Professor Avril Taylor

1
Does written hepatitis C information meet the
needs of injecting drug users?

• Professor Avril Taylor
• University of Paisley

2
Background to Study

• Much information on HCV disseminated through
  written materials
• In 2003 an awareness campaign used cards and
  posters
• Knowledge evaluated pre and post campaign
• No difference in knowledge
• Other health literacy studies find discrepancy
  between literature and reading ability

3
Aims of the Study

• To assess the reading levels of injecting drug
  users
• To assess any association between reading level
  and risk behaviours
• To assess the readability levels of written harm
  reduction leaflets on HCV
• To assess sources of HCV knowledge
• To determine IDUs preference for knowledge
  acquisition

4
Method

• IDUs reading levels assessed using two validated
  tools (REALM and S-TOFHLA)
• Interviewed using structured questionnaire
• - drug use, risk behaviours, knowledge of
  HCV, sources of knowledge, preferred format
• Leaflets assessed using SMOG

5
REALM

• Rapid Estimate of Adult literacy in Medicine
• Assesses adults ability to read common medical
  words and lay terms for body parts and illnesses
• 66-item word recognition test
• One mark is given for each correctly pronounced
  word
• The REALM score is the sum of correctly
  pronounced words

6
REALM Scores and Reading Age
7
S-TOFHLA

• Short Test of Functional Health Literacy in
  Adults
• Respondents read out loud a number of sentences
• Fill in a missing word from a provided list

8
S-TOFHLA

• Your doctor has sent you to have a____________
  X-ray.                                           
          a. Stomach                              
                      b. Diabetes                
                                    c.
  Stitches                                         
           d. germsYou must have an_________
  stomach when you come for_____.                  
          a. asthma                                 
                      a. is                      
       b. empty                                   
                     b. am                       
      c. incest                                   
                       c. if                      
       d. anaemia                                 
              d. itThe x-ray will____________
  from 1 to 3 __________ to do.                 
    a. take                                a.
  beds                    b. view
                                 b.
  brains                   c. talk
                                   c.
  hours                   d. look
                                d. diets

9
S-TOFHLA Grades and Literacy Level
10
Leaflet Assessment

• 10 HCV leaflets distributed within GGHB and the
  recruitment centres were evaluated
• The SMOG (simplified measure of gobbledygook)
  Readability Formula determines the readability
  level of written material
• If someone has a reading age of, say, 12 years,
  they will understand 90-100 of material with a
  readability level of 12
• Most people will understand a readability level
  of about 10

11
Sample characteristics

• 150 Glasgow IDUs
• 69 male
• Mean age 32.02 years
• Mean age left school 14.87 years
• Mean age first injected 21.58 years
• 60 no qualifications
• 48 refused to take part

12
Results

• REALM scores
• 11 years 12
  14 years gt 14 years
• or less
• Total (n150) 12 (8) 34
  (23) 104 (69)
• Males (n104) 11(11) 15
  (14) 78 (75)
• Females (n46) 1 (2) 19
  (41) 26 (56)
• Mean age 35.9
  31.0 31.9
• 11years or less. At the very least will need low
  literacy materials
• 12-14 years. Will struggle with most patient
  education materials
• gt14 years. Will be able to read most patient
  education materials

13
Results

• TOFHLA scores
• Inadequate Marginal
  Adequate
• Total (n150) 19 (13) 14
  (9) 117 (78)
• Males (n104) 16 (15) 9
  (9) 79 (76)
• Females (n46) 3 (7) 5
  (11) 38 (83)
• Mean age 35.1
  33.2 31.4
• Inadequate. Unable to read and interpret health
  texts
• Marginal. Has difficulty reading and interpreting
  health texts
• Adequate. Can read and interpret most health texts

14
REALM and TOFHLA

• REALM
• 11 years or less 12
  14 years gt 14 years
• ( n12)
  (n34) (n104)
• TOFHLA
• Inadequate 9 (75)
  7 (21) 3 (7.5)
• Marginal 0
  6 (18) 8 (8)
• Adequate 3 (25)
  21 (6) 93 (89)

15
Risk Behaviours Injecting with used n/s

• 11 years
  12 14 gt 14 years Total
• or less
  years
• (n12)
  (n34) (n104) (n150)
• Ever share n/s 5 (42) 15 (44)
  55 (53) 75 (50)
• Shared last 4 (33) 6 (18)
  20 (19) 30 (20)
• 6 months

16
Risk Behaviours other paraphernalia

• 11 years or less 12 14 years gt 14 years
  Total
• (n12)
  (n34) (n104)
  (n150)
• Ever share spoon 8 (67) 20
  (59) 73 (70) 101 (67)
• Shared spoon 6 (50) 14
  (41) 47 (45) 67 (45)
• last 6 months
• Ever share filter 8 (67)
  19 (56) 74 (71) 101 (67)
• Filter last 6 months 6 (50) 13
  (38) 49 (47) 66 (44)

17
HCV Knowledge

• Think easily transmitted
• 11 years
  or less 12 14 years gt 14 years Total
• Injecting with used n/s 11 (92)
  34 (100) 101 (97) 146 (97)
• Drawing up used spoon 11 (92)
  34 (100) 88 (85) 133 (89)
• Used filter 11
  (92) 32 (94) 92 (89)
  135 (90)
• Used flush water 10 (83)
  29 (85) 90 (87) 129
  (86)

18
How received Hepatitis C knowledge

• 11 years 12 14 gt14 years
  Total
• or less years
• Verbal 10 (83) 25 (74) 81
  (78) 116 (77)
• Poster 1 (8) 8 (24)
  26 (25) 35 (23)
• Leaflet 6 (50) 22 (65)
  76 (73) 104 (69)
• Other 1 (8) 3 (9)
  14 (14) 18 (12)
• (TV, press
• etc)

19
Found source helpful/very helpful

• 11 years 12 14 gt 14 years
  Total
• or less years
• Verbal 9 (90) 22 (80) 69
  (85) 100 (86)
• Poster 0 5 (63) 15 (58)
  20 (57)
• Leaflet 0 5 (23)
  15 (18) 20 (19)
• Other 1 (100) 3 (100) 11
  (79) 15 (83)
• (TV, press
• etc.)

20
Leaflet assessment

• 10 leaflets ranged between equivalent reading age
  of 13-17 years
• Mean readability level of 15-16 years
• Those with reading age of 12-14 years or less
  (31) would have problems understanding most of
  the leaflets
• Some of those aged gt14 years would have
  difficulty reading the leaflets

21
Would you like to know more about Hepatitis C?
22
Leaflet assessment

• Leaflet
  Reading Age
• L1
  14-15
  
• L2
  13-14
• L3
  13-14
• L4
  14-15
  
• L5
  13-14
  
• L6
  17-18
  
• L7
  13-14
• L8
  15-16
• L9
  17-18
• L10
  17-18
• Aim is for readability of 10 or under

23
Preferred source of information

• 11 years 12 14 gt14 years
• or less years
• Verbal 11 (92) 29 (85)
  71 (68)
• Leaflets/posters 1 (8) 1 (3)
  23 (22)
• TV/DVD/Web 0 3 (9)
  7 (7)

24
Conclusion

• At least average reading age
• Risk behaviours continue despite widespread
  knowledge of injecting transmission factors
• At least one third would have difficulty reading
  current literature
• Only 19 of those who had read a leaflet found it
  helpful only 18 of those with reading age of
  gt14 found it helpful
• Only 23 had read a poster
• Preferred source of information was verbal
  communication for all reading groups
• 60 wanted to know more about HCV 57 of gt14
  group
• Implications for staff training