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Muscat DM, Morony S, Nutbeam D, Ayre J, Shepherd HL, Smith SK, Dhillon HM, Hayen A, Luxford K, Meshreky W, McCaffery K. Learners' experience and perceived impact of a health literacy program in adult basic education: a qualitative study. Public Health Res Pract 2020; 30:29231909. [PMID: 32601653 DOI: 10.17061/phrp29231909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives and importance of the study: Adult literacy programs aim to empower learners to participate more effectively in everyday life. This includes programs with health content embedded in curricula to target health literacy. Adult learners who attend these programs represent a heterogeneous population, but include a high proportion of hard-to-reach or socially disadvantaged groups in terms of age, ethnicity, educational background, language and prevalence of learning disabilities. In 2014, we conducted a cluster-randomised controlled trial of a health literacy program in adult basic education classes across New South Wales, Australia. This paper reports findings from a qualitative study exploring learners' experience of the course and its perceived impact on their lives, as well as their understanding and confidence about health. STUDY TYPE Qualitative interview study. METHOD We conducted semistructured interviews as part of the evaluation of the 18-week health literacy program, with participants purposively recruited from six health literacy classes (n = 22). Researchers trained in qualitative methods interviewed adult learners either face to face or over the phone using a topic guide. Data was analysed using the Framework method, a matrix-based approach to thematic analysis. RESULTS The majority of interviewees were female, lived in metropolitan areas and were from non-English-speaking backgrounds. Most had existing self-reported health problems and inadequate functional health literacy. Most participants described positive impacts of the health literacy course on their language, literacy and numeracy skills, functional health literacy skills, and health knowledge. They also reported being able to translate this into health actions including interacting with providers, accessing and using healthcare, and managing health and illness (e.g. making healthier food choices). Learners also described positive social outcomes of the course, including feelings of connectedness and interpersonal trust within a new network of learners, and reported sharing new knowledge with others in their communities. CONCLUSIONS The findings add value to existing limited evidence that has demonstrated the untapped potential of adult basic education to develop health literacy skills among socially disadvantaged groups. Learners valued the opportunity to share experiences in structured group learning, and reported confidence to transfer new knowledge into their home and wider social network.
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Affiliation(s)
- Danielle M Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Suzanne Morony
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Don Nutbeam
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Julie Ayre
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Heather L Shepherd
- School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia; School of Psychology, University of Sydney, NSW, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Australia
| | | | - Andrew Hayen
- Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Karen Luxford
- Clinical Excellence Commission, Sydney, NSW, Australia
| | | | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia;
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Meshreky W, Hennessy D, Gilmour R, Tobin S, Sheppeard V. Examining the use of antiviral prophylaxis for influenza outbreaks in residential aged care facilities in NSW, Australia. Public Health Res Pract 2020; 30:29121904. [PMID: 32152617 DOI: 10.17061/phrp29121904] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Influenza attack rates in closed population settings, such as residential aged care facilities (RACFs), can be more than 50% during annual epidemics. Uncertainty about the effectiveness of neuraminidase inhibitors (NAIs) as prophylaxis for influenza outbreaks has led to variations in their use in RACFs in New South Wales (NSW), Australia. OBJECTIVES To examine the use of prophylactic NAIs by NSW RACFs for residents during influenza outbreaks in the 2015 influenza season. METHODS A prospective cohort study of influenza outbreaks reported to NSW Public Health Units from 1 June 2015 - 31 October 2015. RESULTS Eighty-eight RACFs reported influenza outbreaks; 86 were included in the study. Fifty-two RACFs used prophylactic NAIs; 34 did not. The median time to start NAI prophylaxis from the onset date of the first case was 8.5 days (range 2-23). The average proportion of residents within a facility that received prophylaxis was 51%percnt; (range 0.7-95). CONCLUSION Variations in the use of prophylactic NAIs exist across RACFs. Earlier initiation of NAI prophylaxis, improved resident coverage where appropriate and other practice changes are recommended for the management of influenza outbreaks in RACFs.
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Affiliation(s)
- Wedyan Meshreky
- NSW Public Health Training Program, NSW Health, Sydney, Australia;
| | - Daneeta Hennessy
- NSW Biostatistics Training Program, NSW Health, Sydney, Australia; Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, Australia
| | - Robin Gilmour
- Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, Australia
| | - Sean Tobin
- Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, Australia
| | - Vicky Sheppeard
- Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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McCaffery KJ, Morony S, Muscat DM, Smith SK, Shepherd HL, Dhillon HM, Hayen A, Luxford K, Meshreky W, Comings J, Nutbeam D. Evaluation of an Australian health literacy training program for socially disadvantaged adults attending basic education classes: study protocol for a cluster randomised controlled trial. BMC Public Health 2016; 16:454. [PMID: 27233237 PMCID: PMC4884424 DOI: 10.1186/s12889-016-3034-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with low literacy and low health literacy have poorer health outcomes. Literacy and health literacy are distinct but overlapping constructs that impact wellbeing. Interventions that target both could improve health outcomes. METHODS/DESIGN This is a cluster randomised controlled trial with a qualitative component. Participants are 300 adults enrolled in basic language, literacy and numeracy programs at adult education colleges across New South Wales, Australia. Each adult education institute (regional administrative centre) contributes (at least) two classes matched for student demographics, which may be at the same or different campuses. Classes (clusters) are randomly allocated to receive either the health literacy intervention (an 18-week program with health knowledge and skills embedded in language, literacy, and numeracy training (LLN)), or the standard Language Literacy and Numeracy (LLN) program (usual LLN classes, specifically excluding health content). The primary outcome is functional health literacy skills - knowing how to use a thermometer, and read and interpret food and medicine labels. The secondary outcomes are self-reported confidence, more advanced health literacy skills; shared decision making skills, patient activation, health knowledge and self-reported health behaviour. Data is collected at baseline, and immediately and 6 months post intervention. A sample of participating teachers, students, and community health workers will be interviewed in-depth about their experiences with the program to better understand implementation issues and to strengthen the potential for scaling up the program. DISCUSSION Outcomes will provide evidence regarding real-world implementation of a health literacy training program with health worker involvement in an Australian adult education setting. The evaluation trial will provide insight into translating and scaling up health literacy education for vulnerable populations with low literacy. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000213448 .
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Affiliation(s)
- Kirsten J McCaffery
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Suzanne Morony
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle M Muscat
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Heather L Shepherd
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.,Concord Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Karen Luxford
- Patient Based Care, Clinical Excellence Commission, Sydney, NSW, 2000, Australia
| | | | - John Comings
- Center for International Education, University of Massachusetts, Amherst, MA, 01003, USA
| | - Don Nutbeam
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
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