HEAL - Health Education & Adult Literacy Program - New York Presbyterian Hospital

Ambulatory Care Network Community Health Education and Outreach

HEAL - Health Education & Adult Literacy Program

Overview

The HEAL (Health Education & Adult Literacy) Program fulfills the mission of service, education, and research through community engaged projects at NewYork-Presbyterian Columbia University Medical Center. The program's primary goal is to reduce the rate of medication errors and increase compliance with treatment as prescribed by medical providers to the patient population in Washington Heights and Inwood. This is accomplished by the development and implementation of a health education curriculum that responds to health literacy skills of the population served. This program is being implemented throughout the pediatric Ambulatory Care Network (ACN) sites, Best Beginning (Home Visiting Program at Alianza Dominicana), and local Early Head Start Programs.

Program Objectives

Develop culturally health responsive education material regarding medication adherence using the basic tenets of health literacy
Train pediatric providers, family support workers, Head Start providers and community volunteers to appropriately address low health literacy
Improve quality of health care for the poor and other underserved communities comprised of diverse ethnic and racial groups
Create tools and assessments to address the issue of low health literacy skills among patients
Implement the tools and assessment in collaboration with Community Based Organizations and local Head Starts

Health Education Materials:

The curriculum is used by our volunteer parent educator and pediatric providers to discuss topics regarding medication management, over the counter medicines, the use of over the counter medicines home remedies, the appropriate care of upper respiratory infections and the difference between the common cold and the flu. This curriculum is in English and Spanish and includes handouts that parents can take home.

The HEAL curriculum was informed by three focus groups with the collaboration of Alianza Dominicana, Best Beginning Program. Focus groups consisted of 22 community members residing in Washington Heights. Two of the focus groups were held in Spanish and one in English. The findings of the focus groups demonstrate the participants' opinions for each of the topics listed below.

Doctor interaction with patients

Explain specific ailments verbally, not with handouts.
Examine patient thoroughly, ask family questions and listen to concerns or comments
Outline a treatment plan for the family and ask for the family's input. Give the family several options

Medications

General distrust of medications. Fear of overdose and side effects. When they don't want to give medicine and use something else instead, they don't tell the doctor.
Want accurate instructions that include a visual and tsp/ml conversion for oral syringes.
When they pick out over-the-counters (OTC) they ask friends or use previously used OTCs
When they go to the doctor for a sick visit they expect medication

Home Remedies

For some, a secondary healing source after western medicine does not work. Others use when children too small for OTCs
Some don't tell doctor about home remedies because it would insult the doctor/patient relationship. Others don't tell the doctor because they fear a negative response

Training

Trainings are conducted for all pediatric residents at Morgan Stanley Children's Hospital of NewYork-Presbyterian (MSCHONY), General Pediatrics faculty, selected1st year medical student, family support workers from Best Beginnings at Alianza Dominicana and staff at local Head Starts. Trainings consist of teaching basic tenets of health literacy in conjunction with cultural competency and effective communication with patients' caregivers. A train the trainer module has been created to teach volunteers how to implement the HEAL curriculum in ACN waiting rooms.

In an effort to determine the areas of focus for the training, a study titled The Health Literacy and Verbal Communication Gap in Patient/Parent/Provider Pediatric Encounters was designed to assess the current communication gap that exists between pediatric medical providers and patients' caregivers. The study revealed areas in which there is room for improvement and they are as follows:

Allowing the patient's parent to describe the problem uninterrupted
Asking if the patient's parent has questions before the end of the visit
Using visual methods
Identifying additional resources
Knowing and using the teach-back method, particularly regarding medication instructions
Asking about the patient's caregiver's ability to follow treatment plans
Using interpreter phone service when needed

Outreach & Accomplishments:

Since the initiation of the program in 2007, over 300 patients' caregivers have been encountered by volunteers, 2nd year pediatric residents and 4th year medical students. In addition, Twenty Family Support Workers from the Best Beginning Program at Alianza Dominicana have been trained in the implementation of the curriculum to inform the participants in their home visiting program. Also a train-the-trainer curriculum was developed in partnership with the community coordinator in order to teach pediatric providers and HEAL volunteers about cultural competency, the importance of health literacy, communication skills, basic disease knowledge, and common medical complaints in the community. To date we have trained 20 volunteer parent educators, 6 first year medical students, 40 pediatric residents and 15 pediatric attending physicians.

A new educational module has been added to the curriculum as we recently were part of a pilot study in collaboration with the ACURI (Appropriate Care of Upper Respiratory Infections) Project.

In this project, we helped design and pilot three health literacy educational modules, a cold care kit and a series of evaluation tools. The project was conducted at the Columbia University EHS (Early Head Start). This EHS is located in the Washington Heights community of New York City. The new module entitled The Supportive Care for URIs/Antibiotic Resistance was based on the CDC's "Get Smart" Campaign, and previous published research studies. The educational modules were piloted in two randomly selected EHS classes. The three modules were taught to each class individually during class time and took place sequentially once per week over a 3 week period. At the beginning of each module, the information from the previous module was reviewed. All educational modules were presented in English and Spanish and were taught either by a health educator or a pediatric resident with the help of the health educator. Each module included two parts, informational and skill building. The modules, each about 1.5 hours, were taught in an interactive format, during which parents were given information, expressed their opinions and experiences.

Following the intervention, the mean score on the composite knowledge / attitude health literacy score increased 61.0%, from 4.1 (total possible: 10) to 6.6 (p < .05). The mean score on the composite care practices also increased 28.2%, from 3.9 (total possible: 5) to 5 (p < .05).