Abstract

Objective: This evaluation aimed to determine the effectiveness of a whānau health literacy pilot at two District Health Boards (DHBs) in Auckland, New Zealand. The pilot had two distinct components including: (i) A whānau/fanau programme to encourage healthy lifestyles and improve health literacy, and (ii) The provider/service programme to identify service barriers to health literacy and create an action plan for change at the service level.

Methods: The evaluation design was quasi-experimental with a mixed methods approach involving a comparison (N=33) and intervention group (N=32). Participant and whānau outcomes were captured through: audit of clinical indicators, qualitative interviewing and patient survey and support scale responses. Service outcomes were measured through service indicators and the completion of the Ministry of Health, Framework for Health Literacy Review.

Results: Participant feedback demonstrates a high level of acceptability and satisfaction with navigator support. Key strengths of navigator support identified included: Enhanced patient accountability for lifestyle behavioural change, availability and accessibility of holistic support, the provision of helpful information and resources, and genuine care (manaakitanga) for bariatric patients and their whānau/fanau. A key theme in the kōrero of all evaluation participants was an emphasis on the psychological aspects of both preparing for and recovering from bariatric surgery. A second key theme was that the bariatric journey is largely self and whaanau directed. Participants from one DHB (CM Health) supported by navigators achieved surgery sooner (p=0.01), and had shorter LOS for any post-surgery readmissions (within 20 days of surgery) (p<0.0001) and fewer readmissions following their last outpatient clinic (t=4.68, p<0.0001). There were no statistically significant differences between comparison and intervention group outcomes for Waitemata DHB participants. Organisational health literacy action plans were not implemented at either DHB. Key barriers to action plan implementation included: lack of supportive systems, lack of leadership and management buy-in and support, and health literacy not being understood and therefore undervalued by some staff.

Conclusion: It is essential to prepare participants for the psychological impact of bariatric surgery and the extensive level of self and whānau/fanau-directed care that is needed. Navigator support can improve outcomes for bariatric patients.

Keywords: Health literacy; Bariatrics; Navigator; Psychological supports; Intervention; Surgery; Family inclusive care; Service improvement