1. Cervical Screening: participation and informed consent Carla White September 2015

2. 1.Encouraging participation – priority groups (1 ½ hrs) 2.Helping women understand informed consent (½ hr) 3.Understand how to use the Three Step Model for health literacy (throughout) 2 Purpose

3. Health literacy definitions Good health literacy means people: “have the capacity to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions” Kōrero Mārama, 2010 Health literacy is an interaction between the skills of individuals and the demands of the health system http://www.moh.govt.nz/moh.nsf/indexmh/korero-marama-health- literacy-maori-feb2010 3

4. NZ health literacy statistics More than 56.2% of adult New Zealanders (1,626,000 adults) have low levels of health literacy. (IALS 2006 figures) 4

5. These groups have poorer health literacy Older people Unemployed Younger people People living in rural areas 5 Health literacy in NZ

6. We all have low health literacy occasionally: we forget things health information is unfamiliar and complex friends give us the wrong information a health practitioner is unclear. 6 Health literacy is not static

7. What affects health literacy? communication skills of health professionals complexity of health services resources that are difficult to understand a person’s literacy and numeracy 7 Health literacy in NZ

8. Schema Ideas need to connect to what is ‘known’ to grow schema Sometimes schema needs to be altered before new information can be added 8

9. Sex Example: Initial schema Pain Cancer Embarrassing Rare CANCER 9 “should do”

10. Well developed schema father normal Results HPV Frequency All Blacks Pre- cancer Regular test NCSP Provider options Surviv- able Immunise girls Matt Te Po Embarrassing Reduce Pain PRE CANCER Do for you Treat- able 10 No symptoms Preventable Relax

11. Three steps to better health literacy 11

12. What questions do you ask women? What concerns or questions do women have? 12 Step 1: Ask/find out what people know

13. Step 2: Build Work in pairs to describe how you respond 13

14. Step 2: Build health literacy skills and knowledge Reinforce and emphasise Link to what a person already knows Prioritise important messages Give information in logical steps Give information in manageable chunks Explain technical words Use visuals Help people anticipate next steps 14

15. Listening Listen to understand and acknowledge provide information 15

16. (Build) Listening demands of health interactions “Listening takes place in real time …… The listener does not have the option of reviewing the information presented and has little control over the rate of speech.” Vandergrift, L. (2006) ‘Second Language Listening: Listening Ability or Language Proficiency? in Modern Language Journal, Vol. 90, No. 1, pp. 6-18. 16

17. (Build) Vocabulary Adults need ?? exposures to a new word before it becomes part of their vocabulary Generally adults will struggle to understand a text unless ?? % of the words are high frequency words 17

18. Step 3: Check 1.What questions could you ask to check you’ve been clear and a woman has the information she needs? 2.What questions could you ask a woman to check whether she is willing to have a smear? Not a test for the woman, but about how well you have communicated with her 18

19. Informed consent 19

20. Informed consent What could you ask/say about these points with a women new to the NCSP? Using Ask, Build, Check Using plain language Using pictures or models where possible How could this differ for women who have had the test before? 19

21. Wrap Up

22. Taking action Identify one thing you are going to do as a result of this workshop. 22

23. Further Information www.healthliteracy.org.nz www.nsu.govt.nz www.hqsc.govt.nz 23 cwhite@workbase.org.nz