Effectiveness of a health literacy training curriculum for providers and staff at rural oncology clinics: Results from the rural oncology literacy enhancement study (ROLES)

Limited health literacy (HL) results in medication mismanagement, inadequate utilization of healthcare services, and worse health outcomes. Rural cancer patients tend to have lower levels of HL than their counterparts in more urban areas. The ROLES developed and evaluated a pilot intervention to reduce HL barriers among rural cancer patients. The intervention included a HL curriculum for providers and staff in two rural hospitals. Four modules covered these domains of HL: 1) understanding health literacy and implications for patient care; 2) ensuring patient understanding; 3) communicating numbers to enhance decision-making, and 4) applying HL principles to joint agenda setting and written communication. Health literacy experts tailored and conducted trainings to meet the HL needs identified in the ROLES formative assessment. Participants (N=115) included physicians (14%), nurses (64%), and other medical staff (21%). Knowledge of HL barriers, HL skills, and self-efficacy engaging in HL-friendly practices were evaluated before and after each module with self-administered surveys. Pre and post composite scores were calculated for each module, with higher scores indicating greater HL skills. Paired t-tests were performed to measure change. Pre and post scores ranged from 13-52 and 29-63 (Cronbach's alpha = .62-.86), respectively, across the four modules. Improvements in all four mean composite scores were statistically significant (p<0.005). Participants reported being ‘Satisfied' (31%) or ‘Very satisfied' (66%) with the curriculum. This pilot curriculum increased HL knowledge, skills, and self-efficacy among providers and staff. Future evaluation activities will examine the impact of this training on cancer care.