Pharmacy Health Literacy Assessment Tool User's Guide (continued)

Part IV: Using Assessment Results

Developing the Story

You have collected information from three different sources—objective auditors, pharmacists, and patients. Now you need to look at recurrent themes across those different sets of information and develop the story to tell about the pharmacy.

First, describe the Pharmacy Health Literacy Assessment results—what are they are saying overall about the pharmacy's service to patients with limited health literacy? Craft a few messages about the important assessment results, being careful to show a balanced perspective (strengths and weakness).

Second, compare the results of each component to determine areas of consistency. For example, the results from each of the three assessment components may identify a particular area of weakness that is agreed upon by the pharmacy staff, the patients, and the objective auditors. Areas of convergence increase the confidence in the findings.

Third, identify areas of disagreement among your information sources. For example, one area may be identified as a weakness by patients and objective auditors but not by pharmacy staff. Identification of inconsistencies should not be viewed as problematic, but rather as an opportunity to explore the perspectives of your sources of information. Consider plausible explanations for disagreements. See if you can test the credibility of your explanations.

Fourth, draw implications from the assessment results for quality improvement. How can the pharmacy improve in the areas in which it is weakest? How can it sustain performance in areas of strength? What do you want to happen in response to the pharmacy assessment?

Telling the Story

Decide who needs to hear the story of the pharmacy's status in addressing and overcoming issues related to health literacy. At a minimum, these audiences should include those empowered to make decisions and those responsible for implementing decisions—pharmacy leadership and staff. You may also want to share results with patient advisory or community groups and clinicians who serve pharmacy patients.

Think about what methods of communication will be most effective for each audience. For example, are there meetings during which pharmacy leadership staff can be briefed in person? Does the pharmacy leadership respond to written reports? Different levels of detail may be desired by different audiences. Pharmacy staff may want to see detailed reports of the three parts of the assessment, while leadership may want a more concise overview.

An executive summary of the assessment results should include the following:

• A summary of areas of strength, areas that are being addressed but need improvement, and areas of weakness.
• Acknowledgement of areas of divergence among information sources. For example, pharmacists may feel that they are doing a good job providing clear print materials to patients, but the patients and/or objective auditors feel that they are not doing an adequate job.
• General recommendations for improvement based on the assessment results. For example, if the assessment indicated that the pharmacy staff is not communicating clearly and effectively with patients, the summary should highlight this and recommend strategies to improve verbal communication.

Action Planning for Quality Improvement

For the Pharmacy Health Literacy Assessment to have an impact beyond raising awareness about health literacy, an Action Plan with tangible suggestions for improvement should be developed. True to its name, an Action Plan specifies steps the pharmacy can undertake to improve its service to patients with limited health literacy. Table 5 provides an example of what action steps might be proposed in response to assessment results.

Table 5: Examples of Possible Health Literacy Assessment Results and Proposed Action

Result	Action
Patients do not understand what the pharmacists tell them about how to take their medication.	Train staff in the principles of clear health communication.
Patients find prescription labels and inserts confusing.	Revise labels and inserts using health literacy principles regarding plain language and formatting.
Pharmacy does not provide print materials in languages other than English.	Provide materials and important signs in languages commonly spoken by the patient population.
Layout of the pharmacy is confusing and difficult to navigate.	Create signage that will make it easier to figure out where to go for intake, prescription drop-off, and pick-up.

The more concrete the Action Plan is, the more likely recommendations will be seriously considered. Anticipate questions such as, "Who will conduct the training? How long will it last?"

Finally, make sure that an individual or a group is responsible for implementing the Action Plan. Without establishing accountability, it is likely that initial enthusiasm for making improvements will fade under the daily pressures of running a pharmacy.

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References

1. Literacy-Alberta. The Literacy Audit Kit. Calgary: Literacy Alberta; 1997.

2. Institute of Medicine. Health literacy: a prescription to end confusion. Washington, DC: The National Academies Press; 2004.

3. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st Century. Washington, DC: National Academy Press; 2001.

4. Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America's adults: results from the 2003 National Assessment of Adult Literacy. Washington, DC: National Center for Education Statistics; 2006.

5. Rudd RE, Anderson JE. The health literacy environment of hospitals and health centers. Boston: Health Literacy Studies, Harvard School of Public Health, National Center for the Study of Adult Learning and Literacy; 2006.

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