Integrating Health Literacy Practices Into A Care Model: A Comparative Case Study Of Five Safety Net Primary Care Organizations

Abstract

Miscommunication between providers and patients at risk for low health literacy is an underlying critical driver contributing to inappropriate use of health care systems, poor disease management, and overall increased costs to care. Safety net clinics and their providers are rethinking and redesigning care delivery as part of their overall patient safety and quality improvement efforts. A qualitative study, using a case study approach was undertaken to examine health literacy activities and practices in five primary care safety net clinics that serve patients at high risk for low health literacy. Four major sources of data were examined: 1. information from each clinic summary abstract; 2. applicable Phase I online survey data from the five sites; 3. recorded interviewer observation notes; and 4. the completed interview guides used to record responses from a purposeful sample of administrators and managers, front desk staff, and members of the clinical and nonclinical care teams in these five sites. Particular consideration was directed to examining provider knowledge, attitudes, and perceptions of health literacy, organizational structures, and clinical supports as domains that could influence change in communication barriers. Cross-case analysis was conducted to identify common health literacy activities and practices reported as successful for engaging and communicating with diverse populations in four different geographical locations. Study results are used to inform the development of a practice framework for embedding health literacy into primary care safety net settings using segments of the Care Model (CM) as the organizational construct. The research serves as a foundation for an expanded health literacy approach to improve safety net organizations, provider communication capabilities, and the abilities of patients to manage and improve their health outcomes. The practice framework can be adapted to other health care or service provider organizations that provide services to diverse individuals at risk of low health literacy. In doing so, consideration should be given to the interplay of health literacy, culture and language, and their influence on individuals' attempts to access and navigate the health care system and communicate with providers and other care team members.