Community-based Health Literacy Program For The Vulnerable

Rationale for the program

A community need can be described as the gap connecting what is available and what should be available (Edwards, 2012). A need can be felt by an entire community, a group or one person. It can be as tangible as the need for basic requirements like food, shelter, and water or as intangible as improved community solidarity. A good example of a need is low levels of health literacy among the community members. Health literacy refers to the extent to which individuals can acquire, process, and comprehend essential health services and information for them to make suitable health decisions (U.S. Department of Health & Human Services , 2018). It therefore implies that low levels of health literacy leads to limited use of preventive care and poor health outcomes. This is more common among the less privileged and the elderly people. This program will be designed mainly to help those people at risk of or living with chronic diseases and stay in communities experiencing socioeconomic difficulties. It will be established as a health literacy intervention measure for the people vulnerable to chronic conditions.

This community-based health literacy program will aim at developing people’s capability to communicate efficiently with health care specialists; comprehend their own behaviors; and acknowledge the effects of those behaviors on the self-management and prevention of chronic illnesses. The program content will be organized by representatives from three neighborhood houses situated within regions of socioeconomic disadvantage in partnership with multidisciplinary team of academic health experts.  Neighborhood houses situated within regions of socioeconomic disadvantage are centers that will be bringing locals together to learn, unite, and take back to the community through recreational, educational, social and support activities using community development tactics. The health literacy program will be advanced to the needy people by the directors of the three neighborhood houses particularly targeting community members suffering from or vulnerable chronic ailments. This program will designed to be flexible and adaptive to the requirements of different groups of people with different health needs.

Rationale for the program  

Health literacy program will give people susceptible to or living with chronic diseases ability to obtain, read, comprehend, and utilize healthcare information to make proper health decisions and as well follow treatment instructions. Researches show that roughly 12% of the adult people have appropriate health literacy (U.S. Department of Health & Human Services, 2018). This implies most of the people in the community have just basic or below basic health literacy. Old people and the less privileged are the most affected and have trouble with basic health tasks like reading the label of a given medicine. Low health literacy decreases the feasibility of chronic disease treatment and raises the risk of medicinal error. A health literacy program is thus vital to promote healthy individuals and communities particularly those prone to chronic ailments like diabetes, blood pressure, and heart related disorders.  Since health literacy among the elderly and the underprivileged is a principal contributing factor to health inequalities, it is a continuous and ever-increasing concern for health practitioners. The entire society is responsible for enhancing health literacy among the community members. Most prominently, developing health literacy for the vulnerable is the duty of healthcare and public health experts and programs.

Program Objectives

To have a community that comprehends health terms and could makes appropriate health decisions, the verbal communication and language utilized by healthcare specialists should be at a level such that those people who are not in the health field can comprehend (U.S. Department of Health & Human Services, 2018). This will be one of the characteristics of the proposed program. Health experts who will be in charge will be encouraged to know their audience in order to serve them better. The language which will be used by all program facilitator will be plain language as a strategy for making oral and written information easier to comprehend. Some of the key elements of this language will be:

• Proper organization of healthcare information so most significant points appear first
• Breaking of compound information into comprehensible portions for all targeted community members to understand
• Use of straightforward language that the members can identify with and defining technical healthcare terminologies
• Make use of tables and models to make composite materials easier to comprehend

Use of plain language by healthcare practitioners is among the underlying principles of this program and certainly it will improve the outcomes of the entire system. Community members in need of better healthcare shall be better able to take action to protect their wellbeing as well as that of other people who will require their help.

Proper presentation of healthcare materials or interventions is another basis of this program. A research of 2,600 patient participants carried out in in 1995 by two United States healthcare centers revealed that between 26% and 60% of patients were not able to comprehend materials about scheduling an appointment, a standard informed consent form, or medication directions (Hall, MDiv, Prochazka, MS, & Aaron, 2012). Therefore, this program purposes to reduce this challenge. All summoned community members will be supplied with proper healthcare materials that favor their current state of health and age. Readability of all materials will not be compromised. Format, style, and cultural suitability of the materials will be considered by the program facilitators. Language barriers of the vulnerable community member will not be a hindrance since the program will get some interpreters on board to ease the whole communication process. Other factors which the program will consider is provision of texts that uses illustrations to rely the information such that even those people who have a challenge reading will understand through pictures.

Low health literacy among the old people and the less privileged negatively impacts on the healing result and safety of care delivery (Chesser, Keene, Woods, & Smother, 2016). The deprivation of health literacy affects every segment of the community. Nevertheless, it is uneven in particular demographic groups, like persons with low general literacy, ethnic minorities, recent immigrants, and the old people. These groups are at a higher risk of hospitalization, prolonged stays in hospitals, are less probable to conform to treatment prescriptions, are more probable to make blunders with treatment, and are more in poor health when they are in the beginning search for medical care. This program will, therefore reduce the disparity between a health professionals’ communication of content and a patient’s capacity to comprehend it.

Target Demographic

Elderly people and the less advantaged ones are the community members who are at a high risk of health illiteracy. They are in dire need of knowledge concerning health in order to better their medication outcomes and protect themselves from advancement of chronic diseases.

Individuals most probable to experience low health literacy are the elderly, ethnic and racial minorities, populations with less than a GED certificate or high school certificate or, community members with low revenues, as well as those with compromised health status (Zimmerman, Woolf, & Haley, 2015). Age, access to resources, education, language, and culture are some of the factors which affect people’s health literacy skills.  The extent to which these people acquire, process, and comprehend essential health services and information considered necessary to make suitable health decision is considerably low. These members of the community encounter so many problems some of which include:

• Navigating the healthcare structure, for example filling out complicated forms or sheets and spotting healthcare providers and facilities
• Sharing personal details, like health history, with clinicians
• Engaging in self-care and chronic-condition treatment
• Understanding mathematical models such as risk and probability

Also called silent epidemic, health illiteracy affects people’s access to and usage of the health-care system. It aggravates health discrimination because those individuals whose health and life expectancy is already low down like the old people, underprivileged individuals, and minorities are the ones with no capacity to take part in health-related communications, search for health-related information and make health-related decisions. Low health literacy is linked to poorer healthcare and shoddier health outcomes. This challenge increases the cost of healthcare, because people who have low health literacy are more vulnerable to enroll as inpatients, use fewer preventive services, visit the emergency room and stay longer in hospitals.

 Chronic illnesses such as diabetes, blood pressure and heart sickness are common among elderly adults who have high levels of both general and healthcare illiteracy (McQueen, 2013). In actual fact, many of them suffer from more than one chronic infection and to make the matter worse in of the cases live alone. Studies have proved that most of elderly men stay with their spouses when they attain the age of 85+ years while the women at the same age live alone segregated by the entire community.  These people have nobody to help them make the right healthcare decisions leave alone to help them express self to the medical practitioners (Zhou & Hearst, 2016). Furthermore, a considerable proportion of elderly people suffer from geriatric syndromes coupled with their chronic infections. These diseases involve complicated health procedures which the older adults find a challenge understanding. They also have multifaceted treatment courses and thus pose a challenge to the elderly when trying to make medical decisions.

Elements of the program’s plain language approach

Apart from the common chronic diseases, poor people are more susceptible to other ailments such as malnutrition which due to low health literacy, they find hard to manage. “Diseases of poverty” is the term used to describe these disorders since they are perceived to be triggered mainly by poverty (Singh & Singh, 2008). For numerous social and environmental causes, including inadequate sanitation, crowded working conditions and living, and unequal occupation as sex workers, the underprivileged are more probable to be exposed to many deadly diseases. Mostly these community members are generally illiterate because they do not have any academic qualifications. As a result, after old people, the poor often have low health literacy making it hard for them to protect themselves from the maladies which frequently attack them. In short the old people and the poor have many challenges related to healthcare and they need help of every person capable enough to help them. Thanks to our proposed Health Literacy Program which will take care of their needs.

The Health Literacy Program will seek to engage individuals, communities, professionals, families, organizations and policymakers in a connected, multi-sector endeavor to progress health literacy in the entire community. The action plan of this program is grounded on two central principles:

• Every community member has the right to health information which aids him /her to make informed healthcare decisions
• Health services ought to be conveyed in ways that are simple to comprehend and that develop health, quality of life and longevity.

This program has a number of goals but the main ones include the following:

• Developing and disseminating health and safety information to the needy community members in a correct, easy to get to, and actionable manner
• Promoting changes in the local healthcare system that enhance informed decision-making, access to health services, communication, and health information
• Support and develop local efforts to offer adult edification, English language teaching, as well as linguistically and ethnically suitable health information services in the entire community
• Enhance essential research and the evaluation, implementation, and, development of practices and interventions to advance health literacy among the old and the poor.
• Augment the distribution and usage of evidence-based health literacy practices and interventions in combating against chronic diseases

Most of the strategies draw attention to measures that certain professions or organizations can take to supplement and further these goals. It will take every person working collectively in a connected and harmonized way to enhance access to correct and actionable health information as well as utilizable health services. Through concentration on health literacy problems and functioning jointly, we can develop the quality, safety, and accessibility of health care for the needy; cut off costs; and enhance the health and quality of life of many people in the community (Scriven, Ewles, & Simnett, 2010).

• Evaluation

Outcomes and measures are part of the evaluation procedure. It is imperative to be aware of and comprehend why we intend to measure and what we want to do with the results prior to beginning. At this juncture we shall find a portrayal of CDC’s Framework for Program Evaluation, as well as probable sources of communication and health literacy measures.

A robust evaluation method ascertains that the following points of concerns are addressed as part and parcel of the assessment so as to determine the value of the program efforts on account of proof or evidence:

• What shall be assessed or evaluated? (That is, what is “the program to be evaluated” and in what setting is it found?)
• Which areas of the program shall be taken into consideration when assessing the program performance?
• What standards or principles (that is the level or form of performance) should be attained for the program in question to be deemed viable?
• What proof or confirmation shall be utilized to specify how the program has performed within the stipulated timelines?
• What conclusions as regards to the program performance are vindicated by matching up the available proof to the chosen principles or standards?
• How shall the lessons acquired from the investigation be utilized to enhance public health efficiency?

Health Literacy Challenges Among the Vulnerable

The above evaluation process of the program is summarized in the above framework sourced from: (Zimmerman, J Holden, & Publications., 2009).

Viable sources of communication and health literacy measures for the evaluation process include the following:

1. Federal Plain Language Guidelines
2. National Standards on Culturally and Linguistically Appropriate Services
3. Consumer Assessment of Healthcare Providers and Systems (CAHPS)
4. The Joint Commission Accreditation Standards
5. Healthy People 2020

We shall start by categorizing the communication and health literacy programs or undertakings in the context of these.

• Is communication in our program adequately valued or undervalued aspect? Noticeable or unnoticeable?
• Which part of the program and undertakings not specifically labeled communication or health literacy consist of these particular elements?
• What do we already measure concerning communication in our program?
• What sorts of systems do we have on board for gathering, assessing, and reporting communication data to the relevant people or organizations?
• Who can dependably or consistently gather and report data or any other pertinent information for us?

Budget

The following is the forecasted budget for our program. Due to various changes which are expected to take place as the program continues to operate, this budget is flexible enough to take care of that. This budget sheet also shall be used by the program facilitators to seek for financial support from individuals, organizations, and well-wishers to support the literacy health program.

category (sort)	Item	Subtotal	Net cost
Salaries and benefits	Part-time health professional	$15000	$15000
Supplies and materials	Printing of posters, pamphlets, and other materials	$500
	Supplies for training materials	$500	$ 1000
Affiliations/memberships	Wellness councils	$150	$ 150
Publications/ subscriptions	Health publications	$300
	Electronic newsletter services	$300	$600
Health educations facilities	Diabetes, blood pressure and other disease log-books	$150
	Relevant literature materials	$200	$350
Health screening and evaluations	This has not yet been planned for
Health lessons	This has not yet been planned for
Health training programs	Chronic ailments workshops	$300	$300
Equipment	Diabetes, heart diseases and other sicknesses monitoring equipment	$800	$800
	Other necessary equipment like bike racks, pedometers, among others	$700	$700
Program Incentives	Prizes, gift cards, and other necessary tools of encouraging liveliness in the program	$500	$500
Miscellaneous	Wellness team buildings among other unaccounted particulars	$2000	$2000
TOTAL			$21,400

This is a visual model showing how our program will work. It will be meant to communicate the program’s operations, activities, projects, and goals. The logic model will also be used to program communication, evaluation, and implementation. The following diagram sourced is an example of a model which will be used in this program.

The above Logic mode sometimes referred to as theory of change, program model, or just a theory of action is a diagrammatic demonstration of how the program is anticipated to generate most wanted results. It displays the relations amongst the resources and inputs at our disposal to produce and distribute health intervention, the services the program will offer, as well as the expected outcomes (Harris, 2013). This logic model will do the following:

• Identify the transitional and eventual results of the program and the ways by which the program undertakings will generate those outcomes
• Show the correlations amongst different components of the program,
• Recognize the impact of external related issues on the program’s capability to generate outcomes
• It will aid to guide the program evaluators, implementers, and developers

What is more, the above logic model will also in some ways help in the evaluation of this program because it answers the following questions:

• What challenge is the program attempting to resolve, and what results symbolize success?
• What supports and undertakings are needed to attain these results?
• What resources and inputs are required to disseminate these supports and undertakings?

The resultant logic model displays the connections in a sequence of reasoning concerning “what causes what” in the way towards the most wanted results. Comprehending the fundamental sense of the program from beginning to end enables the intervention evaluators to choose quantifiable indicators to be utilized in execution and impact scrutiny, including measurement of whether the program delivered services as planned, successfully implemented key intervention activities, offered adequate resources, and achieved the results of interest (Fos, 2010).

This logic will have several uses some of which include the following:

• Facilitating comprehension of compound program interventions
• Guiding the development of measures of vital intervention outcomes, process and inputs
• Clarifying objectives and theoretical gaps
• Tracking intervention progress and changing requirements

As a result, a number of advantages will accrues to this program due to the stringent application of the above logic model:

• Maintaining focus on program intervention procedure and framework
• Offer general idea of multifarious processes
• Draw attention to program changes and interactions
• Adapting to interventions of any level in the community

According to (Thiele, 2013) to “sustain” implies to maintain competently, to supply with necessities, to support from below, to keep in existence and to encourage. He further maintains that not even individuals or nonprofit firms can achieve these things without habitual, significant reflection; in brief, without evaluation. This means that the more institutionalized the evaluation procedure is of a given intervention the more sustainable it is. Therefore evaluation is an important tool for attaining sustainability in our program. As emphasized in earlier sections of this proposal, program evaluation will be conducted once in a while in order to maintain the status quo and sustainability of the entire intervention. As a nonprofit- organization the program shall be regularly monitoring its activities and report back to funders and other supports by use of  conventional parameters of success, such as the number and category of activities undertaken and the number of clients served in a given duration. We believe that sustainability is associated with undertaking “what works” — and cutting off activities which do not help the program achieve its goals. Therefore, every aspect of the program which will be deemed unproductive or adding no value to the existence of this health literacy program will be discontinued with immediate effect. This will encourage all funders and supporters of the intervention to continue facilitating the success of the initiative.

Effects of Low Health Literacy

To ensure this sustainability measures still thrive, there are various steps which will be taken:

1. Developing the program evaluation “blueprint”
2. Laying a concrete groundwork by anticipating data-collection requirements
3. Designing an all-inclusive but focused data-collection scheme
4. Pre-testing our data-collection scheme
5. Collecting baseline data
6. Implementing our program and sticking to the plan
7. Hiring tactically and staying involved
8. Using the results or outcomes over and over again

The program’s central measure of success is improving lives of vulnerable community members through good works. As an organization we shall exist to attain this particular objective and sustain a positive impact over time. The program deserves to succeed and it will succeed and with the help of the above steps, this program will each day move closer to sustainability and success.

References

Beauchamp, A., Batterham, R., Dodson, S., Astbury, B., Elsworth, G., McPhee, C., . . . Osborne, R. (2017). Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia). US National Library of Medicine National Institutes of Health, 114-230. doi: 10.1186/s12889-017-4147-5

Chesser, A. K., Keene, N., Woods, & Smother, K. (2016). Health Literacy and Older Adults-A Systematic Review. US National Library of Medicine National Institutes of Health, 256-300. doi: 10.1177/2333721416630492

Edwards, S. K. (2012). Bridging the Gap: Connecting School and Community with Service Learning. The English Journal, 90(5), 39-44.

Fos, P. J. (2010). Epidemiology Foundations: The Science of Public Health. San Francisco: ossey-Bass,.

Hall, D. E., MDiv, M., Prochazka, A., MS, M., & Aaron. (2012). Informed consent for clinical treatment. Canadian Medical Association Journal, 184(5), 533-540.

Harris, M. J. (2013). Evaluating public and community health programs. San Francisco, Calif: Jossey-Bass.

McQueen, D. V. (2013). Global Handbook on Noncommunicable Diseases and Health Promotion [recurso electrónico]. 

Scriven, A., Ewles, L., & Simnett, I. (2010). Promoting health : a practical guide. Edinburgh : Bailliere Tindall.

Singh, A. R., & Singh, S. (2008). Diseases of Poverty and Lifestyle, Well-Being and Human Development. US National Library of Medicine National Institutes of Health, 6(1), 187-225.

Thiele, L. P. (2013). Sustainability. New York, NY : John Wiley & Sons.

U.S. Department of Health & Human Services . (2018). What is Health Literacy? Retrieved Oct 7, 2018, from Centers for Disease Control and Prevention: https://www.cdc.gov/healthliteracy/learn/

U.S. Department of Health & Human Services. (2018). America’s Health Literacy: Why We Need Accessible Health Information. Retrieved Oct 7, 2018, from Plain Language Materials & Resources: https://www.cdc.gov/healthliteracy/developmaterials/plainlanguage.html

Zhou, J., & Hearst, N. (2016). Health-related quality of life of among elders in rural China: the effect of widowhood. US National Library of Medicine National Institutes of Health, 25(12), 3087–3095.

Zimmerman, E. B., Woolf, S., & Haley, A. (2015, September). Population Health: Behavioral and Social Science Insights-Understanding the Relationship Between Education and Health. Retrieved Oct. 7, 2018, from Agency for Healthcare Research and Quality: https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/zimmerman.html

Zimmerman, M. A., J Holden, D., & Publications., S. (2009). A practical guide to program evaluation planning : theory and case examples. Thousand Oaks, Calif: SAGE Productions.