Jessup Rebecca L, Osborne Richard H, Buchbinder Rachelle, Beauchamp Alison
Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
BMC Health Serv Res. 2018 Dec 20;18(1):989. doi: 10.1186/s12913-018-3801-7.
Health literacy describes the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Suboptimal health literacy is common and is believed to impact up to 60% of Australians. Co-design is a participatory approach to the development of interventions that brings together to staff and patients to design local solutions to local problems. The aim of this study is to describe a staff and patient co-design process that will lead to the development of health literacy interventions in response to identified health literacy needs of hospital patients.
A mixed methods, two-step sequential explanatory design. Step 1: hospitalised patients surveyed and data analysed using hierarchical cluster analysis to establish health literacy profiles. Step 2: clusters presented as vignettes to patients and clinicians to co-design interventions to address needs.
Eight health literacy clusters were identified from surveys. Seven patients attended two patient workshops and 23 staff attended two staff workshops. Three key themes were identified: organisational, provider-patient, and patient self-care. Within these, five sub-themes emerged: "Good quality communication during hospital stay", "Social support for health", "A good discharge", "Care across the continuum" and "Accessing quality information when home". Fifteen potential interventions were produced, including changes to message design and delivery, staff training in assessing for understanding, social support to improve understanding, improving communication consistency across the care continuum, and strategic dissemination of web-based resources.
This study identified fifteen strategies to address health literacy needs of a hospital population. Implementation and evaluation will identify sets of strategies that have the maximum patient, clinician and organisational benefit. This approach allows for the development of locally-driven, contextually-appropriate interventions to address health literacy needs.
健康素养描述的是认知和社交技能，这些技能决定了个体以促进和维持良好健康的方式获取、理解和使用信息的动机和能力。健康素养欠佳的情况很常见，据信影响多达60%的澳大利亚人。共同设计是一种参与式干预开发方法，它将工作人员和患者聚集在一起，为当地问题设计本地化解决方案。本研究的目的是描述一个工作人员与患者共同设计的过程，该过程将促成开发健康素养干预措施，以应对已确定的医院患者健康素养需求。
采用混合方法、两步序贯解释性设计。步骤1：对住院患者进行调查，并使用分层聚类分析对数据进行分析，以建立健康素养概况。步骤2：将聚类以案例的形式呈现给患者和临床医生，共同设计干预措施以满足需求。
通过调查确定了八个健康素养聚类。七名患者参加了两次患者研讨会，23名工作人员参加了两次工作人员研讨会。确定了三个关键主题：组织、医患关系和患者自我护理。在这些主题中，出现了五个子主题：“住院期间的高质量沟通”、“健康的社会支持”、“良好的出院安排”、“连续护理”和“在家时获取优质信息”。制定了15项潜在干预措施，包括改变信息设计和传递方式、工作人员评估理解能力的培训、改善理解的社会支持、提高整个护理连续过程中的沟通一致性，以及基于网络资源的战略传播。
本研究确定了15项策略来满足医院患者的健康素养需求。实施和评估将确定能使患者、临床医生和组织获得最大益处的策略组合。这种方法有助于开发由当地驱动、因地制宜的干预措施，以满足健康素养需求。
