1. Susan Reid Wisconsin Health Literacy Summit 14 April 2015
Using adult learning theories to build patients’ and families’ knowledge of CVD medicines
Susan Reid Wisconsin Health Literacy Summit
14 April 2015

2. Session objectives By the end of this workshop you will have learnt:
how adult learning theories, schema theory, co-construction of knowledge and Vygotsky’s Zone of Proximal Development relate to health literacy interventions
how these theories informed the development of a health literacy intervention about CVD medicines knowledge
results of the intervention

3. Summary of CVD medicines project
Aims
Develop a customised, structured CVD medicines health literacy programme
Trial this in indigenous primary care services:
Primary outcome - CVD medication knowledge
Secondary outcomes - changes in health literacy skills and practices

4. Programme description
Phase 1 programme
In-depth interviews with nine patients and families showed they had limited knowledge but were keen to know more
Training for research nurses
Written resource for patients
Interactive app for use in sessions
Three step health literacy model – Ask, Build, Check

5. Phase 2: trialling the intervention
Full protocol available:
Crengle et al. BMC Public Health 2014, 14:714
Three sessions over one month
Outcome assessments before and after each session
Structured process for doing outcome assessments

6. The participants
Eligibility – CVD diagnosis and taking at least 2 of 4 medicines
96 participants
Mean age 64.3 years (range years)
Females 58.2%
Statins 91.7%
ACE inhibitors 61.5%
Beta blockers 71.9%
Aspirin 85.4%
Angina 60.2% MI 52.0%
TIA 10.4% CVA 25.8%
Mean years with CVD 7.2 years
Comorbidities common:
Diabetes 39.3% Gout 33.3%
COPD 24.4% CHF 24.1%
Data collected March to August 2013 at Ngati Porou Hauora (rural) and Te Hononga o Tāmaki me Hoturoa (urban)

7. The constraints and opportunities
One off training session for research nurses
New way of thinking – Ask, Build, Check needs lots of practice
New way of thinking – shift from telling to other methods of teaching
No opportunity for coaching except inter-rater reliability sessions

8. Three steps to better health literacy

9. What we often observe
1. Assume 2.
Tell
3. Assume

10. Ask people what they know, do and believe
Step 1
Ask people what they know, do and believe
This is the most important step and easiest step

11. knowledge of how texts are organised
Step 1: Prior knowledge
Schema theory
Everyone relates new knowledge to what they already know or have experienced
Content schema
knowledge of the world
Textual schema
knowledge of how texts are organised
56.2% of NZ adults have low levels
76.4% of Māori adults have low levels
Four out of five Māori males
Three out of four Māori females
Māori who live in rural areas have the poorer health literacy skills, closely followed by Māori in urban areas
16-24 and 50 and older have comparatively poor health literacy
Unemployed Māori have poorer health literacy skills
K:\Presentations\2011\Susan\AustLgtermCondConf-6-8Apr2011-PreConfWkshop-Susan Reid-Health Literacy and Chronic Conditions-What is the link

12. Co-construct knowledge
Use a range of different teaching strategies not just telling and telling off:
Modelling
Discussion
Explaining
Remember to link to what they already know
K:\Presentations\2011\Susan\AustLgtermCondConf-6-8Apr2011-PreConfWkshop-Susan Reid-Health Literacy and Chronic Conditions-What is the link

13. Step 2
Build health literacy skills and knowledge and link them to what people already know
We think health professionals do some of this already

15. Zone of Proximal Development

16. Working in the ZPD

17. Step 2: Build health literacy
Use a range of different strategies not just telling
Modelling
Discussion
Explaining
Remember to link new information to what people already know
Prompting
Questions
Giving feedback

18. Example of prompting
Video

19. Check you were clear (and, if not, go back to Step 2)
This is the hardest step and needs the most practice

20. Step 3: Check you were clear
It is the nurse’s responsibility to be clear
Used open and closed questions and prompting during outcome assessments:
“Tell me what you know about your statin”
“Ok now what are the serious side effects that you need to tell us about straightaway?”

22. Results

23. Specific knowledge for each prescribed medicine type

24. Prompting vs spontaneous correct answers

25. Health literacy practices - resources

26. Acknowledgements
New Zealand researchers included Dr Sue Crengle, Michelle Lambert, Dr Matire Harwood (University of Auckland); Susan Reid (Workbase Education Trust); Jennie Harre-Hindmarsh, Julia Brooking, Moko Williams (Ngati Porou Hauora); Marian Hakaraia, Lisa Reddy (Te Hononga o Tamaki me Hoturoa)
We acknowledge the support of all the participants and their families who took the time to be involved in this project
Funding for this project was provided by the Health Research Council of New Zealand
Part of ICIHRP programme funded in New Zealand, Australia (University of Victoria & Victorian Aboriginal Health Services) and Canada (St Michaels Hospital, Toronto & De dwa da dehs nye>s Aboriginal Health Centre, Hamilton)

27. www.healthliteracy.org.nz sreid@workbase.org.nz