Taking a health literacy and person-centred approach to improve translated diabetes self-management education materials

Background: Little is known about health literacy of Australian-Chinese immigrants, or about the health literacy demands of translated materials. Aims: To assess the prevalence of lower health literacy among Australian-Chinese immigrants, evaluate the readability, understandability and actionability of patient education materials for this group, and develop a comprehensive tool for assessing the health literacy demands of translated information. Methods: Mixed methods study design including a cross-sectional survey of Australian-Chinese immigrants’ health literacy using the Functional, Communicative and Critical Health Literacy Scale (FCCHL), assessment of patient education materials using readability indices and the Patient Education Materials Assessment Tool (PEMAT) and multi-stage development of the Person-centered, Culturally-appropriate, Health literacy-informed Tool (POCA-HT). Results: Australian-Chinese immigrants’ health literacy scores were on average 35.3/56 (SD=8.7) with higher health literacy amongst participants with stronger English proficiency. The average reading grade of patient education materials for this group was above national recommendations (M=10.4; SD=0.9), however, they had acceptable mean scores for understandability and actionability in both English and Chinese. The newly-developed POCA-HT, comprising 47 items assessing seven dimensions, identified both strengths (e.g. ‘Information believability’) and weaknesses (e.g. ‘Translation output’) of selected materials. Discussion: Patient education materials for Australian-Chinese immigrants currently do not meet the needs of this group, particularly those with lower language proficiency and health literacy. The POCA-HT can provide a comprehensive means to review and improve the health literacy demands of translated materials given further validation