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W3C-validated transitional XHTML 3.11 Involving people: Making sure IP is accessible to people from disadvantaged groups in general
People from disadvantaged groups may need additional support in order that they can:
- obtain IP materials in a format that meets their needs e.g. through telephone information lines;
- ‘navigate’ IP: knowing where and to whom to go to for both the prescription and the information itself; and,
- receive information in a ‘supported’ way, i.e. have someone available to talk through their particular needs and the information provided.
In designing your IP processes, be aware that, as well as being less likely to benefit from information, people from many disadvantaged groups may not seek better information in the first place.
The pilot sites found that the following factors typically influence the choice of IP format used:
- age of the user
- reading ability and levels of ‘health literacy’
- access to the internet and email
- disabilities – hearing, visual impairment and learning
- language skills.
Involve disadvantaged users in designing IPs and the information to go in directories. Doing so will help you to identify additional support that may be needed and to work with users to see how this can be met.
Learning from the pilots
- Consider mapping local need in respect of: access to information; user profiles; and, deprivation and disadvantage.
Although the pilot sites did not use any data analysis techniques or formal needs mapping, most agreed that, with more time, more comprehensive 'mapping of local user profiles' will be essential to ensure that information is tailored properly for those facing the most severe disadvantages. Hammersmith and Fulham PCT, for example, intend to use Mosaic profiling to establish the profile of the local population and their favoured approaches to accessing information.
- Identify which of your users are likely to need more intensive support, and which are more 'self-managing'.
Recent research tells us that certain disadvantaged groups will need to be more intensively supported if they are to become active participants in their healthcare. These groups include elderly people, those from lower social grades, those with less education and those with chronic illnesses. Such groups will benefit from help that is designed to improve their capacity for self-management, such as through improving their knowledge of health issues and building their self-confidence.
- Consider the range of mechanisms for information delivery available through the organisations in your IP partnership, and the implications of these for user access.
If your organisation relies on the internet to deliver much of your information, you are likely to reach younger people and people in higher socioeconomic groups, but probably fewer from other groups. Try to build in face-to-face, telephone, DVDs, podcasts and other methods as well, to ensure that information is communicated to everyone. Don't risk widening the health inequalities gap.
- Recognise the value of face-to-face interaction
Research continues to support the view that users prefer to receive information through a face to face engagement with a care professional, and preferably a doctor, although other mechanisms are welcome. The Picker Institute, for example, found that, when asked about their preferred sources of information, 73% mentioned their doctor.
Most sites in the pilot developed processes that enable users to receive IPs through face to face contact with professionals or appropriate intermediaries (e.g Expert Patients). This was achieved through a range of engagement activity between services and users, including, for example: standard clinical consultations, outpatient visits, tests and screening sessions, annual health checks, care planning sessions, social care assessments, drop in surgeries and health visits. While a range of mechanisms were adopted in order to maximise accessibility, face-to-face interaction with service users was central to many pilots.
Case study example: Hammersmith and Fulham Council and PCT
Hammersmith and Fulham Council and PCT are pioneers of customer segmentation. They identified 12 distinct segments or groupings within their population, having created a bespoke segmentation model based on Experian's Mosaic™ lifestyle data and taking into account census data, information on service usage, and individual preferences. Using this segmentation, they found evidence that existing processes and channels for delivering the council's services were not meeting basic customer needs and preferences. A distinct and significant proportion of the borough's population (including 'Prosperous Mobile Young Professionals') – whose needs were generally restricted to 'quick' transactional services like council tax and parking – preferred to interact with the council online or by phone. Another distinct cluster of segments (e.g. 'Mixed Inner City Urban – Modest Means' and 'Deprived Families in Public Housing') had greater social care needs and wanted more face-to-face interaction. The result was enhanced service delivery on web and phone channels for services and customer groups that do not require face-to-face support, and multi-skilling staff to deal with customer queries within a single contact, as well as investing in community-based face-to-face reception points that target customers in need.
Information brokers and advocates
Many pilot sites supported the idea of creating a new cadre of support workers who would target disadvantaged users and ensure the high uptake and use of IPs. Some have brought this role into being, either by building it into an existing worker’s responsibilities or, in some cases, creating it as a result of the IP pilot. The exact nature of the work has varied but common features include:
- Providing support, advice and advocacy to users who have complex information needs or experience disadvantages
- Signposting users to appropriate information sources
- Assisting users in using web-based information sites and help-lines
- Informing local managers of IP systems about any gaps in services arising from local demands and needs.
One name suggested for these support workers was 'health navigators'.
On the next page: meeting the accessibility needs of disabled users
