My name is Carolyn Hunter and I am British Doctor currently working in a non-clinical role in George Regional Hospital in Western Cape, South Africa. I am here as part of a six month fellowship aiming to improve health services through quality improvement and service development.

My main focus has been on patient information and educational resources particularly the written resources given to patients in the clinical scenario to improve understanding and retention of clinical information.

It has been difficult to improve the sharing of written information resources as on the whole, they do not exist in the format that is useful for patients i.e. the leaflets need to be

1. Easily printable in black and white on normal A4 paper rather than require colour printing in a glossy brochure format. Partially because storing the amount of patient information leaflets in hard copies in the hospital would take a lot of space and probably the work of a librarian and partially because of the cost of producing the expensive ones.

2. The patient information leaflets ought to be stored on an database that is easily accessible to patients and clinicians. Although most of the population have access to mobile phones, 70% of the population in George and the surrounding area do not have internet access. However having an internet site which can also be downloaded to a hard drive that affords leaflets to be printed by clinicians and given to patients which directs them to that particular website with credible clinical advice would be a useful resource. Particularly if the resources are firstly available in English, Afrikaans and Xhosa the main local languages and then as the resource expands the webpage could primarily be available in the three local languages but with printable .pdf files of patient information resources in the other 8 official languages of South Africa.

3. Patient information resources ought to be pitched at a literacy level appropriate for the majority of the population. Many of the resources produced by non-profit organisations and non-government organisation are available only in English and are at a literacy level higher than that of the majority of the population.

However the leaflets available are often in English, at a high level of literacy, although are available electronically, they do not print well in black and white and they contain information that is 4+ years old.

This highlighted the need for a single coherent approach to ensure the timely provision and flow of quality information that meets the needs of the local communities. There is a need for a national information and prioritization framework to provide patients accessing public health services with standardised, accurate, useful information.

However, it has been difficult to try to facilitate or advocate this on a national or even regional level.

This has resulted in George Regional Hospital developing a template for patient information resources and encouraging hospital staff to develop patient information leaflets in response to clinical information needs. This will hopefully also be taken on board by the other Regional Hospitals in the district over the next few months as it expands.

I am contacting HIFA with some questions and issues that currently need to be resolved that I am hoping the forum ought to be able to share expertise on.

Starting to develop patient information resources and delegating the production of the content of leaflets to different clinical staff within the hospital requires a framework and a prioritization of patient information needs. I was wondering if any work had been done on something like ‘Essential Information Strategy’ in a similar vein to the ‘WHO Essential Medicines Strategy. I mean this in the sense that is there are specific list of patient information resources that ought to form the basis of a wider patient information and education system i.e. is there for example a list of clinical conditions, procedures and medications that ought to cover 80% of information that patients might need to make better healthcare decision and empower them to take ownership of their health?

1. In order to develop resources that can be easily shared across different clinical sites, it is necessary for an online portal or a downloadable database. Does HIFA have guidance or providence of a specific templates or software that could be adapted and used for this?

2. In developing patient information leaflets for patients with limited literacy levels. Is there access to a comprehensive collection of pictograms to clearly demonstrate specific clinical signs, symptoms or directions that could be shared?

3. Is there guidance regarding how best to present information on written patient information leaflets including core standards for written communications with patients?

I apologise that this is rather a long email, and I apologise if it is incoherent at times. I would really appreciate any input or advice that you might have as I try to push this project forward.

Many Thanks,

Carolyn Hunter
IGH Fellow
George Hospital

Courtesy of HIFA