Nursing and allied health professionals’ views about using health literacy screening tools and a universal precautions approach to communication with older adults: a qualitative study

Purpose: Health literacy describes individuals’ abilities to access, understand and use health information. Lower health literacy is associated with poor health outcomes, is more common among older adults and impacts on the effectiveness of rehabilitation/self-management interventions. This research explored nursing and allied healthcare professionals’ views about identifying and responding to older adults’ health literacy needs.
Methods: Qualitative focus groups were conducted with a purposive sample of 22 UK nursing and AHPs working with older adults. Focus groups were audio-recorded, transcribed verbatim and analyzed using framework approach.
Results: Participants used a variety of practices to identify older patients’ health literacy levels, but primarily relied on subtle cues. Participants lacked knowledge and confidence in identifying and addressing health literacy needs. Participants expressed concerns about patient reactions and described practical barriers to using recommended health literacy strategies.
Conclusions: Participants recognized the importance of addressing patients’ health literacy needs, but do not routinely use health literacy strategies, lack confidence and have reservations about recommended health literacy strategies. This impacts on healthcare professionals’ abilities to support patients to self-manage and participate in rehabilitation. Health literacy education for health professionals should consider barriers to using health literacy strategies and be tailored to accommodate variation in teams and professions.Implications for rehabilitation
Rehabilitation professionals need to standardise their practice to health literacy, using strategies which can be easily integrated into routine practice.
To meet older adults’ health literacy needs, rehabilitation professionals should use clear and accessible tailored communication, build trust, assess understanding and involve patients’ social networks.
Rehabilitation professionals would benefit from further education regarding health literacy to build their knowledge/confidence and address their concerns about implementing health literacy strategies.
Professional education regarding health literacy needs to accommodate variation between individuals and teams.

Rehabilitation professionals need to standardise their practice to health literacy, using strategies which can be easily integrated into routine practice.
To meet older adults’ health literacy needs, rehabilitation professionals should use clear and accessible tailored communication, build trust, assess understanding and involve patients’ social networks.
Rehabilitation professionals would benefit from further education regarding health literacy to build their knowledge/confidence and address their concerns about implementing health literacy strategies.
Professional education regarding health literacy needs to accommodate variation between individuals and teams.

研究目的：健康素养（health literacy）指个体获取、理解并使用健康信息的能力。健康素养水平低下与不良健康结局密切相关，在老年人群中更为普遍，且会对康复/自我管理干预的有效性产生负面影响。本研究旨在探讨护理人员及专职医疗人员（allied healthcare professionals, AHPs）对识别和应对老年人健康素养需求的看法。
研究方法：本研究采用定性焦点小组法，通过目的性抽样招募了22名在英国从事老年护理工作的护理人员及专职医疗人员。对焦点小组访谈进行录音、逐字转录，并采用框架分析法（framework approach）开展数据分析。
研究结果：参与者采用多种实践方式来识别老年患者的健康素养水平，但主要依赖细微线索进行判断。参与者在识别和处理健康素养需求方面，普遍缺乏相关知识与信心。参与者对患者的潜在反应表示担忧，并提及了在使用推荐健康素养策略时面临的实际障碍。
研究结论：参与者已认识到满足患者健康素养需求的重要性，但并未常规使用健康素养策略，同时缺乏相关实践信心，且对推荐的健康素养策略存在顾虑。这一现状会影响医护人员支持患者开展自我管理及参与康复的能力。面向医护人员的健康素养教育应充分考量实施健康素养策略的各类障碍，并需针对不同团队与专业的差异进行定制化设计。
康复领域应用启示：
康复专业人员需将健康素养纳入标准化实践流程，采用可轻松融入日常工作的健康素养策略。
为满足老年人的健康素养需求，康复专业人员应采用清晰易懂的定制化沟通方式、建立信任关系、评估患者理解程度，并纳入患者的社交网络支持。
康复专业人员可通过进一步的健康素养相关教育，提升自身的知识储备与信心，同时解决其在实施健康素养策略时的顾虑。
健康素养相关的专业教育需兼顾个体与团队间的差异。

康复专业人员需将健康素养纳入标准化实践流程，采用可轻松融入日常工作的健康素养策略。
为满足老年人的健康素养需求，康复专业人员应采用清晰易懂的定制化沟通方式、建立信任关系、评估患者理解程度，并纳入患者的社交网络支持。
康复专业人员可通过进一步的健康素养相关教育，提升自身的知识储备与信心，同时解决其在实施健康素养策略时的顾虑。
健康素养相关的专业教育需兼顾个体与团队间的差异。