Twenty ‘promising interventions’ selected in IROHLA

Promising practices: evidence for added value of comprehensive approach

You want to start working on health literacy, however you do not know exactly yet what kind of intervention would best fit in your situation and give most benefits? Then here you can find your inspiration!

Twenty ‘promising interventions’ selected in IROHLA

Quality assessment and the selection process of 20 ‘promising interventions’ carried out in the IROHLA project in 2014 led to the following list of ‘shining’ examples for a comprehensive approach of health literacy for older people. Described are the names and the most important findings of these 20 interventions. By clicking on the specific intervention, you will find more information on the features of the interventions, such as target group, costs, materials, implementation challenges, etc. With this information you will get insight in how to implement and adapt the intervention for your own (local) situation, meaning that you will know what aspects of the intervention you can adapt to your own situation and what elements you need to keep unchanged in order to gain the same kind of impact as the original intervention.

1. Automated Telephone Self-Management Support System. The importance of a tailored and personalised approach and an intervention easy accessible through low social and physical barriers was emphasised by Schillinger (2008) in an article referring to the IDEALL project (Improving Diabetes Efforts across Language and Literacy, USA). This tele-health, online self-management diabetes intervention has multiple complimentary components, which facilitated provider – patient communication with patient self-management and health education in a supportive format (e.g. regular calls with a tele-health nurse). Another strong point of this intervention is the fact that it is quite easily transferable to other contexts. Download PDF here

2. DeWalt (2012) showed in Multisite Randomised Trial of a single-session versus multi-session literacy-sensitive self-care intervention for patients with heart failure (USA) that follow-up calls are very important especially in case of vulnerable groups with low health literacy skills. Other strong point for this intervention is the cultural adapted information. Download PDF here

3. In Laforest (2007) I am taking charge of my arthritis, the most prominent aspects for the health literacy research are the components of patient-centredness and shared decision making of the intervention. It shows that a tailor-made approach together with home visits by a variety of professionals are very important aspects with respect to the reach of frail seniors with arthritis. Download PDF here

4. Lorig et al. (2013) and Griffiths et al. (2005) evaluated the Chronic disease Self-management Program (CDSMP) an intervention with the focus on the community (and not on the health system). It shows that an additional course on self-management (here coping skills) next to the regular treatment is very useful. The transferability of this intervention is high and the fact that they already worked with many different target groups shows that it is culturally adapted. The focus is on people with severe mental illness and the programme shows that there is a range of items (medicines, physical activity, etc.) that are discussed during the course. Download PDF here

5. Robare (2011) highlights in 10 keys to healthy ageing focuses on self-management and the importance of one to one counselling at home (personalised approach, coping skills) and trained health counsellors in the community. Also, in this intervention, we see efforts of changing the paradigm of medical care to more emphasis on prevention and an active lifestyle, which is a very important aspect in self-care and self-management. Download PDF here

6. In Pruthi et al. (2010) Promoting a Breast Cancer Screening Clinic for underserved women; a community collaboration a plan of action for a screening program (breast cancer) is highlighted. Here taking away all kind of barriers (social, physical and cultural) is the most important driving force together with building trust. Examples include providing transportation vouchers and language interpreters as well as the use of pictorial charts. Another important aspect is that the activities are embedded in existing structures and that educational materials are adapted to the various target groups. Download PDF here

7. In EXSOTE: Remote monitoring and Health Coaching in South Karelia (Fi) (Renewing Health project, June 2014), the most important success factor in the reach of vulnerable older adults with a chronic disease is the combination of e-health and mobile techniques together with the attention of personal health coaches. This Finnish example is part of the European project ‘Renewing health’ and shows that remote monitoring of diseases should be accompanied by human support in order to be effective. Download PDF here

8. The Talking touch screen, developed in the Netherlands, is an interesting example because of its user-centred design approach: patients with low health literacy skills in physiotherapy practices were actively involved in the development of the talking touch screen, which resulted in the use of simple language, visual elements , pictures and an easy-to-use touch screen. With the Talking Touch Screen patients (Dutch and Turkish) with low health literacy skills get support with filling in a patient’s specific list of complaints (PSK)) on their own. See also other example of Talking Touch Screen: E.A. Hahn et all. (2004). In this example from the USA, a multimedia program was developed to provide a quality of life assessment platform that would be acceptable to patients with varying literacy skills and computer experience. One item at a time is presented on the computer touchscreen and it is accompanied by a recorded reading of the question. Various colours, fonts and graphic images are used to enhance visibility, and a small picture icon appears near each text element allowing patients to replay the sound as many times as they wish. Evaluation questions are presented to assess patient burden and preferences. Download PDF here

9. The Age Action Alliance in the UK is a supporting network where many activities in the field of health ageing are being carried out. Drawn from civil society and the public and private sectors, it takes a positive approach to ageing and seeks practical ways to improve services and support to older people.The network is aiming at a comprehensive approach regarding ageing population, where social inclusion (including digital inclusion) and participation of older adults are an important factor. Download PDF here

10. The voice of older people is the most prominent success factor in the KOVE: Kilburn Older Voices Exchange project in the UK. The intervention is focusing on giving older people an important voice in the community and in this way empowering them to influence the existing system. The intervention offers them the opportunity to be engaged in problem solving and participation in the community. Download PDF here

11. The intervention Erlebnis Internet is an interesting German example of how barriers to the access of the use of internet (digital literacy) by older adults with low socioeconomic status or from other cultural backgrounds can be tackled by means of social support of peers, volunteers and tailor-made education materials, etc.

In the IROHLA research more interventions on the subject of digital literacy have been found. We can mention here also the intervention Electronic health information for life long learning via collaborative learning (EHILLL-CL), which is an interesting example of collaborative learning in an informal setting. This theory-driven intervention, developed and tested in public libraries, aims to improve older adults’ e-health literacy. Participants were highly positive about the intervention and reported positive changes in health-related behaviour and decision making. Download PDF here

12. In the case of the online platform 50plusnet in the Netherlands, strong points are the low threshold character of the intervention and the positive attitude and personal approach of peers and volunteers. 50plusnet is a social network focusing on social inclusion and the prevention of mental health problems. Participants of the social network can get in contact with fellows quite easily and it is possible to start up all kinds of activities together, such as physical activities, cooking classes and cultural activities, etc. Download PDF here

13. Cooper et all. (2011) stress in Physician communication skills training and patient coaching by community health workers (USA), how important it is to focus in an intervention on the communication skills of both professionals as patients. Here physician and patient interventions were designed in tandem to support the therapeutic partnership from both perspectives. Furthermore the intervention shows us the importance of the adaptation of the traditional role of community health workers to the role of coach—an approach that the investigators used because of the evidence for cultural relevance and effectiveness of community health workers in health education and promotion among patients from minority and underserved groups. Download PDF here

14. The intervention Activ ins Alter; investition in die Zukunft alterer Menschen (AU) is focusing on especially vulnerable group within the older population. It is a good example of a personalised approach and activation of frail seniors. The strong element is that it starts with a needs assessment; people are asked what their needs are with respect to a broad range of aspects related to social and health infrastructures and about the possible ways provide the support they need. The intervention is promising in its outreaching character, through the use of home visits by health counsellors. Networks with stakeholders are build and awareness of the problem is raised. It is a very well described and analysed intervention. Also the evaluation on implementation, transferability, and sustainability is reported. A thorough analysis is available in the report Health pro Elderly. Download PDF here

15. The intervention Lebenswerte Lebenswelten focuses specifically on older women with low socioeconomix status. This community-based intervention uses existing structures and networks in the community in order to empower older people with respect to caring for their own health. Home visits by volunteers, intergenerational learning, health cafés and communication and networking amongst different organisations are key elements in this intervention. Download PDF here

16. Emerging technology for at risk chronically ill veterans (USA) creates a ‘Health buddy’ for veterans (mobile device). This e-health intervention is aimed at supporting patients with health problems in the home setting. The ‘buddy’ stands for having support (a friend) nearby as well as raising the feeling of security. Results are positive both at the level of users (decrease in hospital/nursing home/emergency room admissions) as for professionals. The intervention belongs to the cluster ‘e-health interventions’ with emphasis on ‘tailor-made’ and ‘interactive’. Download PDF here

17. The Pairs program (USA) is an educational programme where students are getting experience with the ‘Daily living problems’ of Alzheimer patients. The project is a replica of the Buddy program which has positive evaluations on the level of attitude (empathy) of professionals. The intervention fits into two clusters of interventions: ‘educational interventions’ and ‘Peer/social support-interventions’. Download PDF here

18. Filmauve (FR) aims at informing and empowering care-givers. Relatives and care givers learn strategies on how to cope with the problems of patients with dementia. It explores and educates the social context (spouse and children) of patients. Insight, knowledge and strategies are implemented in all day life of relatives of Alzheimer patients in four sessions (‘Labs’).The intervention is targeted at the empowerment of caregivers. Download PDF here

 19. Ask me 3 (USA). This intervention – an educational website – is based on the principle that every patient should ask their healthcare providers three questions: (1) What is my main problem?; (2) What do I need to do?; (3) Why is it important for me to do this? The ‘communication between the patient and the professional’ is a relevant theme for IROHLA as it increases the health literacy by increasing awareness and sensitivity in both patients and professionals. This intervention has a low cost for implementation, but the website should be culturally adapted to the European context. This intervention has a match with the ‘Teach-back method’ (also focusing on two-way-communication). Download PDF here

20. I want to learn (Ich will lernen) (G). This intervention is an e-learning module, specific for people with low literacy and numeracy skills. It shows that the use of interactive websites with games and exercises (blended learning) is very relevant. I want to learn is comparable with the Dutch intervention Oefenen.nl. Download PDF here

Literature:

D. Schillinger et al. Seeing in 3-D: Examining the Reach of Diabetes Self-Management Support: Strategies in a Public Health Care System. Health Education & BehaviorBehaviorBehaviourBehavior;Vol. 35 (5); 664-682 :October 2008.

D.A. DeWalt et al. Multisite Randomized Trial of a Single-Session Versus Multisession Literacy-Sensitive; Self-Care Intervention for Patients With Heart Failure. Circulation;125:2854-2862: 2012.

S. Laforest et al. “I’m Taking Charge of My Arthritis”: Designing a Targeted Self-Management, Program for Frail Seniors. Physical & Occupational Therapy in Geriatrics Vol.26(4): 2007.

K. Lorig et al.Effectiveness of the Chronic Disease Self-Management Program for Persons with a Serious Mental Illness: A Translation Study; Community Ment. Health J DOI 10.1007/s10597-013-9615-5; Springer Science+Business Media New York; 2013.

C. Griffiths. Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease; British Journal of General Practice: November 2005.

J.F. Robare. The ”10 Keys” to Healthy Aging: 24-Month Follow-Up Results From an Innovative Community-Based Prevention Program. Health Education & Behaviour:2011.

S. Pruthi et al.Promoting a breast cancer screening clinic for underserved women; a community collaboration. Ethnicity & Disease, Volume 20, Autumn 2010.

Renewing Health. EKSOTE. Remote monitoring and Health Coaching in South Karelia; Renewing Health project, June 2014. Available from: http://www.renewinghealth.eu/south-karelia-social-and-health-care-district

Consortium Transparante Fysiotherapie in Achterstandsgebieden (TransFysA). TransFysA, meten in de praktijk. Hogeschool Utrecht.

B. Xie. Older adults, e-health literacy, and collaborative learning: An experimental study. Journal of the American Society for Information Science and Technology; volume 62, Issue 5, pages 933–946:May 2011.

L.A. Cooper et al. A Randomized Trial to Improve Patient-Centered Care and Hypertension Control in Underserved Primary Care Patients. Society of General Internal Medicine:2011.

Institute fur Soziologie der Universitat Wien .Activ ins Alter; investition in die Zukunft alterer Menschen. Institute fur Soziologie der Universitat Wien: 2005.

Resch K, Lang G. Evidence-based Guidelines on Health Promotion for Older People: Social determinants, Inequality and Sustainability National Evaluation Report – Austria. Research Institute of the Viennese Red Cross: March 2008. Available from: Download PDF here

A.L. Jefferson et al. Medical student education program in Alzheimer’s disease: The PAIRS Program. BMC Medical Education:2012.

References

Faculteit Gezondheidszorg; Lectoraat Leefstijl en Gezondheid: June 2012 (in Dutch) Available from: Find website here

Omroep MAX. 50 PLUS NET. Copyright 2004-2014 Omroep MAX. Available from: Find website here

Age Action Alliance. Themes. Age Action Allicance, European Commission, Beth Johnson Foundation; 2012. Available from: Find website here

Kilburn Older Voices Exchange (KOVE). KOVE projects. Web design Copyright 2009 Tony Ellis. Last updated: 08-05-2010. Available from: Find website here

Bundesministerium für Wirtschaft und Technologie (BMWi). Erlebnis Internet-Erfahrung schaffen; Den Einstieg in die digitale Welt vermitteln-eind Leitfaden für multiplikatorinnen und Multiplikatoren. BMWi: 2011; Available from: Download PDF here,

Sozialmedizin der Medizinischen Universität Graz. Projekt Lebenswerte Lebenswelte fur Altere Menschen:Promoting Healthy Ageing in Rural and Semi-Urban Communities in Austria: März 2003 bis März 2006 . Available from: Find website here

Bosch. Bosch North America:Veterans Health Administration Receives Grant to Extend Use of Bosch Healthcare’s Health Buddy Telehealth System. Bosch Health Administration Grant: March 2010. Available from: Find website here and here

Y. Magar et al. Alzheimer: un programme pour soutenir léntourage des personnes atteintes. Sante de l’homme 377: 2005. Available from: Find website here

Institute for Healthcare Improvement (IHI). Ask me 3. IHI:2014. Available from: Find website here and Download PDF here

Deutscher Volkshochschul-Verband e.V. (DVV). Ich-will-lernen.de-das DVV Lernportal. Available from: Find website here. (Accessed November 2014)