SOCIETY

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 hospital stays, frequent visits to general practitioners, frequent ambulance travel, 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 services, and financially are burdening the health system (Doyle et al., 2017; Howard et al., 2005).

In Greece, there is lack of HL research. One of the most important studies is  the one of the HLS-EU group, where 45%  reported low level of HL.

According to the WHO, the strengthening of the HL of the general population is a multifactorial process in which healthcare service users, health services and health professionals participate.

Health professionals in Greece do not know the concept and meaning of HL, although they are facing with its consequences, such as older people ‘s therapeutic and medical non-adherence. 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, treat them with disrespect, using medical jargon (Efthymiou et al., 2022). Misunderstandings are created in the health service that negatively affect the care of patients and their compliance to treatment. HL at the service level also involves 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 is reported that 24-85% of all side effects could be avoided (Rao & Polit, 2014). In Greece, according to recent data, health professionals have positive attitudes about practices that promote patient safety, although in some areas such as education, medical malpractice communication, communication skills, lag (Antonakos et al, 2021).

Method of design and implementation

This project is postdoctoral research 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) "Identifying the needs and tool search. 

(a) a literature review was conducted to search for available tools to enhance HL and (b) two focus groups of health professionalsb and the older adults. The groups were held online due to the pandemic restrictions and in collaboration with organizations such as Centers for Older Adults Leisure Activities (KAPI), Dementia Counseling Centers and the University of the Older adults (from which seniors and professionals were recruited to participate in focus groups).

2) "Development of a toolkit to identify and enhance HL 

The selection of (a) already available tools was made and (b) the 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 quality of the toolkit contents. This phase was completed in August 2022.

The methodology followed in this third phase had four pillars:

 (a) online training (webinars) of health professionals from various regions of Greece and 

Health professionals were iinvited  to participate through social networks and announcements. The duration of the meetings was 4 hours, with a theoretical and a practical part. At this stage, the tools were evaluated before and after the seminars.

In total, 6 webinars completed: October 20, 2021, October 27, 2021, November 3, 2021, January 26, 2022, March 9, 2022, April 16, 2022

(b) application of the tools by professionals for a period of 2 months. Evaluation and focus groups followed aiming to improve the quality of the toolkit contents. This phase was completed by August 2022.

(c) At the end of the two months, the final evaluation was conducted followed by a focus group aimed at improving the toolkit.

(d) The tools were adapted according to the feedback we received from health professionals.

Originality and Innovation

 The program is a social innovation. The toolkit is an original idea successfully piloted.

The need to enhance the older adults’ HL   became imperative during the pandemic, where they needed to be informed and follow protection measures. The low level of HL affects and leads to misunderstandings of medical information (e.g., vaccination) circulated through various media (television, newspapers, internet). Older adults with a low level HL are unable to evaluate and apply the range of medical information they receive. Thus, we aim at the role of health professionals to enhance the HL skills of the older adults.
The innovation of the program is based on the training of health professionals to identify and empower older adults 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 organisations "Certified Health Literacy Organisations" and the training of their colleagues (train the trainers).

Possibility of reproducing the practice

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 creating a network of health professionals-colleagues to promote practices for services that promote and strengthen user HL.