Evaluation of a Longitudinal Medical School Health Literacy Curriculum.

Abstract

Background: Despite recommendations that medical schools incorporate health literacy (HL) into curricula and identification of consensus areas of HL competence, high-quality data are needed for curricular characteristics and structured evaluation that foster sustained HL competency adoption.

Objective: This study aimed to develop and evaluate a comprehensive longitudinal medical school HL curriculum using qualitative and quantitative assessments. We sought to ground this in existing theory and provide evidence for generalizable use and further theory refinement.

Methods: Across three medical student cohorts, HL was integrated into a 14-month pre-clinical professional development course. The longitudinal curriculum was informed by consensus-derived HL competencies and Bloom's Taxonomy. Student self-assessment and reflection data were linked across three timepoints and analyzed using mixed methods: an inductive approach identified key qualitative themes; exploratory factor analysis (EFA) identified prevalent factors within self-assessments; and analysis of variance identified differences across timepoints.

Key results: Three qualitative themes emerged from student reflections: emotions associated with a backward reading exercise; shifts in awareness of HL as a patient challenge; and plans to continue using HL practices. Among 336 students with quantitative data across all timepoints, EFA identified three factors: foundations, shame-free environment, conveying information. Over the curriculum, students demonstrated significant (p < .05) improvements in each factor.

Conclusions: Our longitudinal HL curriculum, grounded in existing competencies and conceptual framework, elicited positive changes related to medical student HL competencies. Qualitative data demonstrating motivation and intention to continue applying HL practices were augmented by quantitative data showing increased adoption of self-reported behaviors over curricular timepoints. This study fulfills multiple features of a conceptual framework for HL curricula in health professions education, including sequenced, interactive sessions, multiple instruction modes, reflection, integration of knowledge and skill education, and varied assessment methods. Our findings can be used by investigators, institutions, and professional accreditation organizations to broadly enhance HL education.