Qualitative Insights into the Experience of Teaching Shared Decision Making Within Adult Education Health Literacy Programmes for Lower-literacy Learners

Overview

Journal Health Expect

Publisher Wiley

Specialty Public Health

Date 2017 Jul 6

PMID 28678433

Citations 9

Authors

Danielle M Muscat

Suzanne Morony

Sian K Smith

Heather L Shepherd

Haryana M Dhillon

Andrew Hayen

Lyndal Trevena

Karen Luxford

Don Nutbeam

Kirsten J McCaffery

Affiliations

Soon will be listed here.

Abstract

Background: Enhancing health literacy can play a major role in improving healthcare and health across the globe. To build higher-order (communicative/critical) health literacy skills among socially disadvantaged Australians, we developed a novel shared decision making (SDM) training programme for adults with lower literacy. The programme was delivered by trained educators within an adult basic education health literacy course.

Objective: To explore the experience of teaching SDM within a health literacy programme and investigate whether communicative/critical health literacy content meets learner needs and teaching and institutional objectives.

Design And Participants: Qualitative interview study with 11 educators who delivered the SDM programme. Transcripts were analysed using the Framework approach; a matrix-based method of thematic analysis.

Results: Teachers noted congruence in SDM content and the institutional commitment to learner empowerment in adult education. The SDM programme was seen to offer learners an alternative to their usual passive approach to healthcare decision making by raising awareness of the right to ask questions and consider alternative test/treatment options. Teachers valued a structured approach to training building on foundational skills, with language reinforcement and take-home resources, but many noted the need for additional time to develop learner understanding and cover all aspects of SDM. Challenges for adult learners included SDM terminology, computational numerical risk tasks and understanding probability concepts.

Discussion And Conclusions: SDM programmes can be designed in a way that both supports teachers to deliver novel health literacy content and empowers learners. Collaboration between adult education and healthcare sectors can build health literacy capacity of those most in need.

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Skills for Shared Decision-Making: Evaluation of a Health Literacy Program for Consumers with Lower Literacy Levels.

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Evaluation of an Australian Health Literacy Program Delivered in Adult Education Settings.

McCaffery K, Morony S, Muscat D, Hayen A, Shepherd H, Dhillon H Health Lit Res Pract. 2019; 3(3 Suppl):S42-S57.

PMID: 31687657 PMC: 6826892. DOI: 10.3928/24748307-20190402-01.

References

Shepherd H, Barratt A, Trevena L, McGeechan K, Carey K, Epstein R . Three questions that patients can ask to improve the quality of information physicians give about treatment options: a cross-over trial. Patient Educ Couns. 2011; 84(3):379-85. DOI: 10.1016/j.pec.2011.07.022. View

Koh H, Berwick D, Clancy C, Baur C, Brach C, Harris L . New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care'. Health Aff (Millwood). 2012; 31(2):434-43. PMC: 5102007. DOI: 10.1377/hlthaff.2011.1169. View

Haun J, Patel N, French D, Campbell R, Bradham D, Lapcevic W . Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study. BMC Health Serv Res. 2015; 15:249. PMC: 4482196. DOI: 10.1186/s12913-015-0887-z. View

Berkman N, Sheridan S, Donahue K, Halpern D, Crotty K . Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011; 155(2):97-107. DOI: 10.7326/0003-4819-155-2-201107190-00005. View

Freedman A, Miner K, Echt K, Parker R, Cooper H . Amplifying diffusion of health information in low-literate populations through adult education health literacy classes. J Health Commun. 2011; 16 Suppl 3:119-33. DOI: 10.1080/10810730.2011.604706. View

Joseph-Williams N, Edwards A, Elwyn G . Power imbalance prevents shared decision making. BMJ. 2014; 348:g3178. DOI: 10.1136/bmj.g3178. View

Morony S, Lamph E, Muscat D, Nutbeam D, Dhillon H, Shepherd H . Improving health literacy through adult basic education in Australia. Health Promot Int. 2017; 33(5):867-877. DOI: 10.1093/heapro/dax028. View

McCaffery K, Morony S, Muscat D, Smith S, Shepherd H, Dhillon H . Evaluation of an Australian health literacy training program for socially disadvantaged adults attending basic education classes: study protocol for a cluster randomised controlled trial. BMC Public Health. 2016; 16:454. PMC: 4884424. DOI: 10.1186/s12889-016-3034-9. View

Nutbeam D . The evolving concept of health literacy. Soc Sci Med. 2008; 67(12):2072-8. DOI: 10.1016/j.socscimed.2008.09.050. View

10.

Muscat D, Morony S, Shepherd H, Smith S, Dhillon H, Trevena L . Development and field testing of a consumer shared decision-making training program for adults with low literacy. Patient Educ Couns. 2015; 98(10):1180-8. DOI: 10.1016/j.pec.2015.07.023. View

11.

Muscat D, Morony S, Smith S, Shepherd H, Dhillon H, Hayen A . Qualitative insights into the experience of teaching shared decision making within adult education health literacy programmes for lower-literacy learners. Health Expect. 2017; 20(6):1393-1400. PMC: 5689229. DOI: 10.1111/hex.12580. View

12.

Janamian T, Jackson C, Dunbar J . Co-creating value in research: stakeholders' perspectives. Med J Aust. 2014; 201(3 Suppl):S44-6. DOI: 10.5694/mja14.00273. View

13.

Weiss B, Mays M, Martz W, Castro K, DeWalt D, Pignone M . Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005; 3(6):514-22. PMC: 1466931. DOI: 10.1370/afm.405. View

14.

Galesic M, Garcia-Retamero R, Gigerenzer G . Using icon arrays to communicate medical risks: overcoming low numeracy. Health Psychol. 2009; 28(2):210-6. DOI: 10.1037/a0014474. View