1. Health Literacy eLearning - creation and evaluation of an engaging online experience Katrina Grieve, Patient Education Specialist Bridget Morant, Information Specialist, Consumer Health St. Michael’s Hospital, Toronto.

2. In this session, we will: 1.Discuss the process of developing Health Literacy eLearning modules 2.Demonstrate principles of effective eLearning design 3.Share the challenges of developing and implementing a rigorous evaluation Objectives

3. Why develop health literacy e-learning modules? To raise awareness among health care providers and students about: What is health literacy and what factors affect it? Why is health literacy important? What can health care providers do?

4. Health Literacy The degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions. Health Literacy – A Prescription to End Confusion, Institute of Medicine, 2004.

5. Health Literacy involves many factors Fundamental Literacy Scientific Literacy Civic Literacy Culture and social identity Zarcadoolas et al. Advancing Health Literacy: A Framework for understanding and action, John Wiley & Sons, Inc. 2006.

6. Why is health literacy important? More Canadians managing chronic health conditions Shorter hospital stays Change in expectations: from ‘patient’ to ‘health consumer’ Health literacy is significant determinant of health Health Literacy in Canada – A Healthy Understanding, Canadian Council on Learning, 2008 The Agency for Healthcare Research and Quality (AHRQ) Report 2010

7. Canadian Council on Learning, 2008 88% of Seniors

8. Less use of preventive services Delayed diagnoses Less adherence to medical instructions Poorer self-management skills Higher health care costs Poorer Health Berkman ND et al Health Literacy Interventions and Outcomes: An Updated Systematic Review. Agency for Healthcare Research and Quality. March 2011 Wolf MS, Gazmararian JA, Baker DW. Health Literacy and Functional Health Status Among Older Adults. 2005. Archives of Internal Medicine. Low health literacy has been linked to:

9. Need for Universal Precautions Health Literacy can be a challenge for us all

10. Development Process 1.Used content from Health Literacy Workshop: Powerpoint slides as a basis 2.Defined objectives, set target length 3.Created e-learning modules, along with voiceover

11. Barriers to Health Literacy Physical factors (like pain, cognitive, vision or hearing impairment) Emotional factors (like fear of death, fear of being a burden, concern about taking up too much of clinician’s time) Medical concepts and terminology Attitudes / beliefs Demographics (socio-economic status, age, language) Access to community support Environment (isolation, busy clinic) First version

12. eLearning Design Considerations Visual appeal: How will you make your material stand out? Use variety to maintain interest Engage participant with the material: buttons, quizzes, roll over Keep information brief: (10-15 minutes per e-learning module) Include options to move forward, backward, repeat, access more information as needed. Engage all learning styles: visual, auditory, reflective, kinesthetic Include voice-over Summarize key points

13. Health Literacy e-learning – redesigned Fall 2013

14. Part 2

15. October is Health Literacy Month Campaigns to promote our eLearning

16. Feedback “This was a very enjoyable and informative course, thank you!” “If everyone tries to understand and follow these suggestions, both health care workers and patients can benefit greatly.” I loved the course! I found the interactivity reinforced the learning… it helped me to better understand what my role might be as a team member in terms of facilitating learning, communication, and recognizing situations where more advocacy is needed. But we wanted to know more… about the impact

17. Evaluation Study – What is the impact? Patient Health Literacy: Understanding the Roles and Capacity of Health Professionals Study design Recruit medical residents to take the eLearning modules Conduct surveys – pre, post, follow-up Focus Knowledge Perceptions & Attitudes Skills competencies Satisfaction with course Impact: plans for application; actual use of strategies Focus Knowledge Perceptions & Attitudes Skills competencies Satisfaction with course Impact: plans for application; actual use of strategies

18. Developing a rigorous evaluation Benefits: Explore impact of eLearning Gain better understanding of relevant factors Support from Research Consultant, Centre for Faculty Development: –Survey design –Support with application to the Research Ethics Board (REB) Led to: Better quality study with more nuanced questions

19. Examples of questions 1.How often do you encounter patients who misinterpret the treatment instructions provided to them? 2.How often do you encounter patients who you think do not truly understand how to manage their health condition? 3.How often do you encounter patients who you think do not truly understand how to access care when they need it? 4.How often do you encounter patients who you think do not truly understand preventative aspects of disease management?  Never  Rarely  Sometimes  Often  Very Often CURRENT PERCEPTIONS OF PATIENT HEALTH LITERACY

20. Fine-tuning relevant factors Understanding of health literacy Awareness of the issue among own patients Perceptions of health literacy in general & ease of identifying Attitudes about role & responsibility to address the issue Perceptions of time constraints in clinical practice Level of confidence in own skills (to enhance patient understanding) Current use of strategies to enhance patient understanding Post-course survey & follow-up Repeat survey questions (as above) Satisfaction with eLearning course – content, design, ease of use Motivation for Change Actual implementation: did you do anything differently?

21. Research Training Challenges Time & training involved Longer timeline (REB approval took 3-5 months) REB requirements led to unexpected challenges Recruitment problems Research Protocol Letter of Information/Consent Recruitment emails & flyers Application Checklist

22. Next steps – revised evaluation plan Open up study to all health care providers Integrate surveys into eLearning modules Collect results over time Evaluate

23. Lessons learned Take time to understand the constraints of potential study participants Prepare a variety of recruitment strategies ahead of time; have a plan B Consider integrating evaluation into an e-learning module, as part of an evaluation study Evaluation needs careful planning. It takes time and resources to do it effectively Think Long-Term