Health literacy in planning and evaluation

Wayfinding means understanding how people navigate spaces and providing signage and layouts that support easy access and navigation.

Detailed instructions are found in the NSW Wayfinding for Healthcare Facilities guidelines.

A wayfinding audit is also available on the NSW Health Quality Audit and Reporting System (QARS), called CEC_Wayfinding_for_Hospitals_and_Health_Services

You can use a tool like the Patient Education Materials Assessment Tool (PEMAT) to score resources. It assesses the understandability and actionability of print and digital patient education materials. The Patient Education Materials Assessment Tool (PEMAT) and User’s Guide is available from the Agency for Healthcare Research and Quality (ahrq.gov).   You can also see how individual resources stack up against guidelines or checklists for developing patient information. There are many of these available, like the Checklist for designing consumer-friendly health information developed by the Northern NSW Health Literacy Project. Many organisations have their own guidelines or processes for developing consumer information, such as Illawarra Shoalhaven, Western Sydney and Northern NSW Local Health Districts.

Other commonly used surveys that ask about patients’ experience of care can give us an idea of whether health professionals are using best-practice health literacy strategies. These surveys do not measure health literacy, but they do measure aspects of care that health literacy strategies aim to improve. 

Bureau of Health Information (BHI) patient survey 

There are multiple patient surveys, which ask questions like:

• Did the health professionals explain things in a way you could understand?
• During your stay in hospital, how much information about your condition or treatment was given to you?
• Did the health professionals listen carefully to any views or concerns you had?
• Were you involved, as much as you wanted to be, in decisions about your care and treatment?
• Thinking about when you left hospital, were you given enough information about how to manage your care at home?

There are many more relevant questions. You can download the results of these surveys for the state, broken down by Local Health District and hospital, or use the Bureau of Health Information Data portal  to search for results.   

Patient Reported Measures (PRMs)

Patient Reported Experience and Outcomes Measures (PREMs and PROMs) can be used within services. There are disease specific measures and more general measures, such as Inpatient and Outpatient PREMs. These include questions like:

• Did the health professionals explain things in a way you could understand?
• I was involved as much as I wanted in making decisions about my treatment and care
• Have you been given enough information about how to manage your care at home?

Measures and more information can be found on the Resources for clinicians and patients page from the NSW Agency for Clinical Innovation.

1. Consider the health literacy barrier you are trying to address
2. Measure the change in the behaviour associated with that specific barrier (either a consumer or an organisational/health professional behaviour change). E.g.:
   1. each patient offered smoking cessation advice has a quit smoking plan documented
   2. no show rates for clinic decrease after implementing actions to improve access / writing the reminder letter in plain language / implementing a reminder text message
   3. registration for program increases after simplifying the registration process
   4. Changes in self-reported use of teach-back by healthcare workers over time.
   5. Changes in client knowledge about their condition, before and after teach-back is used.
   6. Decreases in readmission rates for issues where client understanding of self-management is paramount.
   7. Peer observation of how individual staff use teach-back.
   8. Chart audit to see how many times teach-back is being documented.
   9. Changes in satisfaction surveys of clients or caregivers.

By showing improvements in these areas you are showing improvements in health outcomes and health behaviours that evidence tells us are supported by better health literacy.