Report on the Needs Assessment

2.4 How hard-to-reach patients like to learn

FINDINGS
Interviewed patients like to learn in many different ways. Their most popular choices are listening to oral presentations, one-to-one dialogues with educators and watching videos. (Numbers do not add up to 100% because respondents could choose more than one answer.)

To learn about health, 16 (45%) patients prefer to be in the hospital, while 13 (37%) patients prefer to be at home. Other patients prefer to be in a CLSC, in their northern community or elsewhere. While the majority do not prefer to be in the hospital, it is the single most common preferred location for learning. Interviewed patients said that they are comfortable in the hospital, that it is convenient, and that that they can concentrate on learning while at the hospital.

Patients gave many answers to the question: What makes a good teacher? (See Appendix 7). The answers can be grouped into four large categories: someone who is qualified and knows his or her subject; someone who is a good communicator and listener; someone who values positive human relationships and someone who is empathetic and can relate to subjects outside his/her field of expertise (the qualities of a good pedagogue).

Many dialysis patients are blind or have serious eyesight problems. This has obvious impact on appropriate kinds of information/education. Out of 126 Dialysis patients on the unit list for a particular day in April, 11 were blind or had very bad eyesight, according to the unit nurse. Sight impaired patients in the focus group indicated patient discussion groups as a preferred way to learn.

The focus group held with Oncology Hematology patients lead us to believe that even among patients who were not perceived to be hard-to-reach and who are more likely to read than hard-to-reach patients, the computer is not an attractive medium for learning. This confirms findings about computer programs discussed in section 2.3.

ANALYSIS
Findings reveal that like any cross-section of the population, hard-to-reach patients have many different styles and preferences for learning. Hard-to-reach patients include a large proportion of low-literate people who are not comfortable with written material and computers. The fact that 6 out of the 8 Dialysis patients who participated in the focus group were blind or almost blind led to atypical results regarding the usefulness of written material, computer programs and videos. But overall, the findings indicate that hard-to-reach patients prefer to watch, listen and engage in dialogue and group exchanges, rather than read or use computers.

A majority of patients seem to like learning with health care workers on a one-to-one basis. This has serious implications for staffing since this can be both time-consuming and costly. Health Education Centres should take this into account but try to slowly introduce and increase the importance of group learning processes which are also popular among interviewed patients, are less costly and, according to the literature, hold a lot of potential. Building a volunteer component with retired medical staff is another possible strategy. It is logical that patients who opt to participate in a focus group meeting would be attracted to learning through patient discussions. This seems to indicate that for some patients, (and the group of Dialysis patients was composed almost entirely of hard-to-reach patients) learning through group processes is a popular option. The Health Education Centres should capitalize on this.

The findings suggest that location is an important factor to consider in health education. The hospital appears to be a convenient place for learning. Patients prefer to learn in a place where they have time to think and ask questions.

Looking at the answers to the question What makes a good teacher? one can hypothesize that hard-to-reach patients especially need good teachers who offer a balance between knowledge and expertise about health on the one hand, and teaching skills and human qualities on the other.

2.5 Needs of health care professionals as educators of hard-to-reach patients

FINDINGS
Health care professionals spoke of the need to have written material available in the languages spoken by the largest numbers of patients. The issue of producing documents in other languages triggered questions from health care professionals, such as whether it would be realistic and worthwhile to translate documents into additional languages. Some interviewed health care professionals said that only basic health information should be translated.

The majority of informants indicated that more time is needed to assess the literacy and comprehension level of patients and teach hard-to-reach patients. Some health care professionals raised the issue of the additional human resources needed to improve patient education. They asked "Who has the time for all of this?" and "Will resources be provided for additional staff?"

Health care professionals identified two items that they need the most as teaching tools, posters and videos (to show on site and to lend to patients). Dialysis nurses who participated in the focus group saw a need for expertise in the production of posters, videos, etc. One physician said that simple diagrams should be used more often to replace long instructions and gave the example of wordless emergency cards used in planes as an interesting model. Interviewed health care professionals identified the need for the administration to allocate more financial resources to translation, plain language writing, training health care workers and buying videos and visual materials.

The focus group with six members of the Practice and Quality Improvement Council (PQIC) Sub-Committee on Patient Education discussed in particular the need to upgrade and improve written material for all patients. This is a priority of the Sub-Committee. They insisted on the need to hire professional researchers, writers and translators. They said that nurses should not be expected to write in plain language, to translate, to design pamphlets etc. This are not trained for this and do not have the time. Participants in this focus group said that nurses and other health care workers should be trained in plain language oral communication rather than plain language writing. Participants concluded that ideally, health care workers should have a large spectrum of teaching tools, information, and ways to communicate with patients: written information, oral communication, videos, visual information, etc. in order to meet the different needs and learning styles of patients. The health educator should pick what is most appropriate for the patient or family member. However, the current priority of the Sub-Committee is to update and re-write the written information given to patients and families.

ANALYSIS
The majority of informants indicated that more time is needed to assess the literacy and comprehension level and teach hard-to-reach patients. The Health Education Centres would provide both information and health education services, and it follows that more human resources would need to be allocated to patient education.

More visual materials, updated written documents in plain language and more health videos appear to be important needs for health care professionals, but these people do not have the time to look for these materials nor the skills to produce them. Other specialists (i.e. education consultants, video producers, plain language experts etc.) will have to be involved, at least partly, in searching for, adapting and/or producing these types of documents and teaching tools.

The need for human and financial resources to implement these initiatives is a fundamental issue given the currents shortages of both in hospitals. It appears that human and financial resources from outside the hospital need to be identified to support, at least partly and initially, the pilot Health Education Centres.