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BACKGROUND: Published evaluations of successful interventions to prevent falls in people with sight impairment (SI) are limited. The aim of this feasibility study is to optimise the design and investigation of home safety (HS) and home exercise (HE) programmes to prevent falls in older people with SI.METHODS: A community-based feasibility study in north-west England comprising a three-arm randomised controlled trial (RCT) allocated participants to (1) a control group receiving usual care and social visits, (2) an experimental group receiving the HS programme and (3) an experimental group receiving the HS + HE programme. Participants were community-dwelling, aged 65 years and older and sight impaired. Primary outcome data on falls were collected continuously over 6 months. Secondary outcomes on physical activity (self-report and instrumented) and adherence were collected at baseline and 3 and 6 months for HE and at 6 months for the HS programme. Costs for the HS and HS + HE groups were calculated from logs of time spent on home visits, telephone calls and travel. The research assistant and statistician were blinded to group allocation.RESULTS: Altogether, 49 people were recruited over a 9-month period (randomised: 16 to control, 16 to HS, 17 to HS + HE). The interventions were implemented over 6 months by an occupational therapist at a cost per person (pounds sterling, 2011) of £249 (HS) and £674 (HS + HE). Eighty-eight percent (43/49) completed the trial and 6-month follow-up. At 6-month follow-up, 100 % reported partially or completely adhering to HS recommendations but evidence for adherence to HE was equivocal. Although self-reported physical activity increased, instrumented monitoring showed a decrease in walking activity. There were no statistically significant differences in falls between the groups; however, the study was not powered to detect a difference.CONCLUSION: It is feasible and acceptable for an occupational therapist to deliver HS and HE falls prevention programmes to people with SI living independently in the community. Future studies could access Local Authority Registers of people with SI to improve recruitment rates. Further research is required to identify how to improve adherence to HE and to measure changes in physical activity before conducting a definitive RCT.TRIAL REGISTRATION: ISRCTN53433311 , registered on 8 May 2014.

Introduction: Health literacy includes the cognitive and social skills which determine the motivation and ability of individuals to access, understand and use information to promote good health. People with lower health literacy do less well in the NHS and are less likely to adopt health self-management strategies than people with higher levels of health literacy. There is no published research exploring the impact that lower health literacy levels have on individuals managing the consequences of musculoskeletal (MSK) disease. This study explored the impact of lower health literacy levels for people living with a MSK disease Methods: Key contacts identified potential participants from Rheumatology clinics, GP surgeries, Colleges and community groups. Participants over 18 years, with a MSK disease and either thought to have lower health literacy or self-identifying as having lower health literacy were included. Participants completed a Rapid Estimate of Adult Literacy in Medicine (REALM) and demographic questionnaire. Semi-structured interviews were audio-recorded, transcribed and analysed thematically. Findings: Nine women and nine men aged 29-82 years participated. This group were predominantly white British, and most completed high school education. Ten participants had a lower level of literacy (i.e. scored < 6 on REALM). Four themes emerged; 1) Experiencing low health literacy as a service user; capturing the range of service users’ responses to the challenge of lower health literacy, ranging from ‘hiding’ to open disclosure 2) The impact on living and working; where people revealed a range of understanding about their condition and frequently recounted being told by health professionals nothing could be done for their MSK pain. 3) Engaging with MSK education; where participants identified family, friends and neighbours as the most useful and frequent information resources. 4) Strategies for self management; here people identified “going over words” and using practical help. In keeping with participants’ recollections of hearing that ‘nothing could be done’ about their condition, they generally seemed unaware of what self-management was, or how it could assist them.Discussion: People with lower levels of health literacy and MSK disease manage complex social and co-morbid medical conditions. Information provided by health professionals is not always useful and many relied on their social networks for support. People recalled that often they had been told that there was nothing that could help their pain or arthritis; it couldn't be cured. This impacted negatively on the incentive for people with lower health literacy to recognise and engage with self-management approaches. To better support people with lower health literacy and MSK conditions to engage with self-management strategies, all agencies need to emphasise the potential benefits and use easily accessible clear messages to communicate these.

HEALTH LITERACY is the ability to ‘gain access to, understand and use information’ for health (Nutbeam 2008). Developing sound health literacy skills can be complex and being health literate is not simply the ability to read and write; it requires many different skills, including navigation though healthcare systems, comprehension, listening and interacting, analytical and decision-making abilities.

Purpose:To evaluate the effectiveness of patient education provided to people with arthritis and lower levels of literacy. MethodA systematic review was conducted. Electronic databases were searched from 1946 to 2012. Randomised controlled trials with primary interventions designed for individuals with arthritis and lower levels of literacy were included. Results2440 studies were identified. Three community studies and three rheumatology clinic studies met the inclusion criteria. Trial outcomes included patient knowledge, self-efficacy, arthritis related illness, general health and anxiety. The community based studies recruited a higher proportion of people with lower levels of literacy. There was a moderate level of support for the effectiveness of patient education interventions in increasing knowledge (ES: 1.00-2.8) and self-efficacy (ES 0.1- 0.2) and decreasing self-reported arthritis illness. ConclusionsOnly a small number of trials were sufficiently robust to be included in this systematic review. Patient education interventions for people with arthritis who also have lower levels of literacy appear to be moderately effective in the short term at increasing knowledge although this is not equal across all literacy groups. The effectiveness of interventions on self-efficacy, arthritis and general health have lower effect. Trials also included people with adequate literacy. Many studies that offer valuable information had to be excluded as they were not methodologically robust enough to include in a systematic review. Future trials need to be robustly designed and reported and assess interventions with the specific target population.Contribution to the conceptual/practice/evidence base of health literacy This systematic review reports both community and clinical trials in the same analysis. Whilst different approaches to health literacy may be evident (risk vs asset) both aim for an improvement in patient outcome and provide useful evidence for application within patient education. Our results show minimal to moderate short term evidence for targeted patient education interventions for people with arthritis and lower levels of literacy.

Objective: to conduct a systematic review to assess the effectiveness of patient education interventions delivered or directed by health professionals for people with musculoskeletal conditions who also have lower levels of literacy.Methods: electronic databases were searched from 1946 to May 2012. Randomised controlled trials with primary interventions designed specifically for individuals with musculoskeletal conditions and lower levels of literacy were eligible for inclusion. The quality of the study was determined by assessing method of randomization, allocation concealment, creation and maintenance of comparable groups, blinding of patients and providers, control of confounding, and the validity and reliability of outcome measures.Results: of the 2440 studies located using the search strategy, six studies met the inclusion criteria. Three public health community studies and three rheumatology clinic based studies delivered educational programmes to people with musculoskeletal conditions who also had lower levels of literacy. Three moderate quality studies suggest that musculoskeletal educational interventions had a small short term effect on knowledge and two moderate quality studies suggest musculoskeletal interventions had a small effect on self-efficacy (although results on self-efficacy were conflicting in one of these studies). Only one moderate quality study showed a small effect on anxiety and one on self perceived health and wellbeing in people with lower literacy.Conclusions: high quality evidence is lacking on the effectiveness of musculoskeletal education interventions for people with lower literacy levels. Research programs that test the effectiveness of patient education interventions for arthritis must recruit and engage people with lower levels of literacy

Health literacy is the context and ‘skills necessary for an individual to use and understand health information’(Nutbeam 1998). Low health literacy is associated with increased morbidity and mortality. However, both individuals with low and adequate health literacy levels have reported difficulties understanding health information (Shaw et al. 2009). Research demonstrates that printed healthcare materials and patient-provider interaction is not always meeting the health literacy needs of individuals.This workshop will begin by describing an overview of current research in the health literacy area. This will also include the presenter’s own work exploring health literacy in the context of falls prevention (Brooks et al. 2012). Methods of determining the level of literacy required to read information will be described, and participants will be invited to evaluate, in pairs, examples of printed service user healthcare materials. Feedback will be shared with the group, and the implications of lower health literacy for communication in practice will be discussed. Participants will also be asked to take part in a role play activity, focussing on verbal communication strategies to enhance service users’ understanding. Finally, best practice guidance will be shared with workshop participants. Occupational therapists are in an excellent position to meet the communication and information needs, and enhance the health literacy skills of service users. This workshop will improve communication and practice delivery; particularly with older people. The content and format of this workshop have been developed in collaboration with an older carer of a regular health service user.