Promoting Health Literacy at Hawthorne Education Center

1. Promoting Health Literacy at Hawthorne Education Center Jennifer P. Rho, MD, MPH

2. Hawthorne Education CenterRochester, MN • Rochester Public School’s facility dedicated to adult and family literacy • Serves 3000 learners per year, 700 per day • Employs 60 teachers and staff members • 100 volunteers per week • Highly committed learners, staff and volunteers

3. Hawthorne Education CenterRochester, MN • Courses of study: English as a Second Language, Adult Basic Education, GED, High School Diploma, Hand in Hand, Citizenship preparation • Ages 15-80+, average age 25-30 • Represents 30+ countries including U.S. born learners • >80% living below federal poverty level

4. Health at Hawthorne: A Challenge • At least one ambulance per month at school prior to health promotion activities (pre-2005) • Obvious health disparities among learners • Pervasive problems with health care access • High uninsurance • 34% of Hawthorne learners are uninsured vs. 3% uninsured in Rochester area (2007) • Low health literacy - many those who have insurance act functionally uninsured

5. Literacy Levels

6. Health at Hawthorne:An Opportunity One of the main reasons Hawthorne learners say that they are learning English is so that they can talk with their doctor.

7. The Early Days • Environment was ripe for health promotion at Hawthorne • Eager public health student • Helped in whatever way I could

8. Hawthorne Health Services • Opened Sept 2005 • Collaborative among Hawthorne Education Center, Migrant Health Services, Olmsted County Public Health and Winona State University • Open 4 days per week • Free to Hawthorne learners and family members • 4 providers, public health nurse, office assistant, Americorps VISTA volunteer • Funded through donations

9. Hawthorne Health Services Promote health literacy through: • Providing health education • Providing limited health services at Hawthorne • Identifying and accessing sources for health insurance and primary health care • Collaborating with others in the community • Providing case management for learners with ongoing health concerns

10. What We Have Accomplished • 5500 patient visits at the clinic since opening • Additionally: • Annual health fair serves 400 learners/year • Annual flu shot clinic provides >200 vaccinations/year • Multiple other community partnerships-Mayo Breast Clinic • Multiple health ed programs • Introduced hundreds of health professionals to health literacy • Jobs skills to community members - medical interpretation • Very few ambulance visits to Hawthorne since clinic opened

11. Service-Learning • Provides opportunity for reciprocal learning about health literacy • Train the next generation to provide patient-centered care • Provides manpower to implement health promotion activities • Great opportunity to build relationships • >50 nursing students/yr • Varying number of med students • Health fair, flu shot, screenings, exercise class, book club

12. Annual Health Fair • 400+ learners • Great community participation • Guide for participants • Follow-up survey • Nutrition • Weight loss • Exercise • Dental Care • Blood pressure • (Stress)

13. Annual Cold and Flu Clinic • Education-focused • Service-learning • Classroom based • Video • Posters • Flu shot clinic

14. Health Literacy Book Club • Taught by nursing students and medical students • ESL level 5 • Small groups • Health Literacy Special Collection • http://www.healthliteracy.worlded.org/ • Staying Healthy Florida Literacy Coalition • Culture and Health • Ask Me 3

15. Mayo Patient Ed Pilot • Field test Mayo Patient Ed materials with Hawthorne learners • Goals: • To increase the health literacy of Hawthorne learners through the process of systematically evaluating patient ed materials • To empower the Hawthorne learners to advocate for themselves when they do not understand health info that has been provided to them • To utilize the expertise of the Hawthorne community (teachers and learners) to improve the quality of Mayo patient ed materials developed for Mayo patients

16. Participatory Methods • Hawthorne teachers and administrators participated in every aspect of development and implementation • Classroom based • Picked topic and individual materials to review • Chose methods • Gave input on the eval tools • ESL, GED, Diploma

17. How we included everyone • Initial meeting • Chose topic - healthy living • Chose items to review • Chose evaluation methods (Doak & Doak) • SAM • Individual and group review for learners • Met with teachers (ESL, Reading, GED, Diploma). Reviewed items and SAM. Did SAM together on food pyramid • Teachers chose which items they wanted to review with their class • Reviewed 1 item per week for 4 weeks

18. Healthy living • Topic has been consistently important to adult learners

19. In The Classroom • 8-10 classrooms per item • Lead by a patient educator • Introduction - “This is your chance to be the teacher, to teach us how we can make health information easier to understand for you and your family” • Individual Evaluation • Read designated pages • Circle words that they did not understand • Multiple choice questions to assess understanding of content • Group review/teaching • Debriefing with teachers, learner feedback

20. Results • Teachers and learners were VERY engaged and motivated • Strong interest in healthy living info • All of the materials were beyond the literacy levels of the learners • Positives: mutually beneficial, collaboration, community expertise, group interaction, valuable information • Negatives: Too much data, too much time

21. Recommendations • Rewrite the 4 tested items to match ESL level 4 • Establish process to selectively test pt ed materials with adult learners during development • Tie into CASAS - develop lesson plan

22. What have we learned over the past 6 years? • Hawthorne learners utilize available health services when health education is provided • Hawthorne learners participate more when the health topic is important to them • Health activities should be guided by the community as much as possible

23. A Note about Research • Research has never been the guiding force behind our health activities • Concerns about vulnerable population • Community-led research • Action-oriented • Education-focused • Marcia Drew Hohn, Ed. D. • Literacy Leader Fellow 1996-1997

24. Why We Have Been Successful • Health literacy has been a topic of mutual interest • Spirit of cooperation • Hawthorne remains in control • Reciprocal learning • Individual agendas are minimized - careful selection of partners • Efforts are a combination of civic engagement, community organizing, service learning • Grass roots, bottom up approach, flexible, responsive • No money to argue over

25. Community Engagement Strategies • Use existing community infrastructure when possible • Get involved in your community • Work with organizations not institutions-one exists to effect change, the other to maintain the status quo • Asset-mapping • Few organizations want another needs assessment • Win-win situations - can help offset lack of funding • Service-learning/Reciprocal learning • Face time is very important • “The process is the product”

26. Tips for getting started • Look for unique opportunities • Be humble - be a leader without being “the expert” • Utilize the practical expertise of community organizations and community members • Relationships take time - start small and get to know the community (all levels) • Minimize agenda setting • Recognize that the community way is different than the academic way • Plan to sustain the program

27. Future Plans • More collaboration • Mayo Med School • Mayo Ophthalmology • Mayo Dermatology • Public Health Immunizations • Revamped health fair • Healthy eating class • Expand offerings for health literacy book clubs • Work with Mayo Pat Ed to develop pt ed materials • PRECEDE-PROCEED • Hopefully some funding