Clear Conversations: A mixed methods evaluation of a verbal health literacy initiative for health service providers

Background Understanding health information can be difficult. Consequently, people may struggle to know how to manage their health. This may negatively impact on healthy practices leading to poorer health outcomes. This study aimed to evaluate a verbal health literacy training initiative, incorporating Teach-back, Chunk and Check, Open Questions and Simple Language alongside implementation support from a health literacy officer, to enable clear conversations between health service providers and users. Methods A mixed methods evaluation was conducted across two health programmes serving a geographical region of a million people in the United Kingdom: A Pulmonary Rehabilitation Programme delivered by five physiotherapists in a hospital setting, and a Weight Management Programme delivered by 12 health improvement advisors in a regional government authority. The five evaluation components were: 1. A survey of 110 service providers’ perceptions of the training. 2. Observations of service delivery by 11 service providers before and after training. 3. Two focus groups with 11 service providers six months post-training. 4. Change in 73 service users’ health literacy levels over time. 5. Change in service users’ health and wellbeing outcomes. Results Service providers found the initiative useful. Changes in communication practice, such as increased use of Chunk and Check and Open Questions, were observed post-training. Both programmes were delivered in group settings where Teach-back was reported to be challenging to apply but beneficial in one-to-one interactions in wider practice. Implementation support from the health literacy officer was perceived as helpful but difficult to deliver to busy teams. The health literacy levels of service users improved by the end of their programme but there was no evidence that the initiative improved health and wellbeing outcomes. Conclusions The verbal health literacy initiative was well received and enhanced service providers’ communication skills. The techniques within the initiative may be easier to apply in one-to-one consultations with service users than in group-delivered care. Strengthened implementation support may improve adoption and effectiveness in practice. Further evaluation of a strengthened initiative should focus on controlled before and after designs on larger samples to measure the effect on service users’ health literacy levels and health and wellbeing outcomes.