Incorporating health literacy in education for socially disadvantaged adults: an Australian feasibility study.
BACKGROUND
Adult education institutions have been identified as potential settings to improve health literacy and address the health inequalities that stem from limited health literacy. However, few health literacy interventions have been tested in this setting.


METHODS
Feasibility study for an RCT of the UK Skilled for Health Program adapted for implementation in Australian adult education settings. Implementation at two sites with mixed methods evaluation to examine feasibility, test for change in participants' health literacy and pilot test health literacy measures.


RESULTS
Twenty-two socially disadvantaged adults with low literacy participated in the program and received 80-90 hours of health literacy instruction. The program received institutional support from Australia's largest provider of vocational education and training and was feasible to implement (100 % participation; >90 % completion; high teacher satisfaction). Quantitative results showed improvements in participants' health literacy skills and confidence, with no change on a generic measure of health literacy. Qualitative analysis identified positive student and teacher engagement with course content and self-reported improvements in health knowledge, attitudes, and communication with healthcare professionals.


CONCLUSIONS
Positive feasibility results support a larger RCT of the health literacy program. However, there is a need to identify better, multi-dimensional measures of health literacy in order to be able to quantify change in a larger trial. This feasibility study represents the first step in providing the high quality evidence needed to understand the way in which health literacy can be improved and health inequalities reduced through Australian adult education programs.
The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. dmus5397@uni.sydney.edu.au.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. dmus5397@uni.sydney.edu.au.
Danielle M
DM
Muscat
Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
Sian
S
Smith
Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.|Concord Clinical School, The University of Sydney, Sydney, NSW, 2006, Australia.
Haryana M
HM
Dhillon
The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
Suzanne
S
Morony
Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia.
Esther L
EL
Davis
Patient Based Care, Clinical Excellence Commission, Sydney, NSW, 2000, Australia.
Karen
K
Luxford
Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.|Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia.
Heather L
HL
Shepherd
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
Andrew
A
Hayen
Center for International Education, University of Massachusetts, Amherst, MA, 01003, USA.
John
J
Comings
Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
Don
D
Nutbeam
The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
Kirsten
K
McCaffery
D000328:Adult; D000368:Aged; D001315:Australia; D005240:Feasibility Studies; D005260:Female; D057220:Health Literacy / Q000379:methods* / Q000592:standards*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D036301:Qualitative Research; D035862:Vulnerable Populations
Adult education; Health education; Health inequalities; Health literacy; Qualitative