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					Communication and Health Literacy




             Project Brief



 Helping people access, understand and use
 information we provide about health and
    wellbeing and our services and care.


           10 November, 2010
                               ACKNOWLEDGEMENTS
                  This document has been created jointly by members of the
                  DHHS Communication and Health Literacy Working Group:
                                    Siobhan Harpur (Chair)
                            Belinda Fenney-Walch (Project Manager)
                                       Jenny Denholm
                                       Claudia Duenow
                                        Karen Forster
                                       Angela Holmes
                                         Mark Pegg
                                        Celina Sargent
                                    Susan Stipcevic-Webb
                                       Deb van Velzen
                                         Eliza Young


DHHS Mission: To design and implement a sustainable, people-focused health and
human services system which supports individuals and communities to be active partners in
the management of their own health and wellbeing.

Glossary
In this paper, this is what we mean by the following words or terms:

Word or term                       What we mean

Client(s)                          People who use DHHS services and information now and
                                   in the future, including patients, clients, customers,
                                   consumers and carers.

Health literacy                    The knowledge and skills needed to access, understand,
                                   and use information related to physical, mental and social
                                   wellbeing (Communications and Health Literacy Working
                                   Group, DHHS, Tasmania).

Health                             A state of complete physical, mental and social well-being
                                   and not merely the absence of disease or infirmity.
                                   (Preamble to the Constitution of the World Health
                                   Organization as adopted by the International Health
                                   Conference, New York, 19-22 June, 1946; signed on 22
                                   July 1946 by the representatives of 61 States (Official
                                   Records of the World Health Organization, no. 2, p. 100)
                                   and entered into force on 7 April 1948.)




                                                                                  Page 1 of 13
1. Title                  Communication and Health Literacy Project Brief

2. Sub-title              Helping people access, understand and use information we provide about
                          their health and wellbeing and our services and care.

3. Objectives             The objectives of this project are to:
                          1. Raise awareness that a large proportion of people currently using our
                             services don’t understand what we tell them or have the capacity to act
                             on information we give them, and this has a significant impact on health
                             and wellbeing outcomes and the efficiency of health and human services.
                          2. Gain insight into the experiences of staff and service users relating to
                             communication and interaction, and opportunities for improvements.
                          3. Create a Communication and Health Literacy Action Plan for implementation
                             across DHHS in 2011 and beyond.
                          4. Promote the benefits of involving people in the management of their own
                             health and wellbeing and developing productive relationships between
                             DHHS staff, service users and community members.

4. The facts              •   In 2006, the ABS found 1 :
                              o only 41% of adults in Australia and 37% of adults in Tasmania had
                                what was considered to be adequate health literacy to meet the
                                complex demands of everyday life.
                              o in Tasmania, 63% of adults did not have what was considered to be
                                adequate health literacy
                              o even amongst Australians with 16+ years of formal education, 31%
                                did not have adequate health literacy.

5. Background/            •   For this project, the word “health” is a broad term that aligns closely
   Context                    with the World Health Organization’s definition of health: “Health is a
                              state of complete physical, mental and social well-being and not
                              merely the absence of disease or infirmity”2 and relates to human
                              services as much as it relates to health services.
                          •   The catalyst for this project is the growing awareness globally that many
                              people have inadequate health literacy, and that this has a significant
                              impact on health and wellbeing, and on health and human services.
                          •   Health literacy is more than being able to read and understand
                              information about health. The Australian Bureau of Statistics (ABS)
                              defines health literacy as “the knowledge and skills needed to understand and
                              use information relating to health issues such as drugs and alcohol, disease

    1
        ABS, Social Trends 4102.0, June 2009.

    2
      Preamble to the Constitution of the World Health Organization as adopted by the International Health
    Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official
    Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.


                                                                                                     Page 2 of 12
                          prevention and treatment, safety and accident prevention, first aid,
                          emergencies and staying healthy.” 3
                      •   The DHHS Communications and Health Literacy Working Group defines
                          health literacy as: the knowledge and skills needed to access,
                          understand and use information related to physical, mental and
                          social wellbeing.
                      •   Health literacy is thought to be a better predictor of health status than
                          education, socio-economic status, employment, race or gender 4 .
                      •   Health literacy affects a person's involvement in the formal health and
                          human services systems and decisions they make in the home, workplace
                          and community 5 . Health literacy impacts on tasks like following dosage
                          instructions and affects whether people seek screening or diagnostic
                          tests or routine child health and development tests.
                      •   Health literacy affects people’s:
                          o ability to navigate the healthcare and human services systems,
                            including filling out forms and locating providers and services
                          o ability to share personal information, e.g. health history
                          o ability to engage in self-care and chronic disease management
                          o ability to understand mathematical concepts e.g. probability, risk
                          o ability and motivation to make good choices in relation to preventive
                            health.
                      •   Those with inadequate health literacy:
                          o have less knowledge of conditions and treatment
                          o have less ability to understand and recall written and oral health
                            information and instructions
                          o have less knowledge about health and wellbeing determinants,
                            understanding about healthy lifestyles and the importance of
                            preventive health.
                          o have greater dependence on healthcare providers
                          o are admitted to hospital and use emergency services more
                          o participate less in
                                       routine screening e.g. for cervical or prostate cancer
                                       screening for sexually transmitted diseases
                                       services for childhood health maintenance
                                       influenza vaccination programs.

                      • This project helps to places clients and patients at the centre of all we do

3
    ABS, Social Trends 4102.0, June 2009.
4
    Weiss, Partnership for Clear Health Communication, 2006.

5
    ABS, Social Trends 4102.0, June 2009.

                                                                                                 Page 3 of 12
                    and aligns closely with the DHHS Mission (supporting individuals and
                    communities to be active partners in the management of their own
                    health and wellbeing) and Strategic Directions 1, 2 and 3:
                    o Supporting individuals, families and communities to have more
                      control over what matters to them.
                    o Promoting health and wellbeing and intervening early when needed.
                    o   Developing responsive, accessible and sustainable services.

6. The approach •   Tackling this issue is essential if we are to improve individual and
                    community health and wellbeing outcomes and may, over time, reduce
                    the cost of providing health and human services.
                •   This project takes as its starting point the premise that people’s lack of
                    health literacy is our problem to solve, not theirs.
                •   The project will consider ways to:
                    1. Create health and human service environments that don’t assume
                       people are health literate.
                    2. Improve the way DHHS and its staff interact with clients and patients.
                    3. Improve the quality of information provided to clients/patients and the
                       broader public.
                    4. Improve the health literacy of people who use our services, and
                       advocate for improvements in literacy and health literacy across the
                       community.

7. Outcomes     DHHS staff have the skills, resources and motivation to interact and
                communicate more effectively with people who use our services.
                People who use our services (and the broader Tasmanian community)
                become more health literate and are more engaged in management of their
                own health and wellbeing.

8. Outputs      •   A Power Point presentation and fact sheets summarising the issues
                    relating to communication and health literacy.
                •   Informal staff interviews and an online survey to find out
                    o about staff experience interacting with people who use our services
                    o about the barriers to effective interaction between staff and clients
                    o about strategies staff use to help clients understand, and to assess
                        clients’ understanding of information or instructions we provide
                    o what staff think DHHS should do to improve communication
                        between staff and clients
                    o existing projects and resources.
                •   Consumer consultation to find out
                    o about people’s experience interacting with staff and understanding
                      and using the information they are given
                    o what people do if they have trouble understanding information or


                                                                                    Page 4 of 12
                           instructions provided by DHHS
                        o why people think they have trouble understanding and using
                          information provided by DHHS
                        o how people think communication and interaction between clients and
                          DHHS could be improved
                        o how people think health literacy could be improved across the
                          community.
                    •   A review of existing research and related projects.
                    •   A DHHS Communication and Health Literacy Action Plan, likely to include:
                        o a Communications and Health Literacy Policy that sets out the roles and
                          responsibilities for departmental and operational units with regard to
                          helping clients and patients understand
                        o strategies for improving one-on-one communication and interaction
                          between staff and people who use our services
                        o staff training resources, including a relevant module for staff
                          orientation / customer service training
                        o a proposal for inclusion of a relevant module (or modification of
                          existing modules) in undergraduate medical training, and other
                          relevant undergraduate courses
                        o guidelines for non-written communication and processes for quality-
                          checking of written information including forms, letters and signage
                        o strategies for working with individual clients or groups to improve
                          literacy relating to specific health or human service topics
                        o a list of existing resources and projects
                        o a communication strategy and related tools
                        o an evaluation plan, including key performance indicators.
9. How will the The short term measures of success will be successful delivery of outputs.
   success of the In the long term, the project will be deemed successful if:
   project be
   measured       • DHHS staff are able to communicate and interact more effectively with
                      people who use our services
                    •   People in Tasmania are better able to access, understand, communicate
                        and use information about their health and wellbeing.
                    Key performance indicators and measures of success will be developed for
                    the Communication and Health Literacy Action Plan.

10. Budget:         No funding has been allocated to this project.




                                                                                       Page 5 of 12
11. Stakeholders
                   Governance
                   Department of Health and Human Services (DHHS) Departmental Executive
                   DHHS Chronic Conditions Clinical Network Steering Committee
                   Project Sponsor (Director of Public Health)
                   DHHS Communications and Health Literacy Working Group
                   Business Owner (Population Health)
                   Consultation
                   DHHS Operational Units (Area Health Services, Statewide and Mental Health
                   Services,, Ambulance Tasmania, Population Health, Housing Tasmania, Disability,
                   Child, Youth and Family Services)
                   Relevant DHHS Departmental Units
                   DHHS Staff Reference Group
                   Consumer Reference Group
                   Adult literacy groups
                   Community service organisation representatives
                   Chronic Conditions Clinical Network
                   Department of Education
                   Tasmanian Aboriginal Health Services
                   Outcome Impacted
                   DHHS service providers
                   DHHS CEOs and Deputy Secretaries
                   DHHS Communications Contact Group
                   Department of Education
                   People who use our services (and their family and carers)
                   Significant influencers and potential advocates
                   DHHS Secretary
                   Minister for Health
                   Minister for Human Services
                   DHHS Health Literacy Network
                   Social Inclusion Unit (Department of Premier and Cabinet)
                   General Practice Tasmania, General Practice Divisions
                   Other key stakeholders
                   Adult literacy groups
                   DHHS Clinical Advice and Network Development Unit
                   Tasmania Chronic Disease Prevention Alliance
                   Premiers Physical Activity Council
                   New South Wales Health Literacy Network
                   Consumer / Carer Advocacy and Representative Groups


12. Governance     Project           Dr Roscoe Taylor
                   Sponsor

                   Project           Chronic Conditions Clinical Network Steering Committee:
                   Steering          • Dr Annette Douglas, GP (Clinical Leader)
                   Committee         • Dr Helen Cameron-Tucker (Deputy Clinical Leader)
                                     • Catherine Brown, State Manager, Office of Aboriginal
                                        and Torres Strait Islander Health, DoHA
                                     • Mark Broxton, Manager of Allied Health Services,
                                        General Practice North
                                     • Siobhan Harpur, Transition CEO Population Health

                                                                                        Page 6 of 12
            •   Kathy Kirby, Director eHealth Innovation, DHHS
            •   Graeme Lynch, CEO, Heart Foundation Tas
            •   Dr Roland McCallum, Endocrinologist and General
                Physician, Royal Hobart Hospital
            •   Giuliana Murfet, Nurse Unit Manager, Diabetes Centre,
                North West Regional Hospital
            •   Tracey Turale Primary Health Care Coordinator,
                Central Highlands Rural Primary Health Service
            •   Robin Wilkinson, Consumer representative
            •   Marguerite Grieve, Network Development
                Coordinator
Project     •   Belinda Fenney-Walch, Senior Program Consultant,
Manager         Social Marketing, Population Health
Project     •   Belinda Fenney-Walch, Senior Program Consultant,
Team            Population Health
            •   Susan Stipcevic-Webb, Mgr Community Engagement &
                Stakeholder Relations
            •   Angela Holmes, Health Management Trainee,
                Population Health


Project     •   Siobhan Harpur, Transition CEO Population Health
Working         (Chair),
Group       •   Jenny Denholm, Senior Advisor Strategic
                Communications and Coordination
            •   Claudia Duenow, Senior Policy Officer - Quality and
                Safety, Care Reform
            •   Belinda Fenney-Walch Senior Program Consultant,
                Population Health
            •   Karen Forster, Team Leader, Policy and Education Unit,
                Cancer Screening
            •   Angela Holmes, Health Management Trainee,
                Population Health
            •   Mark Pegg, Senior Communications Consultant,
                Disability and Childrens Services
            •   Celina Sargent, Policy Officer, Youth Health
            •   Susan Stipcevic-Webb, Mgr Community Engagement &
                Stakeholder Relations
            •   Eliza Young, Media and Communications Officer, North
                West Area Health Service
            •   Deb van Velzen, Policy Officer Multicultural Health
Project     The 300-member Chronic Conditions Clinical Network
Reference   (CCCN) will perform functions of a reference group.
Group

Health      An informal Tasmanian health literacy network has been
Literacy    established to assist with information sharing and
Network     engagement of staff.


                                                          Page 7 of 12
                       Work will be shared among working group members and other staff
13. Resources
                       according to the capacity of individuals.

14. Reporting          The Working Group Chair and Project Manager will report to the CCCN
    Requirements       Steering Committee and the Project Sponsor.
                       The Project Sponsor will report to the Departmental Executive.

15. Consumer,          A consumer consultation plan will be developed. The plan will include:
    Carer and           o An online consumer survey
    Community           o Informal interviews (and assisted completion of online surveys) with
    Engagement             consumers at four regional Community Houses.
                       A staff consultation plan will also be developed.

16. Assumptions        •   Research findings by the ABS are an accurate reflection of the size and
                           scope of the communications and health literacy challenge.
                       •   Senior managers across DHHS will support development and
                           implementation of a health literacy action plan.
                       •   Working group members can deliver the project’s stated outputs.

17. Constraints        •   There is no additional funding or human resources to support this
                           project. Work must be undertaken within existing resources. The
                           project manager and working group members are undertaking this
                           project on top of existing workloads.
                       •   There may be insufficient staff engagement if communication and health
                           literacy are not considered significant compared with other issues.

18. Related Projects   o    DHHS Your Care, Your Say: Consumer, Carer and Community
                            Engagement Strategy: a whole-of-agency framework aimed at fostering
                            an organisational culture that actively encourages and helps people get
                            involved in decisions about their care and that of their communities.
                       o    National Safety and Quality Framework (Australian Commission on
                            Safety and Quality in Health Care): designed to guide action to improve
                            the safety and quality of care provided in health care settings. Includes:
                            “increase health literacy” as a strategy.
                       o    DHHS Self Management Framework
                       o    Working in Health Promoting Ways, the DHHS Health Promotion
                            Framework
                       o    DHHS 'A Fair Go' Strategic Review
                       o    Population Health: Health Equity Training Series (DHHS Staff)
                       o    Population Health: Health Equity Training Series (Community Sector)

19. Capturing the      The project team will undertake project closure activities that document
    lessons learnt     lessons learned.




                                                                                      Page 8 of 12
20. Major milestones

         Project     Consultation Consultation Formal       Results of     Review of   Commencement Feedback on         Finalisation of
         Brief       tools and      period and consultation consultation   existing    of development draft Plan from   Communications
         finalised   plan finalised awareness  period       analysed       research    of             stakeholders      and Health
                                    raising    completed                   and         Communications                   Literacy Acton
                                    started                                related     and Health                       Plan
                                                                           projects    Literacy Acton
                                                                           completed   Plan

    Due 5 Oct        25 Oct       4 Nov         4 Dec        23 Dec        23 Dec      Feb - March     April – May      June 2011
                                                                                       2011            2011




                                                                              Page 9 of 13
21. Governance Diagram


                                  Departmental Executive
                                      Corporate Client
                                Agency’s overarching decision body
                                 Considers final draft Action Plan



                                Director Population Health
                                       Project Sponsor
                         Oversees the high level management and decision
                                              making



                           Chronic Condition Clinical Network
                                     Steering Committee
                                Project Steering Committee
                                    Receives progress updates
                         Provides advice about any proposed key initiatives
                                    Considers draft Action Plan


                        Social Marketing Senior Program
                                        Consultant
                                      Project Manager
                      Coordinates, monitors and manages the day to
                     day activities in accordance with the project plan.
                      Reports progress to project steering committee
                                         and sponsor



                                Project Working Group
                       Assists the project manager in delivery of the
                     project’s outputs; assist with the decision making;
                           provides advice on project directions.
                     Chaired by the Transition CEO, Population Health




                              Informal project reference
                                        groups
                           The 300-member Chronic Conditions
                           Clinical Network and the Tasmanian
                           Health Literacy Network, including the
                              Communications Contact Group




                                                                              Page 10 of 13
22. Governance: Roles and Responsibilities

Departmental Executive
The Departmental Executive is the Agency’s overarching decision body. In the context of
this project the DE is the Corporate Client and has the role of considering the draft
Communication and Health Literacy Action Plan. Once endorsed the DE also has a role in
supporting implementation of the Action Plan.

Director Population Health
The Director of Population Health has ultimate accountability and responsibility for the
project. In the context of this project the Director of Population Health acts as the Project
Sponsor and oversees the high level management and decision making, lends support by
advocacy at senior levels, and ensures that the necessary resources are available to the
project. The role and responsibilities of the Project Sponsor are to:
   •   be accountable for the delivery of the project’s outcome
   •   oversee the high level management and decision making
   •   lend support and promote the benefits of the project at senior levels (including
       Departmental Executive)
   •   ensure that the necessary resources (both financial and human) are available to the
       project.

Chronic Condition Clinical Network Steering Committee
The Chronic Condition Clinical Network (CCCN) Steering Committee, in addition to its
current role, will take on the role of the Steering Committee for this project. The roles and
responsibilities for the Steering Committee (in relation to this project) are to:
   •   receive advice about the progress of the project
   •   provide general direction and advice about the project, including the strategies
       identified for inclusion in the Communication and Health Literacy Action Plan
   •   provide support and advocacy for the project.

Social Marketing Senior Program Consultant
The Social Marketing Senior Program Consultant is responsible for the delivery of the
project’s outputs. In the context of this project the Social Marketing Senior Program
Consultant acts as the Project Manager and is responsible for organising the project into
one or more sub-projects. The role and responsibilities of the Project Manager are to:
   • manage the day-to-day aspects of the project and its sub-projects in accordance with
       the project plan, developing the project documentation, resolving planning and
       implementation issues, and monitoring progress and budget.
   • report to the Project Sponsor and Project Steering Committee
   • identify risks and risk mitigation strategies
   • work closely with the Communications and Health Literacy Working Group.




                                                                                  Page 11 of 12
Communications and Health Literacy Working Group
The Project Working Group consists of a number of specialists from across the Agency,
including the Communications Contact Group, Care Reform and Population Health.

The roles and responsibilities of the working group are to:
   • work with the project manager to deliver the project’s outputs
   • jointly implement the consultation plan
   • assist with decision-making
   • provide advice about the project directions.

Individual members of the working group will provide advice on matters relevant to their
areas of speciality, e.g. culturally and linguistically diverse communities, young people and
whole-of-agency related projects.




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