Outcomes and Critical Factors for Successful Implementation of Organizational Health Literacy Interventions:A Scoping Review

Organizational health literacy (OHL)-interventions can reduce inequality and demands in health care encountered by patients. However, an overview of their impact and critical factors for organization-wide implementation is lacking. The aim of this scoping review is to summarize the evidence on: (1) the outcomes of OHL-interventions at patient, professional and organizational levels; and (2) the factors and strategies that affect implementation and outcomes of OHL-interventions. We reviewed empirical studies following the five-stage framework of Arksey and O'Malley. The databases Scopus, PubMed, PsychInfo and CINAHL were searched from 1 January 2010 to 31 December 2019, focusing on OHL-interventions using terms related to "health literacy", "health care organization" and "intervention characteristics". After a full-text review, we selected 24 descriptive stu-dies. Of these, 23 studies reported health literacy problems in relation to OHL-assessment tools. Nine out of thirteen studies reported that the use of interventions resulted in positive changes on OHL-domains regarding comprehensible communication, professionals' competencies and practices, and strategic organizational changes. Organization-wide OHL-interventions resulted in some improvement of patient outcomes but evidence was scarce. Critical factors for organization-wide implementation of OHL-interventions were leadership support, top-down and bottom-up approaches, a change champion, and staff commitment. Organization-wide interventions lead to more positive change on OHL-domains, but evidence regarding OHL-outcomes needs strengthening

Positive Outcomes of a Comprehensive Health Literacy Communication Training for Health Professionals in Three European Countries:A Multi-centre Pre-post Intervention Study

Many professionals have limited knowledge of how to address health literacy; they need a wider range of health literacy competencies to enhance empowerment and person-centred prevention. We evaluated whether: (1) a comprehensive health literacy training increased self-rated competencies of health professionals to address health literacy related problems and support the development of people's autonomy and self-management abilities after training and 6-12 weeks later, (2) professionals were satisfied with the training, (3) outcomes differed for the three participating European countries. Health professionals (N = 106) participated in a multicentre pre-post intervention study in Italy, the Netherlands and Northern Ireland. The 8-hour training-intervention involved health literacy knowledge, the practice of comprehensible communication skills, shared decision-making, and enhancing self-management. Self-rated health literacy competencies and training satisfaction were assessed at baseline, immediately after training and 6-12 weeks later, and analysed by multi-level analysis. Professionals' self-rated health literacy competencies significantly improved following training in all three countries; this increase persisted at 6-12 weeks follow-up. The strongest increase regarded professional's skills to enhance shared-decision making and enabling self-management after training and follow-up respectively. Professionals perceived the training as relevant for practice. Competency increases seemed to be consistent across countries. In three countries, professionals' self-rated health literacy competencies increased following this comprehensive training. These promising findings should be confirmed in a further full effect study. Implementation of this training in European education and health care may improve person-centred communication by professionals and might help to tackle health literacy related problems and to strengthen people's abilities in achieving better health outcomes

Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students:A Randomized Controlled Trial

Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient's autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students' competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations

Developing and pilot testing a comprehensive health literacy communication training for health professionals in three European countries

Objective: Skills to address different health literacy problems are lacking among health professionals. We sought to develop and pilot test a comprehensive health literacy communication training for various health professionals in Ireland, Italy and the Netherlands. Methods: Thirty health professionals participated in the study. A literature review focused on evidence-informed training-components. Focus group discussions (FGDs) explored perspectives from seventeen professionals on a prototype-program, and feedback from thirteen professionals following pilot-training. Pre-post questionnaires assessed self-rated health literacy communication skills. Results: The literature review yielded five training-components to address functional, interactive and critical health literacy: health literacy education, gathering and providing information, shared decision-making, enabling self-management, and supporting behaviour change. In FGDs, professionals endorsed the prototype-program and reported that the pilot-training increased knowledge and patient-centred communication skills in addressing health literacy, as shown by self-rated pre-post questionnaires. Conclusion: A comprehensive training for health professionals in three European countries enhances perceived skills to address functional, interactive and critical health literacy. Practice implications: This training has potential for wider application in education and practice in Europe. (c) 2017 Elsevier B.V. All rights reserved

Stable Love, Stable Life? The role of support and acceptance in relationship satisfaction of couples living with Menière’s disease.

Samenvatting Achtergrond: De ziekte van Ménière is een chronische ziekte die bestaat uit drie symptomen: aanvallen van duizeligheid, tinnitus en gehoorverlies. De ziekte van Ménière kan stressvol en belemmerend zijn en raakt patiënten en hun partners. Patiënten en partners zijn onderling afhankelijk in hun relatie en ze ondersteunen elkaar in het omgaan met de ziekte van Ménière. Het bieden van ondersteuning kan door actieve betrokkenheid (actief praten met elkaar over problemen en het delen van gevoelens) of door beschermend bufferen (het vermijden van het praten over problemen en gevoelens). De hoofdvraag is hoe de ziekte van Ménière de levens van patiënten en hun partners beïnvloedt in hun relatie. We onderzochten hierbij de invloed van ondersteuning (actieve betrokkenheid en beschermend bufferen), kwaliteit van leven en acceptatie op de relatietevredenheid van patiënten en hun partners. Methode: In deze cross-sectionele studie ontvingen we 426 ingevulde vragenlijsten van patiënten en hun partners nadat zij waren benaderd door de Nederlandse Vereniging voor Slechthorenden (NVVS). In totaal werden 142 paren (142 patiënten en 142 partners) opgenomen in deze studie. Patiënten en partners vulden een vragenlijst in over relatietevredenheid, ondersteuning, acceptatie en kwaliteit van leven. Resultaten: We vonden dat patiënten en partners tevredener waren met hun relatie wanneer ze meer actieve betrokkenheid waarnamen van elkaar, dit gold voor vrouwelijke patiënten in het bijzonder. Beschermend bufferen had een geringe negatieve invloed op relatietevredenheid. Actieve betrokkenheid was vooral belangrijk bij mannelijke patiënten en vrouwelijke partners met een hogere mate van angst en depressie. Wanneer zij in dit geval meer actieve betrokkenheid waarnamen, dan waren ze ook tevredener met hun relatie. Acceptatie van de ziekte van Ménière was in staat om de negatieve invloed van een slechtere kwaliteit van leven en beschermend bufferen op relatietevredenheid van patiënten weg te nemen. Voor mannelijke partners was acceptatie eveneens belangrijk, want acceptatie kon gedeeltelijk de negatieve invloed van angst, depressie, slechtere vitaliteit en beschermend bufferen op de tevredenheid met hun relatie wegnemen. Acceptatie had geen invloed op relatietevredenheid van vrouwelijke partners. Actieve betrokkenheid was de sterkste voorspeller van relatietevredenheid en acceptatie was de op een na sterkste factor. Conclusie: Koppels zijn wederzijds afhankelijk in hun relatie en actieve betrokkenheid is voor alle groepen belangrijk. Vrouwen zien zichzelf meer dan mannen als wederzijds afhankelijk in relatie tot anderen. Voor hen is actieve betrokkenheid extra belangrijk. Het is belangrijk om specifieke behoeften van individuen te onderzoeken, want acceptatie was belangrijk voor patiënten en mannelijke partners, maar niet voor vrouwelijke partners. Voor koppels die problemen ervaren met de ziekte van Ménière is relatietherapie aan te bevelen want dit kan relatietevredenheid en leefomstandigheden verbeteren.