Critical appraisal training to expand health literacy and reduce health disparities

Background: Today, there is an increased focus on the role of health literacy in reducing health disparities. Groups at most risk for poor health may also have the least access to tools to help them evaluate evidence. The ability to critically appraise evidence for credibility and quality, and to analyze relative risks and benefits is important for healthcare decisionmaking. It is also crucial for effective communication with others, including policy makers. Methods: We implement and evaluate workshops for diverse, issue-based groups of consumers and others who work on their behalf: consumer advocates, journalists and healthcare providers. We use a strategy of problem-based learning: attendees suggest topics on tobacco, pharmaceuticals and other issues as a basis for choosing papers that we then critically appraise small group sessions. The project is informed by ongoing quantitative and qualitative evaluations. Results: Confidence in critical appraisal skills increases by about 30%. Responses to knowledge questions are less interpretable. Participants report that they will use critical appraisal skills to identify valid sources of information, evaluate treatment options, recognize financial conflicts of interest, effectively communicate health information, and critique drug and tobacco advertising. Results will inform the development of a web-based course on critical appraisal of tobacco industry-funded research. Conclusion: The workshops help participants develop “good taste in evidence.” Over the long term, this project will help us determine whether critical appraisal training might be a useful tool for decreasing health disparities by reducing barriers to the use of evidence by and on behalf of underserved groups.