Introduction:
Ask Me 3 is a bilateral healthcare communication intervention [1]. Posters displayed in clinics invite patients to question physiotherapists during their consultation. Physiotherapists use teaching aids and visual models when explaining and speak in lay language, pausing often to allow patients time to consider the information and formulate questions. Patients are then asked to teach back (explain in their own words) what they understood. The 2011 European Health Literacy Survey reported that half of Europeans had problematic health literacy. Participation- where patients question and volunteer information to aid treatment selection is enhanced by health literacy and a clinic atmosphere that welcomes discussion [2].
Objectives: To measure health literacy and participation in patients attending physiotherapy. To monitor the impact of implementing the Ask Me 3 intervention on health literacy and participation in patients' receiving physiotherapy and compare the findings with patients who receive physiotherapy only
Methods: Physiotherapists(n=5)and adult patients(n=20) completed a five week pilot cluster control trial in two physiotherapy clinics with ten patients per clinic. The intervention clinic displayed Ask Me 3 posters prominently. Participants in the intervention clinic received Ask Me 3 training including written and oral information. All patient participants completed the Newest Vital Sign - health literacy outcome measure [3] and a mixed method questionnaire to measure participation before and after the trial. Post study feedback was sought from all physiotherapists. Quantitative data was analysed using SPSS version 20. Qualitative data was interpreted using thematic analysis.
Results: Each group had 5 patients with adequate health literacy scores and reported similar values for participation before the trial. No statistical difference was found between the two groups' outcome measures in any quantitative analysis. Health literacy improved significantly (p ≤ 0.01) in both groups. Statistical physiotherapy attendances: Intervention group mode 1, mean 1.7; Control group mode 5, mean 3.2. The qualitative data contained positive statements of patient empowerment to participate within the intervention group only. Four patients from the intervention group reported changes in behavior and confidence during all healthcare consultations such as "no longer fearing questions would be construed as criticism" and "now asks when unsure".
Conclusions: Health literacy improves by attending physiotherapy. Health literacy and patient participation are dynamic concepts varying within and between individuals. Significant differences in the number of physiotherapy attendances was a confounding limitation of the study and may have contributed to the minimal differences between the two groups' quantitative outcomes, however the Ask Me 3 qualitative data was positive. The intervention prompted patients to question during consultation - highlighting their actual concerns and thus facilitating targeted answers. The teach back clarified patient understanding for the physiotherapist. This clarity and targeted information delivery may improve patient outcomes with fewer physiotherapy visits. Physiotherapists delivering Ask Me 3 (n=3) found the questions and use of lay language easy, the teach back and pausing somewhat challenging, but will continue to use it in their practice and recommended further use of Ask Me 3 in clinics.
Ethics: Ethics approval granted by Sligo University Hospital Research Education Committee.
References
1. National Patient Safety Foundation. (National Patient Safety Foundation, Boston, USA 2016), pp. Health literacy resource to improve communication between patients and healthcare practitioners in the health care setting.
2. K. Haywood, S. Marshall, R. Fitzpatrick,Patient participation in the consultation process: a structured review of intervention strategies. Patient Educ Couns 63, 12-23 (2006).
3. G. Rowlands et al.,Development and validation of a measure of health literacy in the UK: thenewest vital sign. BMC Public Health 13,116 (2013).
