Health Literacy Programme Report April 2015 March 2016 Programme and Evaluation Report Reporting on actions from Making it Easy: A national health literacy action plan for Scotland Building workforce capability for health literacy Developing the Health Literacy Place website as the national health literacy resource for Scotland Health literacy is about people having enough knowledge, understanding, skills and confidence to use health information, to be active partners in their care, and to navigate health and social care systems (Scottish Government, 2014) Date: 21 st April 2016 Version: Three Approved: 6 th May 2016 www.healthliteracyplace.org.uk Twitter: @healthlitplace Contact: Lindsey Murphy, Senior Knowledge Manager Health Literacy NHS Education for Scotland lindsey.murphy@nes.scot.nhs.uk 1
1. Executive Summary This report provides an overview of activity and evaluation findings of activity undertaken during 2015-2016 to progress two of the actions contained within Making it Easy: a health literacy action plan for Scotland (Scottish Government, 2014), namely: Workforce awareness and capabilities A national health literacy resource for Scotland The Health Literacy Place To take forward work under these headings the Senior Knowledge Manager Health Literacy focused efforts under the following headings: Building workforce capability through learning and training Development of the Health Literacy Place as the national go to place for health literacy information and support in Scotland Creation and development of a health literacy supporter network Communications and engagement to promote health literacy A variety of learning and training opportunities have been developed and delivered over the past year with approximately 360 members of health and social care staff in Scotland participating in some type of learning/awareness session or training course. Feedback from these shows a greater understanding and awareness of health literacy and its relevance to practice along with enthusiasm to take forward activity. The training opportunities available have been provided at awareness raising levels through to Train the Trainer and work is now underway to create a suite of online learning for health literacy. The Health Literacy Place website (www.healthliteracyplace.org.uk) was refreshed and officially launched in October 2015. Since then the site has saw a significant increase in activity, positive feedback and comments on the website and recognition as an example of good practice in other UK countries and beyond. The site was revised and rewritten in partnership with various stakeholders in Scotland and feedback suggests that the new website has been extremely well received. To support the sustaining of health literacy as a priority for health and social care staff in Scotland activities such as Train the Trainer and the development of a supporter network have been undertaken. It is the intention of these activities to grow capability across Scotland to support the ambition of the national action plan for Scotland to be a health literate society. 2
During 2015-2016 a communications and engagement plan was also produced to support the two relevant actions from the national action plan and activities such as campaigns, the creation of a dedicated Twitter account and the production of health literacy resources for health and social care have been undertaken. Those engaged in health literacy activities in Scotland feel that they are kept up-to-date and it is apparent from discussions with supporters and stakeholders across Scotland that there is an appetite for further activities and developments over the next year. Health literacy as a topic is linked to a range of policies and priorities in Scotland in addition to the national action plan. These include the Healthcare Quality Strategy for Scotland (Scottish Government, 2010) and the 2020 Vison (Scottish Government, 2011). During the past year Dr Catherine Calderwood, Chief Medical Officer for Scotland published her annual report titled Realistic Medicine (Scottish Government, 2015). This further emphasises the importance of health literacy as a priority issue for Scotland and makes reference to: Health literacy is a determinant of poor health outcomes and a significant cause of health inequalities The impact that poor health literacy has on informed consent and shared decision making We need to make healthcare simpler and more engaging so that it is responsive, particularly to those with the greatest health literacy needs. The report that follows provides more detail on the achievements that have been made over the past year in relation to the relevant two actions from Making it Easy and offers recommendations for learning from experience to date alongside suggestions for future activity. Health literacy is currently high on the national agenda in Scotland and is therefore an excellent time to continue in our efforts with health and social care staff in Scotland to raise awareness and develop sustainable solutions for integrating the promotion and improvement of health literacy standard practice. A summary report is also available at the Health Literacy Place website www.healthliteracyplace.org.uk. Lindsey Murphy Senior Knowledge Manager Health Literacy NHS Education for Scotland 3
2. Introduction The Scottish Government produced Making it Easy: a national health literacy action plan for Scotland (Scottish Government, 2014) with the following vision: We want Scotland to be a health literate society which enables all of us to have sufficient confidence, knowledge, understanding and skills to live well, on our own terms, and with any health condition we may have A multi-agency group worked together in writing the action plan which included a set of actions to support the achievement of this vision. NHS Education for Scotland and the Scottish Government recruited a Senior Knowledge Manager Health Literacy to lead on the following actions: Development of the Health Literacy Place website as the national go to place for health literacy information and support Building workforce capability for health literacy across health and social care. The post was filled and commenced in April 2015 for 12 months. 3. Programme activities In order to achieve the actions, set out in Making it Easy the Senior Knowledge Manager Health Literacy (SKM) initially focussed on the development of a workplan (appendix i) and a communications plan (appendix ii) for the year. To support the delivery and to engage with relevant stakeholders the Senior Knowledge Manager (SKM) created the Health Literacy Website and Learning Advisory Group. The terms of reference for this group including membership can be found in appendix iii. The following sections of this report will outline activities relating to the following pieces of work during 2015-2016. Development of The Health Literacy Place website Building workforce capability through learning and development Development of a health literacy supporters network Communication and promotional activities. 3.1 Development of the Health Literacy Place website The Health Literacy Place was originally developed as a community site within the wider Knowledge Network website (www.knowledge.scot.nhs.uk). The main 4
objective for the website was for it to be the national go to place for health literacy information and support in Scotland for health and social care staff. It was felt from discussions with stakeholders that the community aspect of the site was not currently being utilised and people may be put off by the request to join as a member which required having an Athens account and registering with the site. Discussions therefore took place with relevant NES colleagues in Knowledge Services and Digital to discuss the purpose of the site, what we wanted to achieve and the best way to do this. Options were considered such as updating the existing page, moving everything to a new page and restructuring with support from a digital company to make it more engaging and with improved structure or to build a new site using Umbraco. It was agreed that the way forward would be to create a new website using Umbraco, this was developed by Screenmedia. The Senior Knowledge Manager was responsible for the production of personas and user journeys to inform the development of the new website. From the development of these and consultation with stakeholders a number of site requirements were identified. These are listed in the table below along with action that was taken or has yet to be taken. Being able to work across a range of internet servers and devices (also being mobile responsive) Offer up-to-date news relating to health literacy activity in Scotland and beyond that is kept maintained To support those who wish to be health literacy supporters and allow them to join up with each other by offering a networking tool to allow users to share ideas and ask for support Where possible attempt to align professional groups where appropriate Have links to local board areas for people that can be contacted regarding health literacy at a local level Have a discussion forum with easily identifiable threads The site was tested on various servers and is mobile responsive A three item news section is available on the home page. It is the administrator s role to update this, news does not automatically update The site promotes people connect and people are encouraged to add health literacy as a subject interest. We are currently exploring the use of PC to support those who have been trained as health literacy trainers. This hasn t yet been done, there is potential to add professional groups as subject tags to support resource searching dependent on discipline There are no local contacts on the site at present, potential to contact supporters asking for their approval for the supporter contact sheet to be added to the site Via People Connect although this has still to be utilised 5
Be able to link to social media sites to allow users to easily post and share site content Provide a range of tools and example communications/documents/resources to support public health and clinical practice and assist people when communicating with patients /service users Provide up-to-date evidence and research on health literacy Pages can be shared via Facebook, Twitter, LinkedIn, Google Plus and email. This is provided within the tools and techniques page and site users and stakeholders are encouraged to provide information to update. There is a range of content within the resources library and the evidence pages, Knowledge Services are looking at setting up alerts for new research relating to health literacy to support the Senior Knowledge Manager in keeping this section current The consultation period informed development of the site information architecture and also the functionality requirements. This involved carrying out telephone interviews with stakeholders who were involved with the development of the national action plan and those identified as users of the website. A new logo was created for the website to be used on any work being carried out under the health literacy banner by NES. Following the agreement of this the content from the existing website was transferred over alongside the production of new content that was required. The work took a total of five months from initial developments to completion and handover of the site, the website then had to be populated by the Senior Knowledge Manager. The Health Literacy Place www.healthliteracyplace.org.uk was officially launched at an event on 22 nd October 2015. A range of partners were invited to this event and over 50 delegates attended the event in Edinburgh. The event coincided with Health Literacy Month and to support promotions a business case was submitted to and approved by NES for a Twitter account which was also launched at this time @healthlitplace. The development of the website was supported by wider NES colleagues, Scottish Government leads, the Scottish Health Literacy Action Plan Implementation Group (appendix iv) and the Health Literacy Website and Learning Advisory Group. 3.2 Building workforce capability through learning and development 6
A mixture of learning opportunities and resources were developed during 2015-2016 to support the activity within the national health literacy action plan relating to building capability within the health and social care workforce for health literacy. The learning and training activities fall loosely under the following categories. 3.2.1 Health literacy awareness raising The learning outcomes for this course are that delegates will have: An increased knowledge of what health literacy is and why it is important Increased awareness of the tools and techniques to support and promote health literacy in practice An awareness of the resources and information that is available to support you in promoting health literacy The course has been delivered via Webex over the past year but there is potential to deliver it face-to-face for groups on request dependent on capacity. The sessions have been delivered to a number of mixed groups as well as dedicated sessions for staff working in health information and in pharmacy. 3.2.2 Health Literacy Train the Trainer The learning outcomes for this course are that delegates will: Have increased knowledge about health literacy Have an improved understanding of the impact of health literacy on health and social care services Be able to identify how we can promote and improve health literacy Have increased awareness of the resources available to support them in sharing knowledge with others and deliver health literacy sessions. Train the Trainer is for any staff within health and social care interested in learning more about health literacy whilst gaining the skills and confidence to share learning with others. 3.2.3 Health literacy input to staff conferences and events In addition to organised training the Senior Knowledge Manager is required to respond to a number of requests for input at staff events to raise awareness of health literacy. This has been requested for staff conferences, training days and dedicated CPD sessions. The learning outcomes most often are aligned to the awareness raising session but these sessions are tailored both in terms of length 7
and content to meet the needs of the group and to engage with them by relating the subject to their area of work. 3.3 Development of a health literacy supporter network To assist the spread of health literacy information and messages across Scotland at a local level it was decided to make use of both People Connect and also the development of a health literacy supporter network. To this end, promotions were made via the website, at events and through local NHS boards asking people to: 1. Set up a profile on People Connect (if they did not already have one) and add health literacy as a subject interest 2. Sign up as a health literacy supporter (role of the supporter can be found in appendix v) Various information was sent to the health literacy supporters during the year, including, information on Health Literacy Month, information on health literacy training and events and updates on the website. 3.4 Promotional and other activities Throughout the year various promotions took place both by the Senior Knowledge Manager, the wider Knowledge Services Group and NES and other stakeholders, including but not limited to, members of the Scottish Health Literacy Action Plan Implementation Group, Health Literacy Website and Learning Advisory Group and health literacy supporters. October is Health Literacy Month and this month was used to encourage all stakeholders to promote health literacy and some key messages. A briefing paper was sent to all stakeholders outlining some information about health literacy and the campaign month, some key messages and some ideas for promotions. This coincided with the launch of the website. During October a Twitter account to further engage people in the work relating to health literacy in Scotland and the website was produced, this account is managed by Knowledge Services at NES and can be found @healthlitplace on Twitter. In addition to the development of the website as a resource to support workforce capability, resources were developed to be used at events and during conversations with health and social care staff in the form of a leaflet and a postcard. The leaflet, titled What is health literacy and why is it important to me? can be accessed here. It covers information such as what is health literacy, why it is important and what health and social care staff can do to support and improve health literacy. The 8
postcard was created to support follow up from events and provides information on health literacy as well as asking people to agree to take action around learning more about health literacy or becoming more involved. The postcard can be accessed here. These resources are used regularly in training and at events alongside resources including (click on the links to access): Making it Easy: a national health literacy action plan for Scotland Making it Easy: a quick guide Making it Easy: video Teach back postcard In addition to the business outlined above the Senior Knowledge Manager has been involved in raising awareness of health literacy in Scotland with a range of groups. An example of this is the links being made with the Directors of Public Health and the Scottish Health Promotion Managers to explore the role of these disciplines in health literacy. Papers have been presented to both groups and further plans for discussion are in place. Requests have also been made for discussion with subgroups of the Chief Nursing Officer to explore their role in health literacy and how this can be developed. Requests for information and guidance are received from a variety of colleagues across Scotland, the UK and globally. Examples of some activities outwith the role s main remit which the Senior Knowledge Manager has contributed to include: Health Information Resources Service action plan for NHS Ayrshire & Arran NHS Inform website redesign Development of health information materials including new cervical screening leaflets for patients Requests for information or approval for use of our website information from agencies in countries such as Austria Requests to share presentations and training materials with UK colleagues in England and Northern Ireland Sharing experiences of work undertaken to date with colleagues in NHS England Linking with public libraries in Scotland and England in terms of their role in promoting health literacy Part of the organising committee for the 4 th UK Health Literacy Conference. The Senior Knowledge Manager aims to work closely with NES colleagues and has made links with leads from NMAHP, Medical, Healthcare Associated Infection, Psychology and Dental to identify and promote links with health literacy. 9
4. Evaluation framework As this programme of activities were limited in the first instance to delivery over one year it is difficult to measure any longer term impact. Therefore, a logic model was developed to identify contributions towards medium and longer term outcomes. The full logic model, which was agreed by the Health Literacy Website and Learning Advisory Group can be found in appendix vi, this includes a list of output and outcome indicators used to inform this evaluation. 5. Evaluation activities and findings 5.1 Development of the Health Literacy Place website The main source of information on the Health Literacy Place website is available through the use of Google Analytics. Other sources include feedback from sessions such as the launch of the Health Literacy Place and training sessions where the website is presented and discussed. Feedback from the Health Literacy Place launch event suggests that the website was very well received with 95% of delegates who completed a feedback form stating that they had a better understanding of health literacy and a better understanding of how they could make use of the website. Specific comments gave recognition of the presentations such as how to make use of the website and also having the opportunity to visit the website and use it first-hand. Delegates at the launch event suggested that future improvements could explore health literacy in the community setting, how it could be extended to consider community libraries and volunteering sector and how they can be supported to use the tools and techniques promoted, embedding the video in the website rather than using Vimeo to improve access, incorporation of non-clinical staff examples, broader publicising with various staff groups. Of the delegates who completed a feedback form (n=23) 17 stated that they intended to visit and engage with the website, others stated they have already made use of the site. Furthermore, feedback from training suggests that people find being given an overview of the website and the site itself is useful: The website with the pictures is looking really good and I particularly like the very up-to-date evidence section The following graph shows use of the Health Literacy Place each month during 2015-2016. 10
Health Literacy Place Visits 2015-2016 3500 3000 2500 2000 1500 1000 500 0 Sessions Users Page views As can be seen the use of the site was generally static during the first half of 2015-2016. The number of sessions, users and page views all increased in October 2015 when the website was launched. While there were fewer page views in November there was a continued increase in both users and sessions. Areas identified for improving the site appear to be focused on broadening the scope of the site to encourage engagement from community staff, social care, voluntary sector and non-clinical staff. Work should continue to encourage new users to the site but also ensuring that existing users have a reason to return. The site has a 53.85% bounce rate (where people land on a single page then leave) and a 28.97% exit rate, there is potential to work on the pages where people tend to visit most (outlined in the table below) to encourage further engagement with other pages on the site. Average time spent on pages on the site is 1 minute 26 seconds. Top five pages viewed on the Health Literacy Place: Home page 26.46% Tools and techniques 7.33% Resources library 5.26% Learning and Development/National training/nhs Education for 3.54% Scotland Learning and Development 3.29% The percentages in the table above are in relation to the total number of pages viewed. 11
5.2 Building workforce capability through learning and development During 2015-2016 various training opportunities were made available via NHS Education for Scotland. These are advertised on relevant pages of the website and promoted via various routes, this may be a contributor to the NES training pages being one of the most viewed pages on the website. Further local training is also available in a number of territorial boards across Scotland. Knowledge Services in NES responded to a number of request for health literacy input to specific staff events and conferences, a breakdown of this is provided below. Event Audience Date Numbers (if known) Faculty of Public Health Public Health Nov 2015 25 (app) annual conference 3 rd European Health Literacy Health literacy Nov 2015 30 (app) Conference champions (global) Health Care Support Workers Health Care Support Feb 2016 10 (app) conference Workers Resources Officers Resources Officers Oct 2015 40 (app)d Conference Scotland Dental Nurse Training Dental Nurses PDS Nov 2015 8 General Practice Nurse GP Nurses Nov 2015 30 (app) Training UK Health Literacy Health literacy Mar 2016 50 (app) Conference champions (UK) BMJ Masterclass GPs Oct 2015 100 (app) Infection control training A&E Nurses Sept 2015 12 NHS Scotland event 2015 NHS Scotland staff June 2015 Poster Health Literacy Train the Trainer Train the Trainer sessions were held four times and a total of 28 people took part in these. The courses in the West seem to be more popular and a dedicated session for NHS Ayrshire & Arran took place as there was a lot of interest from this area following dissemination of training information via their health literacy leads and the Ayrshire & Arran Self-Management Network. At the start of each courses delegates were asked to complete a pre training questionnaire and also mark on a confidence ruler how confident they would fee at that point in time if they were asked at that point in time to deliver a health literacy session to raise awareness of the topic with others. As can be seen from the graph below there was a shift to increased confidence when delegates were asked to again 12
complete the confidence ruler at the end of the day (where 0 is the least confident and 10 is the most confident). Confidence in delivering health literacy sessions/awareness raising 12 10 8 6 4 2 0 0 1 2 3 4 5 6 7 8 9 10 Pre training Post training At the end of the day a post training questionnaire was provided to all delegates. Within this form people were asked about how they felt the learning outcomes for the session had been met. Delegates will: Have an increased knowledge about health literacy Have an improved understanding of the impact of health literacy on health and social care services Be able to identify how they can promote and improve health literacy Have the skills and resources to support them in sharing knowledge with others and deliver health literacy sessions Strongly Agree agree 23 5 20 8 16 12 24 4 Neutral Disagree Strongly disagree The above shows that there is scope to provide more focus during the sessions on the impact that poor health literacy can have on health and social care services and how people can work to improve health literacy. 13
Delegates rated other aspects of the training as follows: Strongly agree Agree Neutral Disagree Strongly disagree I received enough information about the training before attending Handouts/supporting information was useful/appropriate The delivery methods used were appropriate The content was relevant to my area of work The trainer was knowledgeable in the subject area The length of the course was good 13 12 3 23 5 22 6 19 9 26 2 18 9 Further comments from delegates with regard to the above responses indicated that for some they had booked onto the course at a later stage and therefore did not receive pre-course information and also that future sessions could focus more on training techniques. Delegates stated that they found the course really informative and interesting with lots of good, practical information. All delegates agreed that they would take action following the training and during the sessions it was agreed that a three month follow up would take place to find out about any action taken and to identify any further support that would be required. Ideas for the future included methods for sharing updates and new information and offering support to each other through a trainers network. It was discussed that People Connect may be a medium which could support this. When asked what type of action people would take, suggestions included: Offer and deliver training to colleagues/peers/teams/others Share learning with others Identify opportunities to link this with other training Take back learning and ideas for discussion with team/managers regarding next steps Find out what is happening in own area already regarding health literacy Review/update existing health literacy training Implement tools and techniques that have learnt about into practice. When asked for any other comments on the training, feedback included: Well facilitated 14
Interesting and informative Trainer very knowledgeable and explained the subject well Consider using role play for future sessions Training raised awareness among people who already had a reasonable knowledge Excellent session Enjoyable session Excellent trainer Training needs to be spread out over all health board areas. It was also of interest to see a shift in understanding of what health literacy is as delegates were asked to define the term both at the start and the end of the course. The definitions provided at the end were much more in line with those we use nationally and showed greater understanding of what health literacy encompasses. Since the last training session a number of people remain on a waiting list and others have expressed interest in future courses which are being arranged for the coming year. Health literacy awareness raising Webex A total of 5 awareness raising sessions were delivered over Webex to a total of 28 participants. Following each of these sessions a short survey was distributed via Questback, unfortunately this has had a low response rate with only 4 people completing the questionnaire. From those who did respond, all stated that they learned something new during the session. Examples of what had been learned included other resources and signposting opportunities. In terms of what people liked least about the session, some felt that while the length was appropriate for a quick overview more time would be needed to expand on other elements, also that the session was felt to have a clinical focus and it would be good to look more at health improvement and health literacy. While some commented that they would prefer face to face it was also noted that the session did work well via Webex and that it was good to complete the training in the workplace. Other positive feedback stated that the course moved at a good pace and the information was well presented by a nice friendly voice. 15
Delegates were asked to what extent the learning outcomes were met: An increased knowledge of what health literacy is and why it is important Increased awareness of the tools and techniques to support and promote health literacy An awareness of the resources and information that is available to support you in promoting health literacy Fully Slightly met met 3 1 4 3 1 Partly met Not met at all I don t know Other feedback on the training suggests that people found the training useful and well delivered and that they were particularly interested in the tools and techniques to promote health literacy and that they prefer UK or Scottish information and videos rather than American information and content. Delegates indicated that they plan to use the awareness to better communicate with the public, to consider offering guidance for using printed information which takes into account health literacy principles. Discussions are underway regarding the potential to produce teach back videos for Scotland for staff to use individually to support practice or as an educational tool during training and learning sessions. 5.3 Development of a health literacy supporter network At the end of the year all supporters and wider stakeholders were sent a short questionnaire to support collation of information against indicators outlined in the evaluation framework and to support future work with these networks. The findings related to various aspects of health literacy activity but asked supporters and stakeholders questions such as whether they felt communicated with, whether they felt informed and how things could be improved. A total of 31 supporters signed up during 2015-2016, this is slightly lower than was projected but it is anticipated that more will sign up during 2016 as promotions and training activities continue and new contacts are made. At the end of 2015-2016 41 people have identified health literacy as a subject interest on People Connect. At the end of 2015-2016 a feedback questionnaire was sent to all health literacy supporters and members of the Health Literacy Website and Learning Advisory Group. A total of 10 people responded to this questionnaire. 16
In terms of awareness of health literacy support and resources, all those who responded were aware of the website and the leaflet for health and social care staff, 8 were aware of the Twitter account. People were asked to rate aspects of the Health Literacy Place and provided the following feedback. Opinion of Health Literacy Place V Poor Poor Neutral Good V Good 0 1 2 3 4 5 6 How would you rate the content of the site How would you rate the accessibility of the site How would you rate the navigation within the site How easy is it to find the site online When asked what they use the website for most stated it was to keep them up-todate with information and developments. Others use the site to assist them in delivering training and learning opportunities and signpost other professionals to the site. The site appears to be promoted by those who responded through including the website in their autosignature, via social media, through training, at events and through bulletins. General comments on the site made reference to the evidence based information it provides, that it is an excellent source of information and that it has developed well over the past year. Colleagues were also asked to rate the leaflet developed for health and social care. Of those who responded (n=10) nine stated that they found the layout very good or good, one stated neutral and ten stated that they found the content very good or good. Some suggestions were made about ensuring the relevancy to social care is focused on to support then and encourage them to engage with the materials Four out of the ten respondents follow the @healthlitplace Twitter account while six do not, when asked why responses indicate that some do not have Twitter (n=5), some are not able to access at work (n=1) or not able to use Twitter (n=2). In terms of engagement with and involvement in health literacy activities in Scotland, all respondents stated that they felt they are kept up-to-date with information. The 17
majority stated email as the preferred method of communication while consideration was also recommended to the wide range of methods available to meet the needs of all those we wish to engage with. Communication during the past year was unplanned and arose as required, there may be potential in the coming year to develop a planned approach to communications, this would include for example communication around Health Literacy Month to ensure that people receive the information they need to support them in this in a timeous manner. The following feedback was provided in terms of some of the intended outcomes for this work: Responses relating to programme outcomes 7 6 5 4 3 2 1 0 I now have an increaed understanding of the importance of health literacy I am more aware of how health literacy relates to health outcomes I am more aware of the tools and resources to support health literacy I feel skilled in sharing knowledge about health literacy I feel more confident in using health literacy tools and resources Strongly agree Agree Neutral Disagree Strongly disagree 5.4 Promotional activities All those who had been asked to participate in promotional activities as part of health literacy month were sent through a short feedback form asking about what they did, unfortunately response to this was low. Due to other priorities such as getting the website prepared for the launch event the briefing paper for the campaign did not go out until 1 st October. From those who did respond, activities included: Delivering training and information sessions Adding the website address to autosignatures Sending out tweets and retweeting @healthliplace tweets with some of the key messages Communication during the past year was unplanned and arose as required, there may be potential in the coming year to develop a planned approach to communications, this would include for example communication around Health Literacy Month to ensure that people receive the information they need to support 18
them in this in a timeous manner as recommended by health literacy supporters and members of the Advisory Group. Following the set-up of @healthlitplace Twitter account Twitter analytics were used to identify some of the key findings in terms of Twitter activity. The @healthlitplace Twitter account went live on 19 th October 2015. Analytics for the website shows the following engagement and interactions with the account. It is difficult to express these visually together due to the different measures and size of measures that are used. The table below gives an overview of Twitter impressions (the number of times tweets were seen), engagements (the number of times a person interacted with a tweet) and the engagement rate (the number of engagements divided by the number of impressions). Impressions Engagements Engagement rate October 2100 161 2.7% November 2200 44 1.2% December 3100 67 1.4% January 7200 108 1.8% February 2900 32 0.9% March 5800 109 1.3% The table below shows the number of engagements in graphical form alongside the number of times a tweet was clicked on, the number of times a tweet was retweeted, the number of times a tweet was liked and the number of times a tweet was retweeted. Twitter engagement @healthlitplace 180 160 140 120 100 80 60 40 20 0 October November December January February March Engagements Link clicks Retweets Likes Replies In terms of top tweets, these are the tweets each month that resulted in the most interaction: 19
October = #myfirsttweet welcome to the Health Literacy Place account! Visit the website now at healthliteracyplace.org.uk November = Info/slides from #Healthliteracy Place website launch event now available: http://www.healthliteracyplace.org.uk/blog/2015/news/health-literacyplace-launch-post-event-information/ December = Why not make a #newyearsresolution to promote #healthliteracy by using teach back January = Looking forward it #hcsw2016 https://twitter.com/darrielorna/status/693078234624348161 February = The importance of #healthliteracy in #clinical and #community settings https://twitter.com/richardosborne4/status/702996357368254464 March = Call for system wide approach to #healthliteracy, focus on self-care and #healthpromotion https://twitter.com/literacyhealth/status/712192001517686784 During the initial period of 2016-2017 it is recommended that this and other analytical data is used to implement the beginnings of an engagement plan incorporating various methods, including face-to-face, but with a focus on digital opportunities. While there will always be ad-hoc information and opportunities for sharing information, some activity should also be planned. An example of this could be planning tweets to send out at certain times based on what tweets appear most popular and interacted with. The use of Hootsuite will also be explored as a means to scheduling tweets and messages to ensure that even if the account is unmanned there will still be opportunities for engagement. 6. Conclusion and recommendations As can be seen from the information contained in this end of year report, there has many achievements during 2015-2016 to advance actions contained within the national health literacy action plan as well as contributions to other local and national initiatives to promote and develop health literacy understanding, engagement and activity. During the past year a set of strong foundations have been laid which can be built on during 2016-2017 to enable wider reach and a greater impact on workforce capability and practice. There is learning which can be gained from the past year as well as recommendations for the future, both through growing existing activity and developing new opportunities. Since the beginning of 2015-2016 the policy context for health literacy has grown stronger with various references to health literacy made through the Chief Medical Officer s Annual Report (Scottish Government, 2016)). This report provides further direction and impetus to focus on health literacy as a priority for health and social care in Scotland and recognises the role of health 20
literacy in reducing health inequalities. Strategic links are also being formed with Public Health which should be recognised and built on during the coming year. The following priorities for recommended activity led by the Senior Knowledge Manager Health Literacy and supported by the Health Literacy Workforce and Learning Advisory Group are therefore considered to be as follows. These are for consideration by NHS Education for Scotland, Scottish Government and the Health Literacy Website and Learning Advisory Group before being developed into a formal action plan. The Health Literacy Place Website and Social Media 1. Continue to maintain the website and keep the site fresh and engaging through blogs, news and development of existing and new pages 2. Work to ensure that the evidence section within the website is kept up-to-date and holds relevant and current evidence for health literacy to support health and social care staff in Scotland 3. Continue to build the resource library within the site and add/refine tags based on consultation with users to support them in finding resources that are relevant to them 4. Work with stakeholders to identify methods for engaging social care and 3 rd sector staff in the website and making it more relevant to these groups 5. Explore other developments to the site in partnership with stakeholders, for example, making links with Scottish Government, Our Voice and the Storytelling Village to create blogs and pages highlighting the role of storytelling in health and social care and its role in health literacy 6. Regularly monitor Twitter and plan activity as part of a wider engagement plan to carry out social media promotions and communications and explore the opportunities of other social and digital platforms. Developing and delivering a range of learning opportunities to build workforce capability 1. Continue to develop the Health Literacy Train the Trainer programme and offer to health and social care across Scotland 2. Work with existing trainers to offer support and encourage activity in local areas to build sustainability of training for health literacy 3. Continue to develop and deliver health literacy awareness raising through Webex as the primary delivery method 4. Build a suite of learning and training materials to be hosted on the Health Literacy Place available for staff at local and national levels to access and make use of to carry out awareness raising activities 21
5. Develop e-learning modules in partnership with Digital colleagues and health literacy stakeholders on the following topics with a view to producing a single online course for health literacy a. Health literacy tools and techniques b. Health literacy, person centred care and quality improvement c. Health literacy and health inequalities 6. Respond to requests for input to learning events as required and identify opportunities to promote health literacy activity in Scotland Testing and spreading health literacy innovation through Public Health and community/other settings 1. Work with colleagues in local areas who are interested in taking forward local health literacy programmes to support them in developing, delivering and testing these to share learning with others 2. Work with relevant colleagues in NHS Education for Scotland to identify and build connections with Self-Directed Support 3. Consider opportunities to work with public libraries in Scotland to develop their health literacy role as providers of health and wellbeing information. For all activities above and other objectives which will be taken forward by Senior Knowledge Manager within NHS Education for Scotland an exit strategy will also be considered for end 2016-2017 in partnership with management for when the post is due to end. 7. References Scottish Government (2010) The Healthcare Quality Strategy for Scotland. Scotland: Scottish Government. Scottish Government (2011) Everyone Matters: 2020 Workplace Vision. Scotland: Scottish Government. Scottish Government (2014) Making it Easy: a health literacy action plan for Scotland. Scotland: Scottish Government. Scottish Government (2016) Realistic Medicine. Scotland: Scottish Government. 22
8. Appendices Senior Knowledge Manager Workplan 2015 2016 Appendix i Senior Knowledge Manager Health Literacy Workplan April 2015 March 2016 Activity Timescales Create a role of the HL supporter and include plans for promotion in comms/engagement plan May 2015 Carry out engagement and communication activity to commence recruitment of HL supporters (in June 2015 partnership with PHP Health Literacy) Carry out interviews with key stakeholders to consult on and inform activity relating to the HL Place, HL June 2015 Champions and capacity building Set up HL Website and Learning Advisory Group and host first meeting where future meetings and format of June 2015 these will be agreed Contribute to the HL Implementation Group being led by Graham Kramer and Kate Burton Ongoing Attend sessions/meetings including but not limited to PLT events to engage with staff at a board level June onwards Contribute to the review of the NHS Inform website June onwards Health information in libraries June onwards September Contribute to Knowledge into Action network activities to link health literacy to the broker role and vice July onwards versa Carry out review of web content and work with Screenmedia on design and create new layout May-June 2015 Sign off templates for move to Umbraco July 2015 Set targets for new and return visitors to the Health Literacy Place and monitor these using Google analytics July onwards 23
(carry out online training in using Google analytics) Develop a range of promotional resources for use at events to promote and raise awareness of the HL Place (further detail contained in separate plan) Redraft Health Literacy Place website based on recommendations and feedback from consultation with key stakeholders Produce a blog which offers updates on practice and activity of the SKM Identify others with roles and activity that could create blogs/case studies for the website and facilitate this Update website and host launch as per website development Gantt Chart Launch the revised HL Place Manage and contribute to discussion threads on the site and encourage others to do so Carry out a range of promotional activities and communications to promote the HL Place and increase engagement (further detail contained in separate plan) Review resources being uploaded to the site and tag/store accordingly Produce a TtT style Health Literacy session with supporting resources and facilitator pack and pilot with early adopter boards via Webex or face-to-face if needed Amend and roll out as required ensuring that promotions take place via HL Place and target HL supporters Explore the potential for a PBSGL module on health literacy sensitive practice Develop and deliver if opportunity is available Link with health literacy supporters in each board area to: Promote event for stakeholders and supporters to launch the refreshed HL Place and the range of learning opportunities available Explore the potential for roadshows for each board area led by SKM for Health Literacy and local supporters to engage and involve wider staff at a local level September onwards August 2015 July August 2015 June onwards July onwards July September September/October August onwards Ongoing Ongoing July 2015 August onwards June July August September September/October October December Explore the potential to develop a Learnpro module on HL awareness raising August 24
Take forward Learnpro development if feasible Carry out an engagement activity with wider social care staff to explore their understanding and needs relating to health literacy sensitive practice to inform future work for the HL Implementation Group (potentially through Alliance and self-directed support workers) Informed consent Work with Advisory group to identify information and activities for this topic area which can be promoted via the site and used to contribute to existing health literacy training sessions Review guidance and information to develop informed consent section on the HL Place which includes: Links between HL and informed consent (why it s an issue) Guidance and links to other sources of information Supporting paperwork Resources and educational tools for learning Medicine management Work with Advisory group to identify information and activities for this topic area which can be promoted via the site and used to contribute to existing health literacy training sessions Review guidance and information and develop a medicine management section on the HL Place which includes: Links between HL and medicine management Guidance and links to other sources of information Supporting paperwork and tools Resources and educational tools for learning Long term conditions Attend self-management conference and identify opportunities for information and resources to include in October March January March 2016 August October August December August October August December May-June 25
training and on the Place that link HL requirements to self-management Link with the Alliance and ALLIS to identify and explore opportunities for joint working to promote health literacy as a pre-requisite for living with LTCs (link to self-management) Work with Advisory group to identify information and activities for this topic area which can be promoted via the site and used to contribute to existing health literacy training sessions Review guidance and information and develop a LTC section on the HL Place which includes: Links between HL and management of LTCs Guidance and links to other sources of information Supporting paperwork and tools Resources and educational tools for learning Create outcomes chain and evaluation plan utilising KiA resources, incorporating process and outcome evaluation Gather evidence and information to inform evaluation Carry out outcome evaluation questionnaires/surveys/focus groups to be identified via evaluation plan Produce evaluation report Ongoing August October August - December June July November ongoing November February February April 26