Health literacy at Shepherds of Good Hope

Mar 14, 2016 by

the oaks

How many people have ever walked past a homeless person on the street and dropped some change into a hat or a cup? How many people have wondered if they were doing the right thing?

At The Oaks, a Shepherds of Good Hope supportive living facility, we know we’re doing the right thing when we give money to homeless people as part of an innovative program run by Ottawa Inner City Health. At The Oaks, residents are being paid to attend health literacy sessions where they can learn more about their specific health challenges. We talked with Wendy Muckle, Executive Director of Ottawa Inner City Health, and Ray Macquatt, Program Manager at The Oaks, to talk about the program and the early results.

Q. Why is raising awareness of health issues so important? 

Wendy: The Health Literacy project is part of a larger initiative to improve care for people in their final years of life who would benefit from chronic palliative care. There is very clear evidence the benefits of providing chronic palliative care are limited if the individual is not part of the health care team — directing how they want to receive care and what their goals of care are. We recognized that health literacy is very low and our clients had failed to benefit from the usual ways people learn about the diseases that affect them. We sought financial help from the Community Foundation of Ottawa to allow us to try unconventional approaches to improving health literacy.

Ray: A lot of our clients are not aware of the damage they are doing to their health. They know they’re not healthy but they don’t know exactly what is happening. For example, they know eating too much salt is bad for you but they don’t know exactly why. If we give them more education, then they can start to take control.

Q. When did Ottawa Inner City Health recognize the need that the clients needed this interaction? 

Wendy: We recognized the need to improve access to palliative care much earlier in the disease process about two years ago. We recognized that people were suffering because of the symptoms of these illnesses. We used an evidence based tool (SPICT) to review the cases of anyone who had died in the past 15 years in Inner City Health and used that information to identify 5 disease processes which were likely to cause suffering to our clients in their final years of life. We decided to develop a chronic palliative care strategy to improve our capacity to reduce the suffering of clients through improving health literacy of clients and training of our front line staff.

Q. How are the sessions held? Do you bring in experts?

Wendy: The sessions are held at The Oaks. We have an amazing volunteer named Jeff Ling who worked with the clients to develop the training modules for each health topic. He works with the clients as a group to help them learn the content through discussion. The sessions are designed for people with low literacy skills in that they do not rely on written words but more strongly on pictures to guide the learning of content. The format involves learning about the disease (what is it), what is usual care (what to expect if you are diagnosed with this problem) and five things you can do to help yourself if you are living with this disease.

Ray: We’re dealing with small groups. Ten people seem to be the magic number. Some people have participated in every session while others have only come once or twice. The sessions will cover topics like liver health, mental health, chronic obstructive pulmonary disease, something they are most likely suffering from.

Q. How do you get that initial engagement to get the clients to attend? 

Wendy: Initially we met with the clients to talk about the project and see if they even wanted to get involved. They agreed to give it a try. We planned for how to get the project started and then relied on the clients to direct how they wanted it to evolve. Clients are paid a small stipend for participation and this has proven to be very effective. Although the payment is small – $5 for participating in a session – it was done to demonstrate respect for their time as they were being trained to help each other. There is also very good evidence about the efficacy of paying people for health interventions. These clients are extremely poor since all their funds go to pay for staying at The Oaks, their alcohol and tobacco costs. Most clients have less than $50 per month in disposable income so even earning an additional $20 per month means a lot to them. It was also a way to show them that they could earn money through conventional means versus panhandling or other not so desirable means.

Q. How have the clients responded? Without comprising any privacy concerns, are there any anecdotes you can share about the impact these sessions have had on any individual client?

Wendy: We were amazed at how many of the clients participated. We were amazed at their ability to learn and retain the content they learned since many had very negative school experiences. We realized this method of learning took advantage of their verbal and auditory skills and their high levels of sensitivity to distress in the people around them. These are skills which allowed them to survive when they were homeless so it was very interesting to see how we could take advantage of their strengths in a different context.

One of the clients reported: “I was really glad that I had the training about cancer. Right after the training I got diagnosed with cancer and I knew exactly what to expect. If I had not had the training, I would have been too scared to go through the testing so I could be treated.”

What was interesting was that the clients have recognized that in order to help each other, they need to be stronger and healthier. This has led into an entirely new and unexpected phase of the project where clients who want to improve their health have developed individual plans with the help of the volunteer. They plan for certain changes to their behaviour which are monitored by the staff and for which they are paid a very small amount as an incentive. For example, smoking two less cigarettes a day earns you 50 cents. Walking from The Oaks to Dow’s Lake and back earns you $1. We met with the clients this week to see if they wanted to continue beyond the 3 months which was our initial commitment. They do and they are planning to add in more group activities like a hockey game and cooking contest.

Ray: They like it. They are asking ahead of time to know what each week’s topic is going to be. We do the sessions on Saturday and attendance has been good. We want to start having one-on-one sessions. We want to ask them: What did you learn? What changes do you think you can make to improve your health? If we can get some people cutting back on their alcohol or cigarette consumption, that’s a good thing. We have three people who went to detox right after the sessions.

Q. We hear that one of the goals of these sessions is to encourage the clients to become mentors or advocates for their fellow residents. How does that work? 

Wendy: We recognized that sometimes the clients are difficult to engage around their own health but they always want to help each other. We recognized that information that comes from their peers often has a much greater impact than what we tell them as doctors or nurses. We wanted to make sure that as their friends went through an illness, they knew what was happening and how to support them.

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