Community-Based
Health Literacy
Interventions

PROCEEDINGS OF A WORKSHOP

Joe Alper, Rapporteur

Roundtable on Health Literacy

Board on Population Health and Public Health Practice

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and AbbVie Inc.; Aetna Foundation; Agency for Healthcare Research and Quality (HHSP23337024); American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Media; Health Literacy Partners; Health Resources and Services Administration (HHSH25034011T); Humana; Institute for Healthcare Advancement; Merck Sharpe & Dohme Corp.; National Institutes of Health (HHSN26300054); National Library of Medicine; New York University Langone Health System; Northwell Health; Office of Disease Prevention and Health Promotion (HHSP23337043); and UnitedHealth Group. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-46667-7
International Standard Book Number-10: 0-309-46667-9
Digital Object Identifier: https://doi.org/10.17226/24917

Additional copies of this publication are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2018 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Community-based health literacy interventions: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24917.

PLANNING COMMITTEE ON COMMUNITY-BASED HEALTH LITERACY INTERVENTIONS¹

STEVEN TEUTSCH (Chair), Adjunct Professor, Fielding School of Public Health, University of California, Los Angeles

LAURIE FRANCIS, Senior Director of Clinic Operations and Quality, Oregon Primary Care Association

ROMANA HASNAIN-WYNIA, Chief Research Officer, Denver Health

ANDREW PLEASANT, Senior Advisor on Health Literacy Interventions, Research, and Evaluation, Health Literacy Media

EARNESTINE WILLIS, Kellner Professor in Pediatrics, Medical College of Wisconsin

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.

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ROUNDTABLE ON HEALTH LITERACY¹

BERNARD ROSOF (Chair), Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and CEO, QHC Advisory Group, LLC

WILMA ALVARADO-LITTLE, Principal and Founder, Alvarado-Little Consulting, LLC

SUZANNE BAKKEN, Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University

CINDY BRACH, Senior Health Policy Researcher, Agency for Healthcare Research and Quality

GEMIRALD DAUS, Public Health Analyst, Office of Health Equity, Health Resources and Services Administration

TERRY C. DAVIS, Professor of Medicine and Pediatrics, Louisiana State University Health Sciences Center

CHRISTOPHER DEZII, Director, Healthcare Quality and Performance Measures, Bristol-Myers Squibb

JENNIFER DILLAHA, Medical Director for Immunizations, Medical Advisor, Health Literacy and Communication, Arkansas Department of Health

JAMES DUHIG, Head, Risk Communication and Behavioral Systems, Office of Patient Safety, AbbVie Inc.

WILLIAM ELWOOD, OppNet/Health Scientist Administrator, National Institutes of Health

ALICIA FERNANDEZ, Professor of Clinical Medicine, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco

LAURIE FRANCIS, Senior Director of Clinic Operations and Quality, Oregon Primary Care Association

LORI HALL, Director, Health Literacy, U.S. Medical Strategy and Operations, Lilly USA, LLC

LINDA HARRIS, Director, Division of Health Communication and eHealth Team, U.S. Department of Health and Human Services

JOAN KELLY, Chief Patient Experience Officer, New York University Langone Health System

LAURIE MYERS, Global Health Literacy Director, Merck Sharp & Dohme Corp.

CATINA O’LEARY, President and Chief Executive Officer, Health Literacy Media

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.

MARYLYNN OSTROWSKI, Executive Director, Aetna Foundation

MICHAEL K. PAASCHE-ORLOW, Professor of Medicine, Boston University School of Medicine

TERRI ANN PARNELL, Principal and Founder, Health Literacy Partners

KIM PARSON, Strategic Consultant, Proactive Care Strategies, Humana

KAVITA PATEL, Managing Director for Clinical Transformation and Delivery, The Brookings Institution

ANDREW PLEASANT, Senior Advisor on Health Literacy Interventions, Research, and Evaluation, Health Literacy Media

LINDSEY A. ROBINSON, Thirteenth District Trustee, American Dental Association

STACEY ROSEN, Associate Professor of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and Vice President, Women’s Health, The Katz Institute for Women’s Health

RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard T.H. Chan School of Public Health

STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group

MICHAEL VILLAIRE, Chief Executive Officer, Institute for Healthcare Advancement

EARNESTINE WILLIS, Kellner Professor in Pediatrics, Medical College of Wisconsin

AMANDA WILSON, Head, National Network Coordinating Office, National Library of Medicine

MICHAEL S. WOLF, Professor, Medicine and Learning Sciences, Associate Division Chief, Research Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University

WINSTON F. WONG, Medical Director, Disparities Improvement and Quality Initiatives, Kaiser Permanente

Consultant

RUTH PARKER, Professor of Medicine, Pediatrics, and Public Health, Emory University School of Medicine

Health and Medicine Division Staff

LYLA HERNANDEZ, Senior Program Officer

MELISSA FRENCH, Program Officer

ALEXIS WOJTOWICZ, Senior Program Assistant

ROSE MARIE MARTINEZ, Senior Board Director, Board on Population Health and Public Health Practice

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID R. CHALLONER, University of Florida. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.

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Acknowledgments

The sponsors of the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Health Literacy made it possible to plan and conduct the workshop on community-based health literacy interventions, which this publication summarizes. Federal sponsors included the Agency for Healthcare Research and Quality; Health Resources and Services Administration; National Institutes of Health; National Library of Medicine; and Office of Disease Prevention and Health Promotion at the U.S. Department of Health and Human Services. Non-federal sponsorship was provided by AbbVie Inc.; Aetna Foundation; American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Media; Health Literacy Partners; Humana; Institute for Healthcare Advancement; Merck Sharp & Dohme Corp.; New York University Langone Health System; Northwell Health; and UnitedHealth Group.

The roundtable would like to thank each of the moderators, panelists, reactors, and speakers for their time and effort. Moderators, panelists, reactors, and speakers were, in alphabetical order, Cynthia Baur, Cindy Brach, Maureen Daniels, William Elwood, Michele Erikson, Oscar Espinosa, Leslie Gelders, Ariella Herman, S. Marisa New, Catina O’Leary, Andrew Pleasant, Anil Thota, Michael Villaire, Sherrie Flynt Wallington, Earnestine Willis, and Caroline Young.

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Contents

ACRONYMS AND ABBREVIATIONS

1 INTRODUCTION

Organization of the Proceedings of a Workshop

2 PRESENTATION AND DISCUSSION ON THE COMMISSIONED PAPER

Discussion

3 EXAMPLES OF COMMUNITY-BASED HEALTH LITERACY PROGRAMS

Health Literacy in Public Libraries

Cover Missouri’s Community Health Literacy Program

Health Literacy in Head Start Programs

Moderated Panel Discussion

Discussion

4 EVALUATING COMMUNITY-BASED HEALTH LITERACY INTERVENTIONS

Potential Issues and Challenges in Evaluating Community-Based Health Literacy Interventions

Moderated Panel Discussion with Evaluators

Discussion

5 WHERE DO WE GO FROM HERE?

Moderated Dialogue

Discussion

6 REFLECTIONS ON THE DAY

REFERENCES

APPENDIXES

A Workshop Agenda

B Biographical Sketches of Workshop Moderators, Speakers, and Panelists

C A Review and Report of Community-Based Health Literacy Interventions

Boxes, Figures, and Tables

BOXES

1-1 Statement of Task

2-1 Categories Used to Organize the Results of the Literature Review

2-2 Reported Outcomes in the 74 Reviewed Papers

3-1 Suggestions from Speakers for Implementing Community-Based Health Literacy Interventions

4-1 Suggestions from Speakers for Evaluating Community-Based Health Literacy Interventions

4-2 Possible Goals for Evaluation

FIGURES

3-1 Health Literacy Media’s (HLM’s) pilot program planning process

3-2 The four communities chosen for the pilot projects

3-3 Health Care Institute’s strategic implementation plan phases

3-4 Health Care Institute’s five levels of evaluation

3-5 The Eat Healthy, Stay Active strategic implementation model

3-6 Sample outcomes for adults who participated in Eat Healthy, Stay Active pilot training

3-7 Sample outcomes for children who participated in Eat Healthy, Stay Active pilot training

3-8 Many elements of the Health Care Institute’s approach are integrated into the new Head Start program performance standards

4-1 Logic model for the Life Enhancement Program

4-2 Health literacy improvements in the Life Enhancement Program

4-3 Logic model for the Theater for Health intervention in Peru

4-4 Health literacy improvements from the Theater for Health intervention in Peru

C-1 Flowchart for selection of papers for full-text review

TABLES

2-1 Inclusion and Exclusion Criteria for the Literature Review

3-1 Demographics of the Four Pilot Communities

4-1 Evaluation of the Life Enhancement Program Using the Calgary Charter Health Literacy Scale

4-2 Dose–Response Data for Three Health Literacy Interventions

C-1 Keywords for Searching the Literature

C-2 Search Strategies in Commercial Library Databases

C-3 Detailed Search Strategy in PubMed (performed April 12, 2017)

C-4 Criteria for the Inclusion and Exclusion of Papers in the Review

C-5 Codes and Directions for Community-Based Health Literacy Intervention Review

C-6 Centers for Disease Control and Prevention Best Practices Framework

C-7 Drop-Down Lists for the Cells

C-8 Included Studies

C-9 Frequency of Labels to Identify Intervention Communities

Acronyms and Abbreviations

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