The Ophelia (OPtimise HEalth LIteracy and Access) process : using health literacy alongside grounded and participatory approaches to develop interventions in partnership with marginalised populations

This paper seeks to explore the potential of a newly developed, grounded and participatory approach to development of health-literacy and health-care access interventions for equity – the Ophelia (OPtimising HEalth LIteracy and Access) process (Batterham et al., 2014). The methodology involves undertaking a needs assessment of the target population using intensive qualitative and quantitative methods, developing vignettes of key sub-groups within the population based on their health literacy profile of strengths and weaknesses, and then engaging with frontline practitioners and community membersin developing realistic solutions (Batterham et al., 2014).

Health literacy mediates the relationship between educational attainment and health behavior: a Danish population-based study

Individuals with a lower education level frequently have unhealthier behaviors than individuals with a higher education level, but the pathway is not fully understood. The aim of this study was to investigate whether health literacy mediates the association between educational attainment and health behavior (smoking, physical inactivity, poor diet) and obesity. The study included respondents ages 25 years or older drawn from a large population-based survey conducted in 2013 (N = 29,473). Two scales from the Health Literacy Questionnaire were used: (a) Understanding health information well enough to know what to do and (b) Ability to actively engage with health care providers. Multiple mediation analyses were conducted using the Karlson-Holm-Breen method. The study showed that health literacy in general and the ability to understand health information in particular mediated the relationship between educational attainment and health behavior, especially in relation to being physically inactive (accounting for 20% of the variance), having a poor diet (accounting for 13% of the variance), and being obese (accounting for 16% of the variance). These findings suggest that strategies for improving health behavior and reducing health inequalities may benefit from adopting a stronger focus on health literacy within prevention, patient education, and other public health interventions.

Training a system-literate care coordination workforce.

People with chronic complex conditions continue to experience increasing health system fragmentation and poor coordination. To reverse these trends, one solution has been an investment in effective models of care coordination that use a care coordinator workforce. Care coordinators are not a homogenous workforce - but an applied professional role, providing direct and indirect care, and is often undertaken by nurses, allied health professionals, social workers or general practitioners. In Australia, there is no training curriculum nor courses, nor nationally recognised professional quality standards for the care coordinator workforce. With the growing complexity and fragmentation of the health care system, health system literacy - shared understanding of the roles and contributions of the different workforce professions, organisations and systems, among patients and indeed the health workforce is required. Efforts to improve health system literacy among the health workforce are increasing at a policy, practice and research level. However, insufficient evidence exists about what are the health system literacy needs of care coordinators, and what is required for them to be most effective. Key areas to build a health system literate care coordination workforce are presented. Care coordination is more than an optional extra, but one of the only ways we are going to be able to provide equitable health services for people with chronic complex conditions. People with low health literacy require more support with the coordination of their care, therefore we need to build a high performing care coordinator workforce that upholds professional quality standards, and is health literacy responsive.

Optimising health literacy and access of service provision to community dwelling older people with diabetes receiving home nursing support

Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS).

Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method.

Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice.

Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

Depresión en pacientes con epilepsia: Revisión sistemática de la literatura

Esta revisión sistemática de la literatura tuvo como objetivo investigar sobre la depresión en personas con epilepsia en la última década (2005-2015), enfocándose en identificar en el paciente con epilepsia: características sociodemográficas, prevalencia de la depresión, tipos de intervención para el manejo de la depresión, factores asociados con la aparición y el mantenimiento de la depresión y por último, identificar las tendencias en investigación en el estudio de la depresión en pacientes con epilepsia. Se revisaron 103 artículos publicados entre 2005 y 2015 en bases de datos especializadas. Los resultados revelaron que la prevalencia de depresión en pacientes con epilepsia es diversa y oscila en un rango amplio entre 3 y 70 %, por otro lado, que las principales características sociodemográficas asociadas a la depresión está el ser mujer, tener un estado civil soltero y tener una edad comprendida entre los 25 y los 45 años. A esto se añade, que los tratamientos conformados por terapia psicológica y fármacos, son la mejor opción para garantizar la eficacia en los resultados del manejo de la depresión en los pacientes con epilepsia. Con respecto a los factores asociados a la aparición de la depresión en pacientes con epilepsia, se identificaron causas tanto neurobiológicas como psicosociales, asimismo los factores principales asociados al mantenimiento fueron una percepción de baja calidad de vida y una baja auto-eficacia. Y finalmente los tipos de investigación más comunes son de tipo aplicado, de carácter descriptivo, transversales y de medición cuantitativa.

Red de Conocimientos Campesinos: hilos de saberes, experiencias y tensiones en Zona Bananera

El conocimiento campesino se ha pensado como un cúmulo de saberes y prácticas tradicionales que las personas que trabajan la tierra han aprendido y transmitido de generación en generación. Pero para el análisis de las relaciones que construyen los campesinos con la tierra, el agua, las semillas, los cultivos, los químicos, las herramientas de trabajo y el dinero, es importante considerar el conocimiento campesino como una red de aprendizajes, saberes, experiencias, prácticas y relaciones territoriales. Aquella red se teje desde múltiples actores tales como funcionarios de instituciones estatales y bancarias, empresarios, familiares, vecinos y amigos, quienes inciden, influyen e intervienen en los recursos que manejan los campesinos. Esta tesis aborda la construcción, reconstrucción y materialización del conocimiento sobre el trabajo en la tierra que han configurado campesinos agricultores en el municipio de Zona Bananera, Magdalena. En las parcelas que poseen dichas personas, han confluido diferentes controles sobre el uso de recursos por parte de empresas bananeras y extractoras de aceite, trabajadores del Instituto Colombiano para la Reforma Agraria INCORA, gobiernos locales y docentes de educación superior. Allí, los campesinos por medio de su conocimiento han apropiado, negociado, disputado y resistido saberes que regulan, restringen y direccionan el manejo de recursos en sus tierras.