Form #15 Form #15 Health Literacy Team Leader Interview - Post-implementat

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Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

ttachment R: Health Literacy Team Leader Interview

(Post-Implementation)

Demonstration of Health Literacy Universal Precautions Toolkit

Thank you for taking the time to talk with me about the health literacy work that you and your team are doing at your practice. As we talk, please keep in mind that there are no “right” or “wrong” answers to any of the questions I ask you — we are simply interested in learning about the experiences of your health literacy team and about the process of implementing the health literacy tools your practice has chosen.

This interview will take between 60 and 90 minutes. All responses will be kept confidential to the extent permitted by law. I will be recording this interview, so that I won’t miss anything you say. After our meeting today, we will transcribe the recording of our conversation. However, no names or identifying information will be included in the transcript. Can I confirm that you are okay talking with us about these topics today? (Wait for verbal consent.)

Interviewer: Check this box  to indicate that the person provided verbal consent.

I will now turn on the digital recorder as we begin the interview. Are you ready?

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I’d first like to ask you a few questions about the health literacy team at your practice. These questions have to do with Tool #1 in the Health Literacy Toolkit, “Form a Team.”

1. What was the process of forming the team like? (Probe: What makes you say that? What were the barriers to forming the team? What helped to facilitate it? Was the process easy? Difficult? Straightforward? Complicated?)

2. In your opinion, is there anyone who you think should be on the team, but isn’t? (Probe: Who? What position(s) do they hold? Why do you think they should be on the team? Why aren’t they on the team? How can this be resolved?)

3. How would you describe the dynamics among team members? (Probe: What makes you say that? Do certain people dominate? How do decisions get made?)
   More specific probes:
   Did the whole team complete the assessments?
   Did the whole team choose the aims to work on?

Did the whole team decide on the tools to work on and how to implement them?
Did you divide your team up and have certain staff work on only certain activities?

Public reporting burden for this collection of information is estimated to average 90 minutes per response, the estimated time required to participate in this interview.  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

4. How would you describe the effectiveness of the team, in terms of accomplishing the team mission? (Probe: What makes you say that? What are the barriers to team effectiveness? What helps to facilitate team effectiveness? If problematic: How can this be resolved?)

5. Did Tool #1, “Form a Team” help you launch your team? (Probe: What was helpful about the tool?)

6. Based on your work with the team and what you have learned about the Health Literacy Toolkit, do you have any thoughts about ways to revise or improve Tool #1, “Form a Team”? (Probe: Why? How could these suggestions be implemented?)

Okay, great; thank you. Now I’d like to ask you some questions about Tool #2, “Assess Your Practice.”

7. When your team members completed the Health Literacy Assessment Questions and compared their results, how easy was it to identify areas that clearly needed improvement? (Probe for details: Why do you say that? Were any of the results of the assessment a surprise?)

8. How easy was it to come to consensus within the team about what areas to address? (Probe: Why? What was the process like? Were there any surprises?)

9. How would you describe the process of choosing a tool from the Toolkit that addressed the aim that your team came up with? (Probe: How easy/difficult was it? What makes you say that? What were the barriers and challenges to choosing a tool? Was the tool you chose the one you thought you would select prior to conducting the assessment?)

10. Did you find Tool#2 “Assess Your Practice” helpful? (Probe: Would you recommend it to another practice undertaking health literacy improvement? Why/Why not?)

11. Based on your work with the team and what you have learned about the Health Literacy Toolkit, do you have any thoughts about ways to revise or improve Tool #2, “Assess Your Practice”? (Probe: Why? How could these suggestions be implemented?)

Thanks—this information is very helpful. Now I’d like to ask you some questions about the process of implementing the particular tool(s) that your team chose. [Ask each of the following questions for each tool (#4-20) implemented by the practice. Change wording as needed for specificity.]

12. Your practice decided to implement [state tool # and name], right? (Probe: Why did you decide to implement this tool? Why did you decide not to implement others?)

13. What plan did your team come up with for implementing this tool? (If so: Probe for details: Why? What was the process of deciding on a plan like? Was it difficult to decide? What processes did your practice develop as a result of implementing this tool?)

14. Did you develop a written plan for implementing these tools? (If so: Can we have a copy?)

15. What part or parts of this tool did you find to be the most useful? (Probe: Why do you say that? Can you give an example of how it was useful?)

16. What part or parts of this tool were less useful and/or more difficult to implement? (Probe: Why do you say that?) Do you have any suggestions for revision or improving these parts?

17. Did you encounter any surprises in implementing this tool? (If so, probe for details and examples: What were they?)

18. What helped with the implementation of this tool? (Probe for details. Why and how?)
    
    
    

19. What challenges did you experience in the implementation of this tool? (Probe for details. Why and how? How did you overcome those challenges?)

20. Who was involved in the implementation of this tool? Please name the people (and their positions) who engaged in tasks relevant to the implementation, and please tell me what those tasks were.

21. (For each person named): Approximately how long did it take him/her to do this work over the course of the implementation period?

22. How did the roles and responsibilities within your practice have to change in order to implement this tool? (Probe for details: Why?)

23. What strategies were used to introduce the new clinical tools and processes to the staff? Were these strategies effective? (Probe for details and examples. Why or why not? If strategies from the toolkit were not effective: what would you change?)

24. Did you need to make any changes in the way that you document patient visits as a result of implementing this tool,? (If so: Why? What changes? How did you undertake them? If they don’t mention patient charts specifically: Did you need to make any changes in the way that you document in patient charts?)

25. Did your practice’s technology and/or information systems have to change in order to implement this tool? (Probe for details. How? Why?)

26. Has the tool become a regular part of care in your practice? (Probe: Do all staff in the practice use the tool? Do they use it consistently? How do you know this? How has it become integrated into your practice?)

27. What kinds of reactions, if any, did you receive from patients when implementing this tool? (Probe for details and examples. Did they seem to think the changes were positive? Did they react at all? Did they give you any specific feedback?)

Now I have a few questions about how you tracked your progress.

28. If you have already reassessed your practice, how would you describe the reassessment process? (Probe: How easy/difficult was/is it? What makes you say that? What were/are the barriers and challenges to reassessment? Did you change anything based on your reassessment?)

29. Did you implement the Track Your Progress portion of the tool? (Probe: Why or why not? How did you implement the Track Your Progress suggestions? Which approaches outlined in the Track Your Progress portion of the tool did you implement?)

30. If yes: Did the Track Your Progress portion of the tool help you to evaluate your progress in implementing this tool? (Probe: How did or didn’t it help? How easy was it to track your progress?)

31. Did you develop other ways to track your progress? (Probe: Please describe. How easy was it to track your progress using these approaches?)

32. What changes in implementation did you make as a result of tracking your progress?

Great, thank you. That is very helpful.

33. What have you learned about implementing these changes? (Probe: What would you do differently if you were implementing this tool from scratch?) What recommendations would you make for other practices trying to make similar changes? (Probe for details and examples.)

34. What recommendations do you have for revising or improving this tool? (Probe for details and examples, including revisions to the Track Your Progress section.)

I now have some questions about the culture and leadership of your organization.

[NOTE: Ask These Questions Once Across All Tools Implemented]

35. What, if any, resistance or pushback did you get from staff members in your practice or affiliates of your practice? (Probe for details and examples: What kind of resistance or pushback? How was it expressed? From whom did you receive it? What did you do after you received it? Why?)

36. Did practice leadership support the changes you proposed as part of your plan? (If so: How did they demonstrate their support? Were there any differences between the leadership within your specific area and the leadership in the larger organization?)

37. Did leaders provide adequate time and training needed for staff to work on the implementation? (If so: How? Probe for examples. If not: What additional amount of time and type of training would have been helpful?)

38. Did your team have enough resources to adequately carry out this project? (If not, what additional resources would have been helpful?)

I also have a question about the technical assistance you received.
[NOTE: Ask These Questions Once Across All Tools Implemented]

39. How useful and sufficient was the technical assistance you received in helping your practice overcome implementation challenges? (Probe for details and examples: What assistance was particularly helpful/not helpful? What other technical assistance would have been better?)

Okay, great. I have just a few final questions before we finish.

40. Thinking about this project in its entirety, what would you say were the most positive aspects about implementing the health literacy tools? (Probe for details: Why do you say that?)

41. What were the most valuable changes you made? (Probe for details: Why do you say that? Why are/were they valuable?)

42. What were the most negative aspects about implementing the health literacy tools? (Probe for details: Why do you say that?)

43. What would you say was the most difficult thing about implementing the tools? (Probe: Why do you say that? What would have made it easier?)

44. What advice would you give another practice that wanted to work on health literacy issues using the Toolkit? (Probe for details and reasoning.)

45. Did you make any health literacy improvements that were not part of the Toolkit? (Probe: Please describe. Why did you think they were needed? Would you recommend including a tool in the Toolkit on this?)

46. Overall, would you say that trying to address health literacy in your practice has been worth the effort? (Probe for details and reasoning: Why or why not? How worthwhile was it?)

47. Do you think that the changes made as part of participation in the Health Literacy Project benefitted your patients? (Probe: If so, in what ways did your patients benefit? If not, why do you think your patients did not benefit?)

48. Do you think that the Health Literacy Project benefitted your staff? (Probe: If so, in what ways did your staff benefit? If not, why do you think your staff did not benefit?)

49. Do you plan to continue implementing the Toolkit? (Probe: If so, do you plan to continue implementing the tools you selected? Do you plan to implement additional tools?)

Thank you so much. That concludes my questions. But before we finish, the very last thing I’d like to know is whether there is anything I have missed. Is there anything else about your health literacy team’s experience that you think I should know? (If not: Thank you for your time!)

Public reporting burden for this collection of information is estimated to average 15 minutes per response, the estimated time required to participate in this survey.  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Form Approved: OMB Number 0935-XXXX Exp. Date xx/xx/20xx. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Post-Implementation Qualitative Interview with Health Literacy Team Leader -- Page 5 of 5