Professor Richard Osborne and Dr Alison Beauchamp, Deakin University

Ophelia Masterclass

8 & 9 October 2015, Letham and Glasgow University

During 8th and 9th October staff from the Ophelia project, part of the School of Health and Social Development at Deakin University, Australia provided a masterclass to a range of staff from across Scotland. The first session took place in Letham with members of the community and health practitioners followed by a session for health literacy stakeholders in Scotland. The purpose of these sessions were to support participants in understanding health literacy informed approaches to co-production working with vulnerable community members through to policymakers.

It was intended that by the end of the session participants will have made advancement towards being able to:

Describe the strengths and weaknesses of various patient engagement processes
Describe the various approaches to public health intervention development and the benefits of including co-production approaches
Detail the ways in which health literacy determines patient-centred care
Describe a range of intervention development approaches that contribute to generating fit-for-purpose and implementable interventions.

The Ophelia project stands for OPtimisingHEalthLIteracy to improve health and equity and the day covered the various stages and tools required to implement an Ophelia programme with a chosen community. The project makes use of the stages of intervention development recommended by

Needs assessment (of patients and of system) – if you get this stage wrong, everything else will be wrong
From the needs assessment create a matrix of immediate programme objectives
From the target users select interventions, methodologies and practical strategies and suggestions
Co-designing and planning the intervention
Prioritisation, adoption and sustainability
Monitoring and evaluation

The learning was delivered by a good mix of presentations, activities and group discussion to support delegates in understanding the principles of Ophelia and how it works practically. The first sessions looked at innovation and the group worked at their tables to explore what makes innovation work/not work. The point of the session was to emphasise that the point of Ophelia is to ensure things are in place so that innovation can happen. The importance of the first stage of intervention mapping (the needs assessment) was then discussed and the importance of how questions are asked and how they are interpreted.

Aims and objectives of an Ophelia project

“The overarching aim of an Ophelia project is to improve health outcomes and reduce health inequalities for people”. The group worked on examples of a project focus, scope and aims to help them define ideas for each of these and make distinctions between them.

The Health Literacy Questionnaire (HLQ)

The session then moved on to explore the Health Literacy Questionnaire (HLQ), a key tool used in the Ophelia process. The HLQ is a tool administered for any Ophelia project which looks at various measures relating to health literacy. These questions fall under the following nine dimensions:

Feeling understood and supported by healthcare providers
Having sufficient information to manage my health
Actively managing my health
Social support for health
Appraisal of health information
Ability to actively engage with healthcare providers
Navigating the healthcare system
Ability to find good health information
Understand health information well enough to know what to do

The Health Literacy Questionnaire (HLQ) uses nine domains of questions which are themed into different quality assured measures of health literacy. If you are interested in running an Ophelia project you will need some training in carrying out the questionnaire, a short training video is available along with scripts to support administration. With regards to the scales in the questionnaire, you don’t have to use all the scales but for the ones you do choose you must ask all the questions contained within it. The cost of running Ophelia is $250 per project (this relates to the cost of a licence for the HLQ), the technique has been validated if used correctly in line with the nine identified health literacy ‘dimensions’. A toolkit for Ophelia will be available January/February 2016 on their website. A FAQ is available regarding the administration of the HLQ, as is a You Tube video and the project team recommend that 70-100 people from the group you are most interested in is a good number to gather data from.

Developing Vignettes

This stage of the process takes place after the HLQ data has been gathered and analysed, it is likely that those involved in the project will need to develop skills around this stage of the programme also. These vignettes create examples of the type of people that are represented in the responses to help make them ‘real’ for people taking part in the project. The vignettes that are developed are then validated at workshops when you ask delegates if they can relate to the examples. The Ophelia toolkit provides information and examples for designing vignettes.

Solutions workshop

Once the data has been analysed and vignettes created the project team will host solution workshops. You need to consider what part of the service they relate to, are they service users or providers. During the solutions workshop(s) you should prioritise the issues identified from the Ophelia process, look at how they fit together and identify solutions i.e. what can be done to improve things for the patients/target group. At this point in the day the group took part in an activity to practice the tips for running a solutions workshop making use of the vignettes and identifying an intervention idea.

Selecting your intervention

It is recommended that logic models are used to align the solutions with aims, this is useful as logic models are already widely used and recognised as a tool across health and social care in Scotland. The Ophelia team recommend that you align your intervention ideas with intervention objectives and identify the different ‘levels’ that the intervention will work at i.e. individual level, practitioner level, organisation level. From here the group looked at the development of logic models and outcomes, at this point evaluation was discussed and consideration given to examples of outcome evaluation measures.

The day closed with discussion around Ophelia principles and a summary discussion of what had been covered.

Author: Lindsey Murphy