Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia)

Abstract

BackgroundThe need for healthcare strengthening to enhance equity is critical, requiring systematic approaches that focus on those experiencing lesser access and outcomes. This project developed and tested the Ophelia (OPtimising HEalth LIteracy and Access) approach for co-design of interventions to improve health literacy and equity of access. Eight principles guided this development: Outcomes focused; Equity driven, Needs diagnosis, Co-design, Driven by local wisdom, Sustainable, Responsive and Systematically applied. We report the application of the Ophelia process where proof-of-concept was defined as successful application of the principles.MethodsNine sites were briefed on the aims of the project around health literacy, co-design and quality improvement. The sites were rural/metropolitan, small/large hospitals, community health centres or municipalities. Each site identified their own priorities for improvement; collected health literacy data using the Health Literacy Questionnaire (HLQ) within the identified priority groups; engaged staff in co-design workshops to generate ideas for improvement; developed program-logic models; and implemented their projects using Plan-Do-Study-Act (PDSA) cycles. Evaluation included assessment of impacts on organisations, practitioners and service users, and whether the principles were applied.ResultsSites undertook co-design workshops involving discussion of service user needs informed by HLQ (n = 813) and interview data. Sites generated between 21 and 78 intervention ideas and then planned their selected interventions through program-logic models. Sites successfully implemented interventions and refined them progressively with PDSA cycles. Interventions generally involved one of four pathways: development of clinician skills and resources for health literacy, engagement of community volunteers to disseminate health promotion messages, direct impact on consumers’ health literacy, and redesign of existing services. Evidence of application of the principles was found in all sites.ConclusionsThe Ophelia approach guided identification of health literacy issues at each participating site and the development and implementation of locally appropriate solutions. The eight principles provided a framework that allowed flexible application of the Ophelia approach and generation of a diverse set of interventions. Changes were observed at organisational, staff, and community member levels. The Ophelia approach can be used to generate health service improvements that enhance health outcomes and address inequity of access to healthcare.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4147-5) contains supplementary material, which is available to authorized users.

Health literacy screening of patients attending a student-led osteopathy clinic: A pilot investigation

“…Beauchamp 21 in a Victorian chronic pain population. The latter authors demonstrated that Health Literacy Questionnaire factor scores were lower for those who did not speak English at home, with small to large effect sizes.…”

Application of validity theory and methodology to patient-reported outcome measures (PROMs): building an argument for validity

“…Items are scored from 1 to 4 in the first 5 scales (Strongly Disagree, Disagree, Agree, Strongly Agree), and from 1 to 5 in scales 6–9 (Cannot Do or Always Difficult, Usually Difficult, Sometimes Difficult, Usually Easy, Always Easy). The HLQ has been in use since 2013 [56, 57, 64–72] and was designed to furnish evidence that would help to guide the development and evaluation of targeted responses to health literacy needs [64, 73]. Typical decisions made from interpretations of HLQ data are those to do with changes in clinical practice (e.g.…”

“…For example, an ethnographer who lived with Roma populations assessed each of the HLQ scales according to how Roma people might understand them [79]. The outcome was a decision that the HLQ scales, specifically as used in needs assessment for the Ophelia process [73], resonate with elements of successful grassroots health mediation programs in Roma communities 1.2 Application of a systematic translation protocol that provides evidence that linguistic equivalence and cultural appropriateness are highly likely to be achieved, thus supporting the argument for the successful transfer of the intended meaning of the source language constructs while maximising understanding of items, response options and administration methods in the target language and cultureConstruct irrelevance and construct underrepresentation in the target culture are consideredEvidence that a structured translation method, with detailed descriptions of the item intents, was appropriately implementedEvidence for the effective engagement of people from the target language/culture in the translation processEvidence of the confirmation of congruence of items and constructs between the source language and culture and the target language and culture to ensure construct relevance and avoid possible construct underrepresentationFormal and documented translation method and process to manage translations to different languages, including documentation of participants in translation consensus meetings. A developer or other person deeply familiar with the PROM’s content and purpose oversees the concordance between the intents of original items and target language items.…”

“…This has not yet been systematically conducted for the HLQ. As a start to this sort of research, the English HLQ [55, 73], as well as the Danish [60] and German [61] studies, could be considered mainstream populations, whereas the Slovak [62, 77, 79] translation is an example of a targeted study of validity generalisation in a specific population 5. Validity and consequences of testing [11] — the intended and unintended consequences of test use, and as traced to a source of invalidity such as construct underrepresentation or construct-irrelevant components 5.1 PROM users (e.g.…”

“…predicted or actual actions taken from score interpretation and use) and if these align with the intended benefits, as stipulated by the developers of the source language PROM. For example, the OPtimising HEalth LIteracy and Access (Ophelia) process [73] supports healthcare services to interpret and apply data from the nine HLQ scales (supported by co-design research practices) to design health literacy interventions. Evaluation cycles integrated into the Ophelia process aim to keep the interventions directed towards client, health professional, service and community health literacy.…”