Using adult learning theories to
build patients’ and families’
knowledge of CVD medicines
Susan Reid
Wisconsin Health Literacy Summit
14 April 2015
Session objectives
• By the end of this workshop you will have learnt:
• how adult learning theories, schema theory, coconstruction of knowledge and Vygotsky’s Zone
of Proximal Development relate to health literacy
interventions
• how these theories informed the development of
a health literacy intervention about CVD
medicines knowledge
• results of the intervention
Summary of CVD medicines project
Aims
• Develop a customised, structured CVD medicines
health literacy programme
• Trial this in indigenous primary care services:
• Primary outcome - CVD medication knowledge
• Secondary outcomes - changes in health literacy
skills and practices
Programme description
Phase 1 programme
• In-depth interviews with nine patients and families
showed they had limited knowledge but were keen
to know more
• Training for research nurses
• Written resource for patients
• Interactive app for use in sessions
• Three step health literacy model – Ask, Build,
Check
Phase 2: trialling the intervention
• Full protocol available:
• Crengle et al. BMC Public Health 2014, 14:714
www.biomedcentral.com/1471-2458/14/714
• Three sessions over one month
• Outcome assessments before and after each
session
• Structured process for doing outcome assessments
The participants
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Eligibility – CVD diagnosis and taking at least 2 of 4 medicines
96 participants
Mean age 64.3 years (range 41-87 years)
Females 58.2%
Statins 91.7%
ACE inhibitors 61.5%
Beta blockers 71.9%
Aspirin 85.4%
Angina 60.2%
MI 52.0%
TIA 10.4%
CVA 25.8%
Mean years with CVD 7.2 years
Comorbidities common:
• Diabetes 39.3%
Gout 33.3%
• COPD 24.4%
CHF 24.1%
Data collected March to August 2013 at Ngati Porou Hauora (rural) and Te Hononga o Tāmaki me Hoturoa (urban)
The constraints and opportunities
• One off training session for research nurses
• New way of thinking – Ask, Build, Check needs lots
of practice
• New way of thinking – shift from telling to other
methods of teaching
• No opportunity for coaching except inter-rater
reliability sessions
Three steps to better health literacy
What we often observe
1.
2.
Assume
Tell
3.
Assume
Step 1
Ask people what
they know, do and
believe
This is the most important step and easiest step
Step 1: Prior knowledge
Schema theory
Everyone relates new knowledge to what they already
know or have experienced
Content schema
knowledge of the world
Textual schema
knowledge of how texts are
organised
Co-construct knowledge
Step 2
Build health literacy
skills and knowledge
and link them to what
people already know
We think health professionals do some of this already
Zone of Proximal Development
Working in the ZPD
Step 2: Build health literacy
Use a range of different strategies not just telling
• Modelling
• Discussion
• Explaining
Prompting
Questions
Giving feedback
Remember to link new information to what people
already know
Example of prompting
Video
Step 3
Check you were
clear (and, if not, go
back to Step 2)
This is the hardest step and needs the most practice
Step 3: Check you were clear
• It is the nurse’s responsibility to be clear
• Used open and closed questions and prompting
during outcome assessments:
• “Tell me what you know about your statin”
• “Ok now what are the serious side effects that
you need to tell us about straightaway?”
Results
Specific knowledge for each prescribed
medicine type
100%
100%
100%
100%
100%
99%
80%
60%
59%
40%
32%
26%
20%
10%
2%
0%
Knows name
Before
Knows why take
After Session 1
Knows instructions
After Session 2
Knows side effects
After session 3
Knows treatment targets
Prompting vs spontaneous correct
answers
Mean number of prompts by nurse or whānau during education session
12
10
8
6
4
2
0
Statin
ACEI
Pre Sess 1
BB
Post 1Sess
Session 2
Session 3
Aspirin
Health literacy practices - resources
Use of resources during outcome assessments
100%
80%
60%
40%
20%
0%
Pre Sess 1
Pre Sess 2
Own info
Pill card
Pre Sess 3
Booklet
Acknowledgements
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New Zealand researchers included Dr Sue Crengle, Michelle
Lambert, Dr Matire Harwood (University of Auckland); Susan Reid
(Workbase Education Trust); Jennie Harre-Hindmarsh, Julia
Brooking, Moko Williams (Ngati Porou Hauora); Marian Hakaraia,
Lisa Reddy (Te Hononga o Tamaki me Hoturoa)
We acknowledge the support of all the participants and their families
who took the time to be involved in this project
Funding for this project was provided by the Health Research Council
of New Zealand
Part of ICIHRP programme funded in New Zealand, Australia
(University of Victoria & Victorian Aboriginal Health Services) and
Canada (St Michaels Hospital, Toronto & De dwa da dehs nye>s
Aboriginal Health Centre, Hamilton)
www.healthliteracy.org.nz
[email protected]