Developing a Health Literacy Universal Precautions Toolkit (Text Version)

On September 15, 2009, Darren Dewalt made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (2.7 MB) (Plugin Software Help).

Slide 1

Developing a Health Literacy Universal Precautions Toolkit

DeWalt DA, Hawk V, Broucksou K, Hink A, Brach C, Callahan LF

AHRQ Annual Meeting 2009

Slide 2

Project in Process

• Rationale.
• Process.
• Prototype.
• Feasibility.

Slide 3

Rationale

• Low health literacy is common.
• We do not have good strategies for knowing who is struggling with health information.
• Health literacy universal precautions is:
  • structuring the delivery of care in the practice as if every patient may have limited health literacy

Slide 4

Process

• Identify and review tools.
• Identify gaps.
• Develop plan for toolkit organization.
• Create implementation guidance.
• Test individual tools.
• Create "toolkit" as unified approach.
• Pilot test toolkit in practices.

Slide 5

Tool identification and review

• Searched the internet via Google (health literacy, health communication, health education materials).
• Directed inquiries: Advisory Board, Health Literacy List Serve, primary care practices in PBRN.
• Conducted conference calls with practices in NC and across the country with a reputation for working on health literacy universal precautions.

Slide 6

Tool Review

• Catalogued tools
  • Training for clinicians and staff.
  • System changes in practices.
  • Use of educational media.
  • Connections with community organizations.
• Made assessment of how tool could be used in primary care
  • Ease of use.
  • Documented experience or research on tool.
  • Format (book, internet, video, etc).
• Avoided creating a catalog of patient education materials.

Slide 7

Results

Total number of tool candidates identified.

Slide 8

Gaps to Fill

• Practice assessment for primary care.
• Individual tools (form templates for practices, patient follow-up procedures, etc.)
• Implementation guidance.

Slide 9

Implementation Guidance

• How do we take an idea and get it implemented reliably and sustainably in practice?
• Steps for implementation.
• Frame in the Model for Improvement (PDSA).
• Examples of how others have done it.
• Ways to track progress.

Slide 10

Image: Using the Teach Back Method: Helping Your Patients Understand

Slide 11

Image: Using the Teachback Method

Slide 12

Image: Using the Teachback Method

Slide 13

Test Individual Tools

• Each "tool" or "implementation guidance" was tested in 2-4 practices.
• Practices reviewed the tool and attempted implementation on a small scale.
• Reviewed feedback by conference call.
• Received feedback from Advisory Board.

Slide 14

Create Prototype Toolkit

• Developed the framework for the toolkit
  • Introduction.
  • Getting Started
    • Form a team.
    • Assess your practice.
    • Raising awareness in your practice.
• Built in tutorial for Model for Improvement.
• Added examples of practices doing this work.

Slide 15

Toolkit Organization

• Introduction and getting started.
• Assessment of practice.
• Four Key Changes
  • Effective Oral Communication.
    • E.g. teach back method.
  • Effective Written Communication.
    • E.g., forms, education materials.
  • Self-Management and Empowerment.
    • E.g., action plans, encouraging questions.
  • Supportive Systems.
    • E.g., community resources, supportive systems.

Slide 16

Final List of Tools

• Getting Started
  • Forming a team.
  • Assessing your practice.
  • Raising awareness.

• Effective Oral Communication
  • Communicating Clearly with patients.
  • Using the teach back method.
  • Following-up with patients.
  • Improving telephone communication.
  • Using the brown bag review.
  • Addressing language differences.
  • Knowing your patients: understanding differences.

• Effective Written Communication
  • Designing easy to understand forms.
  • Using effective health education.
  • Making your practice easy to navigate.
  • Creating a welcoming front desk.

• Self-Management and empowerment
  • Encouraging questions.
  • Action plans.
  • Improving medication adherence.
  • Obtaining patient feedback.

• Supportive systems
  • Providing support for patients.
  • Getting patients the medications they need.
  • Using health resources in your community.
  • Using Literacy Resources in your community.

Slide 17

Image of pages from the toolkit

Slide 18

Feasibility Testing in Process

• 8 practices (pediatrics, family medicine, internal medicine).
• Each practice performs an assessment.
• Each practice chooses 5 tools to try to implement in 3 months.
• Follow-up phone calls to be completed end of September.

Slide 19

What are we learning?

• Practices start from very different levels
  • Health literacy expertise.
  • Practice change expertise.
• Need to grab the attention of practices
  • Video helps.
  • Get entire practice involved (not just clinicians).
  • Assessment results helpful.
• Practices want
  • "Real life" examples.
  • Quick start guide.
• Volume of tools is a bit overwhelming.
• Must be easy to navigate the toolkit.

Slide 20

Conclusion

• Conducted a thorough search for tools.
• Juxtaposed toolkit with chronic care model/medical home.
• Designed from perspective of making incremental changes.
• Overwhelming for some practices.
• Requires close attention and hard work, just like any reliable practice change.

Slide 21

Acknowledgements

• Authors
  • Darren DeWalt, MD, MPH
  • Leigh Callahan, PhD
  • Victoria Hawk, RD, MPH
  • Kimberly Broucksou, MSW, MPA
  • Ashley Hink, MPH
  • Rima Rudd, ScD
  • Cindy Brach, MPP

• Advisory Panel
  • Michael Barr, MD, MBA
  • Toni Cordell
  • Gail Neilsen, RTR, BSHCA, SAHRA
  • Michael Paasche-Orlow, MD, MPH
  • Ed Wagner, MD, MPH

• North Carolina Network Consortium.