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Welcome! This webinar has been made possible with support from the Canadian Institutes of Health Research Improving the Health of Adults with Limited Literacy: What’s the evidence? You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
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Improving the Health of Adults with Limited Literacy: What's the Evidence?

Jan 16, 2015

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Health Evidence

Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health (NCCDH), hosted a 60 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on interventions to improve the health of adults with limited literacy, presenting key messages, and implications for practice on Wednesday October 31, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Karen Fish, Knowledge Translation Specialist, and Connie Clement, Scientific Director, both from the NCCDH.

This webinar focused on interpreting the evidence in the following review:

Clement, S., Ibrahim, S., Crichton, N., Wolf, M., Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.
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Page 1: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Welcome! This webinar has been made possible with support from the

Canadian Institutes of Health Research

Improving the Health of Adults with

Limited Literacy:

What’s the evidence? You will be placed on hold until the webinar begins.

The webinar will begin shortly, please remain on the line.

Page 2: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What’s the evidence? Clement, S., Ibrahim, S., Crichton, N., Wolf, M.,

Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.

http://health-evidence.ca/articles/show/19393

Page 3: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Housekeeping Use Q&A to post comments/questions

during the webinar ‘Send’ questions to All

(not privately to ‘Host’)

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connection (vs. wireless), to help prevent connection challenges

WebEx 24/7 help line: 1-866-229-3239

Q&A

Participant Side Panel in WebEx

Page 4: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Welcome!

This webinar has been made possible with support from the Canadian Institutes of Health Research

Improving the Health of Adults with

Limited Literacy:

What’s the evidence?

Page 5: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Maureen Dobbins Scientific Director Tel: 905 525-9140 ext 22481 E-mail: [email protected]

Kara DeCorby Managing Director

Lori Greco Knowledge Broker

Lyndsey McRae Research Assistant

Robyn Traynor Research Coordinator

The Health Evidence Team

Heather Husson Project Manager

Jennifer Yost Guest Presenter

Page 6: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What is www.health-evidence.ca?

Evidence

Decision Making

inform

Page 7: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Why use www.health-evidence.ca?

1. Saves you time

2. Relevant & current evidence

3. Transparent process

4. Supports for EIDM available

5. Easy to use

Page 8: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Knowledge Translation

Supplement Project

CIHR-funded KTB-112487

Page 9: Improving the Health of Adults with Limited Literacy: What's the Evidence?
Page 10: Improving the Health of Adults with Limited Literacy: What's the Evidence?

National Collaborating Centre for Determinants of Health

Connie Clement Scientific Director

Karen Fish Knowledge Translation Specialist

Page 11: Improving the Health of Adults with Limited Literacy: What's the Evidence?

About the National Collaborating Centre for Determinants of Health

Our work Translate and share evidence to influence interrelated social determinants of health and advance health equity through public health practice

Our audience • Organizations that make up the public health sector in

Canada • The practitioners, decision makers and researchers

who work within public health

Visit us at www.nccdh.ca

Page 13: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Review Clement, S., Ibrahim, S., Crichton, N., Wolf, M.,

Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.

Page 14: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Questions?

Page 15: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Summary Statement: Clement(2009) P Adults with limited literacy or numeracy I Complex, multi-faceted interventions C Any active or inactive control O Health-related outcomes: clinical outcomes; health

knowledge; health behaviours; self-reported health status/quality of life; health-related self-efficacy/confidence; utilization of health care; health professional behaviour/skills

Quality Rating: 10 (strong)

Page 16: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Complex Interventions

Multi-faceted intervention (more than one element) & intended to improve outcomes for people with limited literacy.

Main categories:

Health professional-directed Literacy education Health education/management

Most common elements included: Care management Verbal presentation Material in simplified language Pictorial information

Videos Audiotapes Checking for understanding Spacing information

Page 17: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Definition of Health Literacy Canadian Expert Panel on Health Literacy, 2008

“The ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life-course.”

Page 18: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Overall Considerations

Complex interventions are effective in improving some health-related outcomes – health-related self efficacy/confidence; utilization of health care; and health provider behaviour/skills – for people with limited literacy

The evidence is mixed on clinical outcomes, health knowledge and health behaviours.

There is no impact on self-reported health status/quality of life.

Page 19: Improving the Health of Adults with Limited Literacy: What's the Evidence?

General Implications Public health should promote/support/implement: Complex, multi-faceted interventions to address

patients with limited literacy in the areas of health-related self efficacy, utilization of health care, and communication with health providers.

Page 20: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Public health should consider that…

High quality review, based on low-moderate quality RCTs

Many outcomes are based on the results of 1 study; majority of included studies may not have had an adequate sample size to observe statistical significance

Interventions studied varied widely – health issue addressed; duration, intensity, and delivery; extent to which literacy factored into the intervention – as did the types of measures and control groups used.

Due to this variation, it is not possible to identify if specific intervention components were more effective than others.

Page 21: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What’s the evidence? Outcomes reported in the review*

Clinical Outcomes Health Knowledge Health Behaviours Self-Reported Health Status / Quality of Life Health-Related Self-Efficacy / Confidence Utilization of Health Care Health Provider Behaviour / Skills Satisfaction Levels

*Only the primary outcomes from each study are addressed in this evidence table. Review authors reported on primary and secondary outcomes but only included

data for primary outcomes.

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What’s the evidence? Clinical Outcomes Literacy education: Reduced median depression scores in adults with depressive

symptoms (6) vs. usual care (10) in a community setting (p=0.04).

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What’s the evidence? Clinical Outcomes (continued)

Health education: Educational session with clinical pharmacist reduced

death/hospital admission for adults with heart failure (IRR 0.53, 95% CI 0.32-0.89).

Educational session with pharmacist reduced systolic (mm Hg, -7 vs. 2, 95% CI -16 to -3, p=0.008) and diastolic blood pressure (mm Hg, -4 vs. 1, 95% CI -9 to -1, p=0.002) in adults with poorly controlled type II diabetes. No impact on total blood cholesterol or haemoglobin levels.

No impact on blood pressure and cholesterol for African-American adults with high blood pressure or cholesterol.

Page 24: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What’s the evidence? Health Knowledge Health education: Verbal counseling, provided with dispensed medication,

increased understanding of dosage regimen (% correctly reporting, 88%) vs. usual care (70%) in a hospital pharmacy (p=0.03).

Group education improved understanding of HIV-related terms (mean score (SD), 6.16 (7.97)) vs. usual care (1.91 (3.60)), (t=-3.16, p<0.0001) but had no impact on overall HIV knowledge in Latino Spanish-speaking adults with HIV.

Page 25: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What’s the evidence? Health Knowledge (continued)

Health education (continued): No impact on mothers’ knowledge of newborn hearing

screening in a maternity unit setting but, in a subgroup analysis, there was a significant increase for mothers with lower levels of education (5.00 vs. 3.38, p<0.05)

No impact on: veterans’ hypertension knowledge; medication knowledge in adults aged 65+ with a chronic illness.

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What’s the evidence? Health Behaviours

Health education: Personalized dietary feedback, booklets and structured

telephone calls reduced self-reported fat intake (mean score (SD), 1.87 (0.35)) vs. usual care (1.95 (0.34)) (p=0.0027) but had no impact on self-reported fiber intake for adults in a rural area.

A nutrition-focused heart disease prevention program reduced sodium intake (mean mg (SD), 2545.97 (1164.12)) vs. attention control (3118.13 (2386.19)), (p<0.05) in Hispanic adults, but had no impact on total fat, saturated fat, or cholesterol intake.

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What’s the evidence? Health Behaviours (continued)

Health education (continued): Low-fat nutrition group education improved self-reported

healthy low fat eating in low-income families (mean difference, -0.03, 95% CI -0.01 to -0.005).

Low-fat nutrition group education reduced caloric intake (change in % calories from total fat, -2.8 (2.4)) vs. an alternative program (-0.5 (2.0)), (p=0.01).

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What’s the evidence? Health Behaviours (continued)

Health education (continued): Intensive diabetes management program improved self-report

of Aspirin use by adults with poorly controlled type II diabetes (% correctly reporting, 91%) vs. usual care + 1 hr educational session (58%), (p<0.0001).

No impact on medication adherence for veterans with hypertension or Latino Spanish-speaking adults with HIV.

Page 29: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What’s the evidence? Self-Reported Health Status

Health education: Education session with a clinical pharmacist had no impact on

heart failure-related quality of life reporting in adults with heart failure.

Page 30: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What’s the evidence? Health-Related Self-Efficacy Health education: Tailored health education telephone intervention (with verbal

medication explanation) increased self confidence in hypertension management for veterans (mean score change, 0.33) vs. usual care (-0.10), (p=0.007)

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What’s the evidence? Utilization of Health Care Health professional-directed: Health professional-directed intervention, in which

professionals receive training on screen and patient communication, increased percentage of patients screened for colorectal cancer (42.3%) vs. usual care (32.4%) (p=0.003).

There was no impact in a subgroup analysis of higher literacy groups in the same study.

Page 32: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What’s the evidence? Health Provider Behaviour Health professional-directed: Health professional-directed intervention, in which physicians

were notified of patients’ literacy status, increased use of literacy-relevant management strategies when treating adults with type II diabetes (% reporting use of >3 strategies, 20%) vs. usual care (7%) (OR 4.7, 95% CI 1.4-16.0, p=0.01).

Health education: Group health education improved Latino Spanish-speaking

adults with HIV’s perceived quality of communication with health providers (mean score change (SD), 5.28 (5.37)) vs. usual care (1.11 (5.97)) (p<0.001).

Page 33: Improving the Health of Adults with Limited Literacy: What's the Evidence?

What’s the evidence? Satisfaction Levels Patients: Intervention group (adults with poorly

controlled type II diabetes in an intensive educational session) were more satisfied than those receiving usual care (Diabetes Treatment Satisfaction Questionnaire, difference in mean change, 3, 95% CI 1-6).

Providers: Intervention group (physicians notified of diabetes patients’ literacy status) were less satisfied (82%) than those receiving usual care (96%) (adjusted OR 0.2, 95% CI 0.1-0.5)

Page 34: Improving the Health of Adults with Limited Literacy: What's the Evidence?

General Implications Public health should include and/or support complex, multi-faceted interventions, for adults with limited literacy, to improve:

Health-related self efficacy

Utilization of health care

Communication with health providers

**Public health decision makers should be aware that limited evidence (i.e. 1 study) is available for most of the outcomes described in this review.

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General Implications

For adults with limited literacy:

The evidence does not recommend complex interventions for improving self-reported health status or quality of life.

The evidence cannot definitively recommend/reject complex interventions to address dietary outcomes, overall health knowledge and behaviours. However, the interventions appear to be effective in improving specific knowledge and behaviours, such as understanding key terms, medication dosage regimes and correct medication self-reporting.

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Questions?

Page 37: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Posting Board For a copy of the presentation please visit our

posting board: http://forum.health-evidence.ca/

Login with your health-evidence username and password or register if you aren’t a member yet.

Page 38: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Evaluation Survey Please check your email for a link to an

evaluation survey.

It take 5 minutes to complete!

If you did not personally register for the webinar, please e-mail Jennifer McGugan at

[email protected] to be sent the survey.

Page 39: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Canadian Institutes of Health Research Institute of Population and Public Health

Funding Opportunities

• Population Health Intervention Research to Promote Health and Health Equity

• Knowledge Translation Awards • Institute Community Support Grants and

Awards • CIHR’s Open Operating Grants Program

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Page 40: Improving the Health of Adults with Limited Literacy: What's the Evidence?

Population Health Intervention Research Example

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Evaluation of traffic safety interventions in B.C. Jeffrey Brubacher, et. al (UBC)

Looking at whether number of vehicle crashes changed after changes to the province’s Motor Vehicle Act. Findings will influence B.C.’s road safety strategy and will be of interest to traffic safety lawmakers from other Canadian provinces and territories.

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• Visit ResearchNet for current CIHR

funding opportunities: http://www.researchnet-recherchenet.ca/

• For further information please contact us [email protected]

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References

Rootman, I. & Gordon-El-Bihbety, D. (2008) A vision for a health literate Canada: Report of the Canadian Expert Panel on Health Literacy. Ottawa, ON: Canadian Public Health Association. Retrieved from http://www.cpha.ca/uploads/portals/h-l/report_e.pdf

Begoray, D., Gillis, D., Rowlands, G. (Eds.) (2012) Health Literacy in Context: International Perspectives. Nova Science Publishers, Inc., New York

Public Health Association of British Columbia. (2012). An inter-sectoral approach for improving health literacy for Canadians: A discussion paper. Victoria, BC: Author. Retrieved from http://www.phabc.org/userfiles/file/IntersectoralApproachforHealthLiteracy-FINAL.pdf

National Collaborating Centre for Determinants of Health. (2007). Scan of family literacy and health: Final report. Antigonish: NS: Author. Retrieved from http://nccdh.ca/resources/entry/scan-of-family-literacy-and-health