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).
Developing a Health Literacy Universal Precautions Toolkit
DeWalt DA, Hawk V, Broucksou K, Hink A, Brach C, Callahan LF
AHRQ Annual Meeting 2009
Project in Process
- 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
- 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.
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.
- 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.
Total number of tool candidates identified.
Gaps to Fill
- Practice assessment for primary care.
- Individual tools (form templates for practices, patient follow-up procedures, etc.)
- 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.
Image: First page of article entitled: "Using the Teach Back Method: Helping Your Patients Understand".
Image: Second page of article entitled: "Using the Teach Back Method: Helping Your Patients Understand".
Image: Last page of article entitled: "Using the Teach Back Method: Helping Your Patients Understand".
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.
Create Prototype Toolkit
- Developed the framework for the toolkit
- 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.
- 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.
- Effective Oral Communication.
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.
Image of pages from the toolkit.
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.
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.
- 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.
- 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.