The Health Literacy National Demonstration Site – What did we do The Health Literacy National Demonstration Site – What did we do? 7th February 2018 Jonathan Berry – NHS England Sarah Hassell – Public Health England (PHE)

Definition “The personal characteristic and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health” World Health Organisation 2015

Why did we do it? 43%/61% of English working age population do not understand health information they are given (IHE 2015) Build on existing work led by PHE East Midlands Existing Arms Length Bodies (ALB) commitment Test existing interventions Significant areas of health inequalities in the East Midlands

System Drivers PHE Strategic plan for the next four years: better outcomes by 2020: putting prevention at the heart of the health and care system NHS England Next Steps on the Five Year Forward View - Enhance patient activation, support self-management for LTCs, and improve prevention STPs / ACS enhance patient activation, support self-management and choice, and improve prevention

Impacts from Practice Not realising that a positive test result can be a bad thing Not understanding how chemotherapy will work Not realising link between food and diabetes control Spraying an asthma inhaler on the neck having been instructed to spray the inhaler on throat, Not realising that 5 a day is roughly five handfuls rather than five bags of fruit and vegetables

What did we do? Health Literacy Awareness Training delivered to 239 staff in various organisations: including Local Authorities, Voluntary Sector, NHS (GPs and hospital staff), Fire Service, Social Care, DWP 57 staff trained in improving community health and wellbeing (RSPH accredited) Delivery of the national evidence based health literacy programme to 56 people with low health literacy, living with Type 2 Diabetes and not managing it effectively ALB workshops This built on work done through a previous contract: April-September 2016 12 courses delivered to 146 people

Why did we do it this way? Because health literacy is a two sided issue reflecting: A systems issue – the complexity of health information and the health and care system (awareness raising) The individuals ability – to understand and use information to make decisions about their health and care

Health conditions by socio-economic class STOP AND DO THE THREE ACTIVITIES: READING WRITING MATHS Condition by socio-economic group (rate per 1,000 reporting long-standing condition by socio-economic group of household reference person General Household Survey)

Outcomes for Practitioners A greater understanding of health literacy and the impact of low health literacy on service users Improvement in practitioners knowledge about the services they could refer/signpost service users to Awareness of and greater confidence in using a range of evidence based simplified communication techniques such as Teachback and SMOG

Outcomes for People Increased knowledge in 4 key areas: Leading a healthier lifestyle Ability to self-manage Medication management Accessing the right service

Outputs A Toolkit which can be adapted for local use to support the development of effective approaches to health literacy in other areas, plus Strategic Report https://www.hee.nhs.uk/our-work/hospitals-primary-community-care/population-health-prevention/health-literacy/health-literacy-toolkit

What Changed? Practitioners 87% of participants identified potential changes they would make to their practice because of attending the course Particularly incorporating the practical approaches taught as part of the session eg Teachback/Chunk and Check Knowledge of referral/signposting routes

What Changed? People 97% of participants said they had made changes to their lifestyle following the course. The biggest changes in lifestyle behaviour were: Eating a healthier diet (39%) Exercising more (23%) Reducing sugar intake (13%) At the beginning of the course 45% stated that they sometimes forgot to take their medication. This had reduced to 28% at the end of the course

Was it Sustained? Practitioners – 3 month follow up Participants’ awareness about and understanding of Health Literacy had been maintained. 89% of respondents still considered their awareness and understanding to be “high” or “very high” .Up from14% at the start. 72% of participants considered their confidence in speaking to people about Health Literacy to be “high” or “very high” three months after the end of the workshop Participants had maintained or improved their knowledge about services and support to which they could refer clients 45% had used the techniques to which they had been introduced with clients

Was it Sustained? People – 3 month follow-up 97% figure sustained.The biggest changes in lifestyle behaviour were: • Eating a healthier diet (39%) • Exercising more (23%) • Reducing sugar intake (13%) 23% sometimes forgot to take their medication, down from 45% 82% of participants said they felt the course had helped them to feel more confident in managing their condition 82% of participants said they felt that attending the course had helped them to manage their medication better;

‘I will be able to put the training into practice I took the portion size handout to work and photocopied it for everyone! They couldn’t believe it’ ‘Has given me confidence to actually discuss these issue sensitively, allowing me to support people effectively’ ‘Really made me "experience" how it would feel to have low levels of literacy’ ‘I will be able to put the training into practice

Next Steps Publish the Impact Evaluation Report Test simplified communication techniques in the Shared Decision Making arena Further ALB workshops Supporting adoption in other areas

Contact details Jonathan.Berry2@nhs.net Janet.flint@hee.nhs.uk Sarah.Hassell@phe.gov.uk mandy.wardle-mcleish@chlfoundation.org.uk

What Will We All Do Next?