Enhancing Educator Engagement in School Mental Health Care Through Digital Simulation Professional Development

BACKGROUND

Despite the critical role of educators as gatekeepers for school mental health services, they receive limited training to support student mental health. We report findings from a trial of an online mental health role‐play simulation for elementary school teachers on changes in attitudes and self‐reported helping behaviors for students experiencing psychological distress.

METHODS

We randomly assigned 18,896 elementary school teachers to wait‐list control or intervention conditions in which they received the 45‐ to 90‐minute online role‐play simulation. We administered a version of the validated Gatekeeper Behavior Scale at baseline and postintervention, which measures attitudinal dimensions shown to predict teacher helping behavior change. Self‐reported helping behaviors were collected at baseline and 3‐month follow‐up. Outcomes were compared between the intervention follow‐up and control group baseline measures.

RESULTS

The intervention group posttraining scores were significantly higher (p < .001) than the control group for all the preparedness, likelihood, and self‐efficacy Gatekeeper Behavior subscales. All 5 helping behaviors were significantly higher among the intervention group at follow‐up compared to the control group at baseline.

CONCLUSIONS

We found that a brief online role‐play simulation was an effective strategy for improving teacher attitudes and behaviors needed to perform a positive mental health gatekeeper role in schools.

     

Patient public involvement (PPI) in health literacy research: Engagement of adults with literacy needs in the co-creation of a hospital-based health literacy plan

Background

People with literacy needs can experience many challenges in accessing, understanding and using health services and health information. Such challenges can adversely impact patient-provider interactions and ultimately, health outcomes. Healthcare providers need to be aware of health literacy (HL) to address the demands of healthcare systems, improve their interactions with communities and patients and promote patient engagement for improved health outcomes.

Methods

This paper reports on a process of patient and public involvement (PPI) with participants in an adult literacy programme acting as PPI contributors to identify priority areas for a local hospital HL action plan and to develop a protocol for a PPI process with other groups. A qualitative community-based participatory research study design informed by principles of PPI was undertaken, drawing on the tools of participatory and visual methods, open discussion and workshop format to facilitate a process of co-creation. Three workshops with six PPI contributors took place to identify issues to be included in the hospital action plan. PPI contributors identified issues and grouped these into priority areas using discussion and ranking procedures.

Results

Key areas prioritised for HL action by the PPI contributors were: verbal communication, emphasising the patient's right to understand, and improved understanding of medication use. These were incorporated into the action plan. The workshop format and process were deemed acceptable to the group and input on improvements will be incorporated into further work in this area.

Conclusion

PPI acts as a lever in the knowledge translation process. Genuine engagement with service users can meaningfully contribute to relevant and sustainable changes to services as well as foster the empowerment of service users.

Patient or Public Contribution

Members of the public with literacy needs actively participated in the co-creation of a HL action plan for a local hospital and in the development of a protocol for a patient and public process for HL research.     

Personal strengths reported by people with chronic illness: A qualitative study

Background

Self‐management of chronic illness can be highly demanding and people need to mobilize their personal strengths to live well with their condition. More knowledge is needed about how people with chronic illness perceive and use their personal strengths as a basis for better integrating empowering person‐centred approaches into health care.

Objective

To explore what people with chronic illness describe as their strengths relevant to their health and well‐being.

Setting and Participants

Thirty‐nine participants (11 men) from 4 outpatient self‐management programmes were recruited to individual or group interviews. Participants included patients with chronic respiratory disease (n = 7), chronic pain (n = 18) and morbid obesity (n = 14). Interviews were analysed using content analysis.

Results

A number of personal strengths were reported and categorized into 3 domains: (i) Internal strengths, (ii) External strengths and (iii) Self‐management strategies. Internal strengths included being persistent, having a positive outlook, being kind and caring, experiencing positive emotions, being kind towards oneself, reconciling oneself with the situation, having courage and having knowledge and insight. External strengths included support from family, friends, peers and health‐care providers. Self‐management strategies included being active, planning and prioritizing, reducing stress, goal setting and seeking knowledge and help.

Discussion and Conclusion

The study provides insights into personal strengths as reported by people with chronic illness. The results complement prior findings on strengths in people with health challenges and can aid in incorporating person‐centred approaches into health care.     

Yarning quiet ways: Aboriginal carers’ views on talking to youth about sexuality and relationships

Issue addressed

Research suggests that young Indigenous people want carers to take a more active role in discussions about sexual health. The aim of this study was to ascertain carers’ perspectives of: the importance of providing young people with information about sex and sexual health; what they want young people to know about sex and sexual health; and facilitators and barriers to discussing sex and sexual health with youth.

Methods

Thirteen focus groups and three interviews were conducted with 81 carers in four rural and urban regions of Western Australia. Data were coded using a thematic approach, analysed using inductive Framework Analysis, and interpreted using the Aboriginal Family Wellbeing Model of Empowerment.

Results

Many participants recognised the need for talking with young people about sex, and said they drew upon resources such as books, pamphlets and television and used humour to impart lessons. However, a large proportion of participants reported difficulties in educating youth about sex. Participants noted that colonisation had disrupted traditional structures for educating young people, and that sex was a challenging topic. The forced removal of children had interfered with Indigenous family structures and deprived some participants of the opportunity to acquire knowledge and skills from their own parents.

Conclusions

Our findings emphasise the potential role of culture and empowerment in further improving outcomes related to relationships and sexual health. There is a need for more research into models of culturally‐empowering, family‐centred strategies for improving the sexual literacy of Indigenous youth.     

The role of patient–provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men

We examined factors that may be associated with whether Black men who have sex with men a) disclose their sexual orientation to healthcare providers, and b) discuss their sexual health with healthcare providers to inform interventions to improve HIV prevention efforts and reduce HIV incidence rates among Black men who have sex with men. During 2011–2012, we conducted semi-structured individual in-depth interviews with Black men who have sex with men in New York City. Interviews were audio recorded. We examined transcribed responses for main themes using a qualitative exploratory approach followed by computer-assisted thematic analyses. Twenty-nine men participated. The median age was 25.3 years; 41% (n = 12) earned an annual income of < US$10,000; 72% (n = 21) had a college degree; 86% (n = 25) reported being single; 69% (n = 20) self-identified as gay or homosexual. We identified three main themes affecting whether the men discussed their sexual orientation and sexual health with healthcare providers: 1) comfort discussing sexual health needs; 2) health literacy; and 3) trust. Identifying strategies for improved comfort, health literacy and trust between Black men who have sex with men and healthcare providers may be an important strategy for increasing sexual health patient–provider communications, increasing opportunities for HIV prevention including testing and reducing HIV-related health disparities.     

Variation in Networks and Forms of Support for Care‐Seeking Across the HIV Care Continuum in the Rural Southeastern United States

Purpose

In spite of progress in understanding the importance of social support for health outcomes in Persons Living with HIV (PLWH), more remains to be known about mechanisms of support most beneficial at each stage of HIV treatment. In this study, we use a qualitative analytic approach to investigate the forms and sources of social support deemed most integral to the diagnosis, care engagement, and medication adherence behaviors of a diverse sample of PLWH in a mostly rural health district in the Southeastern United States.

Methods

In‐depth interviews (N = 18) were collected during the qualitative phase of a larger mixed methods needs assessment for the Northeast Georgia Health District. A deductive‐inductive analysis of participant narratives revealed variation in the perceived importance of particular forms and sources of social support during the initial versus advanced stages of HIV care.

Findings

PLWH identified the emotional, informational, and appraisal support provided by family as especially critical for emotional stability, coping, and care linkage during the initial stages of diagnosis and treatment. However, once in care, PLWH emphasized informational and instrumental forms of support from care providers and appraisal support from peers as key influences in care engagement and retention behaviors.

Conclusion

Increased understanding of the social support mechanisms that contribute to the HIV treatment behaviors of PLWH can fill knowledge gaps in research and inform the efforts of health care providers seeking to leverage various aspects of the social support toward improving the care retention, health, and wellness outcomes of PLWH.     

Critical appraisal training increases understanding and confidence and enhances the use of evidence in diverse categories of learners

Background

Training in evidence‐based medicine is most commonly offered to physicians, medical students and health‐care decision‐makers.

Setting and participants

We partnered with community organizations to recruit participants and develop trainings for consumers, non‐physician health‐care providers and journalists in California.

Intervention

We conducted half‐day and one‐day workshops in critical appraisal of health evidence. Workshops consisted of didactic presentations, small‐group practice sessions and class discussions.

Outcome measures

We measured knowledge and confidence immediately before and after the workshops and at follow‐up 6 months later. We also asked participants to describe their use of health evidence before the workshops and at follow‐up.

Results

At baseline, 41% of the consumers, 45% of the providers and 57% of the journalists correctly answered questions about health evidence. Scores increased by about 20% (P < 0.05) in all groups at the end of the workshops and remained significantly over baseline at follow‐up. At baseline, 26% of the participants were confident in their understanding of critical appraisal concepts, significantly increasing to 54% after the workshops and sustained (53%) at follow‐up. During discussions, participants’ comments often focused on funding and the potential effects of financial conflicts of interest on study findings. Participants did not use evidence more frequently at follow‐up but said that they applied workshop skills in evaluating research, communicating with others and making decisions about health care.

Conclusion

It is possible to successfully conduct critical appraisal workshops to aid health‐related decision making for groups who have previously not had access to this kind of training.     

Oral Health Literacy among Clients Visiting a Rural Dental College in North India-A Cross-Sectional Study

Background

Limited health literacy among adults is one of the many barriers to better oral health outcomes. It is not uncommon to find people who consider understanding oral health information a challenge. Therefore, the present study assessed oral health literacy among clients visiting Gian Sagar Dental College and Hospital, Rajpura.

Materials and Methods

A cross-sectional study was conducted on 450participants who visited the Out Patient Department (OPD) of Gian Sagar Dental College and Hospital for a period of two months (Nov–Dec, 2013). A questionnaire was given to each of the participants. Oral health literacy was graded on a 12-point Likert scale based on the total score. Oral Health Literacy of the participants was assessed as low, medium and high on the basis of responses. Statistical analysis was done using SPSS-15 statistical package. ANOVA and Student t-test were used to do comparisons between groups.

Results

Low oral health literacy scores were reported in 60.2% (271) participants. More than 60% of the study participants had knowledge about dental terms such as ‘dental caries,’ and ‘oral cancer.’ Only 22% of the graduates had a high literacy score. Mean oral health literacy score according to educational qualification was statistically significant (p<0.05), whereas there was no significant difference in terms of age and gender (p>0.05).

Conclusion

The majority of the participants had low literacy scores. There is a need to address these problems especially among rural population by health care providers and the government.     

Kickin’ Asthma: School‐Based Asthma Education in an Urban Community

BACKGROUND: In urban communities with high prevalence of childhood asthma, school‐based educational programs may be the most appropriate approach to deliver interventions to improve asthma morbidity and asthma‐related outcomes. The purpose of this study was to evaluate the implementation of Kickin’ Asthma, a school‐based asthma curriculum designed by health educators and local students, which teaches asthma physiology and asthma self‐management techniques to middle and high school students in Oakland, CA. METHODS: Eligible students were identified through an in‐class asthma case identification survey. Approximately 10‐15 students identified as asthmatic were recruited for each series of the Kickin’ Asthma intervention. The curriculum was delivered by an asthma nurse in a series of four 50‐minute sessions. Students completed a baseline and a 3‐month follow‐up survey that compared symptom frequency, health care utilization, activity limitations, and medication use. RESULTS: Of the 8488 students surveyed during the first 3 years of the intervention (2003‐2006), 15.4% (n = 1309) were identified as asthmatic; approximately 76% of eligible students (n = 990) from 15 middle schools and 3 high schools participated in the program. Comparison of baseline to follow‐up data indicated that students experienced significantly fewer days with activity limitations and significantly fewer nights of sleep disturbance after participation in the intervention. For health care utilization, students reported significantly less frequent emergency department visits or hospitalizations between the baseline and follow‐up surveys. CONCLUSIONS: A school‐based asthma curriculum designed specifically for urban students has been shown to reduce symptoms, activity limitations, and health care utilization for intervention participants.     

Effects of Perceived Discrimination and Trust on Breast Cancer Screening among Korean American Women

Objective

Korean American (KA) women continue to have lower breast cancer screening rates than other racial groups. Perceived discrimination and trust have been associated with breast cancer screening adherence, but little is known about the associations in KA women.

Self-rated literacy level does not explain educational differences in health and disease

Background

Although literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health.

Methods

Data was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals’ self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health.

Results

People with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%.

Conclusion

Measuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.     

Health Literacy Environmental Scans of Community-Based Dental Clinics in Maryland

Objectives. We conducted health literacy environmental scans in 26 Maryland community-based dental clinics to identify institutional characteristics and provider practices that affect dental services access and dental caries education.Methods. In 2011–2012 we assessed user friendliness of the clinics including accessibility, signage, facility navigation, educational materials, and patient forms. We interviewed patients and surveyed dental providers about their knowledge and use of communication techniques.Results. Of 32 clinics, 26 participated. Implementation of the health literacy environmental scan tools was acceptable to the dental directors and provided clinic directors with information to enhance care and outreach. We found considerable variation among clinic facilities, operations, and content of educational materials. There was less variation in types of insurance accepted, no-show rates, methods of communicating with patients, and electronic health records use. Providers who had taken a communication skills course were more likely than those who had not to use recommended communication techniques.Conclusions. Our findings provide insight into the use of health literacy environmental scan tools to identify clinic and provider characteristics and practices that can be used to make dental environments more user friendly and health literate.The first assessments of health literacy among US adults found that a majority of them have difficulty using health information with accuracy and consistency.1,2 These findings are especially relevant for chronic diseases such as oral disease, which require continual self-care and ongoing professional interactions. In the early stages of health literacy inquiry, health literacy was defined as “the degree to which individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions.”3^(p21) Although the initial focus was on the individual, health literacy has evolved to be understood as an outcome of the match or mismatch between health literacy skills of the public and both the skills of health professionals and the characteristics and expectations of the health systems.4,5Oral health literacy has embraced this expanded framework for understanding some of the barriers to optimal oral health. The report, “The Invisible Barrier: Literacy and Its Relationship With Oral Health,” addresses several barriers. This report acknowledges that many health care providers are not trained to assess and address the literacy needs of their patients. As a consequence, they may orally present information without ensuring that the patient understands what has been communicated. Next, many health care providers use educational materials that may not have been developed with plain language and are difficult to understand and use. In addition, patients are often reluctant to admit that they do not understand something a health care provider says or are reluctant to ask questions or do not know how to ask questions for more information. Furthermore, many low-literacy patients either do not perceive that they have a problem or do recognize that they have a problem and work to conceal it because of shame or embarrassment.6Oral health literacy is of critical concern for the health of the nation because higher levels of oral health literacy have been shown to be associated with enhanced oral health knowledge, recency of dental care visits, lower levels of dental caries, lower no-show rates, and improved oral health–related quality of life.7–11 Furthermore, recent data indicate that adults with young children do not understand how to prevent dental caries. This finding is especially true for adults with lower levels of education or whose children are Medicaid recipients.12 However, the health sector cannot improve the literacy skills of the public, nor can health professionals wait until the education sector improves. Instead, health professionals and health care institutions can work to remove literacy-related barriers to health information, to preventive services, and to care.13–16To deliver high-quality, patient-centered care, health care organizations must take steps to reduce the complexity of the health care system, which can help address the mismatch between the health literacy skills of the public and the demands of the health system.17,18 A “health literate organization” is one that makes it easier for people to navigate, understand, and use information and services to ensure their health. For example, steps organizations can take to become more health literate include integrating health literacy into planning, providing staff with health literacy training, providing print materials that are easy to understand and act on, and using health literacy strategies in interpersonal communications with patients.19,20In this feasibility study, we focused on the use of a health literacy environmental scan (HLES) to identify institutional or agency characteristics that enhance or inhibit access to oral health information and preventive and treatment services. Environmental scans include reviewing accessibility, signage, navigation, written communications (print materials posted in the clinic, online, and distributed to clients), and spoken communication.19 This HLES included dental clinics in Maryland located in federally qualified health centers (FQHCs) and county and city health departments. These clinics are essential safety nets that expand access to comprehensive primary and preventive health care, and provide quality, affordable health care to the underserved, underinsured, and uninsured.This HLES is part of a statewide model of oral health literacy assessment. The Maryland health literacy model has focused on prevention of dental caries among parents of young children and for children younger than 6 years. The model includes assessments of health literacy skills and knowledge and practices of caries prevention among health care providers, the public, and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Head Start staff.12,21–23     

Distributed health literacy among people living with type 2 diabetes in Portugal: Defining levels of awareness and support

This study embraces a patient‐centred and narrative‐oriented notion of health literacy, exploring how social networks and personal experiences constitute distributed health literacy (DHL) by mapping out health literacy mediators of each individual and how they enable self‐management skills and knowledge of health conditions. Semi‐structured interviews with 26 patients with type 2 diabetes were conducted in a Primary Care Center of Porto (Portugal) from October 2014 to December 2015. Data were collected based on McGill Illness Narrative Interview (MINI). Following the grounded theory, interviews were analysed as case‐based and process‐tracing‐oriented. Three awareness narratives emerged: (i) a narrative of minimisation revealing minimal impact of diabetes in patients’ lives and daily routines, resignation towards “inevitable” consequences of the diagnosis and dependence of a large network of health literacy mediators; (ii) a narrative of empathy, where patients tended to mention readjustments in their lives by following medical recommendations regarding medication without criticism and with few health literacy mediators; (iii) a narrative of disruption, with patients highlighting the huge impact of diabetes on their lives and their individual responsibility and autonomy with respect to the management of diabetes and the search for alternatives to medication, relying on a very restrictive network of mediators. Exploring meanings given to diagnosis, identifying health mediators and analysing the structure of social networks can contribute to understand the distributed nature of health literacy. Assessing DHL can assist health professionals and those providing care in the community in promoting health literacy and providing models for a more patient‐centred health system.