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Creating a Health Literacy Program/ Resource inside an Adult Literacy Center

 My name is Glenn McComas, and I am a recent graduate of East Carolina University with a B.S Degree in 
Public Health Studies and a concentration in Health Education and Promotion. I am currently a Health
 Literacy intern with the Literacy Volunteers of Pitt County and I have the intentions of creating and 
implementing a Health Literacy program/ resource here at LV-PC. Here at LV-PC they mainly focus on adult
 basic education. (reading, writing, and math)
Anyway, I am starting from the ground up with this program as nothing has been done like this in this area 
before. We currently intake students, give them a baseline assessment (CASAS), and based off of their 
results pair them with a tutor that possess skills they lack but only for math and english. Obviously 
the paring process is a little more complex than that, but that is the simplified explanation. Students
 also have a checklist with goals on it, and if they check health literacy related goals such as reaidng a
 medicine bottle or nutrition lable, then that is breifly touched on with a normal education tutor. Most 
of these education tutors do not have any health backround. 
We currently use the CASAS assessment when evaluating new students and it has minimal health literacy 
questions on it (max of 3 per test), we are thinking about adding the Wonderlic GAIN assessments to our 
tool kit but I know that assessment doesn't have any health literacy questions on it either 
The only comlete Health Literacy Assessment I found was the Test of Functional Health Literacy in Adults 
(TOFHLA) and I am afraid it might be too complex for some of our students here. Are you familiar with the 
TOFHLA? I know there is an S-TOFHLA (short) but I'm also not sure this test would be applicable for our
 population. Do you use an assessment or what does your intake process look like?
Pitt County is a mostly rural area with one major city in the middle of it, Greenville, NC. Greenville is 
the home of East Carolina University which offers many great medical programs such a physical therapy
 school, occupational therapy school, dental school, a top ranked nursing school, and of course Brody 
School of Medicine. There are medical facilities and resources everywhere you turn in this city, but yet 
there is no health literacy resource for the population that uses them the most. Rural Pitt county not
 including the college community has some of the worst literacy statistics in the country (1 in 4 cannot 
read a sign) and we know this directly correlates to their health literacy as well. I would like to be the
 first to provide a resource for that population that is aching for one. We already received a small grant 
to start the program but I'm looking for as much input as I can before I begin spending the budget. I'm in
 the process of writing a case statement and another grant to hopefully receive more funding but at this
 point I'm not even sure how to spend it.
So some basic question I have for you:
Do you believe it is a good idea to model the health literacy model after the ABE model, where we do a 
student intake and offer them the TOFHLA or something of the like, and then stratify their health literacy
 level. Then pair them with a tutor to educate them from there in a one-on-one format, or would you
recommend a workshop format? What does your program look like? Do you mainly focus on workshops and 
seminars for specific topics i.e diabetes, PA, nutrition
Do you know of any other health literacy assessments that would be applicable for my population, and do 
you even utilize an assessment in your programs? Also we have a decent amount of ESL students, do you 
have health literacy tutors that teach in other languages? Or how do you serve that population?
What materials would be best to use? Such as books for the tutors to use to teach with and build the 
curriculum with? Any material suggestions would be extremely helpful at this point. 
Where do most programs get their referrals from? Where do they get there students? Would you recommend I 
spend a small portion of the budget on printing materials and create brochures or bookmarks to leave in
 local medical offices? Where do you get your students from?

My vision for the program right now would be to of course help the current students who are here mainly for math and reading, who identify that they have health literacy goals, but to also find a referral process to get more students here just for health literacy. My plan is to work with the internship coordinator at the local university to get a steady flow of two 100 hour per semester interns in here to use as our health literacy tutors each semester (Fall, Spring, Summer). Once I know I will have tutors here then I plan to work on finding the students who just want to be tutored on health literacy or their goals on a certain disease they or a family member may possess. I plan to do this by advertising our health literacy resource at local medical offices with brochures, pamphlets, and book marks. I am undecided if students should take an an intake assessment and which one so I can evaluate their progress. I am also undecided on what materials to use. Like I previously stated we already have a small grant restricted to heath literacy and we are expecting another one to come in soon, so I am planning this program as if money was not a problem.

I may have missed a question or two but I would greatly appreciate any advice or information anyone is willing to share. Thank you so much in advance and I look forward to hearing from you all.

Comments

esprins's picture
Fifty

the practitioner's guide that I posted a couple of weeks ago may be useful. Addressing the Health Literacy Needs of Adult Education Students: http://www.ed.psu.edu/educ/goodling-institute/professional-development/pracitioner-guide-4/view

Best,

Esther

McComasG09's picture
First

I will give that a read soon as I get some free time. It looks like a great resource, thanks!

Julie McKinney's picture
One hundred

Hi Glenn,

This sounds like a great Project! I have a few suggestions to answer your questions:

Recruiting:

  • Starting with current students can maybe get you some referrals to those students' friends and family. Ask those students where in their community you could have a small event or do a short talk to explain what you are offering.
  • Team up with health clinics or hospitals in your area. Where do the students from the ABE program go for medical care? Find out and talk to the admistrators of these clinics. Your services could be really helpful to the clinics/hospitals by helping them to better serve their population. So make sure that the administrators realize this!
  • If you are recrruiting from the clinics, it sould be much better to have a face-to-face presence than to spend money printing handouts or bookmarks. Posters would be good, but the best thing would be to talk to people face-to-face. Have an event, or have volunteers talk to people in waiting rooms.
  • If you can find out who in your area is responsible for enrolling unisured people for health insurance under the Affordable Care Act, you could team up with them. Ask the state or local Department of Health.

Materials:

I suggest reading the Calgary Charter to get a good sense of health literacy and developing comprehensive curricula:

The Calgary Charter

http://www.centreforliteracy.qc.ca/sites/default/files/CFL_Calgary_Charter_2011.pdf

Here are two materials that I would recommend for the tutors to use directly with students. They each come with an instructor's guide:

Staying Healthy: An English Learner's Guide to Health Care and Healthy Living

PDF: http://www.floridaliteracy.org/FLCHLP/files/SE%20Files/CompleteSEBook.pdf

WEB: http://www.floridaliteracy.org/literacy_resources__teacher_tutor__health_literacy.html

 

What to Do For Health Series

http://www.iha4health.org/default.aspx/MenuItemID/191/MenuGroup/_Home.htm

 

Here's a site where you can find more curricula and teaching activities for addressing health literacy with adult ABE or ESOL students:

The health Literacy Speical Collection

http://www.healthliteracy.worlded.org

 

Good luck, and stay in touch with us!

 

All the best,

Julie

 

J. Peterson's picture
First

Glenn,

If you give me a call I'll explain what we are doing with health literacy.

Joan

~~~~~~~~~

Joan B. Peterson
Executive Director
Literacy for Life at the Rita Welsh Adult Learning Center
The College of William & Mary
P.O. Box 8795
Williamsburg, Virginia 23187-8795
Office(757)221-3325 Fax (757)221-1262
E-Mail: jpeterson@wm.edu
www.literacyforlife.org

Julie McKinney's picture
One hundred

Hi Joan,

I encourage Glenn to call you anyway, but for the benefit of our whole group, can you tell us here a bit about what you are doing?

Thanks!!

David J. Rosen's picture
One hundred

Hello Glenn,

You wrote:

Do you believe it is a good idea to model the health literacy model after the ABE model, where we do a 
student intake and offer them the TOFHLA or something of the like, and then stratify their health literacy
 level. Then pair them with a tutor to educate them from there in a one-on-one format, or would you
recommend a workshop format? What does your program look like? Do you mainly focus on workshops and 
seminars for specific topics i.e diabetes, PA, nutrition

As you suggested, start with students who are already in the LV-PC program. Hold a (nutritious) pot-luck dinner; invite them, their families and also, if they wish, their tutors. Plan for child care for those who may need it during the meeting. The purposes of the meeting might be to:

1) Find out what health information topics they are interested in (asthma, diabetes, cancer, diet and exercise, stress reduction, etc.) You could ask this in an open-ended way and, if needed, follow up with a show of hands on topics you suggest. You want to find out what issues most students care about (for themselves or for family members or friends)

2) Find out (by show of hands) when the best days/times are for (monthly?) meetings. I believe that health literacy is best done in groups -- which may be a departure for LV-PC; (I don't know, however, if that's the case.)

3) Suggest some learning projects the group could do and get a sense of how many people are interested in each project you -- or others -- suggest. For example, they could pick a topic they care about (e.g. HIV/AIDs, asthma, nutritious cooking, weight loss/diabetes prevention, or another issue) and then they could discuss how they want to learn about the topic (guest speakers, online, free, low-literacy level readings or audio files in english or other langauges, YouTube videos, texts, etc.) and how they want to outreach to their community/ies to help others learn (write pamphlets, makje a YouTube video, do community meeting presentations using a set of Powerpoint slides, etc.) One of the things my colleagues and I in Massachusetts have learned is that in a project-based learning approach like what I suggest there are opportunities for students with a wide range of English listening, speaking, reading and writing skills. If you want to know more about projects like these I can suggest some very knowledgeable  Massachusetts practitioners and adult learners (graduates of programs now) who have organized and participated in projects like these. I can also point you to some of the writings they have done that still are posted on the web.

 

Do you know of any other health literacy assessments that would be applicable for my population, and do 
you even utilize an assessment in your programs? Also we have a decent amount of ESL students, do you 
have health literacy tutors that teach in other languages? Or how do you serve that population?

I would't necessarily use a health literacy assessment. Instead, I would start with the individuals and their interests, needs and concerns, expressed orally either individually or in a group.

What materials would be best to use? Such as books for the tutors to use to teach with and build the 
curriculum with? Any material suggestions would be extremely helpful at this point. 

Several years ago World Education developed a hard copy and online compendium of great literacy materials. I believe it is still available online. Let me know, and perhaps I can point you to it. Or, Julie McKinney -- perhaps you would like to let everyone here know about that resource here.

Where do most programs get their referrals from? Where do they get there students? Would you recommend I 
spend a small portion of the budget on printing materials and create brochures or bookmarks to leave in
 local medical offices? Where do you get your students from?

There are lots of ways that literacy programs recruit students. I think you mean how do programs get students who are interested in health literacy? As you suggested, start with those currently enrolled in the literacy program. Form a group. Have them identify how to reach others in their community/ies or neighborhoods. The group could develop a flyer together that they could post in local health clinics, religious organizations, supermarkets and food co-ops, child care centers, and in other places that group members know about. You could keep track of how people heard about the "community health outreach group" (or whatever the students want to call it) and then target those organizations. As students post flyers in organizations they could ask -- is there someone here I could talk with who might be interested in community health issues, who could get the word out to your clients?

One more thing, You may be able to get a small grant ($5,000-$20,000) to support some of this work -- to pay the adult learners stipoends who invest their time in these projects and produce results. You could look for local or state foundations who have a focus on health literacy, community health or disease prevention, possibly on prevention of a particular disease for which community outreach programs are funded.

I hope others reply to your questions, too. It sounds like an exciting opportunity for you and others whom you will be working with..

David J. Rosen

djrosen123@gmail.com

Julie McKinney's picture
One hundred

I think David was referring to this compendium:

Family Health and LIteracy: A Guide to Easy-to-
Read Health Education Materials and Websites for Families

You can find it here:

http://www.healthliteracy.worlded.org/docs/family/

Or print out a PDF version:

http://www.healthliteracy.worlded.org/docs/family/fhl.pdf

 

It is also found under "Teaching Heatlh by Topic" in

The Health Literacy Speical Collection

http://www.healthliteracy.worlded.org

Helene Fisher's picture
First

Hi.  Anna Allen, Co-Founder of Say Ah!, has developed a health literacy curriculum that can be incorporated into ABE and ESOL lesson plans.  We have presented the curriculum a few times now and have gotten very good feedback.  To learn more, please contact Anna at allen@say-ah.org

 

 

J. Peterson's picture
First

We have a representative out in the community giving a health literacy presentation to medical staff and support personnel at private medical offices, clinics, and a local hospital.  The presentation is based on the AMA workshop "Help Patients Understand." Physicians are informed on how best to communicate with low literate adults and are encouraged to refer patients to our health literacy classes.

millercl's picture
First

Hello Glenn,

I am an occupational therapist, practicing for nearly 30 years in South Florida. I am also the National Director of Therapy Operations for HealthSouth. We are a rehabilitation hospital corporation with 100 hospitals in the US and in Puerto Rico. I have been studying health literacy for the last several years as it pertains to healthcare providers in physical rehabilitation. We recently launched clinicians training related to the assessment and interventions related to health literacy. One of the assessments we used to assess health literacy levels in our clients is the Newest Vital Sign. This assessment fits within the domain of occupational therapy and our inpatient physical rehabilitation setting. It is a functional assessment, and only takes minutes to administer.  

This assessment requires a client to read an ice cream nutritional label and then answer health related questions related to the label interpretation. You can obtain the assessment tool and administration instructions on the internet. Several studies are listed below that support the use, reliability, validity etc.

Hope this may help!

Cheryl

Heinrich, C. (2012). Health literacy: the sixth vital sign. Journal of the American Academy of Nurse Practitioners, 24(4), 218-223. doi: 10.1111/j.1745-7599.2012.00698.x

Osborn, C. Y., Weiss, B. D., Davis, T. C., Skripkauskas, S., Rodrigue, C., Bass, P. F., & Wolf, M. S. (2007). Measuring adult literacy in health care:  Performance of the newest vital sign. American Journal of Health and Behavior, 31, S36-S46.

Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., . . . Hale, F. A. (2005). Quick assessment of literacy in primary care: the newest vital sign. Annals of Family Medicine, 3(6), 514-522. doi: 10.1370/afm.405

millercl's picture
First

Hello Glenn,

I am an occupational therapist, practicing for nearly 30 years in South Florida. I am also the National Director of Therapy Operations for HealthSouth. We are a rehabilitation hospital corporation with 100 hospitals in the US and in Puerto Rico. I have been studying health literacy for the last several years as it pertains to healthcare providers in physical rehabilitation. We recently launched clinicians training related to the assessment and interventions related to health literacy. One of the assessments we used to assess health literacy levels in our clients is the Newest Vital Sign. This assessment fits within the domain of occupational therapy and our inpatient physical rehabilitation setting. It is a functional assessment, and only takes minutes to administer.  

This assessment requires a client to read an ice cream nutritional label and then answer health related questions related to the label interpretation. You can obtain the assessment tool and administration instructions on the internet. Several studies are listed below that support the use, reliability, validity etc.

Hope this may help!

Cheryl

Heinrich, C. (2012). Health literacy: the sixth vital sign. Journal of the American Academy of Nurse Practitioners, 24(4), 218-223. doi: 10.1111/j.1745-7599.2012.00698.x

Osborn, C. Y., Weiss, B. D., Davis, T. C., Skripkauskas, S., Rodrigue, C., Bass, P. F., & Wolf, M. S. (2007). Measuring adult literacy in health care:  Performance of the newest vital sign. American Journal of Health and Behavior, 31, S36-S46.

Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., . . . Hale, F. A. (2005). Quick assessment of literacy in primary care: the newest vital sign. Annals of Family Medicine, 3(6), 514-522. doi: 10.1370/afm.405

J. Peterson's picture
First

We have used the Newest Vital Sign too but also promote an even quicker assessment that I discovered in an old New England Journal of Medicine article. The article mentions how a doctor shows her patients a prescription bottle and says "this is not your medication, but if it were how would you take it?" This very quick assessment is now being routinely used in a busy clinic in our area. I suspect more will start using it as well.

http://www.nejm.org/doi/full/10.1056/NEJMp058328

McComasG09's picture
First

I just wanted to thank everyone for all trhe great resources you are posting in here. I haven't commented often but I check the discussion daily and have been going through all the links posted. I am now spending the majority of my time searching for the education materials and sample curricula for adult health literacy and ESOL. Thanks again and keep them coming! 

McComasG09's picture
First
Things have changed for me a little bit, I was recently accepted to a physical therapy graduate program that begins at he end of the summer so I will not be here as long as I would have liked to, to help transition the next intern. Also, after an abundance of research these last few weeks I have realized my original vision is not nearly the same as where I see this program going now.

Originally I wanted model the Health Literacy program after the ABE and ESL program we have here now with an intake assessment, one-on-one tutoring and then another assessment to measure outcomes for grant money threw NCCCS. Recently, I learned the NRS does not have any approved health literacy assessment there for our program is going to have to be fully funded by private grants. With there being no approved assessment I no longer really see a true purpose to assess every new student, I will though, gather all the free assessments I can find to have them on hand as every situation is different and our tutors may need one, or find one useful to gauge the student.

With no longer having an assessment my new dilemma is researching good education materials to utilize in the tutoring process. This is an ongoing process but I have received great resources form this discussion. I have also contacted several other Health Literacy centers and departments all over the country to find out which materials they are using. I have gathered this data and it has been taking longer then I thought to comb threw the materials and decides whats best to spend our starting budget on while also organizing the free materials. I am always looking for new or different materials so if you know of something that is not already posted in this discussion feel free to post it or email it to me?

Literacy Volunteers-Pitt County is in state of drastic change right now as we just got a new Executive Director 4 Months ago, and new Program Director just 2 weeks ago. This new Program Director here is doing a great job to clean things up and organizing the center, and making the orientation and tutor matching process much more efficient. In the orientation process for the students the program director is identifying goals of the student on a goals list, on this list there is a section for "Health" and "Food". My plan is from here on out to add about an hour of health literacy and health education to tutor training so that the tutors can address the students they are paired with that identify health literacy related goals. These are the regular math and english tutors, and I want to have them address the students who come in with primarily math, english, or ESL goals and Health Literacy as secondary goals.

I have networked with the local University (ECU) and have been told by the internship coordinator over at the College of Health and Human Performance that we will be receiving at least one Health Education major "Pre-Intern" each semester. These "Pre-interns" are responsible for working 100 hours throughout the semester at their assigned internship location and I want to have them work with students who come in with only health literacy goals and not the students who come in for math and english. I am also working with the internship adviser to get LV-PC added to the preferred internship list for interns wishing to stay in Greenville. Students like me must complete a 12-week 40 hour per week internship in order to complete our degree, this internship is worth our final 12 credits before graduation. 

My plan is to utilize the "Pre-interns" or "100 hour interns" as health education and literacy tutors and to create workshops or seminars, at least one per semester, to help recruit and involve new and existing health literacy students. For the full-time interns "480 hour interns", the plan is to have them continue to help sustain the program via private funding, basically searching and writing grants, as well as aiding in networking with community medical resources and helping to advance the program in way necessary, such as finding new assessments, education materials, and networking partners that can refer future students.

I am also working on networking and finding "referral" sources so future students can know of the health literacy program/ resource we have available too them. I have been having trouble finding out where the population we are looking to help seeks medical attention besides the local Emergency Room. There is one local clinic I know of that one of my colleagues is interning at, and I have reached out to him, so hopefully we can partner with them. What I mean by that is have them send over patients they believe are at risk or have low health literacy. I'm really counting on this clinic also referring me to other clinics that our target population may seek medical attention and connect with them as well.

This is the first time I have really written my plans out for the program, please let me know what you think and I would really appreciate any advice, or tips you have. Just let me know if you believe I am on the right track and if you have tried anything in the above that was unsuccesful. 

Thanks so much in advance! Have a great day!