Using adult learning theories to build patients and

Using adult learning theories to build patients’ and families’ knowledge of CVD medicines Susan Reid Wisconsin Health Literacy Summit 14 April 2015

Session objectives • By the end of this workshop you will have learnt: • how adult learning theories, schema theory, coconstruction of knowledge and Vygotsky’s Zone of Proximal Development relate to health literacy interventions • how these theories informed the development of a health literacy intervention about CVD medicines knowledge • results of the intervention

Summary of CVD medicines project Aims • Develop a customised, structured CVD medicines health literacy programme • Trial this in indigenous primary care services: • Primary outcome - CVD medication knowledge • Secondary outcomes - changes in health literacy skills and practices

Programme description Phase 1 programme • In-depth interviews with nine patients and families showed they had limited knowledge but were keen to know more • Training for research nurses • Written resource for patients • Interactive app for use in sessions • Three step health literacy model – Ask, Build, Check

Phase 2: trialling the intervention • Full protocol available: • Crengle et al. BMC Public Health 2014, 14: 714 www. biomedcentral. com/1471 -2458/14/714 • Three sessions over one month • Outcome assessments before and after each session • Structured process for doing outcome assessments

The participants • • • Eligibility – CVD diagnosis and taking at least 2 of 4 medicines 96 participants Mean age 64. 3 years (range 41 -87 years) Females 58. 2% Statins 91. 7% ACE inhibitors 61. 5% Beta blockers 71. 9% Aspirin 85. 4% Angina 60. 2% MI 52. 0% TIA 10. 4% CVA 25. 8% Mean years with CVD 7. 2 years Comorbidities common: • Diabetes 39. 3% Gout 33. 3% • COPD 24. 4% CHF 24. 1% Data collected March to August 2013 at Ngati Porou Hauora (rural) and Te Hononga o Tāmaki me Hoturoa (urban)

The constraints and opportunities • One off training session for research nurses • New way of thinking – Ask, Build, Check needs lots of practice • New way of thinking – shift from telling to other methods of teaching • No opportunity for coaching except inter-rater reliability sessions

Three steps to better health literacy

What we often observe 1. 2. Assume Tell 3. Assume

Step 1 Ask people what they know, do and believe This is the most important step and easiest step

Step 1: Prior knowledge Schema theory Everyone relates new knowledge to what they already know or have experienced Content schema knowledge of the world Textual schema knowledge of how texts are organised

Co-construct knowledge

Step 2 Build health literacy skills and knowledge and link them to what people already know We think health professionals do some of this already

Zone of Proximal Development

Working in the ZPD

Step 2: Build health literacy Use a range of different strategies not just telling • Modelling • Discussion • Explaining Prompting Questions Giving feedback Remember to link new information to what people already know

Example of prompting Video

Step 3 Check you were clear (and, if not, go back to Step 2) This is the hardest step and needs the most practice

Step 3: Check you were clear • It is the nurse’s responsibility to be clear • Used open and closed questions and prompting during outcome assessments: • “Tell me what you know about your statin” • “Ok now what are the serious side effects that you need to tell us about straightaway? ”

Results

Specific knowledge for each prescribed medicine type 100% 100% 99% 80% 60% 59% 40% 32% 26% 20% 10% 2% 0% Knows name Before Knows why take After Session 1 Knows instructions After Session 2 Knows side effects After session 3 Knows treatment targets

Prompting vs spontaneous correct answers Mean number of prompts by nurse or whānau during education session 12 10 8 6 4 2 0 Statin ACEI Pre Sess 1 BB Post 1 Session 2 Session 3 Aspirin

Health literacy practices - resources Use of resources during outcome assessments 100% 80% 60% 40% 20% 0% Pre Sess 1 Pre Sess 2 Own info Pill card Pre Sess 3 Booklet

Acknowledgements • • New Zealand researchers included Dr Sue Crengle, Michelle Lambert, Dr Matire Harwood (University of Auckland); Susan Reid (Workbase Education Trust); Jennie Harre-Hindmarsh, Julia Brooking, Moko Williams (Ngati Porou Hauora); Marian Hakaraia, Lisa Reddy (Te Hononga o Tamaki me Hoturoa) We acknowledge the support of all the participants and their families who took the time to be involved in this project Funding for this project was provided by the Health Research Council of New Zealand Part of ICIHRP programme funded in New Zealand, Australia (University of Victoria & Victorian Aboriginal Health Services) and Canada (St Michaels Hospital, Toronto & De dwa da dehs nye>s Aboriginal Health Centre, Hamilton)

www. healthliteracy. org. nz sreid@workbase. org. nz