1. 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)

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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;

16. ‘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

17. 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

18. Contact details Jonathan.Berry2@nhs.net Janet.flint@hee.nhs.uk

19. What Will We All Do Next?