Improving the Health Literacy Environment of Wisconsin Hospitals – A Collaborative Model Sue Gaard, RN, MS Wisconsin Primary Care Research & Quality Improvement Forum November 7, 2008

When do I take my orange pill?

Can I park here?

Topics today Why health literacy? Results from local focus groups A collaborative model to improve health literacy Lessons learned Next steps Questions and discussion

Health literacy defined: “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Institute of Medicine

A failing grade… 36% of U.S. adults have Basic or Below Basic health literacy skills who cannot: recognize a medical appointment on a hospital form understand a clearly written pamphlet about a medical test U.S. Department of Education National Assessment of Adult Literacy, 2003

A local perspective on health literacy Local literacy council recruitment English speaking adults English language learners 2 groups in Oshkosh, Racine, Madison 61 participants Smith, Paul. What are important health issues for low literate adults? A focus group evaluation of health literacy issues, March 2008

Health literacy barriers – five themes Health information Medications Access to health care Forms and consent Anxiety and shame Smith, Paul. What are important health issues for low literate adults? A focus group evaluation of health literacy issues, March 2008

Improving the health literacy environment of Wisconsin hospitals – a collaborative model

Project sponsors and supporters American Academy of Family Physicians St. Mary’s Hospital MetaStar Wisconsin Hospital Association

Project goals Test a collaborative model Identify health literacy barriers Propose effective solutions Recommend processes for future collaboration

Can a collaborative model work? Literacy students are the eyes of the community Health care systems can improve health literacy through service, product, and environmental design Both adult educators and health care providers benefit when literacy students enhance their reading and health care skills

Target population Project focus: St. Mary’s Hospital Patient’s with low literacy or limited English skills Project reach: 122 Wisconsin hospitals and the patients they serve 58 Wisconsin Literacy member programs

Methods Identify common area of study (e.g. navigation, consent forms) Form internal and external evaluation teams St. Mary’s evaluation team Omega School evaluation team Train 6-8 adult literacy students as evaluators Develop assessment tool for students and hospital staff (modified from National Center for the Study of Adult Learning and Literacy guide, The Health Literacy Environment of Hospitals and Health Centers – Partners for Action: Making Your Healthcare Facility Literacy-Friendly)

Methods Conduct internal and external reviews, report findings Roundtable dialogue for staff and students to share findings, prioritize barriers and identify potential solutions Program evaluation focus groups for student and staff teams Identify best practices and areas for improvement Develop guidebooks/toolkits for health care systems and literacy programs External evaluation of process

Keys to successful partnerships Create a shared base on knowledge Identify shared goals and problems Address needs of both entities Secure executive support Collect evidence to measure progress Use existing relationships

Keys to successful partnerships Create a sense of trust Prepare partners for a lot of work Launch the project with an event Seize the opportunity to focus on systemic issues Engage in joint planning and goal setting New York Literacy Assistance Center, Healthy Relationships: A Guide to Forming Partnerships between Health Care Providers and Adult Education Programs.

Lessons learned Joint partnership is key Students need support, community and trust Executive sponsorship within the hospital is necessary yet not sufficient Achieving an authentic experience for students is challenging Don’t promise what you can’t deliver “When you think simple, think complex.”

Next steps Student review and evaluation of “Conditions of Admission Agreement” Student reception at St. Mary’s (project “launch”) Refinement of plan for navigation evaluation Continued student training Development of staff and student evaluations

Questions? Contact: Sue Gaard, RN, MS Confident Conversations, LLC