Dulce do ÓPortuguese Diabetes Association

The National Health Literacy Demonstration Project in Portugal

DIABETES WORLDWIDE NHLDP DEVELOPMENT NEXT STEPS

Summary

https://www.un.org

Political declaration of the third high-level meeting of the General Assembly on the prevention and control of non communicable diseases

Time to deliver: accelerating our response to address non-communicable diseases for the health and well-being of present and future generations

Third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases - 27 September 2018

NON-COMMUNICABLE

DISEASES

PortugalPORTUGAL

HOW CAN WE CHANGE THE EVOLUTION OF

DIABETES?

TYPE 2 DIABETES IN PORTUGAL

APDP

ADJUST: CGM in Insulin-Treated Type 2 Diabetes

APDP – Portuguese Diabetes Association. Dean association of IDF.

Advocacy.

Patient education since 1926.

Diabetes integrated care outpatient clinic (300 patients daily).

Interventions to better support to type 2 diabetes self-management

Close to 170.000 diabetes patients followed by APDP yearly.

Clinical trials, and biomedical and healthcare research.

.

COMMUNITY INTERVENTION PROJECTS

Saber Escolher para bem viver

CHALLENGES IN TYPE 2 DIABETES MANAGEMENT

HEALTH LITERACY

61,4%

HEALTH LITERACY DEMONSTRATION PROJECT

AimTo promote good governance using the available mechanisms to promote health literacy aiming at preventing diabetes and its complications and promoting the populations’ well-being.

General ObjectiveTo develop a demonstration project on the efficiency of a health literacy intervention based on the Ophelia approachfor the promotion of healthy lifestyles and improvement of diabetes control.

TRANSCULTURAL VALIDATION HLQ

IDENTIFICATION OF STRATEGIC PARTNERS

• Estuário do Tejo and Oeiras Health Centres

• Lisboa and Oeiras Municipalities

ANALYZE THE DATA OF THE QUESTIONNAIRES

NATIONAL HEALTH LITERACYCAPACITY BUILDING

WORKSHOP

HEALTH LITERACY DEMONSTRATION PROJECT

1st NATIONAL HEALTH LITERACYCAPACITY BUILDING WORKSHOP14 /15 January 2019

Richard Osborne and Roy Batterham

PARTICIPANTS:

Health Centres Estuário do Tejo and Oeiras

Lisboa and Oeiras Municipalities

APDP

ENSP

Institutional Support

• Towards a common understanding of health literacy• To develop a common understanding of health literacy among participants and appreciation of the

diversity and scope of its influence, and for participants to see its relevasse and potencial in theisr ownsetting

• Health literacy diversity and health inequalities• To recognise the rolr of health literacy in inequalities in acess and engagement and the limitations of

one size fts all approch to health literacy assessment and intervention

• How to get from the need to the interventions• To understand the steeps of intervention develoment and how these mightrelate to health literacy

interventions. To understand the Ophelia process and apply it in your setting

1st NATIONAL HEALTH LITERACY CAPACITY BUILDINGWORKSHOP14 /15 January 2019

• How to get from the need to the interventions

• Designing your own health literacy intervention• Project focus• Scope• Aim

• Establish a data collection

• Establish a project timelines and budget

1st NATIONAL HEALTH LITERACY CAPACITY BUILDINGWORKSHOP14 /15 January 2019

The result of group work…

1 2SCOPE OF THE PROJECTAdults (18-64 years) at risk for type 2 diabetes from differentmunicipalities

SCOPE OF THE PROJECTAdults with type 2 diabetes, residente in Lisboa,

To reduce the number of adults with innapropriate metaboliccontrol in 2 years and promote the health and well-being ofthe population

Improve the appropriate use of health care services andother relevant community resources

Improve the organizations and professionals responsiveness

Co-criation of interventions in health literacy to respond to local literacy needs andcontribute to better health outcomes

PEOPLE WITH DIABETESPREVENTION OF DIABETES

To reduce the risk level for type 2 diabetes in 2 years

Improve the appropriate use of health care services andother relevant community resources

Improve health services and community servicesresponsiveness to local health literacy needs

AIM OF THE PROJECT AIM OF THE PROJECT

1 2 3

Identification of the organizations andstakeholders to be involved(Pharmacies, Fire Department, Associations…);

Diagnosis of the Situation through theapplication of questionaires, interviewsand focal groups to the stakehodersabout the needs, strenghts andweaknesses of the target population, ofthe organizations and their teams.

Co-creation of the interventions, identification of resources, development of support materials for the interventions aimed to organizations, to health professionals and community groups

Implemmentation of the interventions: evaluation of the processes and results for the identification of improvement needs and consequent reformulation and new implemmentation

Creating value: development of clinical pathways, quality monitoring indicators, patient’ safety and funding

INTEGRATED OPHELIA FRAMEWORK FOR HL INTERVENTIONS

9 Cl Row

Labels Num

Average

of AGE Num Fem

Num Liv

alone

Average

of Edu

Average

of Dyear

Num

HbA1c<7

Num

HbA1c7-8

Num

HbA1c>8 Avg HL %HbA1c<7 %HbA1c>8

Num

type 1 %type 1

8 16 51.4 9 1 3.1 19.6 4 7 5 4.01 25.0% 31.3% 7 43.8%

4 35 56.3 21 5 2.6 18.7 12 9 14 3.65 34.3% 40.0% 10 28.6%

7 8 55.9 5 0 3.0 12.4 4 0 4 3.64 50.0% 50.0% 1 12.5%

6 3 61.3 2 1 4.0 19.0 1 0 2 3.49 33.3% 66.7% 0 0.0%

1 51 60.7 27 1 2.3 20.9 13 18 20 3.33 25.5% 39.2% 4 7.8%

3 17 67.6 7 4 2.4 20.5 3 3 11 3.18 17.6% 64.7% 1 5.9%

9 6 64.0 2 1 2.3 24.7 1 2 3 3.08 16.7% 50.0% 0 0.0%

2 26 57.3 9 3 2.5 16.3 5 6 15 2.97 19.2% 57.7% 2 7.7%

5 22 63.1 11 3 2.3 22.5 7 7 8 2.74 31.8% 36.4% 5 22.7%

9 Cl Row

Labels Num

Average

of AGE Num Fem AvgeSc1 AvgeSc2 AvgeSc3 AvgeSc4 AvgeSc5 AvgeSc6 AvgeSc7 AvgeSc8 AvgeSc9

3 17 67.6 7 3.29 2.92 2.92 3.28 2.79 3.47 3.26 3.19 3.49

9 6 64.0 2 3.25 2.92 2.88 3.30 2.88 4.07 3.47 2.83 2.13

9 Cl Row

Labels Num

Average

of AGE Num Fem

Num Liv

alone

Average

of Edu

Average

of Dyear

Num

HbA1c<7

Num

HbA1c7-8

Num

HbA1c>8 Avg HL %HbA1c<7 %HbA1c>8

3 17 67.6 7 4 2.4 20.5 3 3 11 3.18 17.6% 64.7%

9 6 64.0 2 1 2.3 24.7 1 2 3 3.08 16.7% 50.0%

Cluster 6 vignetteMr P is a 64 year old man who has been diagnosed with type 2 diabetes for more than 20 years. He has worked in agriculture all his life and only completed 5 years of schooling. He can read most things that he needs to in his every day life but has difficult with anything that is even slightly technical. When the doctor tries to explain things to him he wishes that the doctor would just tell him what he has to do and be done with it. He feels like he is always having to ask “so what is it that I have to do exactly?” Despite this he had a good relationship with the old doctor who ran the local practice and is getting used to the new team even though he finds them prettyformal and a bit obsessed with paperwork.

Since he retired Mr P’s level of activity has decreased a lot. He was forced to retire due to arthritis and back pain and feels a bit frustrated and bored a lot of the time. Also, when he was working he had no problem controlling his diabetes but now it has become harder and he has also started to put on weight and his blood pressure is getting higher. Mr P’s wife is very keen for him to look after his health and concerned that he is starting to let himself go and seems a bit lost. Mr P knows that if wasn’t for his wife he probably wouldn’t be doing much to care for his health at all.

The result of group work…

1 2SCOPE OF THE PROJECTAdults (18-64 years) at risk for type 2 diabetes from differentmunicipalities

SCOPE OF THE PROJECTAdults with type 2 diabetes, resident in Lisboa,

To reduce the number of adults with innapropriate metaboliccontrol in 2 years and promote the health and well-being ofthe population

Improve the appropriate use of health care services andother relevant community resources

Improve organizations and professionals responsiveness

Co-creation of interventions in health literacy to respond to local literacy needs andcontribute to better health outcomes

PEOPLE WITH DIABETESPREVENTION OF DIABETES

To reduce the risk level for type 2 diabetes in 2 years

Improve the appropriate use of health care services andother relevant community resources

Improve health services and community servicesresponsiveness to local health literacy needs

AIM OF THE PROJECT AIM OF THE PROJECT

next steps…

Project set-up

Data collection and/or Extraction step

Consultation to identify new ideas

• Identify local needs. Co-create local solutions

• Involvement of the collaboration of other members

Optimising health literacyto improve health and equity.

THANK YOU