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Health Literacy in Health Care –
The Vienna model and self-assessment
tool for health-literate hospitals.
Jürgen M. Pelikan
em. Prof. Institute for Sociology, Vienna University
Director, WHO-CC Health Promotion in Hospitals and Health
Care, at The Austrian Public Health Institute, Vienna / Austria
The 4th AHLA International Health Literacy Conference
Health Literacy and Quality of Healthcare Services
November 7-9, 2016 Haiphong, Vietnam
1
Overview / Line of argumentation
1.
Why does Health Literacy matter in health care?
1. Empirical findings from the USA: Limited HL has detrimental effects on
use and outcomes of health care.
2. Some theoretical arguments: Co-Production in health care needs health
literate patients
3. Empirical findings from HLS-EU study: Sick people and patients have
worse HL than average citizens
4. Empirical findings from HLS-EU study: Hl has effects on health status &
use of professional health services of citizens
2. The relational character of health literacy offers different stragies to deal
with low health literacy – also within health care
1. The IOM 10 attributes of a Health Literate Health Care Organization
2. The Vienna Model, self-assessment instrument & feasibility study of
Heath Literate Health Care Organizations, especially hospitals
3. Good Practice interventions to improve (organizational) health literacy in
health care
3. Summary and conclusions
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
2
1. WHY DOES HL MATTER IN HEALTH CARE?
1.1 EMPIRICAL FINDINGS FROM THE USA:
LIMITED HL HAS DETRIMENTAL EFFECTS ON
USE AND OUTCOMES OF HEALTH CARE
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
3
Effects of low health literacy for use and outcomes of
health care – empirical evidence from the USA
Persons with low health literacy …
» Use less preventive services
» Need more emergency treatment
» Have more hospital admissions
» Have more problems to understand health related information
» Are less able to take their medications correctly and have worse selfmanagement
» Are less able to co-produce in treatment and care
» Have worse treatment outcomes
» Have higher risks of complications
» Have more unplanned readmissions
» Cause 3-5% of treatment expenses (Eichler, Wieser & Brügger 2009)
»  improving health literacy in health care contributes to strengthening
effectiveness and efficiency of the healthcare system!
(Berkman et al. 2011, Brach et al. 2012)
4
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
First reactions on these results in USA health care
» In the USA the relevance of low HL for problematic health care
results first led to developing even shorter or short versions
of existing functional HL tests (e.g. TOPHLA, REALM, NVS)
» & testing of patients to adapt professional communication to
individual patients with low HL
» But this procedure has its clear limits!
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
5
1. WHY DOES HL MATTER IN HEALTH CARE
1.2 SOME THEORETICAL ARGUMENTS:
CO-PRODUCTION IN HEALTH CARE NEEDS
HEALTH LITERATE PATIENTS
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
6
Some theoretical arguments: Co-Production in health
care needs health literate patients
»
»
»
»
Decision to adequately consult professional health care
Co-production in diagnosis and therapy
Shared decision making
Compliance and adherence to medication etc. (Miller 2016)
» [..] to apply literacy skills to health-related materials such
as prescriptions, appointment cards, medicine labels, and
directions for home health care“ (Parker et al. 1995: XY).
» Empowerment for disease self-management (Mackey et al
2016)
» Enablement for lifestyle change
» Guarantee behaviour changes (Guntzviller et al 2016,
Yokokawa et al. 2016)
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
7
1.WHY DOES HL MATTER IN HEALTH CARE
3. EMPIRICAL FINDINGS FROM HLS-EU STUDY:
SICK PEOPLE & PATIENTS HAVE WORSE HL
THAN THE AVERAGE CITIZEN
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
8
Health Literacy by 5 social determinants & NVS
(Beta Weights and Adjusted R-Square for Total Sample & Countries) (HLS-EU 2012)
ES -.066
NL .028
FIN. DEP.
NVS
-.327 PL
-.231
.226 BG
.134
DE -.007 SOCIAL STATUS .195 IE
IE .003
EDUCATION
.194 EL
.122
Health Literacy
.100
-.063
IE -.004
AGE
-.141 EL
.058
ES .024
GENDER
.117 NL
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
Adj. R2= .188
(NL .076 /.291 EL)
9
Combined Shares of ‘Fairly Difficult’ and ‘Very Difficult’ Answers of HL Health
Care Items for HLS-EU8 according to Self-Reported Long-Term Health Problems
On a scale from very easy to very difficult. How easy would you say is it to:
12...judge if the information about illness in the media is reliable? (Instructions:
TV, Internet or other media)
10...judge the advantages and disadvantages of different treatment options?
11...judge when you may need to get a second opinion from another doctor?
6...understand the leaflets that come with your medicine?
2...find information on treatments of illnesses that concern you?
13...use information the doctor gives you to make decisions about your illness?
1... find information about symptoms of illnesses that concern you?
3... find out what to do in case of a medical emergency?
7...understand what to do in a medical emergency?
9...judge how information from your doctor applies to you?
5...understand what your doctor says to you?
4...find out where to get professional help when you are ill? (Instructions: such as
doctor, pharmacist,psychologist)
15...call an ambulance in an emergency?
Yes more than one
Yes one
14...follow the instructions on medication?
No
8...understand your doctor’s or pharmacist’s instruction on how to take a
prescribed medicine?
Total
16...follow instructions from your doctor or pharmacist?
0%
10%
20%
30%
40%
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
50%
60%
70%
10 80%
5.1 Schwierigkeit der 16 Aufgaben für KRANKHEITSBEWÄLTIGUNG nach Vorliegen von
CHRONISCHEN ERKRANKUNGEN (gereiht nach Schwierigkeit der Aufgaben für die
Österreichstichprobe).
AUF EINER SKALA VON EINFACH BIS SEHR SCHWIERIG
WIE SCHWIERIG IST ES:
12...zu beurteilen, ob Informationen über eine Krankheit
in den Medien vertrauenswürdig sind?
10...Vor- und Nachteile von verschiedenen Behandlungsmöglichkeiten zu beurteilen?
11...zu beurteilen, wann Sie eine zweite Meinung von
einem anderen Arzt einholen sollten?
6...die Beipackzettel Ihrer Medikamente
zu verstehen?
13...mit Hilfe der Informationen, die Ihnen der Arzt gibt,
Entscheidungen bezüglich Ihrer Krankheit zu treffen?
2...Informationen über Therapien für Krankheiten, die Sie betreffen, zu finden?
7...zu verstehen, was in einem
medizinischen Notfall zu tun ist?
3...herauszufinden, was im Fall eines
medizinischen Notfalls zu tun ist?
1...Informationen über Krankheitssymptome,
die Sie betreffen, zu finden?
9...zu beurteilen, inwieweit Informationen
Ihres Arztes auf Sie zutreffen?
5...zu verstehen, was Ihr Arzt Ihnen sagt?
4...herauszufinden, wo Sie professionelle Hilfe
erhalten, wenn Sie krank sind?
14...den Anweisungen für die Einnahme
von Medikamenten zu folgen?
8...die Anweisungen Ihres Arztes oder Apothekers zur Einnahme der verschriebenen Medikamente zu verstehen?
16...den Anweisungen Ihres Arztes oder
Apothekers zu folgen?
15...im Notfall einen Krankenwagen zu rufen?
0%
l Ja, mehr als eine (N= 209)
l Ja, eine (N= 409)
10%
20%
30%
40%
50%
60%
70%
Summierte Prozentsätzte "ziemlich schwierig" und "sehr schwierig"
l Keine (N= 1175)
l Gesamt (N= 1793)
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
80%
11
Combined Shares of ‘Fairly Difficult’ and ‘Very Difficult’ Answers of HL
Health Care Items for HLS-EU8 according to Self-Reported Health Status
On a scale from very easy to very difficult. How easy would you say is it to:
12...judge if the information about illness in the media is reliable?
(Instructions: TV, Internet or other media)
10...judge the advantages and disadvantages of different treatment options?
11...judge when you may need to get a second opinion from another doctor?
6...understand the leaflets that come with your medicine?
2...find information on treatments of illnesses that concern you?
13...use information the doctor gives you to make decisions about your
illness?
1...find information about symptoms of illnesses that concern you?
very good
3...find out what to do in case of a medical emergency?
good
7...understand what to do in a medical emergency?
fair
bad to very bad
9...judge how information from your doctor applies to you?
Total
5...understand what your doctor says to you?
4...find out where to get professional help when you are ill? (Instructions:
such as doctor, pharmacist,psychologist)
15...call an ambulance in an emergency?
14...follow the instructions on medication?
8...understand your doctor’s or pharmacist’s instruction on how to take a
prescribed medicine?
16...follow instructions from your doctor or pharmacist?
0%
10%
20%
30%
40%
50%
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
60%
70%
80%
12
6.2 Schwierigkeit der 16 Aufgaben für KRANKHEITSBEWÄLTIGUNG nach selbsteingeschätztem
GESUNDHEITSZUSTAND (4 Kategorien) (gereiht nach Schwierigkeit für die Österreichstichprobe).
AUF EINER SKALA VON EINFACH BIS SEHR SCHWIERIG
WIE SCHWIERIG IST ES:
12...zu beurteilen, ob Informationen über eine Krankheit
in den Medien vertrauenswürdig sind?
10...Vor- und Nachteile von verschiedenen Behandlungsmöglichkeiten zu beurteilen?
11...zu beurteilen, wann Sie eine zweite Meinung von
einem anderen Arzt einholen sollten?
6...die Beipackzettel Ihrer Medikamente
zu verstehen?
13...mit Hilfe der Informationen, die Ihnen der Arzt gibt,
Entscheidungen bezüglich Ihrer Krankheit zu treffen?
2...Informationen über Therapien für Krankheiten, die Sie betreffen, zu finden?
7...zu verstehen, was in einem
medizinischen Notfall zu tun ist?
3...herauszufinden, was im Fall eines
medizinischen Notfalls zu tun ist?
1...Informationen über Krankheitssymptome,
die Sie betreffen, zu finden?
9...zu beurteilen, inwieweit Informationen
Ihres Arztes auf Sie zutreffen?
5...zu verstehen, was Ihr Arzt Ihnen sagt?
4...herauszufinden, wo Sie professionelle Hilfe
erhalten, wenn Sie krank sind?
14...den Anweisungen für die Einnahme
von Medikamenten zu folgen?
8...die Anweisungen Ihres Arztes oder Apothekers zur Einnahme der verschriebenen Medikamente zu verstehen?
16...den Anweisungen Ihres Arztes oder
Apothekers zu folgen?
15...im Notfall einen Krankenwagen zu rufen?
0%
l Sehr gut (N= 600)
l Gut (N= 705)
10%
20%
30%
40%
50%
60%
70%
Summierte Prozentsätzte "ziemlich schwierig" und "sehr schwierig"
l Mittelmäßig (N= 414)
l Schlecht bis sehr schlecht (N= 89)
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
80%
l Gesamt (N= 1808)
13
Combined Shares of ‘Fairly Difficult’ and ‘Very Difficult’ Answers of HL
Health Care Items for HLS-EU8 according to number of Doctor Visits
On a scale from very easy to very difficult. How easy would you say it is to:
12...judge if the information about illness in the media is reliable? (Instructions: TV, Internet or other media)
10...judge the advantages and disadvantages of different treatment options?
11...judge when you may need to get a second opinion from another doctor?
6...understand the leaflets that come with your medicine?
2...find information on treatments of illnesses that concern you?
13...use information the doctor gives you to make decisions about your illness?
1...find information about symptoms of illnesses that concern you?
3...find out what to do in case of a medical emergency?
7...understand what to do in a medical emergency?
9...judge how information from your doctor applies to you?
5...understand what your doctor says to you?
4...find out where to get professional help when you are ill? (Instructions: such as doctor, pharmacist,psychologist)
15...call an ambulance in an emergency?
0 times
14...follow the instructions on medication?
1-2 times
3-4 times
8...understand your doctor’s or pharmacist’s instruction on how to take a prescribed medicine?
6 times or more
Total
16...follow instructions from your doctor or pharmacist?
0%
10%
20%
30%
40%
50%
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
60%
70%
80%
14
7.2 Schwierigkeit der 16 Aufgaben für KRANKHEITSBEWÄLTIGUNG nach ARZTBESUCHEN in den
letzten 12 Monaten (4 Kategorien) (Fragen gereiht nach Schwierigkeit für die
Österreichstichprobe)
AUF EINER SKALA VON EINFACH BIS SEHR SCHWIERIG
WIE SCHWIERIG IST ES:
12...zu beurteilen, ob Informationen über eine Krankheit
in den Medien vertrauenswürdig sind?
10...Vor- und Nachteile von verschiedenen Behandlungsmöglichkeiten zu beurteilen?
11...zu beurteilen, wann Sie eine zweite Meinung von
einem anderen Arzt einholen sollten?
6...die Beipackzettel Ihrer Medikamente
zu verstehen?
13...mit Hilfe der Informationen, die Ihnen der Arzt gibt,
Entscheidungen bezüglich Ihrer Krankheit zu treffen?
2...Informationen über Therapien für Krankheiten, die Sie betreffen, zu finden?
7...zu verstehen, was in einem
medizinischen Notfall zu tun ist?
3...herauszufinden, was im Fall eines
medizinischen Notfalls zu tun ist?
1...Informationen über Krankheitssymptome,
die Sie betreffen, zu finden?
9...zu beurteilen, inwieweit Informationen
Ihres Arztes auf Sie zutreffen?
5...zu verstehen, was Ihr Arzt Ihnen sagt?
4...herauszufinden, wo Sie professionelle Hilfe
erhalten, wenn Sie krank sind?
14...den Anweisungen für die Einnahme
von Medikamenten zu folgen?
8...die Anweisungen Ihres Arztes oder Apothekers zur Einnahme der verschriebenen Medikamente zu verstehen?
16...den Anweisungen Ihres Arztes oder
Apothekers zu folgen?
15...im Notfall einen Krankenwagen zu rufen?
0%
10%
20%
30%
40%
50%
60%
70%
80%
Summierte Prozentsätzte "ziemlich schwierig" und "sehr schwierig"
l 0 Mal (N=224)
l 1-2 Mal (N=677)
l 3-5 Mal (N=498)
l 6 Mal oder öfters (N=411)
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
l Gesamt (N=1810)
15
Combined Shares of ‘Fairly Difficult’ and ‘Very Difficult’ Answers of HL Health
Care Items for HLS-EU8 according to Frequency of Hospital Visits
On a scale from very easy to very difficult. How easy would you say it is to:
12...judge if the information about illness in the media is reliable? (Instructions: TV,
Internet or other media)
10...judge the advantages and disadvantages of different treatment options?
11...judge when you may need to get a second opinion from another doctor?
6...understand the leaflets that come with your medicine?
2...find information on treatments of illnesses that concern you?
13...use information the doctor gives you to make decisions about your illness?
1...find information about symptoms of illnesses that concern you?
0 time
3...find out what to do in case of a medical emergency?
1-2 times
7...understand what to do in a medical emergency?
More than 3 times
TOTAL
9...judge how information from your doctor applies to you?
5...understand what your doctor says to you?
4...find out where to get professional help when you are ill? (Instructions: such as
doctor, pharmacist,psychologist)
15...call an ambulance in an emergency?
14...follow the instructions on medication?
8...understand your doctor’s or pharmacist’s instruction on how to take a prescribed
medicine?
16...follow instructions from your doctor or pharmacist?
0%
10%
20%
30%
40%
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
50%
60%
70%16
80%
7.1 Schwierigkeit der 16 Aufgaben für KRANKHEITSBEWÄLTIGUNG nach
KRANKENHAUSAUFENTHALTEN in den letzten 12 Monaten (3 Kategorien). (gereiht nach Schwierigkeit
für die Österreichstichprobe).
AUF EINER SKALA VON EINFACH BIS SEHR SCHWIERIG
WIE SCHWIERIG IST ES:
12...zu beurteilen, ob Informationen über eine Krankheit
in den Medien vertrauenswürdig sind?
10...Vor- und Nachteile von verschiedenen Behandlungsmöglichkeiten zu beurteilen?
11...zu beurteilen, wann Sie eine zweite Meinung von
einem anderen Arzt einholen sollten?
6...die Beipackzettel Ihrer Medikamente
zu verstehen?
13...mit Hilfe der Informationen, die Ihnen der Arzt gibt,
Entscheidungen bezüglich Ihrer Krankheit zu treffen?
2...Informationen über Therapien für Krankheiten, die Sie betreffen, zu finden?
7...zu verstehen, was in einem
medizinischen Notfall zu tun ist?
3...herauszufinden, was im Fall eines
medizinischen Notfalls zu tun ist?
1...Informationen über Krankheitssymptome,
die Sie betreffen, zu finden?
9...zu beurteilen, inwieweit Informationen
Ihres Arztes auf Sie zutreffen?
5...zu verstehen, was Ihr Arzt Ihnen sagt?
4...herauszufinden, wo Sie professionelle Hilfe
erhalten, wenn Sie krank sind?
14...den Anweisungen für die Einnahme
von Medikamenten zu folgen?
8...die Anweisungen Ihres Arztes oder Apothekers zur Einnahme der verschriebenen Medikamente zu verstehen?
16...den Anweisungen Ihres Arztes oder
Apothekers zu folgen?
15...im Notfall einen Krankenwagen zu rufen?
0%
l 0 Mal (N=1300)
l 1-2 Mal (N=424)
10%
20%
30%
40%
50%
60%
70%
Summierte Prozentsätzte "ziemlich schwierig" und "sehr schwierig"
l 3 Mal oder öfters (N=76)
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
80%
l Gesamt (N=1800) 17
1. WHY DOES HL MATTER IN HEALTH CARE?
1.4. EMPIRICAL FINDINGS FROM HLS-EU STUDY:
HL HAS EFFECTS OF ON HEALTH STATUS & USE
OF PROFESSIONAL HEALTH SERVICES
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
18
Percentage Distributions of Self-Assessed Health (SF-36)
by Grouped Health Literacy Index (for Total Sample, HLS-EU 2012)
> There is a considerable rather continuous relationship!
2.2
100
90
12.7
60
Percentages
of Categories of
50
Self-assessed
Health Status 40
14.7
10
0
0.7
5.6
25.9
26.4
0.5
4.4
0.7
2.8
18.7
19.4
0.1
2.7
16.1
Very bad
31.4
35.3
37.4
42.4
35.9
Bad
42.0
Fair
43.7
31.4
40.2
32.7
30
20
9.3
22.4
80
70
5.8
1.3
18.6
10.8
Good
25.1
10.8
15.2
17.7
24.1
34.0
35.2
<15
15-20
20-25
25-30
30-35
35-40
40-45
Grouped Scores of Comprehensive Health Literacy Index
43.8
Very good
45-50
<15[N=102]|15-20[N=259]|20-25[N=600]|25-30[N=1348]|30-35[N=2185]|35-40[N=1531]|40-45[N=1048]|45-50[N=704]| TOTAL[N=7777]
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
19
Effects of Seven Social Determinants as Multiple Predictors on SelfAssessed Health (SF-36) (Beta Weights and Adjusted R-Square for Total, HLS-EU 2012)
> Comprehensive (but not functional) Health Literacy has a considerable effect on self-assessed
health, when relevant social determinants are controlled for!
AGE
.365
HL
-.168
SOCIAL STATUS
-.112
FIN. DEPRIVATION
.071
GENDER
.039
-.036
EDUCATION
-.026a
NVS
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
Adj. R2= .268
a…not
significant on the 0,05 level
20
Associations between 4 Indicators for Health Service Use
and Comprehensive Health Literacy Index (Spearman’s Rho
Correlations for 8 Countries & Total Sample, HLS-EU 2012)
> There are significant correlations for all indicators of total & most countries!
Comp. Health Literacy
and…
Doctor Visits
(last 12 month)
Hospital Services
(last 12 month)
Other Health Professionals
(last 12 month)
Emergency Service
(last 24 month)
AT
BG
DE
EL
ES
IE
NL
PL
TOTAL
rs -.185** -.117** -.073* -.168** -.155** -.077*
-.014
-.095** -.114**
rs -.188** -.121** -.112** -.120** -.065*
-0.048
-.031
-.147** -.062**
rs -0.06
0.033
0
0.061
-0.016
.114** -0.015
rs -.151** -.100** -.112** -.086** -.103** -0.046
-.011
.070*
.062**
-.076* -.061**
[N=998- [N=988- [N=1160- [N=1042 [N=1007 [N=969- [N=990- [N=1035 [N=8199
1003] 1002] 1161] -1043] -1009]
971
992] -1043] -8217]
**. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).
Doctor visits, hospital visits, other health professionals and emergency services from 1= 0 times to 4= 6 times or more
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
21
Doctor´s Visits by Grouped Health Literacy Index
(for Total Sample, HLS-EU 2012)
> There is a slight relationship between Health literacy and doctor´s visits!
100%
90%
17.6%
80%
Percentages
of
categories
of
Doctor Visits
In the last 12
month
70%
60%
30.4%
24.5%
25.5%
23.7%
31.3%
20.3%
22.4%
24.9%
13.7%
15.4%
14.2%
20.7%
21.1%
22.1%
6 times or
more
3 - 5 times
23.2%
50%
40%
30%
20.6%
37.3%
42.2%
43.8%
44.7%
39.9%
1 - 2 times
32.8%
36.1%
15.6%
13.5%
15.7%
17.8%
21.8%
18.7%
23.8%
15 - 20
20 - 25
25 - 30
30 - 35
35 - 40
40 - 45
45 - 50
20%
10%
24.5%
0
0%
>1 5
Grouped Scores of Comprehensive Health Literacy Index
<15[N=102] 15-20[N=256]|20-25[N=599]|25-30[N=1348]|30-35[N=2186]|35-40[N=1534]|40-45[N=1046]|45-50[N=705]| TOTAL[N=7777]
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
22
Effects of 5 Social Determinants and Health Literacy (HL) as Multiple Predictors
on Doctor´s Visits (Beta Weights and Adjusted R-Square for Total, HLS-EU 2012)
> The effect of health literacy on doctor´s visits stays on, when social determinants are controlled for!
AGE
,285
GENDER
,131
HL
,065
SOCIAL STATUS
-,049
EDUCATION
-,037
-,018a
FIN. DEPRIVATION
Adj. R2= ,125
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
a…not
significant on the 0,05 level
23
Effects of 5 Social Determinants, Long-Term Illness, Health Status and Health Literacy
(HL) as Multiple Predictors on Doctor Visits’ (Beta Weights & Adjusted R-Square for Total, HLS-EU 2012) >
No direct effect of health literacy, when health indicators are also controlled for!
LONG-TERM ILLNESS
HEALTH
,317
,239
GENDER
,111
AGE
,078
FIN. DEPRIVATION
-,055
-,019
EDUCATION
-,018a
SOCIAL STATUS
COMP. HL
,001a
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
Adj. R2= ,305
a…not
significant on the 0,05 level
24
2. THE RELATIONAL CHARACTER OF
HEALTH LITERACY OFFERS DIFFERENT
STRATEGIES TO DEAL WITH LOW HEALTH
LITERACY – ALSO WITHIN HEALTH CARE
Pelikan - 4th AHLA, Haiphong 11-2016
Health Literate Organization
25
Health Literacy has to be understood as a relational concept –
that has consequences for possible measurement and interventions
Measure personal HL
competences
Personal
Skills/Abilities
Measure fit
of HL competences
to HL demands
Health
Literacy
Measure situational HL
demands and support
Situational
Demands/Complexity
(Parker, 2009)
Improve individual/
population HL
by offers for
personal
learning (education,
training)
Compensate for HL
deficits of
disadvantaged
groups by specific
compensatory
measures
Improve organizational HL by
reducing situational
demands & offering specific
institutional support >
develop health literate
settings
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ADAPTATION CAN BE A TWO WAY ENTERPRISE:
SYSTEMS SHOULD ADAPT TO PEOPLES´ COMPETENCES!
PEOPLE SHOULD ADAPT TO SYSTEMS´ DEMANDS!
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2.1 THE IOM 10 ATTRIBUTES OF A HEALTH
LITERATE HEALTH CARE ORGANIZATION
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IOM Concept of Health Literate Health Care Organizations
“A health literate
organization makes
it easier for people to
navigate,
understand, and use
information and
services to take care
of their health.”
(Brach et al. 2012)
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Ten attributes of health literate (healthcare) organizations
A health literate organization …
(Brach et al. 2012)
1.
2.
3.
4.
Has leadership that makes HL integral to its mission, structure, and operations.
Integrates HL into planning, evaluation, patient safety, quality improvement.
Prepares the workforce to be HL and monitors progress .
Includes populations served in the design, implementation, and evaluation of
health information and services .
5. Meets the needs of populations with a range of HL skills & avoids stigmatization.
6. Uses HL strategies in interpersonal communications and confirms understanding
at all points of contact.
7. Provides easy access to health information and services & navigation assistance.
8. Designs / distributes print, audiovisual, social media content that is easy to
understand and act on .
9. Addresses HL in high-risk situations, including care transitions and
communications about medicines.
10. Communicates clearly what health plans cover and what individuals will have to
pay for services.
General Change / quality / risk management
Relating to participation principle
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Specific HL content
30
1. Leadership
» Limits efforts not just to a few projects or programs
» Establishes a culture through ongoing language,
expectations, and behavior
» Implements evidence based strategies and works with
researchers to develop and test new ones
» Leadership activities include:
» Setting organizational goals
» Allocating resources
» Delegating authority for oversight
» Cultivating organizational champions
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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2. Integrate health literacy into planning,
evaluation and quality improvement
» Establish ongoing needs assessments reflecting organizational
performance
» Develop metrics, routinely collect data
» Design and conduct rigorous program evaluations
» Track and report communication failures and conduct root cause
analyses to uncover systematic sources of error
» Harmonize health literacy with other organizational priorities
(e.g. pursuing health equity)
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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3. Prepare workforce to be health literate
»
»
»
»
Hire diverse workforce with expertise in health literacy
Incorporate health literacy into orientation sessions
Augment in-house training resources
Identify and implement appropriate new curricula
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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4. Include populations served in information and services
design, implementation and evaluation
» Include members of populations on governing bodies
» Establish advisory groups that involve individuals with limited
health literacy, adult educators, and experts in health literacy
» Collaborate with members of community in design and
testing of interventions and development of materials
» Obtain and incorporate feedback on health information and
services from consumers
» Enlist community members in evaluation teams
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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5. Meet needs of populations with range of health
literacy skills yet avoid stigmatization
» Adopt health literacy universal precautions
» Create an environment that does not impose high literacy
demands
» Streamline information collection
» Provide extra assistance (health educators, navigators, case
management)
» Ask about problems with paying for medicine, provide
assistance with applying for drug coverage
» Use written information to reinforce spoken communication
and provide audiovisual alternatives
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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6. Use health literacy strategies in interpersonal
communications, confirm understanding at all points of
contact
» Create culture that emphasizes verification of every
communication
» Allow adequate time for all interactions
» Plan for language assistance
» Provide technology that facilitates communications (e.g.,
talking touchscreens)
» Treat communication failures as safety issues
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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7. Provide easy access to health information and services,
offer navigation assistance
» Design health care facilities with features that help people
find their way
» Use easily understood language and symbols on signage
» Train staff to respond to navigational inquiries
» Integrate and co-locate multiple services in the same facility
» Help consumers and families understand what health care
benefits and services are offered
» Supply navigators to answer questions, solve problems,
advocate, lend support and give guidance and assistance
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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8. Provide print, audiovisual, and social media
content that is easy to understand and act on
» Consider educational materials as a supplement to, not a
substitute for, in person education
» Stock high-quality educational materials for limited literacy in
multiple ways (e.g., DVDs, patient portals)
» Evaluate materials using state of the art tools
» Make materials available in commonly read languages
» Employ staff and consultants with health literacy expertise
when developing new materials
» Involve target audience in testing and evaluation of materials
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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9. Address health literacy in high risk situations, including
care transitions and medication discussions
» Establish and implement plans to ensure safe communication
during high-risk situations (e.g. meaningful informed
consent)
» Use aids (pill boxes, pill cards) to remind individuals how to
take medicines correctly
» Educate patients and caregivers and confirm understanding
about what hospital says
» Provide easy to understand discharge instructions
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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10. Communicate clearly what health plans cover and
what individuals will have to pay
» Provide staff and resources to find out what treatments are
covered
» Communicate costs of care in advance
» Are familiar with and take into consideration insurance drug
coverage that affects costs of medicines prior to prescribing
» Refer individuals to health insurance consumer and navigator
programs
IOM Roundtable on Health Literacy. Ten Attributes of Health Literate Health Care Organizations.
https://nam.edu/wp-content/uploads/2015/06/BPH_Ten_HLit_Attributes.pdf (Based on Boulware HARC 2016)
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2.2 THE VIENNA MODEL, SELF-ASSESSMENT
TOOL AND FEASIBILITY STUDY OF HEALTH
LITERATE HEALTH CARE ORGANIZATIONS –
ESPECIALLY HOSPITALS
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The IOM 10 attributes are a very good start for a HLHCO,
but also have some limitations & offer potential for improvement
 Limitations of IOM attributes:
• Start from limitations of rather specific individualistic health
literacy research, but still with a clinical bias
• Have a narrow understanding of stakeholders (mainly patients)
and of functions (mainly treatment of patients) of HLHCO
 Goals for a more comprehensive Vienna concept:
• Health literacy is a core concept of health promotion and health
promotion a relevant aspect of quality in reoriented health
services
• Comprehensive & relational understanding of health literacy
• Integration of health literacy in strategies of the comprehensive
setting approach of Health Promoting Hospitals
• Making more explicit use of quality methodology
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HL is relational
Personal
Competences / Abilities
Competences / abilities
Ask,
use
Ask,investigate,
investigate, use
contacts,
…
contacts, …
Health
information
Situational
Demands / complexity
Availability,
accessibility
Find
Education
Education (literacy,
(literacy,
numerady,
numerady, language
language
competence
competence …)
…)
Understand
experience,
Life Life
experience,
judgment,
judgment,
…
…
Practical & problemsolving abilities
creativity …
Health
literacy
& comprehensive!
Appraise
Apply
Language, Reading
level, Images, Layout,
…
Availability of
references, evidence
Applicability of content
& individualized
support
(e.g. consultation)
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Steps and methods of Vienna-HLO study 2014/2015


Comprehensive literature search on health literate healthcare organizations
Cross-check with other healthcare reform movements
•
•



Development of a cognitive map & model
Development of standards, sub-standards and indicators for an
organizational self-assessment tool
Standards development according to the criteria of the International Society
for Quality in Healthcare (ISQua)
•
•
•




Quality movements
Health Promoting Hospitals & Health Services
Identification & translation of indicators – 113 Indicators from 20 instruments
Development of 47 new indicators for areas not covered in the literature (especially
HL of staff, lifestyle development)
Expert consultation
Feasibility study in 9 Austrian hospitals, self-assessment & questions on tool,
follow-up interviews with coordinators
Revision of self-assessment tool based on results of this study
Tool-box for improving organizational health literacy
Publications in German language, publications in English language in
preparation
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Cognitive map of the Vienna-HLO study
HL of
Stakeholder groups
HL for
A) Patients
B) Staff
C) Community
1) Access to,
living & working
in the
organization
A1) HL for living
& navigating
B1) HL for
navigating &
working
C1) HL for
navigating &
access
2) Diagnosis,
treatment & care
A2) HL for coproducing
health
B2) HL for health
literate patient
communication
C2) HL for coproduction of
continuous &
integrated care
3) Disease
management &
prevention
A3) HL for
disease
management &
prevention
B3) HL for
disease
management &
prevention
C3) HL for
disease
management &
prevention
4) Healthy
lifestyle
development
A4) HL for
healthy lifestyle
development
B4) HL for
healthy lifestyle
development
C4) HL for
healthy lifestyle
development
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D) Organizational
structures &
processes –
capacities
implementation
Di) Basic
principles &
capacity
building for
implementing
HL
Dii) Monitoring
of HL structures
& processes
Diii) Advocacy &
networking for
HL
45
Self-assessment tool following the Vienna-HLO model
Patients
Domain1:
Access to, living &
working in the
organization
Staff
Standard 4: Navigation assistance
4.1 Barrier-free contact via website and telephone
4.2 Provision of information relevant for arrival and hospital stay
4.3 Availability of support at main entrance
4.4 Clear and easy-to-understand navigation system
4.5 Free availability of health information for patients and visitors
Standard 5: HL in
patient
communication
Domain 2:
Diagnosis, treatment
& care
Domain 3:
Disease
management &
prevention
Domain4:
Healthy lifestyle
development
Community
Organizational
structures &
processes – capacities
implementation
5.1 in spoken
communication
5.2 in written
communication
5.3 support by language
translators and interpreters
5.4 also in high-risk
situations
Standard 6: Promote
HL of patients and
relatives
6.1 for disease-specific selfmanagement
Standard 6: Promote
HL of patients and
relatives
6.2 for healthy lifestyle
development
Standard 3: Develop
HL skills of staff for
patient
communication
3.1 for all situations that
involve communication
1.1 HL as corporate
responsibility
1.2 Quality assurance of HL
Standard 8:
Contribute to HL in
the region
8.1: promotion of
continuous and integrated
care
Standard 7: Promote
HL of staff
7.2 for healthy lifestyles
Standard 2:
Participative
development of
materials and services
2.1 Participation of patients
2.2 Participation of staff
Standard 9:
Dissemination and
further development
7.1 for the self-management
of occupational health and
safety risks
Standard 7: Promote
HL of staff HL
Standard 1:
Management policy
and organizational
structures
Standard 8:
Contribute to HL in
the region
8.2 contribution to public
health within the realm of
possibility
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9.1 support of the
dissemination and further
development of health
literacy
46
The 9 standards of the Vienna-HLO model
(with 22 sub-standards, 160 indicators)
1. Provide (organizational) capacities, infra-structures & resources for
health literacy in the organization
2. Develop & evaluate materials and services in participation with users
3. Qualify staff for HL communication
4. Develop a supportive environment – provide navigation assistance
5. Apply HL communication principles in all routine communications –
in spoken, written, audio-visual and digital communication & by
providing interpreting and translation support
6. Improve personal HL of patients & significant others by learning
offers
7. Improve personal HL of staff by learning offers
8. Improve HL in the organization’s community & catchment area
9. Share experiences & be a role model for HL in the HC community
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Vienna-HLO Standard
1 The organization has a policy, organizational
structures and resources for health literacy
Content
Organizational health literacy is integrated in the organizational
structures and processes, including organizational quality
management
Substandards
1.1 Health literacy is understood as a corporate responsibility.
(5 indicators)
e.g. organizational health literacy is part of the organization’s
mission statement
1.2 Quality assurance and development of organizational health
literacy is ensured (11 indicators)
e.g. health literacy relevant data are routinely collected in
patient surveys
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Vienna HLO Standard
2 Develop and evaluate materials and services in a
participatory manner
Content:
The organization participatorily involves patients and staff into the
development and evaluation of documents and services relevant for
them
Sub-standards:
2.1 The organization involves patients in the development and
evaluation of documents and services (4 indicators)
2.1.3 Documents are developed and tested in cooperation with
representatives of self-help groups and patient advocates.
2.2 The organization involves staff in the development and
evaluation of documents and services (2 indicators)
2.2.1 The guidance system of the organization is tested by new staff
members or non-local colleagues and improved thereafter
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Vienna-HLO Standard
3 The organization trains staff to communicate with
patients according to health literacy principles
Content
Health literacy is part of human ressource management. Trainings on
health literate communication with patients are available for staff.
Sub-standards
3.1 Staff trainings on health literate patient comunication refer to all
communication situations (14 indicators)
e.g. All staff with patient contact are trained in HL-related tools
and techniques such as “ask me 3” or “teach-back”.
Staff receive regular feedback on their communication quality
Staff training includes:
3.1.8 Use of plain, everyday language
3.1.10 Active listening, ecouragement of asking questions
3.1.14 Collaboration with professional interpretors
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Vienna HLO Standard
4 The organization ensures a supportive physical
environment and navigation support
Content
The organization is designed in a manner that helps people to find their way. Easily to
understood language and symbols are used in information.
Sub-standards
4.1 The organiztion offers first contact via website navigation and telephone (14
indicators)
4.2 The organization provides information which supports accessing to and staying in
it (5 indicators)
4.3 Orienting information is available at the main entrance to assist patients and
visitors (7 indicators)
4.4 The navigation system is clear and easy to understand (2 indicators)
4.5 Health informaton for patients and visitors is available for free (5 standards)
 Everyday words or symbols are used in the navigation system (e.g. “kidney
diseases” instead of “nephrology”)
 The same symbols / words are used throughout the organization (e.g. always
“toilet” or always “washroom”)
 Free health information on frequent diseases is available for patients and visitors
 Free health information on lifestyle issues is available for patients and visitors. 52
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
Vienna HLO Standard
5 The organization ensures that patient communication
follows principles of health literacy
Content
Communication with patients follows health literacy best practice in all forms and
situations of communication, e.g. admission, anamnesis, ward rounds, and discharge.
Thereby specific communication needs of different patient groups are considered.
Sub-standards
5.1 Oral communication with patients is easy to understand and act on (10 indicators)
5.2.Design and distribution of printed materials are easy to understand and act on (9
indicators)
5.3 Design and distribution of computer applications and of social media are easy to
understand and act on (5 indicators)
5.4 Communication in native languages of patients is supported by personnnel and
material ressources (11 indicators)
5.5 Communication follows health literacy best practice in high-risk situations (8
indicators)
 The understanding of patients is checked in every encounter.
 Written information is never used instead of, but always in support of oral
communication
 Written information is designed following HL principles (size of letters, spacing,
53
selection of photos, graphs, …)
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
Vienna HLO Standard
6 The organization contributes to improving the
health literacy of patients and relatives
Content
The organization promotes health literacy of patients and their relatives
/care givers beyond hospital stay.
Sub-standards
6.1The organization supports patients etc. in gaining and improving
health literacy with regard to disease-specific self-management (6
indicators)
6.2 The organization supports patients etc. in gaining and improving
health literacy with regard to developing healthy lifestyles (4 indicators)
 The organization provides information and training on self-management and
prevention after discharge and / or brings patients in contact with organizations
providing such services (e.g. other healthcare providers, adult education).
 The organization offers information and training for caring relatives.
 The organization provides information and training on developing healthy
lifestyles and / or brings patients in contact with organizations providing
such services (e.g. other healthcare providers, adult education).
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Vienna HLO Standard
7 The organization improves the health literacy of its staff
Content
The organization promotes health literacy of staff, especially for selfmanagement of health risks at work and for development of healthy
lifestyles.
Sub-standards
7.1 The organization supports staff in in gaining and improving health
literacy for self-management of work-related health risks (8 indicators)
7.2 The organization supports staff in gaining and improving health
literacy for the development of healthy lifestyles (3 indicators)
 All staff are informed about health-related risks at work and how to
protect themselves against them (e.g. patient lifting).
 Staff are informed about how to improve their lifestyles
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Vienna HLO Standard
8 The organization contributes to improving health
literacy in the region
Content
The organization discharges patients well informed for further
treatment or recuperation and engages and collaborates with other
organizations to improve population health.
Sub-standards
8.1The organization promotes continuity and collaboration in care (11
indicators)
8.2 The organization contributes to health literacy as part of public
health according to ist possibilities (3 indicators)
 The organization collaborates with other organizations (e.g.
schools, enterprises) in the dissemination of health related
information.
 The Organization participates in health fairs to
disseminate information to the public.
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Vienna HLO Standard
9 The organization supports dissemination, sharing of
experiences and acts as role model for improving HL
Content
The organization actively supports and promotes the implementation of
organizational health literacy practices beyond ist organizational
boundaries
Sub-standards
9.1 The organization supports the dissemination and further development
of health literacy concepts and tools (5 indicators)
 HLO related activities and outcomes are part of the organization’s
annual report.
 The organization informs staff in training about HLO
 The organization reports about its experiences at conferences /
professional meetings / in publications.
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Feasibility study of the Vienna-HLO self-assessment tool
 Aim was to explore whether:
• Standards, sub-standards and indicators are understandable and
relevant
• Procedure of self-assessment is understandable and doable
• Results are useful for organizational diagnosis and
benchmarking
 Methods:
• Descriptive analysis of self-assessment data and of feedback on
the tool
• Follow-Up interviews with coordinators of the self assessment in
hospitals
 Participants:
• 9 hospitals differing in type out of 5 federal states of Austria
 Study took place between October 2014 and March 2015
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Results of the Vienna-HLO feasibility study
3.0
Wide variation
2.8
Small variation
2.6
2.4
2.4
Hospital 1
2.2
2.2
Hospital 2
2.1
Hospital 3
2.0
2.0
1.9
1.9
1.8
1.8
1.6
1.8
1.6
1.6
1.8
1.9
Hospital 4
1.9
Hospital 5
Hospital 6
1.7
1.7
1.6
Hospital 7
Hospital 8
Hospital 9
1.4
Mean
1.2
1.0
Standard 4 supportive
environment
Standard 7 improving staff HL
Standard 6 improving
patients' HL
Standard 8 improving
community HL
Standard 5 communication
with patients
Mean
Standard 3 qualifying staff
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Standard 9 networking
Standard 1 organizational
policy
Standard 2 participation with
users
Dietscher & Pelikan 2015
59
Major conclusions from the Vienna-HLO feasibility study
» The model is comprehensive, but can be modularized for
implementation
» The standards are seen as relevant & the self-assessment tool
as comprehensible and feasible
» Self-assessment can support organizational diagnosis &
benchmarking & identification of areas in need for
development
» Specific improvements can be initiated by using the tool box
 To make the tool accessible to other countries as well as to
Health Promoting Hospitals (HPH), the tool has been
translated to English!
 We are planning a working group on health literate health
care organizations within in HPH
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2.3 GOOD PRACTICE INTERVENTIONS TO
IMPROVE (ORGANIZATIONAL) HEALTH
LITERACY IN HEALTH CARE
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Many Best Practices
»
»
»
»
»
Health Literate Materials
Health educators
Navigators
Professional interpreters
Routine literacy
assessment
» Provider training
» Communication
» Campaigns that
encourage question
asking
» Using common language
» Verify comprehension
with teach-back or show
me, teach to goal, chunk
• What is my main problem?
• What do I need to do?
• Why is it important for me to do this?
*National Patient Safety Foundation. Ask Me 3:
good questions for your good health.
http://www.npsf.org/?page=askme3
*AHRQ. Questions to ask your doctor.
http://www.ahrq.gov/patients-consumers/patient62
involvement/ask-your-doctor/index.html
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
Health Literacy Universal
Precautions Toolkit
Health literacy universal
precautions
• Simplifying
communication
• Confirming
comprehension
• Making the health care
system easier to navigate
• Supporting patients'
efforts to improve their
health
21 Tools to help improve
• Spoken and written
communication
• Self-management and
empowerment
• Supportive systems
AHRQ Health Literacy Universal Precautions Toolkit, 2nd Edition.
63
http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/index.html
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
Organisational Health Literacy Selfassessment Resource
• 10 checklists
• assess presence of
attributes outlined in
IOM Roundtable report
• Encourages planning for
future action
– Responsibility
– Timelines
– Etc.
Enliven Organisational health literacy self assessment resource>.
http://www.enliven.org.au/sites/default/files/Enliven%20Health%20Literacy%20Audit%20Resource.pdf64
Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
Sources for good Practice Health Literacy Interventions
and Measures
DeWalt, DA., Callahan, LF., Hawk,
VH., Broucksou, KA., Hink, A.
(2010): Health Literacy Universal
Precaution Toolkit. Edited by the
Agency for Healthcare Research
and Quality.
http://www.nchealthliteracy.org/tool
kit/Toolkit_w_%20appendix.pdf
World Health
Communication
Association. (2011):
Health Literacy „The
Basics“ Revisited
Edition.
http://www.whcaonlin
e.org/uploads/publicat
ions/WHCAhealthLite
racyThe%20Basics.pdf
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WHO Regional Office for
Europe (2013): Health
Literacy. The Solid Facts.
http://www.euro.who.int/__da
ta/assets/pdf_file/0008/1906
55/e96854.pdf
65
Examples for strengthening different health literacyfriendly settings
WHO Regional Office for Europe (2013):
Health Literacy. The Solid Facts.
http://www.euro.who.int/__data/assets/pdf_file/
0008/190655/e96854.pdf
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10. SUMMARY AND CONCLUSIONS
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Extended definition of a health literate healthcare
organization (combination of IOM & HLS-EU & extension)
A health literate healthcare organization …
» makes it easier
» for all stakeholders (patients / relatives, staff / leadership and citizens)
» to access, understand, appraise and use disease- and health relevant
information
» and tries to improve personal health literacy of these stakeholders
» for making judgements and taking decisions in everyday life
» concerning healthcare (co-production) , disease prevention and health
promotion
» to maintain or improve quality of life during the life course.
» To achieve this comprehensive concept systematically and
sustainable, a health care organization will have
» to apply principles and tools of quality management, change
management and health promotion
» and to build specific organizational capacities (infrastructures &
resources) for becoming more health literate.
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Pelikan - 4th AHLA, Haiphong 11-2016 Health Literate Organization
Conclusions: Promises and Challenges
Promises
Challenges
» Embracing the whole
mission will address many
of the most pressing health
care delivery issues
» A tremendous organizational
commitment is required
» HLO is difficult to measure
» Needs process measures of
incremental success
» Dominant focus on individual
diseases and care processes
does detract from broad
organizational health system
changes needed
» Payment and compliance
policies are not yet fully
aligned to support change
»
»
»
»
»
Safety of care
Quality of care
Transparency of care
Fragmentation of care
Implementing Patient
Centeredness in care
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Contact
Thank you so much for your attention!
Jürgen M. Pelikan
Stubenring 6
1010 Vienna, Austria
T:
+43 1 515 61-
F:
+43 1 513 84 72
E:
[email protected]
www.goeg.at
HPH-relevant websites:
www.hph-hc.cc/
www.hphnet.org
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25th International HPH Conference
Don‘t miss the chance to participate in this
unique event!
» Place and date:
University of Vienna, Austria, April 12-14, 2017
» Abstract submission:
http://www.hphconferences.org/abstract-submission/aboutsubmission.html
» Conference program
http://www.hphconferences.org/vienna2017
» Contact:
[email protected]
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References
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Brach C, Keller D, Hernandez LM et al. (2012). Ten Attributes of Health Literate
Health Care Organizations. Washington (DC): National Academy of Sciences:
Institute of Medicine.
Dietscher C, Pelikan JM (2015). Gesundheitskompetente Krankenbehandlungsorganisationen: Machbarkeitsstudie zur organisationalen Selbstbewertung mit dem
Wiener Instrument in österreichischen Krankenhäusern. [Health Literate Health
Care Organizations: Feasibility study of the self-assessment tool following the
Vienna Concept of Health Literate Healthcare Organizations among Austrian
hospitals]. Prävention & Gesundheitsförderung 11:53–61.
Nutbeam D (1998). Evaluating health promotion – progress, problems and
solutions. Health Promotion International, 13(1):27–44.
Parker R (2009). Measuring Health Literacy: What? So What? Now What? Institute of
Medicine, Roundtable on Health Literacy, Washington (DC): National Academy
Press.
Sørensen K, Van den Broucke S, Fullam J et al. (2012). Health literacy and public
health: A systematic review and integration of definitions and models. BMC Public
Health, 12:80.
World Health Organization (1998). Health Promotion Glossary. Geneva: World
Health Organization.
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7.2 References & Resources
Brach, C., Keller, D., Hernandes, LM., Baur, C., Parker, R., Dreyer, B., Schyve, P., Lemerise, AJ., Schillinger, D. (2012): Attributes of Health Literate
Organization, Discussion Paper, Institute of Medicine of the national academies. http://www.iom.edu/~/media/Files/PerspectivesFiles/2012/Discussion-Papers/BPH_HLit_Attributes.pdf
Brach, C. (2013): Becoming a Health Literate Organization: Tools for Community Health Centers. Presentation 3.April 2013 at the Center for Delivery,
Organization and Markets.
DeWalt, D.A., Callahan, L.F., Hawk, V.H., Broucksou, K.A., Hink, A., Rudd, R. & Brach, C. (2010). Health Literacy Universal Precautions Toolkit. (Prepared
by North Carolina Network Consortium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under
Contract No. HHSA290200710014.) AHRQ Publication No. 10-0046-EF) Rockville, MD: Agency for Healthcare Research and Quality.
Kickbusch,I., Maag, D. (2008): Health Literacy. In: Heggenhougen,H.K., Quah,S.R. (Eds.), International Encyclopedia of Public Health, Vol. 3. (pp.204211). San Diego: Academic Press.
Kickbusch I, Pelikan J M, Apfel F, Tsouros A D (Eds.) (2013): Health literacy. The solid facts. Copenhagen: Copenhagen: World Health Organization –
Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf
Levin-Zamir, D, Peterburg Y. (2001): Health literacy in health systems – perspectives on patient self-management Health Promotion
International,16;1:87-94.
Nutbeam,D. (2000): Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st
century. Health Promotion International, 15 (3), 259-267.
Nutbeam,D. (2008): The evolving concept of health literacy. Social Science & Medicine, 67 (12), 2072-2078.
Parker, R. in World Health Communication Association (2009): Health Literacy, Part 1 „The Basics“. WHCA Action Guide.
Pelikan,J.M., Dietscher,C., Schmied,H. (2013): Health Promotion for NCDs in and by Hospitals: A Health Promoting Hospital Perspective. In: McQueen,D.
(Ed.), Global Handbook on Noncommunicable Diseases and Health Promotion (pp.441-460). New York, Heidelberg, Dordrecht, London: Springer.
Pleasant, A. & Kuruvilla, S. (2008): A tale of two literacies: public health and clinical approaches to health literacy. Health Promot. Int. 23(2) 152-159.
Rudd,R. (2005): Navigating Hospitals: Literacy Barriers. Literacy Harvest
Rudd, R.E. & Anderson, J.E. (2006).The Health Literacy Environment of Hospitals and Health Centers – Partners for Action: Making your healthcare
facility literacy-friendly. National Center for the Study of Adult Learning and Literacy and the Health and Adult Literacy and Learning Initiative, Harvard
University School of Public Health.
Sorensen,K., Broucke,S., Fullam,J., Doyle,G., Pelikan,J., Slonska,Z., Brand,H., (HLS-EU) Consortium (2012): Health literacy and public health: A systematic
review and integration of definitions and models. BMC Public Health, 12 (80).
WHO (1986): Ottawa Charter for Health Promotion. In World Health Organization (Ed.), Geneva: WHO.
WHO (1998): Health promotion glossary. Geneva: WHO
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A working group on HLO in HPH
1. Taking up the IOM characteristics and developing these
further to the Vienna model of HLHCO
2. Creating a self-assessment instrument with standards, substandards & indicators for this model
3. Testing feasibility of self-assessment instrument of Vienna
model in Austrian hospitals
4. Translating of model and standards into English
5. Working on adequacy and feasibility of the model and the
standards in context of other health care systems and
societies
6. Translation of self-assessment instrument into other
languages
7. International piloting by feasibility study in selected hospitals
in HPH networks
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