Guide To Embedding Health Literacy

Example: Sample Health Literacy Policy Statement, sourced from Tasmanian Department of Health

• Consumers have a right to information: it is the responsibility of healthcare providers to communicate effectively and check consumers’ understandings of information communicated.
• Consumers have a right to be involved in decision-making about their health and wellbeing.
• A service’s health literacy environment should support and empower consumers to make effective decisions and take appropriate action for their health and health-care.
• We acknowledge that it is difficult to identify someone with poor health literacy and it is best to take health literacy precautions with all consumers.

• all spoken and written communication targeting consumers will meet health literacy standards, be easily understood and tailored to the needs of people from a diverse range of backgrounds
• Offering staff health literacy and communication professional development activities
• considering health literacy in project planning and environmental design of facilities
• involving consumers in communication, project planning and environmental design of our services, and in the development of consumer information material
• advocating for and supporting activities that promote literacy and health literacy. 

Example: Sample Health Literacy Policy, sourced from the Gippsland Guide to becoming a Health Literate Organisation

• Recognising the impact of health literacy on:
  • the health outcomes of individuals
  • costs to the health system
  • preventing chronic conditions
• Addressing the health literacy barriers of clients and communities
• Creating and maintaining an organisational environment that supports staff to develop and enhance their health literacy skills in order to empower clients and community members to improve their health

• Foster a culture where both individual and organisational health literacy is considered part of all decision making within the organisation
• Engage clients and communities in decision making processes
• Build organisational capacity by providing health literacy training for all staff
• Implement the 10 Attributes of a Health Literate Organisation framework [10]

• Access and Equity
• Advocacy
• Client Rights and Responsibilities
• Community and Participant Involvement
• Health Promotion
• Interpreting and Translating
• Service Delivery – Key Components of Care

• 10 Attributes of a Health Literate Organisation
• The Gippsland Guide to Becoming a Health Literate Organisation
• Accreditation standards mapped against the 10 Attributes of a Health Literate Organisation (Available in the Northern NSW Health Literacy Handbook)

Example: Commitment to Health Literacy in position statement, sourced from Health Care Consumers Association Position Statement on Health Literacy

1. with consumers and health services providers to identify their information and training needs
2. to build the capacity of consumers, carers and community members in a number of ways, including the development of resources, delivery of information sessions and skills based workshops
3. with staff of health services to enhance their ability to communicate clearly to meet the needs of consumers and carers.
4. with staff of health services to standardise the development and provision of health information
5. with the [state] Government and local health services to develop and implement policies, training programs and systems to improve the health literacy of people living in [local health area]
6. to become a health literate organisation.

Example: Equity of Access and Health Literacy policy, sourced from South Western Sydney Primary Health Network

• Developing, commissioning and implementing services which ensure equitable access for all of our community members.
• Recognising the impact of health literacy on the health outcomes of individuals and communities, costs to the health system and the prevention and management of chronic conditions.
• Addressing the health literacy barriers of individuals and community groups.
• Creating and maintaining an organisational environment that supports staff to develop and enhance their health literacy skills in order to empower community members to improve their health.
• Fostering a culture where both individual and organisational health literacy is considered as part of decision making within the organisation.
• Engaging community members, including representatives of vulnerable groups, in decision making processes.
• Ensuring that all materials for the community are written clearly, using appropriate language to enhance understanding and are tailored to the needs of the target group.

• Health literacy is the degree to which a person has the capacity to obtain, communicate, process and understand health information and services to make appropriate health decisions.
• [Name of Organisation] recognises the significant impact that low health literacy can have on health outcomes. Low individual health literacy is associated with higher rates of hospitalisation and emergency care and with higher rates of adverse outcomes. It is also associated with lower uptake of preventative approaches like mammography and the influenza vaccine (Australian Commission on Safety and Quality in Health Care, 2014).

• Health equity describes a state in which there are no systematic differences between different groups in their ability to access high quality health services. [Name of Organisation] recognises health inequities as both unfair and avoidable.
• Members in the following groups in [your local region/area] may have specialised needs and may experience health care access barriers: e.g.
  • Aboriginal and Torres Strait Islander people
  • People from a culturally and linguistically diverse community
  • Older people
  • Younger people
  • People living with a disability
  • People living with mental illness
  • socioeconomically disadvantaged people
  • people living in rural and geographically isolated areas
  • LGTBQIA+
• Health literacy and health care access are intrinsically linked, with limited health literacy impacting a person’s ability to perceive and act on a healthcare need. [Name of Organisation] aims to be a health literate organisation to ensure all community members have equitable access to services we deliver or commission.

• All employees

• Executive – to foster an environment which supports consideration of health literacy and equity principles.
• Management – to consider health literacy and equity principles in the planning, delivery and evaluation of services.
• Staff – comply with the equity of access and health literacy policy in the planning, delivery and evaluation of services.

Example: Strategic Objectives of the Northern NSW Local Health District Kids and Families Plan 2017-2022 include the goal of “improving health literacy”.

Example: The Northern NSW Local Health District Strategic Plan 2019-2024 includes an objective to “improve health literacy”

Example: Guideline for developing and reviewing consumer resources

• Searching for existing resources
• Planning new resources
• Consulting stakeholders
• Developing new content
• Meeting the checklist for consumer-friendly health information
• Photography and media consent
• Logos and branding
• Considerations for web content
• Aboriginal Health Impact Statement
• Management approval processes
• Distribution
• Review

Example: Procedure for wayfinding audits, from Illawarra Shoalhaven Local Health District

Example: Policy for policy writing, from Illawarra Shoalhaven Local Health District

Example: Healthy North Coast requirement for newsletter contributions from staff to be written at grade 6 to 8 level

Example: Healthy North Coast Primary Care Impact Quality Improvement Pathway

Example: Plan for health literacy evaluation

Example: Sample Health Literacy KPIs from the Healthy North Coast Women’s Cancer Screening Collaborative Project

Example: Possible KPIs list from Healthy North Coast Mental Health and Alcohol and Other Drugs Directorate

• Completion of organisational health literary assessment and health literacy action plan
• Percentage of actions completed from health literacy action plan for service improvement
• Percentage of practice staff completing health literacy training and/or teach back training
• Number of education sessions delivered
• Percentage of practice staff who do health literacy training reporting increased confidence to use health literacy strategies.
• Percentage of staff who pass a teach-back competency assessment
• Percentage of forms and resources assessed using health literacy standards
• Percentage of staff completing cultural awareness training
• Improvement in proportion of clients attending appointments
• Improvement in patient reported experience
• Improvement in patient reported outcomes
• Number of shared decision making tools integrated into standard care practice
• Proportion of clients who receive written summaries of their appointment and follow up
• Number of case discussions including health literacy as a standard item
• Number of identified health literacy barriers in case discussions
• Development of policy to develop/review health information
• Service information (brochures, website) includes information about accessing service including costs, transport and parking information, access to interpreters, what clients need to bring/have
• Number of improved resources in use
• Scripts developed for staff to guide common or complex conversations and in use by practice staff.
• Uptake of community health coaching programs by various priority groups (KPI dependent on type of program)

• Number staff (including reception and admin staff) completed mental health first aid training
• Number of staff (including reception and admin staff) complete mental health literacy training.
• Number of staff completed education about e-mental health programs available and how to refer to them
• Intake processes reviewed with input from people with lived experience of mental health issues
• Number of standard care pathways reviewed/co-designed with people with lived experience of mental health issues
• Referral pathways developed for people with lived experience of mental health issues
• Percentage of clients with a mental health action plan
• Number of mental health peer workers in service referral system
• Number of clients referred to mental health support services or specialist services
• Uptake of community mental health education programs by various priority groups (KPI dependent on type of program)
• Development of priority groups engagement plan
• Percentage of clients engaged with service from priority populations
• Percentage of service provider training co-delivered with people with lived experience
• Number of clients referred to social prescribing programs
• Number of activities addressing access and user equity
• Number of new clients receiving service
• Number of referrals received for service
• Change in mental health assessment outcomes
• Language in recall and reminder systems is reviewed for non-stigmatizing and trauma informed language
• Number of mental health care plans sent to GPs

Example: Staff orientation video developed by Northern NSW Health Literacy Project

Example: Health literacy education as part of regular education calendar

Example: Evaluation criteria for tenders from Healthy North Coast

Applications to complete a project out for tender by Healthy North Coast must have all application criteria assessed against a scoring guide. Health Literacy questions in the criteria can be scored as excellent, good or poor.

Example application criteria: Outline how your service/program embeds health literacy best practice and improves health literacy within your organisation and for clients.

Scoring guide: Excellent: The plan will include activities specifically designed to make it easier for people to find, understand, assess and use health information and services in the region. It will include health literacy considerations in community engagement strategies. It will also use co-design with community in planning and developing new projects/materials/services. There is a plan to measure and document these activities. Good The plan will include activities to make it easier for people to find, understand, assess and use health information and services in the region. It includes limited health literacy considerations in community engagement (e.g. plain language, health literacy checklists for resources) and has limited plans for co-design. There is a limited plan to measure or document these actions. Poor The plan does not include or clearly describe activities to make it easier for people to find, understand, assess and use health information and services in the region. It does not include health literacy considerations in community engagement strategies or use co-design. There is no clear plan to measure or document these actions.

Example application criteria: Outline how your service/program is mental health literacy responsive. Include the measures you have taken to ensure your service is accessible and easy to use for those with low mental health literacy and low general health literacy.

Scoring guide:   Excellent: The plan will include activities to meet the diverse mental health literacy strengths, needs and preferences of all people. This includes activities to support individuals with mental health lived experience, their families and kinship groups, and communities to make decisions regarding their health and wellbeing, improve their service’s accessibility and effectiveness in understanding and supporting mental and physical health problems and improve equity and health outcomes for people with lived experience of mental health issues or caring kin and communities. There is a plan to measure and document these activities. Good Includes limited activities to support individuals with mental health lived experience, their families and kinship groups, and communities to make decisions regarding their health and wellbeing, improve their service’s accessibility and effectiveness in understanding and supporting mental and physical health problems and improve equity and health outcomes for people with lived experience of mental health issues or caring kin and communities. Does not focus on these areas as a priority.   Poor The plan does not include or clearly describe activities to meet the diverse mental health literacy strengths, needs and preferences of all people. There is no clear plan to measure or document these actions.

Example application criteria: Describe how you address organisational health literacy that ensures procedures and staff support health literacy best-practice.

Scoring guide: Excellent: Can demonstrate that staff undertake health literacy training. Evidence of organisational health literacy assessment and use of health literacy best practice e.g. Teach-Back, plain language. Evidence of use of co-design and consultation to improve their practice.   Good Have a plan for staff to undertake health literacy training and to conduct organisational health literacy assessment. Knowledge of health literacy best practice e.g. Teach-Back, plain language. Plan for co-design and consultation to improve their practice.   Poor No evidence of or plan for staff to undertake health literacy training or to conduct organisational health literacy assessment. Lacks knowledge of health literacy best practice e.g. Teach-Back, plain language.

Example application criteria: Demonstrate actions to improve health literacy have been taken and/or improvements in health literacy have been measured.

Scoring guide:   Excellent: There are at least 3 key performance indicators clearly linked to health literacy improvement. These may include but are not limited to:

• Number or percentage of staff who have attended Health literacy training
• Evidence of co-design and/or community consultation
• Use of tools to measure improvement in printed and digital resources
• Organisational Health Literacy assessment complete and action plan in place
• Use of PREMs and PROMs to demonstrate improvement in client experience and outcomes

Good There is at least 1 key performance indicator clearly linked to health literacy improvement   Poor No relevant health literacy key performance indicators.

Example application criteria: Demonstrate your experience in improvement of organisational health literacy and detail actions you have taken to improve client’s health literacy. Include description of outcomes. 

Scoring guide:   Excellent: Demonstrates comprehensive health literacy actions already taken by the organisation, including Health literacy policy/action plan in place, Staff health literacy training, Use of teach-back, plain language or other health literacy strategies, Evidence of co-design or community consultation/feedback and resulting actions. Includes outcomes of these actions including organisational change or improved patient measures.   Good Demonstrates some health literacy actions already taken by the organisation.

This may include any of the following: Health literacy policy/action plan in place, Staff health literacy training, Use of teach-back, plain language or other health literacy strategies, Evidence of co-design or community consultation/feedback and resulting actions.   Poor No health literacy actions taken by the organisation.