Development of a Communication Intervention for Older Adults With Limited Health Literacy: Photo Stories to Support Doctor–Patient Communication

Abstract

Successful doctor–patient communication relies on appropriate levels of communicative health literacy, the ability to deal with and communicate about health information. This article aims to describe the development of a narrative- and picture-based health literacy intervention intended to support older patients with limited health literacy when communicating during their primary care consultations. We performed a formative evaluation that included a review of the literature and interviews with stakeholders on relevant health literacy issues, qualitative studies with the target group, intervention planning, and a small-scale evaluation. Cocreation with the target group was a major component. Seven photo stories were developed incorporating principles from narrative and social learning theory and covering communication themes and strategies identified during focus group discussions and role-play exercises. The intervention was developed in 3 different formats: 1-page photo stories, narrated video clips using the original photo story pictures, and interactive video clips covering participation and communication during primary care consultations. In our small-scale evaluation, older adults considered the cocreated intervention appealing and comprehensible. The intervention shows promise for improving the health of older adults but needs further evaluation. This study provides a rigorous template for the participatory development of health literacy interventions.

Acknowledgments

We are very grateful to Ágnes Novosath, Péter Csizmadia, and Koós Tamás, who organized the focus group discussions and role-play exercises in Hungary. Furthermore, we are very thankful to all of the focus group participants, all of the actors, photo story designer Ype Driessen, and the general practice where we had our photo shoot. Finally, the development of the interactive photo stories was made possible by the team at ETV.nl.

Funding

This review is part of the IROHLA project. IROHLA is coordinated by the University Medical Center Groningen and has received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under Grant No. 305831.

Supplemental Material

Supplemental online appendices (Appendix 1: Search Terms Used in Medline and Google Scholar; Appendix 2: Interview Outline for Health Care Professionals; Appendix 3: Focus Group Outline) are available on the publisher’s website at http://dx.doi.org/10.1080/10810730.2016.1193918.

Notes

¹ The European Health Literacy Survey was conducted in July 2011 by TNS Opinion in all countries participating in the project, thus Austria, Bulgaria, Germany NRW, Greece, Ireland, The Netherlands, Poland, and Spain. In The Netherlands, 2% of the general population had inadequate health literacy and 27% had problematic health literacy. No data are available for Hungary, but in Bulgaria, 27% had inadequate health literacy and 35% had problematic health literacy. About 12% of all European respondents were found to have inadequate general health literacy, and more than one third (35%) were found to have problematic health literacy.

² The IROHLA (“Intervention Research on Health Literacy among the Aging Population”) project focused on improving health literacy for older people in Europe. It identified and validated a set of 20 best-evidence interventions, constituting a comprehensive approach to addressing the health literacy needs of the aging population in Europe. These interventions were incorporated into an evidence-based guideline for policy and practice for local, regional, and national government authorities (www.healthliteracy.eu).

Additional information

Funding

This review is part of the IROHLA project. IROHLA is coordinated by the University Medical Center Groningen and has received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under Grant No. 305831.