- University of Technology Sydney, Faculty of Health, Sydney, NSW, Australia
| | - Lyndal Trevena
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
| | - Karen Luxford
- Clinical Excellence Commission, Sydney, NSW, Australia
| | - Don Nutbeam
- University of Sydney, School of Public Health, Sydney, NSW, Australia
| | - Kirsten J McCaffery
- University of Sydney, School of Public Health, Sydney, NSW, Australia.,University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, NSW, Australia
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Morony S, Lamph E, Muscat D, Nutbeam D, Dhillon HM, Shepherd H, Smith S, Khan A, Osborne J, Meshreky W, Luxford K, Hayen A, McCaffery KJ. Improving health literacy through adult basic education in Australia. Health Promot Int 2017; 33:867-877. [DOI: 10.1093/heapro/dax028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Suzanne Morony
- Sydney School of Public Health, The University of Sydney, NSW, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
| | - Emma Lamph
- School of Psychology, The University of Sydney, NSW, Australia
| | - Danielle Muscat
- Sydney School of Public Health, The University of Sydney, NSW, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
| | - Don Nutbeam
- Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
- School of Psychology, The University of Sydney, NSW, Australia
| | - Heather Shepherd
- Sydney School of Public Health, The University of Sydney, NSW, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, NSW, Australia
| | - Sian Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Aisha Khan
- College of Global Public Health, New York University, NY, USA
| | - Julie Osborne
- Health and Social Policy Branch, NSW Ministry of Health, NSW, Australia
| | | | - Karen Luxford
- Executive Director, Clinical Excellence Commission, NSW, Australia
| | - Andrew Hayen
- Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Kirsten J McCaffery
- Sydney School of Public Health, The University of Sydney, NSW, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, NSW, Australia
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Nutbeam D, McGill B, Premkumar P. Improving health literacy in community populations: a review of progress. Health Promot Int 2017; 33:901-911. [DOI: 10.1093/heapro/dax015] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Don Nutbeam
- Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Bronwyn McGill
- Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Pav Premkumar
- Southampton Education School, University of Southampton, Southampton, UK
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