Evaluation of a Health Literacy Program for Chronic Conditions

Background: Although much is known about health literacy in concept and practice, more research is needed to understand the mechanisms that improve health literacy and result in healthy behavior change. This is particularly so for those at risk of or living with chronic conditions who reside in communities experiencing socioeconomic disadvantage. Objective: The program aimed to improve the prevention and management of chronic conditions by responding to health literacy needs. Methods: A health literacy program, underpinned by Ophelia principles, was developed in consultation with three Neighbourhood Houses located in areas of socioeconomic disadvantage. Four 7-week group programs were delivered by a multidisciplinary team of academic health professionals. The evaluation aimed to explain how the design, content, and approach to delivery resulted in healthy behavior change and increased health literacy for the participants. Four focus groups were conducted to elicit feedback about the participants’ experience of the program and recommendations for future programs. Data were thematically analyzed. The focus groups were attended by 22 (43%) of the total 51 program participants. Most of the participants were women with one or more chronic condition and residing in an area of socioeconomic disadvantage. Key Results: Four major themes were identified including the components of self-determination theory (SDT) (autonomy and competence and relatedness) and a separate, but related theme of empowerment. Recommendations for improving future programs were categorized separately. Conclusions: The SDT framework is a useful and novel approach to explaining the evaluation outcomes, the application of the Ophelia principles’ underpinning design of the program, and the contribution of a multidisciplinary team of academic health professionals. Future programs will benefit from the SDT as a planning and evaluation framework, as well as understanding the long-term effects of the program within the broader community. [Health Literacy Research and Practice. 2017;1(3):e100-e108.] Plain Language Summary: A team of health professionals developed a 7-week group program that they delivered in the community setting to people who were living with or at risk of developing chronic conditions. The evaluation showed the benefit of providing health information in ways that can be understood and acted upon, as well as the value of a group program that fosters participation. The capacity to understand and recall health-related information to make decisions is fluid and situationally dependent. The ability to find, appraise, understand, and act on information is known as health literacy and reflects one’s personal characteristics and social resources (Jordan et al., 2013). Globally, there is an increasing awareness of the relationship between health literacy and health outcomes, with health literacy thought to be a better predictor of health status than education, socioeconomic status, employment, race, or gender (Weiss, 2007). When health literacy is low, people have less knowledge of conditions, treatment, and health determinants (Pignone, DeWalt, Sheridan, Berkman, & Lohr, 2005). This results in a greater number of preventable hospital admissions, increased use of emergency services, and more medication and treatment errors (Pignone et al., 2005). The health care system is becoming more complex to navigate (Schumacher et al., 2013), and this particularly effects how people self-manage chronic conditions as that requires the ability to respond to test results, meet multiple