Can You Hear Me Now?: Strategies to Provide Clear Health Messages to Diverse Older Adults

Publication ID Published Volume
9434 June 5, 2013 9

Abstract

This health communications activity was initially developed for the “Geroskills Workshop”. The workshop is a campus-wide initiative supported by the Geriatrics and Gerontology Education and Research Program (GGEAR) and geriatrics faculty representing the 6 professional schools on the University of Maryland, Baltimore campus. The workshop is offered each semester with the goal of increasing student interest in geriatrics and exposing health profession and law students to different skills needed to care for older adults. The goal of the health communications activity is to increase student awareness of low health literacy in the geriatric population and introduce or reinforce universal strategies to facilitate clear health communicate with this population.

The activity is designed to be an interdisciplinary small group discussion. This format allows students to gain an appreciation of other professional perspectives related to the barriers and best practices of health communication. The students also learn to use different strategies based on setting and structure of healthcare team. There are no pre-requisites for this activity and it serves as an excellent introductory module to an entry level didactic course or clinical rotation. The level of complexity of the discussion can easily be adjusted based on the allotted time and student level of training. The activity may also be used as a refresher for health care teams currently in practice.

In a report done by Xakellis et. al., the authors build a compelling case for integrating cultural competency training for healthcare professionals working with older adults into the curriculum. As part of the core competencies for caring for diverse older adults the authors describe the attitudes, knowledge and skills of a culturally competent health care professional. Several educational strategies recommended to begin developing these competencies during health care professions training include using case illustrations of complex issues of cultural competency in geriatrics, involve students in interactive case studies, and develop introductory cultural competency workshops. This workshop uses several of these education strategies to promote change in attitudes, knowledge and skills of health care profession students when caring for diverse older adults. The video discussion challenges students’ perceptions of how a patients with low health literacy “looks”. Then through the discussion of the patients in the video students are able to identify red flags of low health literacy while avoiding stereotypes and generalizations. Reviewing and discussing how to implement specific health communication strategies in the “Universal Precautions Toolkit” increases students’ knowledge of appropriate health communication strategies and can have an immediate impact on their communication skills.

This activity supports developing students interprofessional competencies as described in the “Core Competencies for Interprofessional Collaborative Practice” (IPEC 2001) and the “Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree” (AGS 2008). This workshop activity addresses competency domains 1, 3 and 4 of the IPEC core competencies. The activity fosters interprofessional values and ethics related to patient centered communication (competency domain 1) and facilitates interprofessional communication (competency domain 3). Through the interprofessional discussion, students are able to gain an appreciation of other professions’ perspective of patient communication and share new ways to implement strategies in different heath care settings to improve overall patient care. This activity fosters positive team dynamics through interprofessional communication and team based problem solving using a patient case scenario. (competency domain 4). The Parternship for Health and Aging expands the scope of interdisciplinary and team care competencies to include the ability to facilitate communication with older adults and their caregivers in addition to other members of the healthcare team. This patient case scenario highlights the unique healthcare team dynamics when caring for diverse older adults. The students need to take the older adult’s family dynamics and support systems into consideration when developing a communication strategy.

Participant Feedback:
Level 1 evaluations were completed each time the activity was presented. The students filled out presenter evaluations for each session they attended at the Geroskills Workshop. However, there was not a 100% return rate by all students although this was encouraged after each session. Of the 30-35 students that attended the health literacy session, 20 evaluations were returned. The feedback from the students indicated that the facilitator and activity format were engaging and the AMA video enhanced the presentation. All three areas received strongly agrees (18-19 of 20 students rated these areas as strongly agree). Other feedback indicated that some students did not think that 30 minutes was enough time to cover the topic, which may be considered positive feedback (3 of 20 students rated this as either neutral or disagree). The activity was designed to be an introduction to the topic but can be easily adjusted to be longer by including a team based case discussion. Other feedback was related to venue and convenience of time which received mixed feedback (5-6 of 20 students rated these areas from disagree to agree). This suggests that the venue and timing of the activity for students is an important consideration when planning. However, compared to the high rate of agreement received for the activity this did not seem to hamper their ability to be engaged with the activity. Additional students comments were all positive and indicated that the topic was timely, relevance to their current and future practice. There was also comment that expressed appreciation for the patient testimonial video, saying “I enjoyed the video- it really made the problem real.”

For the continuing education presentation, there was at least a 98% response rate because evaluations were required for continuing educations credit. There were 48 evaluations returned for the health literacy presentation. 87% of participants strongly agreed and the remainder agree that the discussion was meaningful, instructive and engaging. There was a slightly lower rate of agreement with 1 hour being enough time to cover the topic (19% of respondents either agreed or were neutral) . Again this was received as a positive response since most agreed that it was enough time but may not be ideal to cover the topic in depth. One potential reason for the desire for additional time was expressed in the written comments. Several respondents said that they would have liked to spend more time doing small group case studies. Similar to the students feedback, the additional comments from the health care professionals were all positive. Several expressed a committed to make a behavioral change after the presentation (eg. change approach to patient education). Others expressed that the discussions opened their eyes to the issue and recognizing that poor health communication among staff is an issue where they practice. The participants feedback about the venue was more positive for the continuing education presentation compare to the students. The participants enjoyed the small group, round table format with easy accessibility to the facilitators.


Citation

Agness C, Fletcher S, Koo L, Cornman R. Can you hear me now?: strategies to provide clear health messages to diverse older adults. MedEdPORTAL Publications. 2013;9:9434. http://doi.org/10.15766/mep_2374-8265.9434

Contains Information Suitable for Patient Education

Educational Objectives

  1. Recognize "red flags" of low health literacy in older adults.
  2. Describe barriers to clear health communication during a patient-provider encounter.
  3. Describe universal strategies to facilitate clear health communication.
  4. Given a patient case scenario, recommend a patient specific strategies to facilitate communication and understanding of health information.
  5. Identify at least 1 strategy from the Health Literacy Universal Precautions Toolkit that you can put into practice.

Keywords

  • Health Knowledge, Attitudes, Practice, Health Literacy, Cultural Competency, Physician-Patient Relations, Interdisciplinary Communication, Geriatrics, Older Adults, Education, Interprofessional Relations, Health Equity Research

References

  1. Kutner M, Greenberg E, Baer J. A First Look at the Literacy of America's Adults in the 21st Century. NCES 2006-470. National Center for Education Statistics. ED Pubs, P.O. Box 1398, Jessup, MD 20794-1398. Available from: http://www.eric.ed.gov.proxy-hs.researchport.umd.edu/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED489066. Accessed August 29, 2012. 
  2. Gazmararian JA, Baker DW, Williams MV, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999;281:545-551. http://dx.doi.org/10.1001/jama.281.6.545
  3. Sudore RL, Mehta KM, Simonsick EM, et al. Limited literacy in older people and disparities in health and healthcare access. J Am Geriatr Soc. 2006;54:770-776. http://dx.doi.org/10.1111/j.1532-5415.2006.00691.x
  4. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31 Suppl 1:S19-26. http://dx.doi.org/10.5993/ajhb.31.s1.4
  5. Brach C, Dreyer B, Schyve P, et al. Attributes of a health literate organization: A discussion paper. (2012) Workgroup on attributes of a health literate organization of the IOM Roundtable on health literacy Available from: http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdf: Accessed August 29, 2012. 
  6. American Medical Association Foundation 2007 Health Literacy Program Video:
"Health literacy and patient safety: Help patients understand". Available at: www.amafoundation.org/go/healthliteracy. Accessed August 29, 2012. 
  7. Health Literacy Universal Precautions Toolkit. AHRQ Publication No. 10-0046-EF, April 2010. Rockville, MD: Agency for Healthcare Research and Quality. Available from: http://www.ahrq.gov/qual/literacy/index.html. Accessed August 29, 2012 
  8. Xakellis G, Brangman SA, Hinton WL, et al. Curricular framework: core competencies in multicultural geriatric care. J Am Geriatr Soc. 2004;52:137-142. http://dx.doi.org/10.1111/j.1532-5415.2004.52024.x
  9. Interprofessional Education Collaborative Expert Panel (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.:Interprofessional Education Collaborative. 
  10. Partnership for Health in Aging. Multidisciplinary competencies in the care of older adults at the completion of the entry- level health professional degree. (2010) American Geriatrics Society. Available from: www.americangeriatrics.org/pha. Accessed August 29, 2012. 
  11. Agness, C., Cornman R. Health literacy: Strategies to communicate clear health messages to diverse older adults. Geroskills Workshop. October 2011. University of Maryland, Baltimore. Baltimore, MD. 
  12. Agness, C. Can you hear me now? Strategies to communicate clear health message to diverse older adults. Guiding the way through geriatric challenges: Geriatric Symposium. April 2012. Easton, MD. 

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ISSN 2374-8265