Co-creation of a roadmap to shared decision making with people with limited health literacy

Background

One in three Dutch people have limited health literacy (HL). For them, playing an active role in their own health care is difficult. Health care professionals often feel not well prepared to support people with limited HL in taking this active role, resulting in suboptimal shared decision-making and poorer health outcomes.

Objectives

To enable healthcare providers within primary care practices to structurally devote attention to shared decision-making and health literacy and make care more person-centered and accessible for all patients.

Methods

A participatory approach was used involving people with limited HL and professionals from 10 primary care practices. The steps of the RE-AIM model (Reach, Effect, Adoption, Maintenance) were followed to systematically implement shared decision-making best practices in the context of limited health literacy. We used a practice check, training for professionals and supporting materials for shared decision-making and health literacy (including the teach-back method, conversation cards, and visual choice cards). Implementation within practices was monitored and evaluated through surveys and focus groups. Facilitating and hindering factors for implementation were identified.

Results

Based on the analysis of implementation trajectories, six steps for successful implementation were identified: 1) exploring and creating support, 2) developing a joint implementation plan, 3) gaining knowledge and experience, 4 setting up daily practice, 5) monitoring, evaluating, and 6) adjusting, creating sustained attention. They were made operational by choosing feasible concrete actions during co-creation sessions with healthcare providers and patients resulting in a practical ‘roadmap’ for shared decision making and health literacy in GP practice.

Implications

With the Together-in-One Roadmap, developed in co-creation, primary care practices can get started step by step with shared decision-making and limited health literacy.

Key messages

• Small, stepwise actions enable primary care teams to implement shared decision-making and address limited health literacy in daily practice.

• Active involvement of patients and professionals in co-creation is essential to develop feasible, sustainable solutions for shared decision-making and health literacy.