The Maryland Office of Minority Health and Health Disparities received a three-year partnership grant that included development of the Primer among its objectives. In February 2011, a formal partnership to develop the Primer was established between the Maryland Department of Health and Mental Hygiene, MHHD, and the University of Maryland College Park, School of Public Health and its Herschel S. Horowitz Center for Health Literacy.
To help inform the co-authors’ development of the Primer, a series of four workgroups (explained below) were formed between October 2011 and September 2012 to provide external input and feedback on the development of the Primer’s framework and its content.
In fall 2012, a final draft Primer was completed to incorporate feedback obtained from June to September 2012. More than 150 reviewers (primarily educators and students) were recruited to conduct standardized evaluations of approximately 250 individual resources that were contained in draft Primer.
The first round of resource reviews was completed in December 2012. Future reviews will be ongoing as new resources are added to the Primer.
Workgroup #1: Identified the core competencies that comprise the Primer’s framework of learning objectives (October 2011)
Dr. Clifford Coleman and Dr. Desiree Lie made formal presentations at a national Workgroup session regarding the development of their respective sets of cultural competency and health literacy learning objectives. The sources used are the following:
• Coleman, Hudson, Maine, Culbert. Health Literacy Competencies for Health Professionals: Preliminary results of a
Modified Delphi Consensus Study. (Publication in preparation).
• Lie DA, Boker J, Crandall S, DeGannes CN, Elliott D, Henderson P, Kodjio C, Seng L. Revising the Tool for Assessing
Cultural Competence Training (TACCT) for curriculum evaluation: Findings derived from seven US schools and expert
consensus. Med Educ Online [serial online] 2008;13:11.
After reviewing each set of learning objectives, participants used a modified “Q Sort Methodology” (Stephenson W., 1953) to engage in a group process of matching the health literacy competencies (63 items) to the competencies presented in the revised Tool for Assessing Cultural Competency Training (42 items). Q Sort is a social science research method to study participants’ subjectivity or point of view.
Participants were assigned to cross-disciplinary groups with members having expertise in cultural competency, health literacy, health care communication, and minority health. Each group examined a subset of health literacy and cultural competency learning objectives.
Group facilitators asked the participants to sort the learning objectives as addressing one of the following three categories:
(1) Solely Cultural Competency,
(2) Solely Health Literacy, or
(3) Both Cultural Competency and Health Literacy.
Based on the results of the matching exercise and the larger group discussion, the participants were able to identify a core set of competencies that encompass both cultural competency and health literacy and to identify gaps, or missing learning objectives. In several instances, the workgroup participants provided suggestions for revised core competency language to more accurately reflect the integration of specific cultural competencies and health literacy competencies.
Participants: There were 31 individuals representing a balance of expertise in cultural competency, health literacy, and health care communication, as well as representatives from five State Offices of Minority Health (Arkansas, California, Indiana, Maryland, and Michigan), the National Institute of Minority Health and Health Disparities, the Agency for Healthcare Research and Quality, the Research Triangle Institute, and Adventist HealthCare, Inc. Workgroup #2: Identified the developmental learning stage for each core competency (December 2011)
Using the results of the first Workgroup’s matching exercise, the second Workgroup engaged in an exercise to link the combined core set of cultural and health literacy competencies to stage of learner (developmental sequencing)—novice, intermediate, advanced.
Participants were assigned to groups based on discipline: 1) Allied Health; 2) Dentistry, Medicine, and Pharmacy; 3) Nursing (two groups); and 4) Public Health and Social Work.
Group size and clusters were based on the number of affirmative responses to the Workgroup letter of invitation, which was sent to Maryland-based health profession schools or programs in each discipline: 15 allied health programs, 4 dental schools/programs, 21 nursing schools/programs, 3 medical schools, 3 pharmacy schools, 4 public health schools/programs, and 3 social work schools/programs.
The results of the first and second Workgroup exercises were analyzed and synthesized in early 2012 before being submitted back to both Workgroups via email for further commentary by conference call in March 2012. Based on the feedback from the two Workgroups, the framework for the Primer was refined further.
The first public draft of the Primer was released to both Workgroups in June 2012. The Workgroups submitted feedback on the draft via conference call in July 2012.
Participants: There were 30 health profession educators representing 23 different university- and community-college based health profession training programs in Maryland. Workgroup #3: Provided overall feedback and comments on the draft Primer from the perspective of how it could be used in a continuing education setting (August 2012)
Participants were assigned to groups that were each composed of the range of continuing education settings in attendance at the session. Feedback was obtained from the participants in response to the following questions:
• What is needed to make the Primer useful for you and your constituents?
• What would be the best approach(es) for encouraging use of the guide in continuing education
• What might hinder use of the Primer? How could those blocks be prevented, reduced,
• Who else should be included in the review and feedback process?
Participants: There were 21 continuing education administrators representing health occupation licensing boards, Maryland chapters of national health profession associations, and health systems organizations across Maryland.
Workgroup #4: Provided general feedback and comments about how to develop a mechanism for obtaining input from community-based consumer groups for future iterations of the Primer (September 2012)
Participants provided recommendations that will be useful for future iterations of the Primer.
Recommendations included developing a process for soliciting input from consumer groups and other stakeholders, and implementing a mechanism to validate the effectiveness of the Primer's resources in achieving the core competency learning objectives outlined in the Primer's six modules.
Participants: There were individuals from the 56-member Cultural and Linguistic Competency Workgroup of the Maryland Health Disparities Collaborative, representing community-based organizations, statewide health advocacy organizations, health systems and health plans, local health departments, and academic institutions.