Clear Conversations: a mixed methods evaluation of a verbal health literacy initiative for health service providers

BACKGROUND: Understanding health information can be difficult, which can limit people's ability to manage their health and adopt healthy practices, leading to poorer health outcomes. This study aimed to evaluate a verbal health literacy training initiative designed to support clear conversations between health service providers and users. The initiative incorporated Teach-back, Chunk and Check, Simple Language, and Open Questions, alongside implementation support from a health literacy officer. METHODS: A concurrent mixed-methods evaluation was conducted across two health programmes serving a population of approximately one million people in the United Kingdom: A Pulmonary Rehabilitation Programme delivered by five physiotherapists in a hospital setting, and a Weight Management Programme delivered by 12 health improvement advisors within a regional government authority. The evaluation comprised five components: (1) Surveys of 110 service providers' perceptions of the training; (2) Observations of 11 service providers before and after training; (3) Two focus groups with 11 service providers six months post-training; (4) Change in 73 service users' health literacy levels using two domains of the Health Literacy Questionnaire; (5) Change in service users' health and wellbeing between baseline and programme completion. RESULTS: Service providers found the initiative useful. Changes in communication practice, such as increased use of Chunk and Check and Open Questions, were observed. Both programmes were delivered in group settings. Teach-back was reported to be challenging to apply in this context but beneficial in one-to-one interactions in wider practice. Implementation support from the health literacy officer was helpful but difficult to deliver to busy teams. Service users' health literacy levels improved by the end of their programme, but there was no evidence that the initiative improved health and wellbeing outcomes. For example, no significant difference was observed in the primary outcome for Weight Management participants in the intervention group compared with controls (0.2 kg, - 2.3 to 1.9; p = 0.84). CONCLUSIONS: In this small evaluation, the initiative was well received and enhanced service providers' communication skills. Further evaluation of a strengthened initiative should focus on controlled before-and-after designs using larger samples to determine the effect on service users' health literacy and health and wellbeing outcomes.