Health literacy competency requirements for health professionals: a Delphi consensus study in Taiwan.

BACKGROUND: Cumulative evidence supports the importance of health literacy in determining the quality of healthcare delivery and outcomes. To enhance health literacy competencies among professionals and alleviate healthcare barriers owing to patients' inadequate health literacy, evidence-based health literacy competency guidelines are needed for the development of health professionals' training curricula. The aim of this study was to validate and refine a set of health literacy competencies, including knowledge, attitude, and skills of health professionals, and to prioritize the importance of health literacy practices among healthcare professionals. METHODS: We employed a consensus-building approach that utilized a modified three-round Delphi process conducted in 2017. An online Delphi panel was assembled, comprising 20 Taiwanese health literacy experts from diverse fields such as medicine, nursing, public health, language, and communication. A set of health literacy competencies previously identified and validated by an international panel of health literacy experts was cross-culturally translated. RESULTS: After three rounds of ratings and modifications, a consensus agreement was reached on 42 of 62 health literacy competencies, including 12 of 24 knowledge items, 9 of 11 attitude items, and 21 of 27 skill items. Of the 32 health literacy practices, "avoidance using medical jargon," "speaking slowly and clearly with patients," and "using analogies and examples" were deemed most important by the panelists. CONCLUSIONS: The Delphi panel's consensus helped to identify a set of core health literacy competencies that could serve as measurable learning objectives to guide the development of a health literacy curriculum for health professionals. The prioritized health literacy practices can be employed as indicators of health literacy competencies that health professionals should learn and routinely use in clinical settings.

Health Literacy and Systemic Racism-Using Clear Communication to Reduce Health Care Inequities.

This Viewpoint describes why people need health information that is easy to understand to make informed decisions about health care and why this is necessary to avoid systemic racism.

"What Questions Do You Have?": Teaching Medical Students to Use an Open-Ended Phrase for Eliciting Patients' Questions.

Patients frequently do not understand health information received in clinical settings, yet rates of question-asking by patients are low, particularly for patients with lower health literacy skills. Experts recommend that health care professionals attempt to elicit patients' questions by using an open-ended phrase, such as "What questions do you have?" as opposed to a closed-ended phrase like, "Do you have any questions?" We compared question-eliciting techniques used during video-recorded observed structured clinical examinations among medical students who had completed a mostly didactic curriculum on health literacy and clear communication (n = 46) to students who completed a newer longitudinal problem-based communication curriculum (n = 32). Students were not aware that they were being observed for specific communication skills. Compared to controls, students in the intervention group were more likely to spontaneously attempt to elicit questions from a standardized patient (65.2% vs. 84.4%, p = .06), and were significantly more likely to use an open-ended phrase to do so (6.7% vs. 51.9%, p = .0002). The longitudinal communication skills curriculum was successful in creating long-term patient-centered question-eliciting habits. Further research is needed to determine whether eliciting questions with an open-ended technique result in patients asking more or different clarifying questions during the closing phase of clinical encounters. [HLRP: Health Literacy Research and Practice. 2022;6(1):e12-e16.].

Prioritized Health Literacy and Clear Communication Practices For Health Care Professionals.

BACKGROUND: Health care professionals need more and better training about health literacy and clear communication to provide optimal care to populations with low health literacy. A large number of health literacy and clear communication practices have been identified in the literature, but health professions educators, administrators, and policymakers have lacked guidance regarding which practices should be prioritized among members of the health care workforce. OBJECTIVE: This study sought to prioritize recommended health literacy and clear communication practices for health care professionals. METHODS: A Q-sort consensus method was used among 25 health literacy experts to rank a previously identified list of 32 health literacy and clear communication practices for health care professionals. Mean ratings for each of the 32 practices were compared using t-tests. KEY RESULTS: Mean ratings for the 32 practices fell along a spectrum from higher to lower importance. The eight top-rated practices formed a cluster, and seven of these items demonstrated clear consensus, whereas one item may have been influenced by one or more outlier rankings. CONCLUSIONS: Although a large number of health literacy and clear communication practices have been recommended in the literature for health care professionals, this is the first known study to rank such practices in terms of importance. The top-rated items can be considered a core set of practices that all health care professionals should learn and routinely use in clinical settings. These consensus opinion results will help health professions educators, administrators, and policymakers to direct potentially limited resources toward improving training in patient-centered communication, and when designing curricula, practice standards, care delivery models, and policies for health care professionals and systems to improve patient outcomes. Future studies should empirically confirm the relative value of the ranked items in terms of patient-centered outcomes. [Health Literacy Research and Practice. 2017;1(3):e90-e99.]. PLAIN LANGUAGE SUMMARY: This is the first study to rank the most important things that health care workers can do to communicate more clearly with patients. A group of 25 experts ranked 32 items in order of importance. The list can be used to improve training for health care workers.

Long-term Effects of a Health Literacy Curriculum for Family Medicine Residents.

INTRODUCTION: Improving education about health literacy for health care professionals has been recommended, and many US family medicine residency programs have developed such curricula. Few studies have evaluated the effectiveness of health literacy curricula for health care professionals. This pilot study aimed to determine whether a longitudinal health literacy curriculum for family medicine residents could achieve long-term sustained improvements in health literacy knowledge and clear communication practices. METHODS: Self-reported pre- and postassessments were conducted for a series of four health literacy didactic and experiential trainings over 11 months with a cohort of 12 first-year family medicine residents (study adequately powered for cohort of 10 or more). RESULTS: Five out of five health literacy knowledge items showed sustained significant improvement immediately after the initial didactic training. Two out of eight clear communication behaviors (eliciting patients' questions through an open-ended approach, and using a teach-back method to check for patients' understanding) showed sustained significant improvements in the 11-month follow-up period. The remaining six behaviors demonstrated a saw-tooth pattern, wherein each training session produced improvements in planned behaviors, which were, however, not maintained at subsequent follow-up assessments. CONCLUSIONS: These data suggest that residents learned the cognitive material related to health literacy and clear communication easily, but had difficulty integrating many trained skills into clinical practice, despite the use of experiential learning techniques. Future studies should use an observational design to assess clear communication behaviors, and should include assessment of potential barriers to implementing clear communication skills in clinical practice.

What do health literacy and cultural competence have in common? Calling for a collaborative health professional pedagogy.

Limited health literacy is recognized as contributing to racial/ethnic and other health disparities through mechanisms of poor understanding and adherence, as well as to limited access to health care. Recent studies have focused on interventions to address literacy gaps between patients and health care providers, focusing on communication techniques and redefining the responsibility for closing gaps. Cultural differences between patient and provider, if left unaddressed, have been shown to contribute to poor health outcomes through misunderstanding, value conflicts, and disparate concepts of health and illness. The dual challenges of limited health literacy and cultural differences are likely to increase with an expanding, increasingly diverse, and older population. There is evidence that training providers to attend to both issues can reduce medical errors, improve adherence, patient-provider-family communication, and outcomes of care at both individual and population levels. The two fields continue to have separate trajectories, vocabularies, and research agendas, competing for limited curricular resources. This article presents a conceptual framework for health professions education that attends simultaneously to limited health literacy and cultural differences as a coherent way forward in training culturally competent providers with a common skill-set to deliver patient-centered care that focuses on health disparities reduction.

Reliability of an individually molded shank shell for measuring tibial transverse rotations during the stance phase of walking.

Use of a shank shell has been shown to estimate tibial transverse rotations better than skin-mounted markers. However, the day-to-day reliability of the transverse tibial rotations using an individually molded shank shell has not been previously investigated. This study examined the between-tests and trials reliability of an individually molded shank shell for measuring peak tibial internal and external rotations, time of peak values, and tibia range of motion during 5 walking trials. The trial-to-trial reliability of tibial transverse rotations was measured in 14 healthy individuals while the test-retest reliability was measured in 10 persons on two occasions. Trial-to-trial reliability for peak transverse rotations, time of peak values, and tibia range of motion ranged from ICC (3,1) 0.59-0.95. The PCA between trials showed that 88-99 % of values were within 3 degrees of agreement. Test-retest reliability for peak rotations, tibia range of motion, and time of peak values ranged from ICC (3,1) 0.70-0.89 with SEM 1.6-2.21 degrees , 0.021 %, and 0.034 %, respectively. The PCA between tests showed that 70-100 % of values were within 3 degrees of agreement. The use of an individually molded shell and the close attachment of the shank shell to the individual's shank resulted in reliable test-retest and trial-to-trial data.