title: Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia).
abstract: The need for healthcare strengthening to enhance equity is critical, requiring systematic approaches that focus on those experiencing lesser access and outcomes. This project developed and tested the Ophelia (OPtimising HEalth LIteracy and Access) approach for co-design of interventions to improve health literacy and equity of access. Eight principles guided this development: Outcomes focused; Equity driven, Needs diagnosis, Co-design, Driven by local wisdom, Sustainable, Responsive and Systematically applied. We report the application of the Ophelia process where proof-of-concept was defined as successful application of the principles.
  
  
  
  Nine sites were briefed on the aims of the project around health literacy, co-design and quality improvement. The sites were rural/metropolitan, small/large hospitals, community health centres or municipalities. Each site identified their own priorities for improvement; collected health literacy data using the Health Literacy Questionnaire (HLQ) within the identified priority groups; engaged staff in co-design workshops to generate ideas for improvement; developed program-logic models; and implemented their projects using Plan-Do-Study-Act (PDSA) cycles. Evaluation included assessment of impacts on organisations, practitioners and service users, and whether the principles were applied.
  
  
  
  Sites undertook co-design workshops involving discussion of service user needs informed by HLQ (n = 813) and interview data. Sites generated between 21 and 78 intervention ideas and then planned their selected interventions through program-logic models. Sites successfully implemented interventions and refined them progressively with PDSA cycles. Interventions generally involved one of four pathways: development of clinician skills and resources for health literacy, engagement of community volunteers to disseminate health promotion messages, direct impact on consumers' health literacy, and redesign of existing services. Evidence of application of the principles was found in all sites.
  
  
  
  The Ophelia approach guided identification of health literacy issues at each participating site and the development and implementation of locally appropriate solutions. The eight principles provided a framework that allowed flexible application of the Ophelia approach and generation of a diverse set of interventions. Changes were observed at organisational, staff, and community member levels. The Ophelia approach can be used to generate health service improvements that enhance health outcomes and address inequity of access to healthcare.
authors.affiliation: Health Systems Improvement Unit, Centre for Population Health, Deakin University, Geelong, VIC, Australia. alison.beauchamp@deakin.edu.au.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. alison.beauchamp@deakin.edu.au.
authors.forename: Alison
authors.initials: A
authors.lastname: Beauchamp
authors.affiliation: Health Systems Improvement Unit, Centre for Population Health, Deakin University, Geelong, VIC, Australia.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Batterham
authors.affiliation: Fred Hollows Foundation, Carlton, VIC, Australia.
authors.forename: Sarity
authors.initials: S
authors.lastname: Dodson
authors.affiliation: Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Brad
authors.initials: B
authors.lastname: Astbury
authors.affiliation: Health Systems Improvement Unit, Centre for Population Health, Deakin University, Geelong, VIC, Australia.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Elsworth
authors.affiliation: Health Systems Improvement Unit, Centre for Population Health, Deakin University, Geelong, VIC, Australia.
authors.forename: Crystal
authors.initials: C
authors.lastname: McPhee
authors.affiliation: Victorian Department of Health and Human Services, Melbourne, Australia.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Jacobson
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.|Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, VIC, Australia.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: Health Systems Improvement Unit, Centre for Population Health, Deakin University, Geelong, VIC, Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
mesh_terms: D003256:Community Participation; D018166:Health Care Reform; D057220:Health Literacy; D006293:Health Promotion; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D010043:Outcome and Process Assessment, Health Care; D011795:Surveys and Questionnaires; D014739:Victoria
keywords: Chronic disease; HLQ; Health Literacy Questionnaire; Health inequities; Health literacy; Health service improvement; Healthcare access; Ophelia