HL is defined as "the knowledge, motivation and skills of individuals to access, understand, evaluate and apply information related to health care, disease prevention and health promotion" (World Health Organization, 2013).
Citizens’ low-level HL is associated with longer hospitalization, frequent visits to general practitioners, frequent ambulance tranfer, more psychiatric counseling sessions and more referrals to day clinics (Vandenbosch et al., 2016). People with low levels of HL are less likely to follow preventive practices, do not comply with therapeutic plans, make increased use of health care services, and comprise economic burden to the health care system (Doyle et al., 2017; Howard et al., 2005). There is lack of HL research in Greece. In the HLS-EU study, one of the most prominent ones, 45% of the participants reported low level of HL.
According to the WHO, the strengthening of the HL of the general population is a multifactorial process in which health care users, health care services and health professionals participate. Health professionals in Greece do not know the concept and meaning of HL, although they have to cope with its consequences, such as non-adherence by older people with therapy and medication. Older healthcare users often face difficulty in communicating with health professionals. They often do not understand the instructions and professionals do not give them the time and space they might need, but they rather treat them with disrespect and using medical jargon (Efthymiou et al., 2022). Misunderstandings are frequently developed in the health care service that negatively affect the care of patients and their compliance with treatment. HL skills in the services also involve the communication that takes place at the front desk (reception) or the forms that a patient needs to fill in (Brach et al, 2012). It has been reported that 24-85% of all side effects could have been avoided (Rao & Polit, 2014) if primary care would be strengthened. In Greece, according to recent data, health professionals have positive attitudes about practices that promote patient safety, although some areas such as education, communication of medical error, communication skills are lagging (Antonakos et al, 2021).
Method of design and implementation
This project is a postdoctoral study by Ms. Efthymiou, funded by the Hellenic Mediterranean University (ELMEPA), under the supervision of Dr. Argyroula Kalaitzaki, Associate Professor of the Department of Social Work of ELMEPA.
Initially, the research team was created, responsible for the adaptation and development of the toolkit.
The program follows a 3-phase methodology:
1) "Need identification and tools search": (a) a literature review was carried out to search for available tools related to enhancement of HL and (b) assessment of the needs of health professionals and the elderly through two focus groups. The groups were conducted online due to the pandemic restrictions and in collaboration with organizations such as Οpen Protection Centers for the Elderly (KAPI), Dementia Counseling Centers and the University of the Elderly (from which elders and professionals were recruited to participate in the focus groups).
2) "Development of a toolkit to identify and enhance HL ": It included (a) selection of already available tools was made and (b) development of new tools (training modules and evaluation forms). The tools were culturally adapted with the help of a team of experts in the field of HL (Academics and professionals).
3) "Pilot implementation of the toolkit": It included (a) online training (webinars) of health professionals from various regions of Greece and (b) application of the tools by professionals for a period of 2 months. Evaluation and focus groups followed aiming to improve the content of the toolkit. This phase will be completed by August 2022.
Originality and Innovation
The program is a social innovation. The toolkit is an original idea successfully piloted.
The low level of HL results in misunderstandings of the medical information (e.g., vaccination) circulated through the media (television, newspapers, internet). Older adults with a low HL level are unable to assess and the medical information they receive. The role of the health professionals is to inform older health care users in a way to understand and evaluate health information and services and to implement preventive measures for their health
The innovation of the program is based on the training of health professionals to identify and empower older adult users with low HL using a range of techniques and tools that have been developed for this purpose.
The program creates a network with health professionals that aims to strengthen the HL of their organizations as "Certified Health Literacy Organisations" and the training of their colleagues (train the trainers).
Reproducibility
The philosophy of the program is based on training the trainers. Health professionals are taking on the role of the trainer in their service and create a network of health professionals-colleagues to promote practices for services that promote and strengthen users’ HL.
