Health Literacy

Health Literacy

Frank O’HaraInstructional Design & Technology 691

Issues and TrendsCollege of Human Resources & Education

West Virginia UniversityDecember 2, 2010

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)

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

Study Purpose

1. 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.

2. Can instructional system design provide a practical and alternative method to improve the effectiveness of adult health literacy delivery.

Why Health LiteracyHealth 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

Obtain, Interpret, Understand,

Health Promotion

Health Protection

Disease Prevention and Screening

Access to Care &System navigation

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)

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)

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)

Instructional Design

• Theories - how we learn

• Strategies for applying theories

• Methodologies to implement strategies

• Course

• Lesson

• Topic

• Activity

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

Assumptions / Facilitation

1. Adults are self –directing and independentT Requires advance organizing and learning under the learners

controlF Facilitating success, - empowerment, self-responsibility

2. Adults have rich life experiencesT Learner appraise new information, knowledge and skill gapsF Help learners become self directing

3. Learning is valued if it meets everyday needsT Requires foundation of basic knowledge and skillsF Encourage learners to identify and locate personal resources

and create their problem solving strategies.

Five Assumptions About Pedagogical Andragogical

Concept of the learner

Personality dependent Adults are independent & self directing

Learners experience role

Resource Accumulated a large amount of experience that is a rich learning resource

Readiness to learn Uniform by age-level and curriculum

Value learning that integrates with the demands of everyday lif e tasks and problem solving

Orientation to learning

Subject-centered I nterested in immediate problem centered approach rather than subject centered

Motivation External rewards and punishment

Motivated to learn by internal drives rather than external ones

Assumptions / Facilitation

4. 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

5. Intrinsic values are more motivating than extrinsic awards

T Provide guided practice and corrective feedbackF Provide time and support so the learner may reflect

on learning goals.

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.

Absorbing

Methods

Connecting

Doing

ReadWatchListen

CurrentLife work

Prior Learning With knowledgePractice, explore, discover

ISD

Horton, W. 2006, E-Learning By Design, p. 39

Adult Learner

Andragogy

Technology

Facilitator

Health LiteracyContent

Course

Learning Outcomes

How do we align the circles for effective learning?

Conceptual Model

Evaluate

Implement

Design

Development

Assessment

Instruction System Design

InstructionalSystemDesign

How do we align the circles for effective and efficient outcomes?

ADDIEAnalysis:

• 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 c

haracteristics 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

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 1 List 2 List 3fat ________ fatigue ________ allergic ________ flu ________ pelvic ________ menstrual ________ pill ________ jaundice ________ testicle ________ dose ________ infection ________ colitis ________

ADDIEDevelopment:

– 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

Conceptual Model

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.

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.

Defining TermsIndividual 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

Conceptual Model*

Market Attributes

Population Health

SES Population Characteristics

Individual SES Characteristics

Community Health Literacy(NAAL, 2003)

Expected Long-Term

Health Outcomes

*Adapted:

Conceptual Model

Age,GenderEducational attainmentRace / ethnicity



Expected Long-Term

Health Outcomes

Conceptual Model

Income - Poverty status, Social Support,Employment StatusLanguage (English)Geographical location

MSA, Non-MSA

SES Population Characteristics


Expected Long-Term

Health Outcomes

Conceptual Model

Health BehaviorsHypertension

Diabetes Heart failureAsthmaScreening RatesCancerHealth Care Utilization

Population Health


Expected Long-Term

Health Outcomes

•health outcomes, •service use, •cost, and •health status

Conceptual Model

Market Attributes

Population Health

SES Population

Characteristics



Health Outcomes Reduced morbidity Avoidable mortality

> Health status > Preventive care

< services < Disability,

< Chronic disease< Hospitalizations< ER resources

> Communications

Documents

Health Literacy