Making it easy – understanding the health and care system: progress report

Progress against actions

The actions in Making it Easy covered four areas. This section describes what we found.

1. A national health literacy resource for Scotland, "The Health Literacy Place"

NHS Education for Scotland (NES) Knowledge Services developed the Health Literacy Place website. The Health Literacy Place is designed to be the "go to" place for health literacy tools and support in Scotland.
A launch event on 22 October 2015 described the benefits of health literacy to delivering safe, person-centred and effective care. This successful event was well attended and positively evaluated. The event was to:

• Show examples of current good practice and innovation in Scotland.
• Demonstrate The Health Literacy Place's resources to support health literacy practice and the health and social care workforce.
• Set the aim of developing a national network of health literacy champions and supporters.

Social media channels were set up to promote the site and raise awareness of new health literacy issues. Some statistics on usage of the Health Literacy Place site and impact from social media activity are included below.

2. Establish a national demonstrator site

Meeting the Health Literacy Needs of People at Transitions of Care was the national demonstrator programme. It was set up to establish and evaluate best practice to meet the health literacy needs of people as they are looked after by different parts of the health and social care service.

A call to action invited Health Boards across Scotland to submit bids. NHS Tayside was awarded the programme in January 2015.

The overall aims of the programme were to:

• Improve communication between patients/carers and their practitioners, and tailor it to their needs and circumstances
• Provide people with meaningful information and check their understanding
• Support staff to cater for the health literacy needs in their patient population
• Improve referrals to out-patient clinics to support greater patient/carer involvement and more effective interactions between people and their practitioners, particularly at "transitions" of care such as between General Practice and hospital.

The findings from the programme are being spread to hospital areas across NHS Tayside. Appointment letters are being changed to be consistent with the new colour-coded signs and direction information in departments, and to provide clearer advice for those new to services. New information is being written in partnership with people accessing services to ensure it is easy to understand.

Better awareness of health literacy has influenced the planning of information resources. Work continues to test new ways of improving health literacy to help people access health services e.g. using tablets to share videos explaining how to self manage some conditions.

The National Demonstrator Site has explored a range of health literacy issues. Reports can be found on the Health Literacy Place website. Some examples of these are:

1. A health literacy walkthrough: navigating the hospital environment

2. Barriers and facilitators to attending clinic appointments

3. Meaningful communication before medical procedures

4. Health literacy training for current and future healthcare staff

5. Improving self-management after diagnosis or discharge

6. Experiences of using Teachback

The programme also tested some new innovations in health literacy. One example is Teachback, which helps check communication between frontline staff and people using their service. Sessions were delivered to nurses and midwives in a way that fit with other learning and team activities.

Dundee University has now included health literacy on their course for trainee nurses. The simulated sessions used to teach trainee nurses provide a place to test assessment tools in future, like Teachback, or others.

The demonstrator worked with the Academic Health Sciences Partnership in Tayside to further improve services and promote person-centred care through partnerships between academics and health service staff.

3. Test and spread health literacy innovations

As well as testing innovations at the demonstrator site, we also focussed on five main tools and techniques:

• Teachback

  The Teachback method is a useful way to check when information is provided that it is being understood. The person is asked to 'teach back' what has been discussed and any instructions that were given. To promote Teachback, we made this video.

  

• Chunk and Check

  Rather than providing a lot of information at once, Chunk and Check breaks down information into more manageable parts. In between each 'chunk' methods such as Teachback are used to check understanding before moving on.

  

• Use simple language

  Use simple language as much as possible. Try explaining things to people as you would to a friend or family member. Having examples or analogies can help.

  

• Always offer help with paper work

  Routinely offering help reduces the pressure on people who may struggle with forms or writing. It also means your service gathers the correct information that it needs. To reduce stigma, ensure that help is offered to everyone.

  

• Use pictures

  Using pictures alongside words when explaining a task or problem can help people understand. For example, its much simpler to see pictures of someone giving an injection or caring for a wound rather than just reading or hearing an explanation.

  

4. Workforce awareness and skills

This action aimed to increase the awareness of the issues of health literacy among those working in health and social care, and develop their skills, knowledge and capability to improve things.

A short video, Health Literacy in Scotland. Making it Easy was produced. It explains the issues and the ways to make things easier for people to understand. It is available here.

A range of training options were made available between 2014-2017 including Health Literacy Train the Trainer, Health Literacy Awareness Raising and bespoke sessions for specific staff groups on request.

During the past two years a total of 90 people have taken part in Health Literacy Train the Trainer courses. The following graph shows the increase in people's confidence in raising awareness of health literacy after finishing the course.

Examples of the actions people planned to take after their training include to:

• Provide information for colleagues and people using services
• Run training with colleagues and work with their wider NHS Board to deliver training to others
• Discuss with their manager how health literacy is important for their department, finding ways to increase awareness of the problem, and make improvements to the service
• Speak to others about how health literacy can become part and parcel of everyday practice
• Encourage clients to be more assertive at medical appointments and for them to advise staff about their health literacy needs
• Incorporate health literacy awareness into all sessions and work
• Revise the local policies, procedures and literature.

Feedback and comments on the training included:

• "Training was well facilitated and discussions were interested and informative"
• "Trainer very knowledgeable about subject and spoke in a manner that explained the subject well"
• "Excellent trainer, needs spread over all health boards"
• "Really enjoyed this course - it's certainly got my brain working and exploring ideas."

An eLearning module was launched in March 2017 to promote further awareness and skills. It is available here.

Together, these have created a core knowledge of health literacy skills on which to build our continued work.