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Health Information Design - bridging the health knowledge Gap

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Ian Jackson

on 15 June 2011

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Transcript of Health Information Design - bridging the health knowledge Gap

1970's Global direction of travel towards a health-care nirvana developed in the context of an increasingly consumerist society and organisational needs, to find efficiencies health-care shaped around each individual's needs, preferences and contexts Stewart et al, 1995 it led to the WHO defining "responsive to people's needs and preferences"
as characteristics of
"High performing
health systems" WHO, 2008 Lansley & Darzi before
him continue this
direction of travel...
away from the old paternalist model
of health-care Global evidence shows that involving patients improves Wanless, 2003 "improves management of long-term conditions" Lansley,2010 "errors can be avoided" Godolphin, 2009 "creates greater self-efficacy" Crawford et al, 2002 Despite the evident benefits
progress towards reaching
the nirvana is slow the nirvana was meant to be reached via Shared Decision-making
& Self-care which form the
"Crux of patient centred care" Legare et al, 2010 "a process by which a healthcare choice is made jointly by the practitioner & patient" legare, et al. 2010 It's in policy...
"Shared Decision-making will become the norm: No decision about me without me." Lansley, 2010 “Whatever the context in which medical decisions are made, you must work in partnership with your patients”...“listen and respect their views about their health, discuss what their diagnosis, prognosis, treatment and care will involve, share the information they want or need in order to make decisions, maximise their opportunities, and their ability, to make decisions for themselves and respect their decisions” Their language is strong and backed
by a note that
"serious or persistent failiure
to follow this guidance
will put your registration
at risk" General Medical Council, 2008 General Medical Council, 2008 The NHS Constitution "Your doctor should listen to you and respond to your concerns and preferences about your healthcare. That way you can find out what is the best treatment for you. NHS staff will give you the information you need to support these discussions and decisions about your healthcare, and to be given information to enable you to do this." SDM helps to uncover the patient's values, beliefs & preferences that shape the selection of available options to help practitioners achieve SDM 'Patient Decision Aids' (PDA's) can be used PDA's can be leaflets, illustratrated forms, 'decision boards', interaction DVD's, online applications, audio workbooks, printed presentation etc Some PDA's can be used for patients to work through as preparation for a healthcare consultation that they can do in their own time, space and pace, while other are used in consultations And in 2003 the International Patient Decision Aid Standards (IPDAS) where created PDA's have their place...
but not all health decisions are taken in consultations we all... whenever we make a choice between the stairs or the lift, a banana or chocolate and/or taking preventative actions to avoid ill health, through healthier behaviours or avoiding ‘risky’ ones, or adjusting a dose of medication. The link between health status and ability to self-care “over 30% of people with poor health do not have knowledge, confidence (self-efficacy) or skills for self management” Ellins & Coulter, 2005 In looking after themselves and their family members, people provide perhaps as much as 85% of healthcare as ‘self-care’ Health Promotion assets, in many forms and under a range of names and labels including PDAs, play a major role in
“the process of enabling people to increase control
over their health and its determinants” Kumar et al, 2004 WHO 1986 Wanless's projections showed that a
'Fully-engaged' public could save £30 billion Wanless, 2003 Although
‘self-care’ applies to everyone, it is most important to the 1 in 3 people living in the UK with a long-term condition DH, 2005 Those 17.5 million create a significant demand on NHS resources As our population grows older, becoming more susceptible to long-term conditions, ensuring we are all more informed about avoiding disease and managing our own healthcare will be key to keeping health service costs down Clear evidence-based information is a key resource to help people discern the best course of action and what they can do to help themselves... Lorig & Holman 2003 (Patient-Information-Forum,-2008) to feel more in control and have greater self efficacy. In that way it has been proposed that ‘information is a first line therapy’and is as much a significant part of care as it may be about care. It isn’t possible to take decisions as in ‘self-care’ or share a decision as in SDM, without the knowledge... ...to allow you to have confidence in your ability to take an informed decision. Providing health information to enable this involvement is key and what’s more, there is a patient demand for it Sihota & Lennared, 2004 However, treatment options are multiplying, research is constantly updated and information about them variable in quality and partiality Further complexity is added by the context of each individual perhaps the biggest context being... increasing the challenge in delivering accurate, accessible, usable and unbiased information These factors reveal the... where people who would most benefit from health information are the least likely to be able to access, understand and/or apply it to their situations Without adequate health literacy, patients face serious difficulties accessing, understanding and making effective use of health information in the contexts of SDM and ‘self-care’ Most reading material in adult
life including healthcare
information is at level 2 or above... ...however, only 45% of the adult population have skills at this level or above Only once understanding levels reach a significant “tipping point”... (O’Connor-et-al.,-2007) ...will patients be able to make choices leading to lower demand on unnecessary frontline services Drawing on Health Promotion theories & practices like social marketing help to create tailored information... shown to improve engagement. Noar et al,2007 User-centered design of information “is not only indispensable as a matter of principle for the creation of ethical communications... ...but it is also important for the creation of effective ones” Jorge-Frascara-1997 patients need information that they can access, understand and apply to themselves to bridge... and make ‘patient-centred’ healthcare a reality. This market for accessible, usable and appropriate health information, that meets the needs of unique patients, acknowledging that one size
doesn't fit all, is one that
ICE is perhaps uniquly placed to deliver on. Particularly the oportunity to take the personalisable & updateable benefits of online publishing and delivering in print, via the ICE hub can help reach those unable to access online information. It would also enable tailoring to the individual level.
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