title: Assessing health literacy practices in a community pharmacy environment: experiences using the AHRQ Pharmacy Health Literacy Assessment Tool.
abstract: BACKGROUND
  The Agency for Healthcare Research and Quality (AHRQ) developed the tool, "Is Our Pharmacy Meeting Patients' Needs? Pharmacy Health Literacy Assessment Tool" to evaluate health literacy preparedness of pharmacy environments from patient, staff, and environmental perspectives. The tool was designed at a clinic-based, outpatient pharmacy of a large, urban, public hospital. Despite the ready availability of this tool and the encouragement of AHRQ to adapt it to other environments, there is no published literature on the dissemination and translation of this tool in the community pharmacy environment.
  
  
  OBJECTIVE
  The five objectives of this study were to: (1) pilot the AHRQ tool "Is Our Pharmacy Meeting Patients' Needs? Pharmacy Health Literacy Assessment Tool" in a community pharmacy environment; (2) evaluate and adapt the tool; (3) describe the use of health literacy practices from patient, staff, and independent auditor perspectives using the revised tool; (4) evaluate the effect of a low-intensity educational health literacy awareness program; and (5) identify opportunities to improve health literacy-sensitive practices in the community pharmacy environment.
  
  
  METHODS
  The study employed a mixed method, posttest-only control group design using community pharmacies in the Tulsa, OK area. Participants included community pharmacists, staff, patients, and independent auditors. Select pharmacy staff members were invited to receive a health literacy training program delivered by a nationally-recognized health literacy expert to raise awareness of health literacy issues. Approximately eight months after the program, pharmacy staffs were surveyed using a written instrument, patients were interviewed by telephone, and the study investigators performed independent environmental audits in each of the selected pharmacies. Results from auditor evaluations, staff survey responses, and patient interviews were compared for similarities and differences to provide a multidimensional perspective about the use of health literacy-sensitive practices.
  
  
  RESULTS
  After piloting and adapting the AHRQ tool for the community pharmacy environment, 60 patients completed telephone interviews, 31 staff members completed surveys, and four independent auditors completed environmental audits in six study pharmacies using the revised data collection instruments. The majority of patients and staff were in agreement that written materials were easy to read. However, the auditors did not report equally high agreement regarding the readability qualities of the written materials. While the majority of staff reported use of literacy-sensitive communication techniques with patients, only a minority of patients reported actual communication with the pharmacist and use of literacy-sensitive communication techniques. At trained pharmacies, a significantly larger proportion of patients reported that the pharmacist spent enough time answering their questions (100% vs. 87%, P = 0.038), but a smaller proportion reported the pharmacists reviewed important information from the written information provided (30% vs. 57%, P = 0.035). A significantly smaller proportion of pharmacy staff also reported using the repeat-back technique at the trained pharmacies (40% vs. 79%, P = 0.035).
  
  
  CONCLUSIONS
  This project is the first to report piloting, revision, and implementation of the AHRQ Health Literacy Assessment Tool in a community pharmacy practice setting. In addition to adapting data collection instruments and implementation strategies, opportunities that target training to facilitate use of literacy-sensitive practices and active patient engagement with literacy-sensitive communication techniques were identified.
authors.affiliation: Department of Pharmacy, Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, 4502 E. 41st Street, Tulsa, OK 74135, USA. Electronic address: Katherine-Oneal@ouhsc.edu.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: O'Neal
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Crosby
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miller
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Murray
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Condren
mesh_terms: D003157:Community Pharmacy Services; D003625:Data Collection; D057220:Health Literacy; D006801:Humans; D010361:Patients; D010595:Pharmacists; D015397:Program Evaluation / Q000379:methods*