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2013 Model Practices (Public)Application Name: 2013 Model Practices (Public) : Los Angeles County Department of Public Health : Say it Right the First Time: Using Plain Language to Empower LA County Public Health Employees to Address Health Literacy Applicant Name: Dr. Fred Dominguez Application Title: Say it Right the First Time: Using Plain Language to Empower LA County Public Health Employees to Address Health Literacy Please enter email addresses you would like your confirmation to be sent to. Practice Title Say it Right the First Time: Using Plain Language to Empower LA County Public Health Employees to Address Health Literacy Submitting LHD/Agency/Organization Los Angeles County Department of Public Health/Health Education Administration Head of LHD/Agency/Organization Jonathan E. Fielding, Director and Health Officer Street Address 600 S. Commonwealth Ave., Suite 700 Practice Contact Person Fred Dominguez fdominguez@ph.lacounty.gov Submitting LHD/Agency/Organization Web Address (if applicable) http://ph.lacounty.gov/hea Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, what is the size of your intended population/audience for this practice and what percent of your target population did you reach?
•Provide the demographics of your target population (i.e. age, gender, race/ethnicity, socio-economic status)
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing.
• Describe the potential public health impact of the practice, and the likely effectiveness of the practice being implemented as intended, and the ease of adoption of the practice by other LHDs.
In your description, also address the following
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice? Los Angeles County Department of Public Health (DPH) serves approximately 10 million residents that live across a 4,000 square mile area. The principal audience for this model practice is the nearly 4,000 member DPH workforce. The County’s geographic complexity and diversity is reflected in the DPH workforce. For example, DPH employees are…
1. Housed in 58 offices throughout the County
2. Ages 50 -59 (32%); 40 – 49 (28.5%); 30 -39 (20%); 60 – 69 (13.5%); Ages younger than 20 years, 20 -29 years, and older than 70 years constituted 6.5%
3. Mostly women, (72.25%) female and (27.5%) male
4. Racially/ethnically diverse—Hispanic (30%), Black (22.5%), Asian/Pacific Islanders (20%), White (19.5%), Filipino (8%), and American Indian (0.14%)
Since 2010, Health Education Administration, a program of the Los Angeles (LA) County Department of Public Health (DPH), has offered quarterly 3-hour training sessions to teach DPH employees how to develop and deliver messages so that diverse audiences can understand, remember, and use after the first time they read or hear it. HEA has reached 12.6% (n=463) of the 4,000 member DPH workforce after 22 training sessions.
The main public health issue that this practice addresses is health literacy.
Every day, health professionals ask their diverse patients to choose a healthy lifestyle, use preventive services, or seek medical care. However, understanding and applying their providers’ recommendations or other forms of information requires health literacy levels that many Americans do not possess. Although much of the health information that the public receives is technically correct, oftentimes, the message is not understood because the message is too technical.
In addressing health literacy, the goal of this practice model is to train DPH employees in plain language skills that when implemented, will improve the communication of health messages to the public. This training, is a 3-hour training session that utilizes both didactic and hands-on components. The specific tasks achieve each training objective which follows the format in the Plain Language Training Manual:
Objective 1: Describe the impact of low health literacy on the public’s health.
- Definition: Health Literacy
- Review the impact of Low Health Literacy in Public Health and how it impacts health disparities.
- Demonstrate examples of Bureaucratic Writing
- Definition: Plain Language
- Discuss Plain Language Benefits and Myths
Objective 2: Define plain language
2.1.The importance of knowing your audience through:
- Identifying Your Purpose, Audience Needs,
- Individual Exercises
- Show examples of Cultural Competency
2.2. The importance of Content through:
- Organizing Key Messages
- Choosing Words Wisely
- Testing Key Messages
- Conduct Class exercises on Readability and Testing Strategies
2.3. The importance of Design through:
- Making Text Easy to Read
- Using Visuals to Enhance Message
- Organizing Document to appear appealing
Objective 3: Apply the three principles of plain language
- Review print materials and PowerPoint: Before and After
- Final group “Plain Language Translation” Exercise
The potential public health impact of this practice model is that applying plain language skills to health materials and other forms of communication will help the public easily understand and use the information the first time messages are read or heard. The likely effectiveness of the practice being implemented as intended is manifested by making training materials available and conducting train-the-trainer sessions. Also beginning in 2014 HEA will begin to conduct Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. training sessions at other local health departments such as Orange County Health Agency and Long Beach Health Department. HEA’s model practice, Plain Language training first began in August 2010. The major activities in implementing the practice occurred in 3 phases:
PHASE 1: Planning
PHASE 2: Implementation
PHASE 3: Evaluation
The start-up, in-kind costs and funding services are:
Implementation, start-up, and in-kind costs include:
- Training manuals (500/year): $5,738.74
- Other training supplies: $5,000
- In-Kind: Incentives, Training Location, and Personnel
- Free: Web based registration
Since 2010, HEA’s 6 member training staff has conducted 22 sessions, training 463 DPH employees, 12.6% of the nearly 4,000 member DPH workforce. Objectives met were measured by our evaluation which showed that
attendees participating in the Plain Language training answered “Strongly agree that training objectives were fully met” (96%); “Strongly agreed that they were satisfied with the training” (97%); “Would recommend the training to colleagues” (97%) and, “Will apply information in the next year” (98%).
The specific factors leading to the success of this practice includes buy-in from the Health Department Director, research evidence showing that improving health literacy show better health outcomes, HEA designated as the program to develop and train DPH workforce. You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles, etc. Describe the public health issue that this practice addresses. (350 word limit) The main public health issue that this practice addresses is health literacy.
Every day, health professionals ask their diverse patients to choose a healthy lifestyle, use preventive services, or seek medical care. However, understanding and applying their providers’ recommendations or other forms of information requires health literacy levels that many Americans do not possess. Although much of the health information that the public receives is technically correct, oftentimes, the message is not understood because the message is too technical.
There are many reasons why health information is difficult to use and understand, including the complexity of how information is presented, the use of unfamiliar scientific jargon, navigating the healthcare system that includes locating providers and services in addition to filling out forms and, the difficulty in understanding information when confronted with their own or a loved one’s stressful or unfamiliar situation.
Research has found that having poor health literacy is a strong predictor of a person's health than age, income, employment status, education level, and race. Further, in the United States, the estimated annual cost of events associated with low health literacy is $106 billion to $238 billion.
In addition, people with certain demographic characteristics are more likely to have trouble reading and understanding health-related information. This includes patients over 65 years old, racial/ethnic minorities, persons with low education or income levels, immigrants, non-native English speakers, or persons with chronic physical and mental health conditions.
What process was used to determine the relevancy of the public health issue to the community? (350 word limit) One of Health Education Administration’s (HEA) roles is to create and review print materials and presentations. The relevancy of this public health issue was highlighted during the Pandemic H1N1 Influenza outbreak during 2009 where HEA was assigned to rapidly create print materials, presentations, and public messages. Before creating these materials, HEA conducted a literature review along with an extensive search of national health agencies to assess what information relevant to the topic was being created along with key behavioral and demographic characteristics that were similar to the LA County population. Two issues arose from the search: material written for the public was too technical to read or understand; large amount of material was not culturally appropriate to our population and not translated to satisfy a diverse population like Los Angeles County. HEA began creating print materials to address the H1N1 outbreak, which were created addressed these two important issues.
Subsequently HEA began reviewing their current print materials as to the appropriateness of being written in plain language and being culturally sensitive. A review was conducted on evidenced based literature and databases which demonstrated articles and analysis by nationally renowned agencies and academic institutions that addressed the importance and need to improve health literacy. Also shown were correlations between low literacy and poor health outcomes. More importantly there exist current guidelines and instructions on creating plain language materials.
On a survey conducted externally by UCLA and an inventory conducted by HEA found that many health related print materials in DPH targeted for the public were not written in plain language or were found not translated appropriately. Thus health literacy has become an issue being addressed by HEA in terms of developing and implementing a plain language training program targeted to DPH employees that are involved in creating public health messages and print materials in an effort to improve health literacy for the residents of Los Angeles County. Finally print materials development is just one example of where plain language plain language is relevant. Many forms of correspondence such as emails and memos can employ the principles of plain language. How does the practice address the issue? (350 word limit) Subsequently HEA began reviewing their current print materials as to the appropriateness of being written in plain language and being culturally sensitive. A review was conducted on evidenced based literature and databases which demonstrated articles and analysis by nationally renowned agencies and academic institutions that addressed the importance and need to improve health literacy. Also shown were correlations between low literacy and poor health outcomes. More importantly there exist current guidelines and instructions on creating plain language materials.
Taken together, low health literacy impacts all Americans. The challenge of this health practice is to improve a LHDs staff capacity to use plain language principles to write and communicate health messages that are easy to understand and use the first time they are read or heard. Please list any evidence based strategies used in developing this practice. (Provide links or other materials for support) American Medical Association, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. Health literacy: Report of the Council on Scientific Affairs. Journal of the American Medical Association. 1999 Feb 10; 281(6):552-7. http://www.ncbi.nlm.nih.gov/pubmed/10022112(accessed October 17, 2011).
Doak, C.C., Doak, L.G., and Root, J.H. Teaching Patients with Low Literacy Skills (2nd ed.). J.B. Philadelphia, PA: Lippincott Company.
http://www.hsph.harvard.edu/healthliteracy/resources/doak-book/index.html (accessed April 29, 2012).
Institute of Medicine of the National Academies, Nielsen-Bohlman, L., Panzer, A.M., and Kindig, D.A. (eds.) (2004). Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. http://www.nap.edu/openbook.php?isbn=0309091179 (accessed April 29, 2012).
National Center for Education Statistics. (2006). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education. http://nces.ed.gov/pubs2006/2006483.pdf(accessed February 14, 2012).
National Institutes of Health, National Cancer Institute. (2008). Pink Book—Making Health Communication Programs Work. Bethesda, MD: Author. http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook (accessed July 22, 2010).
Plain Language Action and Information Network. What is plain language? http://www.plainlanguage.gov/whatisPL/index.cfm (accessed February 14, 2012).
Stableford, S. and Mettger, W. 2007. Plain language: A strategic response to the health literacy challenge. Journal of Public Health Policy 28, no.1: 71-93. http://www.palgrave-journals.com/jphp/journal/v28/n1/abs/3200102a.html(accessed April 6, 2012).
The Joint Commission on Accreditation of Health Care Organizations. 2007. “What did the doctor say?”: Improving health literacy to protect patient safety. http://www.jointcommission.org/What_Did_the_Doctor_Say/(accessed April 6, 2012).
United States Department of Health and Human Services, Healthy People 2020. (2012) Health Communication and Health Information Technology.
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18(accessed April 6, 2012).
United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (n.d.) Quick guide to health literacy. http://www.health.gov/communication/literacy/quickguide/default.htm
(accessed February 14, 2012).
United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2005). Plain language: A promising strategy for clearly communicating health information and improving health literacy.
http://www.health.gov/communication/literacy/plainlanguage/PlainLanguage.htm(accessed April 6, 2012).
United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2010). National Action Plan to Improve Health Literacy.
http://www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf (accessed April 6, 2012).
United States Department of Health and Human Services, Centers for Disease Control and Prevention (2009). Simply Put: A guide for creating easy-to-understand materials. http://www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf (accessed July 22, 2010). Is the practice new to the field of public health? If so, answer the following questions. No What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. A literature review was conducted to determine the availability of health literacy and plain language training resources. The review revealed that many resources existed, however they...
1) Included information about the negative monetary and health effects of poor health literacy, but did not include practical tools that made both concepts easy to remember and apply
2) Primarily focused on clinical settings, specifically, oral communication between patients and providers or written communication in patient education materials
3) Addressed health literacy as a client's deficit rather than an organizational responsibility
4) Failed to recognize the importance of meeting the communication needs of both internal (e.g. employees) and external customers (e.g. LA County residents)
Several federal resources were used to develop the Say it Right curriculum, including Simply Put by the Centers for Disease Control, the Pink Book by the National Institutes of Health, and the Plain Language Action and Information Network website.
How does this practice differ from other approaches used to address the public health issue? The Say it Right curriculum differs from other approaches in the following ways:
1) Relevant health literacy and plan language statistics are included; however, most of the 3-hour training is spent on defining and applying the three principles of plain language—audience, content, and design. Using these three principles makes it easy for audiences to remember and apply the principles at their diverse job sites.
2) The curriculum presents public health examples, instead of clinical examples, to demonstrate the relevance of plain language and health literacy to all DPH employees. The training also uses handouts and examples developed by staff throughout DPH, to learn and apply plain language concepts. Additionally, time is utilized highlighting the relevance of plain language in both external and internal communications (e.g. policies, memos, emails, grant applications, academic publications) to assure all DPH staff understand how their work and worksite can benefit from applying plain language principles. Also, key health education and cultural competency concepts are presented to demonstrate the need for community engagement throughout the communication process.
3) More importantly, by focusing on the workforce's role in improving health literacy, DPH does not focus pointing out deficiencies in communities, further perpetuating health disparities, and instead, moves towards health equity by acknowledging and improving the role government institutions play in assuring clients and partners can access, understand, and use critical public health information.
Is the practice a creative use of an existing tool or practice? If so, answer the following questions. Yes What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. A literature review was conducted to determine the availability of health literacy and plain language training resources. The review revealed that many resources existed, however they...
1) Included information about the negative monetary and health effects of poor health literacy, but did not include practical tools that made both concepts easy to remember and apply
2) Primarily focused on clinical settings, specifically, oral communication between patients and providers or written communication in patient education materials
3) Addressed health literacy as a client's deficit rather than an organizational responsibility
4) Failed to recognize the importance of meeting the communication needs of both internal (e.g. employees) and external customers (e.g. LA County residents)
What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population? Several federal resources were used to develop the Say it Right curriculum, including Simply Put by the Centers for Disease Control, the Pink Book by the National Institutes of Health, and the Plain Language Action and Information Network website.
a. This practice has not been uploaded into NACCHO's toolbox.
b. Elements from these and other resources were combined to create the Say it Right curriculum, a new approach to health literacy and plain language. Firstly, the target audience was the entire public health workforce, without focusing on specific public health specialists traditionally associated with health communications (e.g. health educators). The intent behind this new implementation strategy was to create a workforce and overall organizational culture that acknowledges and understands their role and responsibility to decrease the barriers posed by poor health literacy by communicating more clearly and effectively with both colleagues and clients. How does this practice differ from other approaches used to address the public health issue? The Say it Right curriculum differs from other approaches in the following ways:
1) Relevant health literacy and plan language statistics are included; however, most of the 3-hour training is spent on defining and applying the three principles of plain language—audience, content, and design. Using these three principles makes it easy for audiences to remember and apply the principles at their diverse job sites.
2) The curriculum presents public health examples, instead of clinical examples, to demonstrate the relevance of plain language and health literacy to all DPH employees. The training also uses handouts and examples developed by staff throughout DPH, to learn and apply plain language concepts. Additionally, time is spent highlighting the relevance of plain language in both external and internal communications (e.g. policies, memos, emails, grant applications, academic publications) to assure all DPH staff see how their work and worksite can benefit from applying plain language principles. Also, key health education and cultural competency concepts are presented to demonstrate the need for community engagement throughout the communication process.
3) More importantly, by focusing on the workforce's role in improving health literacy, DPH steers away from pointing out deficiencies in communities, further perpetuating health disparities, and instead, moves towards health equity by acknowledging and improving the role government institutions play in assuring clients and partners can access, understand, and use critical public health information. Who were the primary stakeholders in the practice? The primary stakeholders in the practice are DPH's 3,677 employees, including line staff and administrators throughout the department's 39 programs. However, additional stakeholders including students in the health professions (e.g. Masters in Public Health, Pharmacy)and their instructors, and community partners (e.g. community clinic nurses and epidemiologists)are becoming increasingly interested in the topic as they register to attend the Say it Right trainings. What is the LHD's role in this practice? Health Education Administration (HEA) is the DPH program responsible for:
- Developing and updating the Say it Right curriculum
- Coordinating and securing trainers, training dates, materials, locations, and other logistics
- Training participants and other trainers to use the curriculum
- Evaluating and reporting on the effectiveness of all trainings What is the role of stakeholders/partners in the planning and implementation of the practice? Stakeholders serve in the following planning and implementation capacities:
- Providing recommendations to improve the curriculum and accompanying manual through training evaluations
- Serving as trainers
- Generating interest in and coordinating logistics for trainings to be conducted at their worksite What does the LHD do to foster collaboration with community shareholders?
Describe the relationship(s) and how it furthers the practice's goals. HEA fosters collaboration with community stakeholders in the following ways:
– Offering to conduct training sessions at worksites that can coordinate their own logistics, and secure a group of no more than 30 participants to ensure an adequate trainer to participant ration.
– Distributing training announcements through the [HEALTHED] Listserv, an email list of over 400 internal and external health education partners throughout LA County
– Posting training announcements on a web based platform that allows both internal and external potential attendees view and register for the training
– Sharing training evaluation results at professional meetings and conferences to generate interest in the topic and demonstrate success of plain language efforts
These strategies help HEA meet key programmatic goals as well as the department-wide strategic plan and core public health function of maintaining a competent public health workforce. Describe lessons learned and barriers to developing collaborations. Lessons learned and barriers to developing to collaborations include:
1) Overcoming resistance to organizational change:
Since HEA’s everyday functions include creating standardized messages, including facts sheets and presentations, that are used by DPH staff throughout the County HEA naturally became the plain language champion within DPH. HEA began championing the cause to DPH health educators and public health nurses by highlighting the link between health literacy and plain language, which became instrumental in sharing the message with their colleagues at their own worksites. As a result, through these natural partners, HEA has been able to frame plain language as a tool for assuring that our most vulnerable communities receive the highest quality services from a highly competent workforce.
2) Strengthening employees’ plain language capacity:
Varying plain language skill levels exist within DPH which makes it necessary to assure a base set of knowledge for the organization. Many times people associate plain language with the “dumbing down” of messages. As a result, improving staff’s plain language capacity begins with raising awareness about and providing opportunities to practice plain language principles. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
Both process measures and program outcomes were used to assess the following principal objectives of the plain language training, which include:
1. Describe the impact of low health literacy on the public’s health
2. Define plain language
3. Apply the three principles of plain language
Process measures included recording number of plain language trainings and number of trainee participants. The number of participants were recorded by the online registration and verified with a sign-in roster. Number of meetings were recorded on excel worksheets where evaluation results were recorded. Since 2010, HEA’s 6 member training staff has conducted 22 sessions, training 463 DPH employees, 12.6% of the nearly 4,000 member DPH workforce.
Trainings were evaluated using a paper form that was completed immediately after the training. The evaluation included a 5-point Likert scale that measured the following indicators, whether…
– Training objectives were fully met
– The participant was satisfied with the training
– The participant would recommend the training colleagues
– The participant will use the information learned in the next year
HEA’s evaluation specialist analyzed the data calculating the weighted average percent from participants answering “Strongly agree that training objectives were fully met” (96%); “Strongly agreed that they were satisfied with the training” (97%); “Would recommend the training to colleagues” (97%) and, “Will apply information in the next year” (98%).
Additionally, questions related to the following topics were measured before and after the training:
– Knowledge about the topics presented
– Confidence in applying the knowledge or skills presented
“Before and after training self-reported knowledge” and “Before and after training in self-reported confidence” measured, average percent difference ( 28 % and 28% respectfully). The weighted average was computed for average percent difference for “self-reported confidence” which resulted in 31.1%. A t-test was then performed on the before and after training results. T-test results showed that the plain language trainings demonstrated a positive correlation between the before and after training responses.
Also a one-year follow up was administered to participants that participated in the 2011 trainings. Participants were asked the following questions:
– Have you applied any Plain Language techniques you learned from last years' training session?
– Have you recommended the Plain Language training to anyone?
– Please mark the percentage that indicates how confident you feel in applying the Plain Language techniques you learned?
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
Results obtained showed from the question, “applied any Plain Language techniques you learned” (n=105) that 93% have applied techniques learned. The results from the question “have you recommended the training to other staff members” showed (n=107) that 79% have recommended plain language training to other staff members. The final question “feeling confident in applying the Plain Language techniques you learned,” results showed that after one year 73.9% (n=99) weighted average felt confident in applying knowledge or skills. A separate analysis of the 2011 results looking at the post responses for this question resulted in 87.8% weighted average (n =152) feeling confident in applying knowledge or skills. This is a 14% decrease in confidence over one year or a 16 percentage decrease change over one year.
Results from the 2010 and 2011 trainings were presented as a poster at the annual LA County Health Education Practice Conference to Health Educators and administrators of LA County and outside health agencies and the DPH Science Summit to health department leadership and researchers. The results were also presented at the 2012 American Public Health Association Annual Conference.
Lessons learned from the process and outcome measures of the evaluations have resulted in modifications of the training program, including eliminating an extra practice workshop and including more hands-on practice during the training. The training manual was revised in 2012 to include more information on health literacy and cultural competence. We also standardized the practice worksheets as a final exercise. Lessons learned from the process and outcome measures of the evaluations have resulted in modifications of the training program, including eliminating an extra practice workshop and including more hands-on practice during the training. The training manual was revised in 2012 to include more information on health literacy and cultural competence. We also standardized the practice worksheets as a final exercise. In order to directly evaluate our objectives, HEA has recently created a cognitive recall pre/post test. As to date we have only implemented the pre/post test in our last 3 trainings.
Based on the 12 month follow-up evaluation results, participants showed a 14% decrease in confidence in their ability to apply plain language principles. As a result, HEA now plans to include updates/tips throughout the year to improve participants’ confidence in applying skills throughout the year. On a policy level, DPH has now adopted department wide standards for all educational materials produced by the department, making it mandatory to include health literacy as a standard for print materials. In addition HEA will continue to increase the number of trainings available to outside health agencies. Objective 1: Describe the impact of low health literacy on the public’s health. This objective was implemented in the following sequence that followed the training manual. Evaluation of objective 1
- Definition: Health Literacy
- Review the impact of Low Health Literacy in Public Health
- Discuss how Low Health Literacy impacts Health Disparities
- Review Health Literacy: Whose Responsibility?
- Video: Health Literacy
- Demonstrate examples of Bureaucratic Writing
- Definition: Plain Language
- Discuss Plain Language Benefits
- Discuss Plain Language Myths Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 2: Define plain language This objective was also implemented in the following sequence that followed the training manual.
1. The importance of knowing your audience through:
- Identifying Your Purpose
- Identifying Audience Needs
- Addressing Audience Needs
- Video: Cultural Competency
- Individual Exercises
- Show examples of Cultural Competency
2. The importance of Content through:
- Organizing Key Messages
- Choosing Words Wisely
- Testing Key Messages
- Conduct Class exercises on:
- Readability
- Audience Testing Strategies
3. The importance of Design through:
- Making Text Easy to Read
- Using Visuals to Enhance Message
- Organizing Document to Make it Appealing Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 3: Objective 3: Apply the three principles of plain language
- Review print materials: Before and After
- Review PowerPoint: Before and After
- Final group “Plain Language Translation” Exercise Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? In addressing health literacy, the goal of this practice model is to train DPH employees in plain language skills through HEA’s “Say It Right” curriculum that when implemented, will improve the communication of health messages to the public and the department. This training, The Say it Right Curriculum is a 3-hour training session that utilizes both didactic and hands-on components. The specific tasks taken to achieve each training objective include:
Objective 1: Describe the impact of low health literacy on the public’s health. This objective was implemented in the following sequence that followed the training manual.
- Definition: Health Literacy
- Review the impact of Low Health Literacy in Public Health
- Discuss how Low Health Literacy impacts Health Disparities
- Review Health Literacy: Whose Responsibility?
- Video: Health Literacy
- Demonstrate examples of Bureaucratic Writing
- Definition: Plain Language
- Discuss Plain Language Benefits
- Discuss Plain Language Myths
Objective 2: Define plain language
1. The importance of knowing your audience through:
- Identifying Your Purpose
- Identifying Audience Needs
- Addressing Audience Needs
- Video: Cultural Competency
- Individual Exercises
- Show examples of Cultural Competency
2. The importance of Content through:
- Organizing Key Messages
- Choosing Words Wisely
- Testing Key Messages
- Conduct Class exercises on:
- Readability
- Audience Testing Strategies
3. The importance of Design through:
- Making Text Easy to Read
- Using Visuals to Enhance Message
- Organizing Document to Make it Appealing
Objective 3: Apply the three principles of plain language
- Review print materials: Before and After
- Review PowerPoint: Before and After
- Final group “Plain Language Translation” Exercise What was the timeframe for carrying out these tasks? The timeframe for carrying out the tasks related to each training objective are as follows:
- Objective 1: Describe the impact of low health literacy on the public’s health (45 minutes)
- Objective 2: Define plain language (1.5 hours)
- Objective 3: Apply the three principles of plain language (45 minutes)
Please provide a succinct outline of some basic steps taken in implementing your practice. The basic steps in implementing the Plain Language Training model practice were:
PHASE 1: PLANNING (3-4 months)
1. Identify best practices in health literacy and plain language.
2. Develop and or revise training materials according to literature review findings.
3. Pilot test and revise training materials according to participant feedback.
4. Secure funding for training manuals.
5. Print manual.
6. Establish a quarterly training calendar.
7. Secure training locations throughout the County.
8. Identify trainers.
9. Establish a registration mechanism.
10. Create centralized location for all training materials and equipment.
PHASE 2: IMPLEMENTATION (Year-round)
11. Train trainers to access and use the curriculum and needed equipment.
12. Conduct trainings.
PHASE 3: EVALUATION (Ongoing)
13. Evaluate and improve training materials according to evaluation data.
14. Disseminate results to internal and external stakeholders.
What were some lessons learned as a part of your program's implementation process? Lessons learned during the Plain Language implementation process were:
- Emergency preparedness funding can be leveraged for health literacy/plain language activities since improving communication strategies and infrastructure during non-emergencies only improves communication capacity during emergency situations. Further, increasing staff awareness about the broader definition of emergency situations (e.g. when clients receive new diagnoses, the impact of disease on retention of information), also improves their communication ability.
- Many free web-based services are available to streamline implementation processes, including but not limited to participant registration. Lead agencies should be aware of internal policies, procedures, or infrastructure (e.g. firewalls) that support or prohibit the use of such services.
- Collaboration and mutual accountability to internal and external partners is key to spread the word about training; reach registration targets; assure participants get permission to attend and are held accountable to show up to trainings; secure free training sites; and secure future opportunities to train new partners.
- Continuous monitoring of evidence based practice means training content may change regularly which can prove frustrating for training staff and partners; urge flexibility and heavily involve stakeholders in editing processes to minimize such frustrations.
- Disseminate results broadly as opportunities to conduct this type of work or analyze these types of data are not always available, despite their possible beneficial impact.
Provide a breakdown of the overall cost of implementation, including start-up and in-kind costs and funding services. Implementation, start-up, and in-kind costs include:
- Manuals (500/year): 5,738.74
- Other training supplies: 5,000
- Incentives: In-kind
- Training Location: In-kind
- Web based registration: Free
- Personnel: In-kind
Total: $10,738.74 Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. There is sufficient stakeholder commitment to sustain the existence of the Say it Right training. Stakeholder commitment is evident in evaluation data. For example, when asked, "Would you recommend the Plain Language training?” 97% of participants indicated immediately after the training session and 79% after a 1 year follow-up that they would recommend the training. Secondly, participants from varying DPH programs (e.g. Environmental Health, Division of STD and HIV programs) have requested trainings specifically for their staff and contracted providers. Additionally, participants from community based agencies have made similar requests.
Aside from participant support, support from executive DPH and County leadership (as demonstrated through inclusion in the upcoming edition of the DPH strategic plan; by the presentation of Board proclamations, awards, and memoranda) have elevated the importance of plain language to address health literacy, and establish an expectation that the County workforce as a whole has to assure governmental communications can be easily found, understood, and used.
An increase in requests from academic institutions also highlight the public health workforce’s ability to shape the training and education of future public health professionals; such an impact assures future professionals are equipped with the knowledge and skills needed to meet the needs of LA County’s diverse communities. Describe plans to sustain the practice over time and leverage resources. Plans to sustain the practice over time include conducting more train-the-trainer sessions. Doing so will expand HEA’s capacity to disseminate the plain language message and will empower public health professionals within and outside DPH with the information and tools needed to improve communication for their colleagues, organizations, and clients. Inclusion of health literacy related goals and objectives within the new departmental strategic plan may also present opportunities to leverage funding other than budgets allocated for emergency preparedness efforts. Further, the increased interested from external partners, including academic institutions, may also present alternative funding streams for continued provision of the Say it Right training.
Inclusion of health literacy related goals and objectives within the new departmental strategic plan may also present opportunities to leverage funding other than budgets allocated for emergency preparedness efforts. Further, the increased interested from external partners, including academic institutions, may also present alternative funding streams for continued provision of the Say it Right training.
Practice Category Choice 1: Communication/Public Relations Practice Category Choice 2: Quality Improvement Practice Category Choice 3: Workforce Development Check all that apply. Colleague in my health department Model Practice Brochure E-mail from NACCHO NACCHO Web Site Are you a previous applicant? No |
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