Connecticut Rehab Facility Boosts Health Literacy Skills with AHRQ Toolkit

Patient Safety, Prevention and Care Management
August 2018

Occupational therapists (OTs) at Greenwich Woods Rehabilitation and Health Care Center improved their ability to assess and implement health literacy interventions for patients by 36 percent after a 6-week workshop that featured AHRQ’s Health Literacy Universal Precautions Toolkit. The workshop was administered to OTs, OT assistants, and other therapy and rehabilitation staff at the 217-bed skilled nursing facility in Greenwich, Connecticut.

Improving OTs’ ability to provide information that patients can readily understand and use in their daily lives is an important aspect of their overall rehabilitation, according to Virginia Koenig, who has a clinical doctorate in occupational therapy. Dr. Koenig is an academic fieldwork coordinator at Touro College, New York, and developed and administered the intervention at Greenwich Woods. 

Approximately one-third of U.S. adults have limited health literacy, as measured by their ability to understand health information from written sources. That figure rises to 41 percent for adults aged 65-75, and 70 percent for those older than 75. Low health literacy is also associated with poorer health outcomes and inappropriate use of health services, an AHRQ-funded literature review found. In addition, anyone can experience difficulty understanding health information, especially when they are tired, stressed, or feeling ill. That is why experts recommend health literacy universal precautions—treating everyone as if they were at risk of limited health literacy.

Because the majority of patients at Greenwich Woods are elderly, they face additional challenges such as needing to follow complex medication routines, perform activities of daily living following joint replacement surgery, and manage various chronic conditions.

“We have difficulty communicating information to our patients across the lifespan,” Dr. Koenig noted.  “What we normally do is hand patients an education sheet. But if you don’t understand the information that’s provided to you, you’re not going to be able to self-manage,” she said.  

To increase OTs’ awareness of patients’ health literacy challenges, Dr. Koenig developed a lunch-and-learn workshop consisting of six modules that covered interventions, recommendations, and information provided in AHRQ’s health literacy toolkit. Interventions included the teach-back method, a method that checks patients’ understanding of the information they’ve been given by asking them to explain it in their own words.  At the end of each of the session, participants engaged in a “plan/do/study/act” exercise to help them learn how put new information into practice.

To gauge their progress, Dr. Koenig developed pre- and post-workshop quizzes and a survey that assessed participants’ knowledge of health literacy and their perceived ability to implement interventions. Results indicated that workshop participants’ mean scores on health literacy quizzes increased by 36 percent, and their self-rated ability to assess and implement health literacy interventions (based on a 1 to 5 scale) increased by 17 percent.

A focus on improving awareness of health literacy is in the best interests of health professionals and patients alike, according to Dr. Koenig. “OT is connected to health literacy because our professional emphasis is on client-centered practice,” she said. When patients don’t understand educational materials or instructions, “the success of any rehab service, including OT services, is compromised,” she added. 

Impact Case Study Identifier: 
AHRQ Product(s): Health Literacy Universal Precautions Toolkit
Topics(s): Health Literacy, Medication: Safety, Outcomes, Patient Safety, Prevention, Medication, Medication, Provider: Pharmacist
Geographic Location: Connecticut
Implementer: Greenwich Woods Rehabilitation and Health Care Center
Date: 08/14/2018
Page last reviewed August 2018
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