ORCID Profile
0000-0002-4534-0899
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Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.PEC.2015.07.023
Abstract: Given the scarcity of shared decision-making (SDM) interventions for adults with low literacy, we created a SDM training program tailored to this population to be delivered in adult education settings. Formative evaluation during program development included a review of the problem and previous efforts to address it, qualitative interviews with the target population, program planning and field testing. A comprehensive SDM training program was developed incorporating core SDM elements. The program aimed to improve students' understanding of SDM and to provide them with the necessary skills (understanding probabilistic risks and benefits, personal values and preferences) and self-efficacy to use an existing set of questions (the AskShareKnow questions) as a means to engage in SDM during healthcare interactions. There is an ethical imperative to develop SDM interventions for adults with lower literacy. Generic training programs delivered direct-to-consumers in adult education settings offer promise in a national and international environment where too few initiatives exist. Formative evaluation of the program offers practical insights into developing consumer-focused SDM training. The content of the program can be used as a guide for future efforts to engage consumers in SDM.
Publisher: SLACK, Inc.
Date: 2018
DOI: 10.3928/24748307-20171227-01
Abstract: Instruments to assess the quality and comprehensibility of printed patient education materials may lack proper consideration of how readers derive meaning from text. The Evaluative Linguistic Framework (ELF) considers how factors that influence readers' expectations about health care texts also affect their ability to understand them. The ELF has demonstrated value in improving the quality of patient materials about medication, consent, and self-reported questionnaires, but has not yet been used to evaluate a corpus of patient education materials about chronic disease self-management. This study sought to apply the ELF to examine specific elements of printed self-management patient education materials for chronic kidney disease (CKD) not captured by other tools. From a previously published systematic review, we identified 14 patient education materials (eight self-management, six diet and nutrition) for people with CKD. We used the ELF to identify the different ways the text could be structured, its intended purpose, the relationship established between reader and writer, presence of signposting, its complexity and technicality of language, and factual content. Our analysis identified nine possible structural units, of which “introducing the problem” and “instructing the reader to self-manage” were common to all materials. However, there was no consistency or common sequence to these units of text. The intended readership and aims of the author(s) were not always clear many materials made assumptions about what the reader knew, the language was often complex and dense, and the meta-discourse was sometimes distracting. Our analysis suggests CKD document developers can benefit from a theoretically grounded linguistic tool that focuses on the intended audience and their specific needs. The ELF identified structural units of text, aligned with rhetorical elements that can be uniformly applied for developing self-management education materials for CKD, and provided checks for language complexity. Further work can determine its usefulness for other (e.g., electronic) formats and other chronic diseases. [ HLRP: Health Literacy Research and Practice . 2018 (1):e1–e14.] Helping patients make meaning from information about their condition is a key goal of health care organizations. We analyzed chronic kidney disease patient education materials on self-management using the Evaluative Linguistic Framework. The purpose and intended audience were frequently unclear. We identified nine structural units of text that may assist information providers to plan and structure content.
Publisher: Oxford University Press (OUP)
Date: 25-05-2018
Abstract: Adults with low literacy are less empowered to take care of their health, have poorer health outcomes and higher healthcare costs. We facilitated partnerships between adult literacy teachers and community health providers to deliver a health literacy training program in adult basic education classrooms. Following course completion we interviewed 19 adult education teachers (15 delivering the health literacy program 4 delivering standard literacy classes) and four community health providers (CHPs) about their experiences, and analysed transcripts using Framework analysis. Written feedback from eight teachers on specific course content was added to the Framework. Health literacy teachers reported a noticeable improvement in their student's health behaviours, confidence, vocabulary to communicate about health, understanding of the health system and language, literacy and numeracy skills. CHP participation was perceived by teachers and CHPs as very successful, with teachers and CHPs reporting they complemented each other's skills. The logistics of coordinating CHPs within the constraints of the adult education setting was a significant obstacle to CHP participation. This study adds to existing evidence that health is an engaging topic for adult learners, and health literacy can be successfully implemented in an adult basic learning curriculum to empower learners to better manage their health. Health workers can deliver targeted health messages in this environment, and introduce local health services. Investment in adult literacy programs teaching health content has potential both to meet the goals of adult language and literacy programs and deliver health benefit in vulnerable populations.
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.PEC.2016.05.008
Abstract: Participation in shared decision-making (SDM) may be difficult for adults with lower literacy. Tools to support consumers to engage in SDM are rarely designed for or evaluated with adults with lower literacy and/or poor English language. Qualitative interviews were conducted with 26 adults with lower literacy and/or poor English language skills to investigate (a) whether participants where able to read and understand two generic SDM consumer support tools (Smart Health Choices and AskShareKnow question-sets), (b) which question-set was easier for participants and, (c) perceived usefulness of the question-sets and barriers to use. Interviews were analysed using Framework Analysis. Participants had difficulties understanding terms embedded within both the AskShareKnow and Smart Health Choices questions. Our findings suggest that the AskShareKnow question-set was easier for our participants than the Smart Health Choices questions, and clarification using a structured response was reasonably effective. While participants appreciated the usefulness of the questions, they identified important barriers to use. Generic question-sets alone are not sufficient to support SDM for adults with lower literacy and/or poor English-language skills. To ensure that SDM is accessible to all, we must consider how best to support adults with low literacy and/or poor English-language skills to participate in this process.
Publisher: SLACK, Inc.
Date: 10-2017
DOI: 10.3928/24748307-20170724-01
Abstract: Asking patients to “Teach-Back” information during a health care consultation is widely recommended, yet little is known about patient and provider experiences using this method. Teach-Back has not previously been evaluated in a consumer telephone health service, a situation in which low health literacy can be especially difficult to identify. This study sought to explore telenurse experiences using Teach-Back at a maternal and child health helpline, supplemented with caller experiences. After training maternal and child health nurses to use Teach-Back ( n = 15), we interviewed nurses and callers to the helpline service. We used semi-structured guides to conduct focus groups and telephone interviews and analyzed transcripts of nurse and caller data using the Framework method. This qualitative study forms part of a randomized controlled trial of Teach-Back involving 637 callers. Nurses ( n = 13) reported Teach-Back was helpful to invite questions from callers, summarize information, review action plans, and close calls. Some found it helpful to empower and calm (anxious) callers. Nurses reported they did not always use Teach-Back, either because it was not appropriate or they felt uncomfortable with phrasing. Comfort with using Teach-Back tended to improve with practice. Perceived effect on call duration was mixed. We report s le Teach-Back strategies used by nurses, including the lead-in phrase “just before you go…,” which was considered helpful for initiating Teach-Back at close of a call. Caller reports of Teach-Back were limited ( n = 8) but mostly positive. Teach-Back is a simple communication technique that can be used in a consumer telehealth service to confirm caller understanding and actions to take, and in some cases it may also reduce caller anxiety. Further research on caller experiences and objective impact on call duration is needed. [ Health Literacy Research and Practice . 2017 (4):e173–e181.] Low health literacy can be difficult to identify, especially over the telephone. Asking callers to summarize important information and agreed actions (known as Teach-Back) could help telehealth providers confirm understanding. We interviewed nurses operating a maternal and child health helpline and callers about their experiences with Teach-Back. Findings support Teach-Back for telehealth and suggest Teach-Back can also reduce caller anxiety.
Publisher: The Sax Institute
Date: 2020
Publisher: Wiley
Date: 05-07-2017
DOI: 10.1111/HEX.12580
Publisher: Springer Science and Business Media LLC
Date: 04-06-2016
Publisher: Springer Science and Business Media LLC
Date: 07-03-2018
Publisher: Public Library of Science (PLoS)
Date: 31-10-2018
Publisher: Informa UK Limited
Date: 30-07-2013
Publisher: Elsevier BV
Date: 2013
Publisher: SLACK, Inc.
Date: 10-2017
DOI: 10.3928/24748307-20171208-02
Abstract: Health literacy skills are often assessed in relation to written health materials however, many important communications are in other formats, especially verbal communication with health care providers. This qualitative study sought to examine adult learners' experiences of developing verbal health literacy skills within an Australian adult basic education program, and to explore verbal communication and shared decision-making as a constituent domain of health literacy. We conducted a semi-structured qualitative interview study between September and November 2014 with adult learners who had participated in a single-semester health literacy program that included an integrated shared decision-making component. We analyzed interviews using the Framework method a matrix-based approach to thematic analysis. A hybrid process of inductive and deductive coding was used to interpret raw data. Interviewees were 22 students from six health literacy classes and ranged in age from 18 to 74 years (mean, 48.3). The majority were women ( n = 15) and born outside Australia ( n = 13). Health literacy was generally limited according to the Newest Vital Sign screening tool ( n = 17). The health literacy program appeared to serve two key functions. First, it stimulated awareness that patients have the right to participate in decision-making concerning their treatment and care. Second, it facilitated verbal skill development across the domains of functional (e.g., communicating symptoms), communicative (e.g., asking questions to extract information about treatment options), and critical (e.g., integrating new knowledge with preferences) health literacy. Our findings support the conceptualization of health literacy as a modifiable health asset that is subject to change and improvement as a result of deliberate intervention. Results reinforce verbal health literacy as an important component of health literacy, and draw attention to the hierarchy of verbal skills needed for consumers to become more actively involved in decisions about their health. We present a revised model of health literacy based on our findings. [ Health Literacy Research and Practice . 2017 (4):e257–e268.] We developed a health literacy program for adults with lower literacy to help learners develop skills to talk to health care providers and share health decisions. The program was taught in Australian adult education settings. The article explores the range of health literacy skills needed for communication and decision-making in this study, and presents a model in which verbal skills are an important part of health literacy.
Publisher: Hogrefe Publishing Group
Date: 2012
DOI: 10.1027/1015-5759/A000126
Abstract: Experimental interest in human decision making has been fertile in the past two decades. It is generally recognized that answers to questions involving general knowledge tend to produce overconfidence, whereas responses to perceptual tasks often result in underconfidence. While experimental psychologists debated the relative merits of single or dual explanations of these phenomena, differential psychologists suggested that confidence is a trait: Some people have high confidence and others express the opposite, no matter what type of task is undertaken. The current study examined these different perspectives using two complex cognitive and nine perceptual discrimination tasks from different sensory modalities. Findings suggest that underconfidence does not generalize across the perceptual domain, indicating that a more complex account of the miscalibration effect is needed. Such an account should incorporate both task characteristics and in idual differences to produce a satisfactory psychological explanation of miscalibration. This point is highlighted by the presence of a strong confidence factor that has loadings from confidence ratings from erse perceptual and cognitive tasks employed in this study.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1053/J.AJKD.2014.11.025
Abstract: The "average" patient has a literacy level of US grade 8 (age 13-14 years), but this may be lower for people with chronic kidney disease (CKD). Current guidelines suggest that patient education materials should be pitched at a literacy level of around 5th grade (age 10-11 years). This study aims to evaluate the readability of written materials targeted at patients with CKD. Systematic review. Patient information materials aimed at adults with CKD and written in English. Patient education materials designed to be printed and read, sourced from practices in Australia and online at all known websites run by relevant international CKD organizations during March 2014. Quantitative analysis of readability using Lexile Analyzer and Flesch-Kincaid tools. We analyzed 80 materials. Both Lexile Analyzer and Flesch-Kincaid analyses suggested that most materials required a minimum of grade 9 (age 14-15 years) schooling to read them. Only 5% of materials were pitched at the recommended level (grade 5). Readability formulas have inherent limitations and do not account for visual information. We did not consider other media through which patients with CKD may access information. Although the study covered materials from the United States, United Kingdom, and Australia, all non-Internet materials were sourced locally, and it is possible that some international paper-based materials were missed. Generalizability may be limited due to exclusion of non-English materials. These findings suggest that patient information materials aimed at patients with CKD are pitched above the average patient's literacy level. This issue is compounded by cognitive decline in patients with CKD, who may have lower literacy than the average patient. It suggests that information providers need to consider their audience more carefully when preparing patient information materials, including user testing with a low-literacy patient population.
Publisher: Springer Science and Business Media LLC
Date: 27-05-2016
Publisher: Informa UK Limited
Date: 25-01-2017
DOI: 10.1080/10810730.2016.1258744
Abstract: People with chronic kidney disease (CKD) need usable information on how to live well and slow disease progression. This information is complex, difficult to communicate, and changes during the course of the disease. We examined lifestyle-related printed CKD patient education materials focusing on actionability and visual aids. From a previous systematic review assessing readability of CKD patient information, we identified materials targeting nutrition, exercise, and self-management. We applied the Suitability Assessment of Materials (SAM) and Patient Education Materials Assessment Tool (PEMAT) to evaluate how easy materials were to understand (understandability) and act on (actionability). We created the 5C image checklist and systematically examined all visual aids for clarity, contribution, contradiction, and caption. Of the 26 materials included, one fifth (n = 5, 19%) were rated "not suitable" on SAM and fewer than half (n = 11, 42%) were rated "superior." PEMAT mean subdomain scores were suboptimal for actionability (52) and visuals (37). Overall, more than half of all 223 graphics (n = 127, 57%) contributed no meaning to the text. Images in three documents (12%) directly contradicted messaging in the text. CKD lifestyle information materials require focused improvements in both actionability of advice given and use of visual aids to support people with CKD to self-manage their condition. The fifth C is culture and is best evaluated by user-testing.
Publisher: SLACK, Inc.
Date: 07-2019
DOI: 10.3928/24748307-20190402-01
Abstract: Adult education targeting health literacy (HL) may bring added value in the form of improved health. This study evaluated the effects of a HL program as part of an adult education curriculum for adults with low literacy and numeracy. This was a partial-cluster randomized controlled trial among 308 adults enrolled in basic education programs in Australia. Of the 308 participants, 141 (46%) were randomized to either the standard program (language, literacy, and numeracy [LLN]), or the HL intervention (LLN with embedded health content) the remainder ( n = 167) were allocated to standard intervention programs by the education provider at the class level. The main outcomes were functional HL, self-reported confidence, patient activation, generic HL (ie, HLQ, health knowledge, and self-reported health behavior). Data were collected at baseline, immediately after, and at 6 months post-intervention. Of the 308 participants, 71% had limited literacy and 60% spoke a language other than English at home. Both interventions benefited participants, with improvements from baseline to immediate follow up on in idual-level functional HL (e.g., reading a thermometer HL group 18.4% vs. standard group 7.2% p = .001), confidence (HL group 0.34 vs. standard group 0.06 p = .014) and health literacy questionnaire (HLQ) subscales. At 6 months, improvements in confidence ( p .001) and some HLQ measures were retained. A consistent pattern of increased improvement in the HL program was observed compared to the standard program, although only some measures reached statistical significance: reading a food label (HL group 6.03/10 correct vs. standard group 5.49/10 correct p = .022) confidence ( p = .008) ability to actively manage health (HLQ) ( p = .017), and health knowledge at 6 months (HL group 68% vs. standard group 60% correct, p = .052). HL participants reported being more likely to share course information and rated the program more useful to understand their health. Improving language, literacy, and numeracy generally has potential public health benefits that are retained at 6 months. Integrating health content adds further value to adult basic learning, is feasible, and potentially scalable. [ HLRP: Health Literacy Research and Practice . 2019 (Suppl.):S42–S57.] We compared the effect of an adult education-based health literacy (HL) program versus a standard language, literacy, and numeracy program on students' HL skills and psychosocial outcomes. Although students in both trial arms improved their skills, students in the HL program had better outcomes with higher HL, greater confidence, and higher health knowledge scores at 6 months.
No related grants have been discovered for Suzanne Morony.