THE
HEALTH LITERACY PROJECT: PHASES 1-3
• PROJET
D'ALPHABÉTISATION-SANTÉ
ANTÉCÉDENTS ET SITUATION ACTUELLE
It is estimated that fifty percent of adult
Canadians
have some degree of difficulty with everyday reading materials. However
these difficulties can have different causes, including lack of
education, visual, hearing or cognitive impairment, or language or
cultural differences. Patients with any single or combination of these
barriers are marginalized in the health care system, which today
requires patients to manage and make significant decisions about their
health. Successful health communication can occur when barriers to the
process are recognized and appropriate tools are used to minimize the
difficulties.
A joint health literacy initiative of The Centre for
Literacy of Quebec and the Department of Nursing of the McGill
University Health Centre
(MUHC) has been studying the complex combinations of factors involved
with literacy and health and attempting to identify how various
specific barriers to patient communication can be recognized and
addressed.
PHASE 1
Needs Assessment for
the
Health Education and Information Needs of Hard-to-Reach Patients
The Health Literacy Project of the MUHC began a first phase in 1999
-2000. We conducted a needs assessment of the health information and
education needs of patients who were identified by nurses as
hard-to-reach.
An interview and focus group-based survey of 114
invited
patients, professionals, support staff and family members or caregivers
revealed that:
- A majority of the patients found written
documents
not directly useful because of language barriers although this format
is one of the most common forms of health information.
- Patients and professionals have different
perceptions
of the health education needs of this group.
- Family members want different information than
patients.
- Family members and caregivers are interpreters,
readers and mediators when there are barriers to communication.
- Professionals recognize the need to validate
their
teaching but they require the time, skills and tools to do so.
PHASE 2
Phase 2 of the project (2001-2002) set out to
implement
and evaluate recommendations from Phase 1. Participatory health
education committees on three hospital units chose key health messages,
and writers and designers created multiple versions of each with the
intention of identifying the most effective ones.
This phase lead to the conclusion that we must have
a
clearer understanding of who comprises the
“hard-to-reach”, before we can begin to develop
differentiated means of communicating with them. Currently, health
information is largely a one-size-fits-all enterprise.
PHASE 3
In Phase 3, we conducted a review of the medical
and
education literatures on alternative methods of health communication
such as plain language, audiotapes, videotapes, interactive media and
visuals. The first two have been published as Research Briefs on Health
Communications. To date, we have found that most evaluative studies
excluded patients who did not speak English, who were unable to read or
who had other physical or cognitive deficits, in other words, the
marginalized groups we set out to help.
Research Briefs on Health Communications [Series]
in collaboration with The Centre for Literacy of Quebec
Health
Literacy