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Health Literacy

Health Literacy. Frank O’Hara Instructional Design & Technology 691 Issues and Trends College of Human Resources & Education West Virginia University December 2, 2010. Introduction - the Problem.

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Health Literacy

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  1. Health Literacy Frank O’Hara Instructional Design & Technology 691 Issues and Trends College of Human Resources & Education West Virginia University December 2, 2010

  2. Introduction - the Problem • About half of US adults have difficulty reading print materials to accomplish everyday tasks. • Print materials from simple (social security) to complex tasks (editorial) • Tasks vary from simple (locate) to difficult (interpret meaning)

  3. Adults with limited literacy skills • Lower educational achievement • Likely to report living in poverty, no income in retirement, savings or investments • Likely to report >1 restrictive health conditions • Less likely to engage in civil activities • Are less likely to read, including prose and documents • Disparities exists based on race, ethnicity, access to resources

  4. Study Purpose • Study examines health literacy and its social implications by describing instructional design process and its relationship to curriculum design using the ADDIE model, applying adult learning and constructivism teaching principles to health literacy. • Can instructional system design provide a practical and alternative method to improve the effectiveness of adult health literacy delivery.

  5. Why Health Literacy Health Literacy …”The capacity to obtain, interpret, and understand basic health information and services to the competencies to use such information and services to enhance health.” DHHS Healthy People 2010 • Inadequate health literacy may reduce health status. • Poorer health knowledge • Worsen health behaviors • Threatens health care quality and • Increases health care services costs

  6. Obtain, Interpret, Understand, Health Protection Health Promotion Disease Prevention and Screening Access to Care & System navigation

  7. Review of Related Literature “Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century.” Nutbeam, D. (2000) “Health Literacy: a challenge for American patients and their health care providers” Parker, R. (2000) “Low health literacy prevents equal access to care” Pirisi, A. (2000) “The role of inadequate health literacy skills in colorectal cancer screening” Davis, T. C. (2001) “Optimize patient health by treating literacy and language barriers” Dreger, V. (2002) “Health literacy and diabetic control” Zimmerman, T., (2002)

  8. Review of Related Literature (2) “The role of health literacy in patient-physician communication” Williams, M. V.(2002). “Health literacy and knowledge of chronic disease” Gazmararian, J. A., (2003) “Health literacy, social support and health: a research agenda”. (Lee, SY.D. 2004) “The meaning and measure of health literacy”. (Baker, D.W., 2006) “The causal pathways linking health literacy to health outcomes”. (Paasche-Orlow, M.K, (2007) “Literacy and Health Outcomes” (AHRQ, No. 87, 2004) “Developing predictive models of health literacy. (Martine, L.T., 2009)

  9. Instructional Design, Development and Technology • Instructional design as a detailed specification for development, evaluation and maintenance that facilitates learning. (Richey, 1986) • Instructional development as the process of implementing the plan while ISD is the process of planning. (Gagne, Briggs, & Wager,1992) • “The theory and practice of design, development, utilization, management, and evaluation of process and resources for learning.” (Seels & Richie,1994)

  10. Instructional Design • Theories - how we learn • Strategies for applying theories • Methodologies to implement strategies • Course • Lesson • Topic • Activity

  11. Theory- Conceptual Framework • Andragogy • “the art and science of helping adults learn” • five assumptions – how adults learn, their attitude towards and motivation for learning • Reflective practice , constructivism

  12. Assumptions / Facilitation • Adults are self –directing and independent T Requires advance organizing and learning under the learners control F Facilitating success, - empowerment, self-responsibility • Adults have rich life experiences T Learner appraise new information, knowledge and skill gaps F Help learners become self directing • Learning is valued if it meets everyday needs T Requires foundation of basic knowledge and skills F Encourage learners to identify and locate personal resources and create their problem solving strategies.

  13. Assumptions / Facilitation • Problem centered and immediate approaches have a higher value than subject centered T Learning objectives, - students, institutions, subject, and society are taken into account F Activities and lessons must have meaning and be problem centered and not subjective • Intrinsic values are more motivating than extrinsic awards T Provide guided practice and corrective feedback F Provide time and support so the learner may reflect on learning goals.

  14. Strategies - Constructivism • Learning is an active process of constructing rather than communicating knowledge, • Instruction is a process supporting construction rather than communicating knowledge • Learning is within the learner’s control. • Learning becomes self-directed learning, • Learners construct their own knowledge based on what they already know. • Learners make self-judgments about how and when to modify their knowledge. • The goal of the self-directed learning is the learner seeks to become and accept responsibility for his/her own learning.

  15. Methods Current Life work Prior Learning With knowledge Practice, explore, discover Read Watch Listen Connecting Absorbing Doing ISD Horton, W. 2006, E-Learning By Design, p. 39

  16. Course How do we align the circles for effective learning? Learning Outcomes Health Literacy Content Adult Learner Technology Andragogy Facilitator

  17. Conceptual Model

  18. Instruction System Design How do we align the circles for effective and efficient outcomes? Instructional System Design Assessment Evaluate Design Implement Development

  19. ADDIE Analysis: • Does the learner recognize the learning need? • What is the motivational factor for learning? • Do the subject / content offered have life centered or problem centered meaning? • What life experiences becomes a useful learning resource? • Recognize the cognitive, psychosocial, and physiological characteristics of the learners Design: • learning objectives, instructional topics or units, • sequencing units to the objectives, • content instructional methods and delivery modes, • defining the lessons, and assessing learning

  20. Rapid Estimate of Adult Literacy in Medicine (REALM) ASK THE RESPONDENT TO READ ALOUD THE FOLLOWING WORDS, STARTING FROM LIST 1 AND THEN LIST 2 AND LIST 3. Here are three lists of words. Please read them aloud to me. (GIVE EACH LIST TO RESPONDENT. CHECK WORDS HE/SHE CAN READ/PRONOUNCE CORRECTLY.) List 1List 2List 3 fat ________ fatigue ________ allergic ________ flu ________ pelvic ________ menstrual ________ pill ________ jaundice ________ testicle ________ dose ________ infection ________ colitis________

  21. ADDIE Development: • Preparation or development of the learning units or lessons • Collaborative process • Prototyping • Testing and reflection Implement: • Plan for change – diffusion / adoption process • Delivery should be effective and efficient • Support, monitor, guide Evaluate: • For improving decisions making • Continuous feedback • Examine existing data • Collect new data

  22. Conceptual Model

  23. Summary • For adult learning, effective instructional system designs should focus facilitating the learning environment through the course content, development, constructive learning effective and appropriate media and technology selection that meets the learners needs. • The principles of adult learning should underpin the ISD process, including, encouraging adults to become self-directing, using their past learning experiences, capitalize on their interests and strengths so has to enable them to learn through problem solving, applying news skills and knowledge.

  24. Discussion – Future Issues • Healthy People 2010 Objectives: Draft for the Public Comment notes that health literacy is"increasingly vital to help people critically evaluate health information“ • Literacy is complex, • Multiple variables influence the ISD process • ISD health literacy goal is to improve health outcomes.

  25. Defining Terms Individual Literacy … “the degree to which individuals have the capacity to obtain, process, and understand, the basic health information and services need to make appropriate health decisions.” (N.L.A. 1991) Health Literacy …”The capacity to obtain, interpret, and understand basic health information and services to the competencies to use such information and services to enhance health.” (2) DHHS Healthy People 2010 Media Literacy …”The ability to access, analyze, evaluate, and produce communication in a variety of media forms.” (3) Handbook of Health Communication, (Editor) Thompson, p. 85 Health Education … “is the process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health” (4) Wikipedia

  26. Conceptual Model* Individual SES Characteristics SES Population Characteristics Expected Long-Term Health Outcomes Community Health Literacy (NAAL, 2003) Population Health *Adapted: Market Attributes

  27. Conceptual Model Individual SES Characteristics Age, Gender Educational attainment Race / ethnicity Expected Long-Term Health Outcomes Community Health Literacy (NAAL, 2003)

  28. Conceptual Model SES Population Characteristics Expected Long-Term Health Outcomes • Income - Poverty status, • Social Support, • Employment Status • Language (English) • Geographical location • MSA, Non-MSA Community Health Literacy (NAAL, 2003)

  29. Conceptual Model Population Health • health outcomes, • service use, • cost, and • health status Health Behaviors Hypertension Diabetes Heart failure Asthma Screening Rates Cancer Health Care Utilization Expected Long-Term Health Outcomes Community Health Literacy (NAAL, 2003)

  30. Conceptual Model Individual SES Characteristics SES Population Characteristics Health Outcomes Reduced morbidity Avoidable mortality > Health status > Preventive care < services < Disability, < Chronic disease < Hospitalizations < ER resources > Communications Community Health Literacy (NAAL, 2003) Population Health Market Attributes

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