1. National Health Literacy Demonstrator Programme
Angela Shepherd
NES Nursing & Midwifery Practice Educator
Nursing & Midwifery practice educator, role is supporting nurses and midwives in relation to Continuous Professional development – Do this in a variety of ways
Approached by Phyllis a few years ago to develop and deliver education and training for staff in relation to pilot work on HL- since then – been involved in developing and delivering education and training for the HL demonstrator programme
Nursing for many years - my background is acute medicine and coronary care. But though I had some insight, I wasn’t really sure what HL was.
As I learned more about it, I realised that despite providing a huge amount of vital information for patients over many years, including cardiac rehab info - rarely stopped to check if patients fully understood that information.
This really made me think about my previous practice and what practitioners like myself needed to know in relation to health literacy education and training.
That's what I’m going to talk about this morning.

2. Health Literacy, who is responsible?
Patients/service users
Practitioners
The organisation
The initial focus of the education I provide explores responsibilities:
The issue with many definitions of HL is that they place the problem with individuals rather than the complex and unfamiliar nature of health care environments. A key point I always make is that Health literacy is not just the responsibility of pts and service users, we are all responsible:
Patients and service users have to be given information in ways that they can understand, that understanding must be checked and never assumed.
The focus of health literacy education for practitioners should be on improving communication with patients, carers, relatives and others.
The focus for the organisation should be on ensuring our systems and processes as easy as possible for people to access , navigate and use.

3. Staff Education Understanding the issue Why it’s important
What we can do to help
From a staff education perspective:
It’s vital that staff understanding the issue
In my experience, the term HL – often poorly understood
The education I provide has key focus areas:
Understanding the term health literacy
Understand the extent of the problem - e.g. 43% of adult pop unable to calculate a childhood paracetamol dose
Appreciate the consequences of poor HL
Understanding the importance of the issue
Relies on people knowing - ability to be health literate is important for all of us, we will all, at some time, face issues of health literacy.
HL can be challenging regardless of your background, educational attainment or social status. – however, some groups within the population will struggle even more, people with low literacy, those whose first language isn’t English
The demands that our healthcare environments make of people - admission to hospital, or a diagnosis of disease or illness create fear and anxiety, that may be accompanied by physical pain or discomfort, seriously limits peoples’ ability to understand what’s being said
Know What we can do to help
The education I provide Involves interactive exercises on:
Complexity of giving & receiving simple instructions – simple instructions can be interpreted in different ways
What we hear is not always what is said to us – differences in interpretation
Importance of highlighting the important – tell people what the important bit is.....may not be obvious to them
When I teach people about teach Back:
Talk about how it can improve communication
Impact & Application should be highlighted - why do I need to know this, what use is it to me?
Teach back is a person centred approach to communication, importance of staff being ‘in the moment’ with that patients
Help staff Explore how staff Teach Back could be used in their specific clinical areas/contexts
Teach back takes time to learn and requires practice, it can take longer initially but may save time in the long run
To date, Over 400 practitioners throughout NHS Tayside have undertaken education and training - demand continues

4. Staff ‘get it’ Using personal experiences
Putting health literacy into context
Practising consciously
Consistent use
Sharing personal experiences, both practitioners’ and mine helps to relate to the issues , enabling staff to recognise and cater for the health literacy needs of their patient populations staff get it straight away, you can see the ‘light bulb’ moment.
I learn from staff and share their health literacy stories with other staff, because these lived experiences are really powerful
Important for me to understand the contexts staff are working in, this helps us to look at what’s currently working well and to identify potential areas for improvement
Many practitioners already use Teach Back in an unconscious way, this is good - but when used in a conscious way, will be intentional and focused on specific outcomes...staff will know what they want the pt/service user to know or be able to do after any communication with them, more importantly they’ll check that the pt/service user knows what it is they have to know/be able to do.
Consistent use - Teach Back should be used by everyone for everyone as far as possible
It’s a privilege to work with staff and witness their enthusiasm and commitment to improve services for patients, despite the fact that their current clinical workloads are already so demanding. This is inspiring

5. Challenges Health care systems and process
Staff release for education and training
Implementing change
Can be difficult to change some of our systems and processes, even when we know they are a barrier to health literacy - e.g. midwifery letter/TOPAZ Electronic system used in NHST – poorly laid out, information not clear, appoint time stated - but further down page, instructed to come 20 mins earlier – important info lost in the text – women turned up late, unprepared for ultrasound scan– clinics running late, anxious women, harassed staff - Midwives trying for over 2 years to change this. Partnership working - Adult Learning - expertise of Renata Fraser - experiences of adult learners to review the letter and make it easy to read, use of plain English - boxed off important information – involved medical records – success.....eventually
No surprise that staff release is and probably always will be problematic, as an Educator I strive to find ways round this, delivering education for staff in their own clinical settings, using protected learning time and other learning events.
Any change can be difficult to implement, my role is to support staff to make changes - both to their practice and to their systems and processes – Teach Back is a new way of working for some staff, they need to be supported to use it
Teaching undergraduate students - HL on the curriculum - will address both staff release and the need to change routine practice, because engaging students with Teach Back within their curriculum means they don’t need released from clinical practice to learn this and will hopefully create future practitioners who ‘get it’ , without the need to change ‘entrenched’ practices.

6. Opportunities Enhance patient experience Improving communication
Improving patient safety
Supporting self management
Promoting person centredness
Improving appropriate access
Up skilling staff
The work from the demonstrator programme has provided us with opportunities to improve patient experience through improved communication between patients, staff and others.
Improved communication undoubtedly improves patient safety by improving understanding and therefore the person’s ability to self manage, this is demonstrated by all of the teams involved....
We know that using Teach Back is a very person centred approach
Access to help, information and support has been improved throughout the programme, particularly in relation to paediatric outpatients and the hospital signage.
We’ve been able to provide staff with education and training that has increased their skill set and their confidence, some of the feedback from staff.

7. Thank You Burning Questions