Appendix 1 Patient Engagement Tools

Patient Activation Measure (PAM) - Tool measures patient engagement by examining attributes (e.g., confidence and knowledge to take action, belief in active role)


Appendix 2 Health Literacy Tools

Implementing health literacy universal precautions is considered best practice. Health literacy universal precautions refers to using oral and written strategies as if all patients have some form of low health literacy. Various health literacy assessment tools have been developed for general and specific patient populations. 

Health Literacy Universal Precautions Tool kit - Resource containing various aspects of how to address health literacy including assessments

Health Literacy Tool Shed

Newest Vital Sign (NVS) - Assesses reading as well as numeracy skills

Rapid Estimate of Adult Literacy in Medicine (REALM) - Tests reading ability through pronunciation of health terms

Tests of Functional Health Literacy in Adults (TFHLA) - Examines reading comprehension as well as numeracy skills 

Parental Health Literacy Activities Test (PHLAT) - Assessment of health literacy skills and numeracy skills of parents of young children to determine ability to understand instructions for caring for young children.


Appendix 3 Risk Evaluation and Mitigation Strategy Assessment (REMS)

A REMS is an FDA required risk management plan that uses understandable patient education tools beyond the medication package insert. An example is a medication guide and patient package insert for patients and a communication plan focused on health care professionals.


Appendix 4 Motivational Interviewing

"Through motivational interviewing, clinicians can develop a stronger rapport with patients, better understand their concerns and goals, and address barriers to their engagement...

OARS is a frequently used framework for engaging patients through motivational interviewing. It's an acronym for four key interviewing skills: asking open questions, reinforcing responses with affirmations, practicing reflective listening, and summarizing patients' perspectives.

For example, instead of saying, "You really need to quit smoking," a clinician using the OARS framework might say, "It sounds like there are some barriers in your life that are preventing you from quitting." This shift in language creates space for the clinician and patient to talk through barriers to care and ensure the patient feels heard. By using OARS, clinicians can better empathize with the patients' perspectives and choices."


Appendix 5 Health Literacy Universal Precautions

“Health literacy universal precautions are the steps that practices take when they assume that all patients may have difficulty comprehending health information and accessing health services. Health literacy universal precautions are aimed at—

  • Simplifying communication and confirming comprehension for all patients, so that the risk of miscommunication is minimized.
  • Making the office environment and health care system easier to navigate.
  • Supporting patients' efforts to improve their health.”


Appendix 6 Oral and Written Plain Language

“Plain language (also called plain writing or plain English) is communication your audience can understand the first time they read or hear it.”


Appendix 7 CDC Clear Communication Index

“CDC’s Clear Communication Index goes beyond checklists and readability formulas by:

• Focusing on the most important research-based items that enhance clarity and aid understanding
• Providing a numerical score so that you can objectively assess and improve materials based on the best available science”


Appendix 8 Shared Decision Making

“Shared decision making is a key component of patient centered health care. It is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.”

“In many situations, there is no single “right” health care decision because choices about treatment, medical tests, and health issues come with pros and cons. Shared decision making is especially important in these types of situations:

• when there is more than one reasonable option, such as for screening or a treatment decision
• when no one option has a clear advantage
• when the possible benefits and harms of each option affect patients differently.”

“Shared decision making helps providers and patients agree on a health care plan. When patients participate in decision making and understand what they need to do, they are more likely to follow through.”


Appendix 9 Self-regulatory Learning 

Learning health information can be promoted by supporting patients’ self-regulatory learning processes (how they teach themselves). Self-regulated learning is a process where patients self-test and check responses against key concepts about a chronic disease before restudying information.


Appendix 10 Positive Affect and Self-Affirmation

Positive affect involves the patient thinking about small things which create good feelings. Positive affect should be done each morning. This may support the patient in overcoming challenges to improve health. With self-affirmation, patients think of a moment(s) when they were very proud of themselves to help them overcome health challenges.


Appendix 11 Decision Aids

“What are patient decision aids?

Patient decision aids are tools designed to help people participate in decision making about health care options. They provide information on the options and help patients clarify and communicate the personal value they associate with different features of the options.

Patient decision aids do not advise people to choose one option over another, nor are they meant to replace practitioner consultation. Instead, they prepare patients to make informed, values-based decisions with their practitioner.”


Appendix 12 EDUCATE model

The EDUCATE model is a guide for verbal patient education which leads the educator through five stages to reach teaching objectives. In addition to stages described in the EDUCATE acronym, the model focuses on adequate preparation for teaching and learning, good teaching methods, overcoming barriers to learning, teaching as an interactive process, and assessment of learning.


Appendix 13 NEED

Next Education (NEED) approach is designed to guide educators in developing patient education to meet the needs and challenges of individual patients. The NEED program has specific dialogue tools which address different learning preferences and as a result engage patients who may have not been active in the education process.


Appendix 14 Chronic Disease Self-Management Program

“The Chronic Disease Self-Management Program (CDSMP) is an effective self-management education program for people with chronic health problems. It specifically addresses arthritis, diabetes, and lung and heart disease, but teaches skills useful for managing a variety of chronic diseases. This program was developed at Stanford University. CDSMP workshops are held in community settings and meet 2-1/2 hours per week for 6 weeks. Workshops are facilitated by 2 trained leaders, 1 or both of whom are non-health professionals with a chronic disease themselves. This program covers topics such as techniques to deal with problems associated with chronic disease; appropriate exercise and use of medications; communicating effectively with family, friends, and health professionals; nutrition; and how to evaluate new treatments.”


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