Health Literacy Research
Here I share with you my notes from a rapid-fire series of presentations by international experts in health literacy research followed by lively thoughtful discussions and creative tension between researchers and practitioners.
We need evidence. But do not get hung up on evidence. Evidence is lacking on all aspects of what we do.
Intervention is deliberate interruption.
The Course of Research:
Define the problem.
Develop the solution.
Test the intervention.
Replicate the intervention.
The Process of Evaluation Research:
Qualitative data makes sense from quantitative data. Evaluations need both.
1. Feasibility studies with the target groups. Test messages
2. Theory, Logic Model
3. Process evaluation during implementation
4. Qualitative interviews re use, clarity of message. Are theory and effects consistent?
All stages of evaluation involve the stakeholders
Programs fail for 4 reasons:
Process Failure: Intervention was not delivered as planned (a problem for scale-up)
Theory Failure: Absence of theoretical frame (common in health literacy interventions)
Measurement Failure: Measurement error - measured the wrong thing, or the instrument did not measure what it said it did. (common in health literacy)
Research Design Failure
Health literacy research needs to inform interventions to address the social determinants of health. The determinants are complex; so interventions and evaluations are necessarily complex.
UK Research Council published a framework for complex intervention studies. See the British Medical Journal
Cost of a program is 20 to 50 times the cost of research to demonstrate what works. Ask: Where and when is implementation an idea who time has come?
Be open to industry as a long term partner. Bring forward looking companies and their expertise into the debate. You cannot change Burger King by bashing them. Public/private collaboration requires de-medicalizing our language, clarifying our messages, principle-based and pragmatic approaches.
Phillip Morris is expert in behavior change. We can learn from them the use of education, persuasion, environment, policy, funding and the long term view
Ethnicity is the embodiment of difference. Recording and drawing conclusions based on ethnicity raises deep ethical questions for research.
Outcome measures drive intervention. What we measure determines what we find out about what works and who should do it