Advancing Pharmacy Health Literacy Practices Through Quality Improvement

Activity Guides 1-7

As part of the curricular modules, we developed several Activity Guides to encourage active learning, provide learning activities for use outside of a course, and facilitate student comprehension of the curricular content. The Activity Guides cover the four topic areas mentioned above and shown in Exhibit 1. Each Activity Guide includes a description of the following:

  • Topic: Each Activity Guide addresses one of four topics.
  • Use in: This section indicates in which components of a pharmacy curriculum the activity could be used.
  • Time Commitment Estimate: These are only estimates; for activities that can be used in more than one component of the curriculum, more than one time estimate is provided.
  • Learning Objectives: Learning objectives are provided for every Activity Guide using Bloom's taxonomy of educational objectives.1
  • Description: This section describes the activity with students or residents as the target audience. When the activity can be applied in different components of the pharmacy curriculum, specific detail is provided for use in each component of a pharmacy curriculum as needed.
  • Evaluation Criteria: This section provides criteria to guide faculty's evaluation of activities.
  • Faculty Notes: additional information faculty may need is provided here.
  • Relevant PowerPoint® Slides: PowerPoint® slide decks and slides relevant to each activity are indicated.
  • Resources: A list of relevant resources is provided.

Activities can be used with slide decks, as independent assignments, or as in-class small-group discussions. Table 2 lists all activities, suggested placement in the curriculum, and relevant ACPE standards. To go directly to an activity guide, click on the activity title in the table. Please note that didactic is used broadly in this document to include lectures, seminars, laboratory classes (e.g., pharmacy practice lab) as well as other classes.  


 1 Huitt W. (2009). Bloom et al.'s taxonomy of the cognitive domain. Educational Psychology Interactive.


Increasing Awareness of Health Literacy in Pharmacy

Activity 1: Key Questions to Assess Patients' Health Literacy

Topic: Increasing Awareness of Health Literacy in Pharmacy

Use in:

  • Didactic (assignment).
  • Experiential education (IPPE, APPE).

Time Commitment Estimate: 3-4 hours

Learning Objectives:

  • Describe barriers to using routine screenings for health literacy in a clinical setting.
  • Employ the screening question with at least three non-patient acquaintances.
  • Employ the screening question with patients at IPPE / APPE site.

Activity Description: Read the article by Morris et al. (2006) about a single-item literacy screener. The screening question is: How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy? As you read the article, consider barriers to assessing patients' health literacy levels in a clinical setting and how the approach suggested in the article might address some of these barriers.

Assignment: Practice using the Morris et al. (2006) question with at least three friends or family members. Record each individual's responses, and any other comments or reactions they have to being asked this question. Did any of their responses surprise you? How so? Record your experience asking the question(s) and your reactions. Write a two-three page paper presenting your findings and your reaction to them, and summarizing the pros and cons of health literacy screening in a clinical setting.

IPPE or APPE: Use the question(s) with at least five patients in your pharmacy. Record each patient's responses, and any other comments or reactions they have to being asked this question (s). Did any of their responses surprise you? How so? Record your experience asking the question(s) and your reactions. Write a two-three page paper presenting your findings and your reaction to them and summarizing the pros and cons of health literacy screening in a clinical setting.

Faculty Note: Consult with your institution's Institutional Review Board (IRB) to determine whether or not you need approval for the IPPE/APPE activity. Regardless of the need for IRB approval, the students should obtain informed consent (go to the AHRQ Informed Consent and Authorization Toolkit for Minimal Risk Research link below).

Evaluation Criteria: The paper should:

  • Describe pros and cons of using routine screening for health literacy in clinical settings.
  • Present the findings from using the question.
  • Describe the individual's reflections on the findings.

Relevant PowerPoint® Slides:

Resources:

  • Morris NS, MacLean CD, et al. The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract 2006;7:21.
  • Wolf MS, Williams MV, Parker RM, Parikh NS, Nowlan AW, Baker DW. Patients' shame and attitudes toward discussing the results of literacy screening. Journal of Health Communications 2007 Dec;12(8):721-732.
  • Osborn CY, Weiss BD, Davis TC, Skripkauskas S, Rodrigue C, Bass PF, Wolf MS. Measuring adult literacy in health care: performance of the newest vital sign. American Journal of Health Behavior 2007 Sep-Oct; 31 Suppl 1:S36-546.
  • AHRQ Informed Consent and Authorization Toolkit for Minimal Risk Research.

Activity 2: Instruments to Assess a Patient's Health Literacy Skills — Rationale and Critiques

Topic: Increasing Awareness of Health Literacy in Pharmacy

Use in:

  • Didactic (assignment).
  • Experiential education (IPPE or APPE).

Time Commitment Estimate: 2-3 hours

Learning Objectives:

  • Describe and use a health literacy assessment tool, Newest Vital Sign (NVS).
  • Recognize the demands placed on patients in a health care environment.
  • List skills assessed by the NVS and identify limitations of NVS.
  • Examine issues related to patient shame and health literacy skill assessment.

Activity Description: Use the Newest Vital Sign (NVS) assessment tool to assess your own, a friend's, or a family member's health literacy. As you complete the assessment, pay attention to and list the types of tasks the assessment asks patients to perform. Once you have listed at least five required skills, compare skills assessed by NVS to skills patients need to function in health care and identify potential areas for improvement in the NVS. Write a short summary of your findings and recommendations. After using NVS, read Wolf et al.'s article on patient shame. Create an argument about whether or not providers should use formal assessments such as NVS in a clinical setting. Write a two-page paper describing the above listed tasks.

Evaluation Criteria: As an assignment or as part of experiential education course, the student should have:

  • Listed several skills required to complete the NVS.
  • Listed skills required to function in health care and discussion of gaps left by NVS.
  • Demonstrated familiarity with Wolf et al.'s arguments from the paper.
  • Included thoughtful discussion of benefits and drawbacks of using health literacy assessment tools with patients.

Relevant PowerPoint® Slides:

Resources: 

  • The Newest Vital Sign Assessment (http://www.pfizerhealthliteracy.com/asset/pdf/NVS_Eng/files/nvs_flipbook_english_final.pdf)
  • Wolf MS, Williams MV, Parker RM, et al. Patients' shame and attitudes toward discussing the results of literacy screening. Journal of Health Communications 2007 Dec;12(8):721-732.
  • Osborn CY, Weiss BD, Davis TC, et al., Measuring adult literacy in health care: performance of the newest vital sign. American Journal of Health Behavior 2007 Sep-Oct;31 Suppl 1:S36-46.

Activity 3: Understanding Steps Required to Take Medications

Topic: Increasing Awareness of Health Literacy in Pharmacy

Use in:

  • Didactic (in class or assignment).

Time Commitment Estimate: 30 minutes

Learning Objectives:

  • List eight tasks required of patients in order to follow medication instructions.
  • Describe literacy-related challenges for each task.
  • Describe three strategies that pharmacists can use to minimize challenges for patients.

Activity Description: Form small groups of 6-10, and then divide into two teams—team 1 and team 2. Take 10 minutes in your teams to discuss your assigned topic.

  1. Team 1: Choose a common OTC medication and list the tasks patients must complete in order to properly take the medicine. Identify needed literacy skills.
  2. Team 2: Choose a common prescription medication and list the tasks patients are asked to perform to properly take the medication. Identify needed literacy skills.

After 10 minutes, each team should take 5-10 minutes to share key points discussed within each team. Then in the group, for 10-15 minutes, discuss strategies that pharmacists can use to minimize the challenges patients face when taking prescription or OTC medications.

Evaluation Criteria:

  • Participation by all team members.
  • Students could provide a written summary of the tasks required of patients; potential tasks:
  • Read labels:
    • Remember oral instructions.
    • Understand specific instructions (i.e., "take on an empty stomach").
    • Remember to take pills.
    • Differentiate medications (if taking multiple medications).
    • Plan dosage around meals.
    • Watch for side effects and respond appropriately.
    • Take medications even if symptoms are not present.
    • Track the number of pills left and refill medications when appropriate.
    • Store medications appropriately.
    • Discuss the steps needed for specialty medications (i.e., inhalers).

Relevant PowerPoint® Slides:

Activity 4: Critique of Medication Labels

Topic: Increasing Awareness of Health Literacy in Pharmacy

Use in:

  • Didactic (assignment).
  • Experiential education (IPPE or APPE).

Time Commitment Estimate: 2-3 hours

Learning Objectives:

  • Describe the importance of written information, including medication labels, to patients' understanding of and potential adherence to medication instructions.
  • Describe basic best practices for critiquing and revising medication labels.
  • Recommend changes or improvements to existing medication labels or instructions.

Activity Description: Choose a prescription label or an OTC label for a common medication. Critique the label using guidelines for written information, listing its strengths and weaknesses and providing recommendations for how to improve it. Submit your critique with a copy of the label.

Faculty Note: For in-class use: faculty member will need to provide prescription or OTC labels, and students can break into groups of two or three.

Evaluation Criteria: Students will be evaluated based on their demonstrated application of principles for written communication presented in class and in the guides referenced below. Critiques of the labels should be thorough, highlighting strengths as well as weaknesses. Recommended revisions should reflect application of principles described in referenced materials.

Relevant PowerPoint® Slides:

Resources:

  • Pfizer Principles for Clear Communication (http://www.pfizerhealthliteracy.com/asset/pdf/PfizerPrinciples.pdf), 2nd Edition (go to Ch. 4). Doak LG, Doak CC.
  • B Odegard PS, Gray SL. Barriers to medication adherence in poorly controlled diabetes mellitus. Diabetes Education 2008 Jul-Aug;34(4):692-697.
  • Effect of content and format of prescription drug labels on readability, understanding, and medication use: a systematic review. Shrank W, Avorn J, Rolon C, Shekelle P. Annals of Pharmacotherapy 2007 May; 41(5):783-801. Epub 2007 Apr 10.
  • Principles of Designing a Medication Label for Community and Mail Order Pharmacy Prescription Packages. Institute for Safe Medication Practices.
  • Davis TC, Wolf MS, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med 2006; 145(12):887-894.

Activity 5: Critique and/or Develop Patient Education Materials

Topic: Increasing Awareness of Health Literacy in Pharmacy

Use in:

  • Didactic (in class or assignment).
  • Experiential education (IPPE or APPE).

Time Commitment Estimate: 1-4 hours

Learning Objectives:

  • Explain the importance of written patient education materials, including medication information, to patients' understanding of their conditions and their ability to take medications.
  • Summarize best practices for patient education and information material design.
  • Recommend changes or improvements to existing patient education materials.

Activity Description: Choose patient education materials in a pharmacy or clinic in your community. If no patient education materials are available at your pharmacy, you may find one online. Critique the material using the guidelines for written information below, listing the strengths and weaknesses of the material and providing recommendations for how to improve it. Submit your critique with a copy of the materials.

Optional (at faculty discretion}: Revise materials according to your critique and submit revised materials.

Optional (at faculty discretion): Create new patient education materials based on best practices.

Evaluation Criteria: Students will be evaluated based on their demonstrated application of principles for written communication presented in class and in the guides referenced below. Critiques of materials should be thorough, highlighting strengths as well as weaknesses (where applicable). Recommended revisions (or changes made, or material created, if applicable) should reflect careful application of principles described in referenced materials.

Relevant PowerPoint® Slides:

Resources:

Activity 6: Assess Medication Therapy Management (MTM) Patient Materials

Topic: Conducting Health Literacy Quality Improvement

Use in:

  • Didactic (in class or assignment).
  • Experiential education (IPPE or APPE).

Time Commitment Estimate: 2-4 hours

Learning Objectives:

  • Summarize best practices for patient education or information material design, including basic readability and comprehension best practices.
  • Critique or assess patient education materials for pharmacy services (e.g., MTM).

Activity Description: Choose a patient-oriented item from the resources available from APhA at MTM Central within the Core Elements Toolkit, such as the personal medication record or medication action plan. Alternatively, select a patient education material from your experiential practice site's MTM services or patient care services (e.g., immunization services, counseling materials). Assess the selected material using one of the assessment tools listed below. Write a summary of your findings and your recommendation for improving the material.

Evaluation Criteria:

  • Concise, complete assessment of the selected material using an appropriate tool
  • Specific recommendations for revising the materials are appropriate given the findings from the assessment

Relevant PowerPoint® Slides:

Resources:

  • MTM Central's MTM Core Elements Toolkit (http://www.pharmacist.com/AM/Template.cfm?Section=Pharmacists&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=118&ContentID=18972)
  • Pfizer Principles for Clear Communication (http://www.pfizerhealthliteracy.com/asset/pdf/PfizerPrinciples.pdf), 2nd Edition (go to Chapter 4 for guidelines). Doak LG, Doak CC, eds.
  • National Cancer Institute. Clear & Simple: Developing Effective Print Materials for Low-Literate Readers
  • Davis TC, Wolf MS, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med 2006;145(12):887-894.

Activity 7: What Types of Questions Do Patients Ask?

Topic: Increasing Awareness of Health Literacy in Pharmacy

Use in:

  • Didactic (in class or assignment).
  • Experiential education (IPPE or APPE).

Time Commitment Estimate: 2-3 hours

Learning Objectives:

  • List and categorize the types of questions patients commonly ask pharmacists.
  • Summarize questions pharmacists think patients could benefit from asking.
  • Identify approaches to encourage patients to ask questions.

Activity Description: Read or review the three resources listed below, including the video from AHRQ about patients' questions. Ask a pharmacist for a 5-minute informal interview. During the interview, ask the following types of questions:

  • What proportion of patients or how many patients per day ask questions when picking up their medications?
  • What are the most common questions patients ask you?
  • Do you think that all patients who have questions about their medications ask? Why or why not?
  • Of the patients who actually ask questions, do you think they are asking what they should? Why or why not?
  • Of the patients who don't ask, do you think they understand how to take their medications appropriately?
  • What barriers get in the way of patients asking questions or asking the right questions?
  • How do you facilitate/encourage patients to ask questions?

Write a summary of the pharmacists' responses, adding your own perspective about whether or not patients could ask other specific questions to help them and how pharmacists could encourage patients to ask appropriate questions.

Relevant PowerPoint® Slides:

Faculty Note: Consult with your institution's Institutional Review Board (IRB) to determine whether or not you need approval for this activity.

Evaluation Criteria: Students should provide a complete summary of what they learned from their interviews, describe what specific questions patients should ask of pharmacists, and how pharmacists can help address barriers and encourage patients to ask those questions. The write-up should be thoughtful and complete, incorporate the recommended resources, and include creative recommendations.

Resources:

Go to Activity Guides 8-11.
Go to Activity Guides 12-15.
Go to Activity Guides 16-17.

Page last reviewed December 2011
Internet Citation: Advancing Pharmacy Health Literacy Practices Through Quality Improvement: Activity Guides 1-7. December 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/pharmlitqi/activity-guides1-7.html