Exploring opportunities to improve the health literacy responsiveness of hospital outpatient waiting areas
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2022
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Melbourne Authors
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Physiotherapy
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PhD thesis
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Open Access
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© 2022 Cassandra Elizabeth McDonald
Abstract
Creating health services which are responsive to the health literacy needs of consumers has potential to improve health outcomes and reduce healthcare costs. ‘Responsive’ health services provide appropriate and accessible health information, resources, supports and care environments for consumers. Providing health information, resources and supports in waiting areas is common practice; however, there is limited evidence as to whether this practice is meeting the health literacy needs of adult consumers in hospital outpatient settings. The purpose of this thesis was to explore consumer perspectives on the health literacy responsiveness of hospital outpatient rehabilitation waiting areas.
A scoping review of the literature explored what was known from published and grey literature about the use of outpatient waiting areas to contribute to health literacy. The review found limited studies in hospital outpatient waiting areas. Studies in primary care and community waiting areas suggested that targeted interventions may improve health literacy and related outcomes such as behaviours, and clinical outcomes.
An observational study in two hospital outpatient waiting areas investigated the number and types of health information, resources and supports available for consumers as well as how often and for how long consumers accessed these whilst waiting for their appointments. In-person and video recorded observations revealed that a range of items were available for consumers in the waiting area, however, these were rarely used.
A constructivist grounded theory study explored and theorised opportunities for hospital outpatient waiting areas to contribute to health literacy. Participant observation and semi-structured interviews were conducted with 33 adult consumers attending outpatient rehabilitation at two hospitals. The substantive theory of ‘seeking choice to fulfill health literacy needs’ and related categories indicated that consumers sought choice reflective of their needs; however, the waiting area offered limited choice. Consumers shared ideas to address the lack of choice.
A cross-cultural qualitative in-depth case study explored the perceptions and experiences of CALD consumers accessing health information and resources in hospitals including in an outpatient waiting area. Four adult consumers (two patients, two caregivers) from CALD backgrounds participated in semi-structured interviews with bilingual researchers. Data were analysed using reflexive thematic analysis. Five themes indicated that available health information is not responsive to the language, literacy, or cultural needs of CALD consumers.
A secondary analysis of qualitative interview data using the Framework Method investigated the barriers and enablers experienced by consumers when accessing and engaging with health information, resources and supports in hospital outpatient waiting areas. Consumers’ ideas for designing a health literacy responsive waiting area were also evaluated. Themes and design typologies developed offered practical solutions which could be applied to future waiting area design.
Overall, this thesis found that hospital outpatient waiting areas have potential to contribute to health literacy from the perspectives of consumers. However, in their current state, hospital outpatient waiting areas are not responsive to consumers’ diverse health literacy needs. The findings from this PhD research highlight future avenues for redesigning and coproducing health information, resources, supports and waiting area environments which are responsive to and inclusive of diverse health literacy needs.
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health literacy responsiveness, health literacy, hospital, outpatient, waiting area, consumer perspectives