Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z. I also produce and host this podcast series, Health Literacy Out Loud.

For many years, I worked in a hospital as an occupational therapist, and I often led patient education groups. Of course, those groups then were in person.

Times have changed, as we all know, and a lot of teaching is now happening virtually. I was intrigued to see a posting on the health literacy discussion list about a guide to developing live virtual group patient education.

I am delighted that two of the guide’s three authors agreed to talk with me about this on Health Literacy Out Loud.

Tedi Brash and Melissa Yan both are based in Toronto, Canada. Tedi is a Patient and Family Education Specialist at Unity Health Toronto. She works with clinical teams, patients and families to create and curate quality, easy-to-understand health resources.

Tedi has a keen interest in digital education with a particular focus on content creation and program delivery in the virtual environment.

Melissa Yan is the Patient Learning and Development Coordinator at the University Health Network in Toronto. Melissa plans, tests and evaluates patient education programming and supports clinical teams and healthcare providers to develop effective patient education resources.

Welcome to you both.

Tedi Brash: Thank you for having us.

Melissa Yan: Thank you so much for having us, Helen.

Helen Osborne: All right. Live virtual group education. That’s kind of a mouthful. What does that mean? One of you, take it away. What is live virtual group education?

Tedi Brash: It is certainly a mouthful, and we knew that when we were developing it. But we really wanted to emphasize all the elements that were within it.

The “live,” we were really interested in synchronous learning. Not so much where you would tape it and use it over time, but really in that live environment and what that looks like. We wanted to get it as close to what the personal interaction would be as possible.

“Virtual” is the way everyone is going and the way that we will continue to go, so we are really talking about that online environment.

The last part about the “group patient education” was that we really wanted to emphasize when there’s more than one person in the room, when there’s more than one interaction that could be happening at a time.

That’s how the three tie together. It’s really that idea of it’s live, it’s online and you have a group of people together for a learning experience.

Helen Osborne: Thank you. Every word really matters. That’s certainly true to all our work in patient education.

What else should we know about this, Melissa? I know you bring a slightly different take to this.

Melissa Yan: Maybe we can take a step back and talk about why we thought that it would be important to create a resource like this and to focus on all these components.

Between Tedi and I, we recognized that running education sessions virtually may be a new endeavor for people, so we wanted to create a resource that would help people think about what to consider when developing a virtual education program.

We really wanted to encourage people to not only think about finding a suitable platform for the education, which was definitely a top question that both our teams were receiving, but we wanted to encourage people to take a step back and also consider how to address their audiences’ learning needs in this new learning environment, thinking about things like digital literacy skills and access to technology, knowing not everybody has access to maybe a certain device or the internet, and also how to keep people engaged in a time of Zoom fatigue.

That’s why we wanted to have this focus, so that then we can address all of these elements.

Helen Osborne: You talked about what this learning and this online group environment is, but you also made reference to this resource. That’s how I got introduced to the work you’re doing.

Those sound like two different elements: setting up and running those patient education groups, and then setting up this how-to guide for doing it.

Are those two just very different actions that came together? Or did they work together in the whole process?

Tedi Brash: Both Melissa and I come from slightly different views in terms of creating this guide. We knew that each one could complement the other one, so that’s why we partnered together.

We really wanted to address the preparation and preparing, and that’s why we created the guide, so that when you get to the physical delivery of the education, you’re ready to go.

It was a step process as opposed to an A and a B. It was really this thought about, “If you’re ready to go, then when you deliver your education programming, it’s going to be well done and you’re not going to have to think about it.”

That interaction, which is really what we wanted to emphasize, will just come naturally because you don’t have to worry about anything else.

Helen Osborne: I’ve been looking at your guide, and we’re going to have a link to that certainly on your Health Literacy Out Loud web page. It’s a very methodic step by step, “Here’s what you need to think about. Here are the components of that. Note to yourself: Here’s something extra to be doing.”

Can one of you share a little bit about an example of what might be in that guide so listeners can understand what this is all about? Where does someone start? They want to run these online patient education groups. How does your guide help them get started?

Melissa Yan: The way that we framed this guide is in nine steps, but we wanted to make sure to clarify that this is an iterative process. Going through one step to the next doesn’t mean you can’t go back to a previous step. There’s a lot of going back and forth between the nine different steps.

What users, healthcare providers or anyone who’s planning to run live virtual group patient education can expect to see in this resource are a whole bunch of different steps that relate to patient education best practices, virtual care and telemedicine best practices and even some feedback that we’ve gotten from patients based on their own experience participating in education sessions.

Some of the steps that you’ll expect to see range from everything from identifying your audience and meeting their learning needs all the way through to things like choosing your platform and how to create your content and structure so that then it meets those learning needs, all the way through to the delivery, facilitation tips and evaluation at the very end.

Helen Osborne: It’s kind of this great big recipe, but a recipe for the how-tos of doing this type of education.

What I find interesting about both of you, even though you’re both in Toronto and you know each other, is you’re working at different facilities. I’m just interested in that process of how you can create a guide, create a model for how to do these programs, but to do it from different perspectives.

Did you each bring some certain elements to that that might be different at one facility versus another?

Tedi Brash: Yes, absolutely. I have the honor and privilege of working closely in collaboration with the team at Unity Health and UHN. We really knew the complements that each of us could bring to the table, and we really wanted to bring that forth to anybody using the guide.

It was a natural process for us to collaborate because of the expertise each one of us has in a different realm.

Melissa is incredibly skilled at running big group virtual education where the audience is very diverse, whereas at my hospital, I was much more focused on groups who were running for very specific patient populations on very targeted topics.

To combine the two together just seemed like a natural fit, and it was, quite frankly, a no-brainer from our perspective to go ahead and collaborate. Why not? Why not get that holistic view of virtual education? What we were finding was that it was piecemeal, and that’s why we engaged all those different partners.

Helen Osborne: You’ve both been running these groups, or your facilities have been running these types of groups for a while now?

Melissa Yan:  Yes. I can speak on behalf of UHN and our patient education program, where we’ve been running something called a Health Talk program for almost 20 years at our hospitals. I can give you a bit of background around that.

Before the pandemic, our program had already started to evaluate and look into how we can make our Health Talk program more accessible for our online users.

Just to give some context, our Health Talk is a monthly education session that anyone is welcome to attend. At each session, we have healthcare providers from our hospital, along with community organizations at times, present on a health topic. We also have a patient or caregiver share their experience.

Before the pandemic, they were held in person but also livestreamed and recorded. We found that the online component was held on a platform that was sometimes tricky for our patients to navigate. There wasn’t as much opportunity for people to engage with the speakers remotely, so we wanted to see how we could improve this learning experience for these attendees.

Then when the pandemic hit, many of our clinics and our Health Talk program had to rapidly shift to online completely. It was really interesting that we had a range of clinics from epilepsy and stroke to red blood disorder programs reaching out to ask about a set of guidelines to help them with this shift.

But there wasn’t a single resource outlining these best practices, so through our own practice of shifting Health Talk online, along with working with these clinics and hearing their questions and concerns, we were able to put all this knowledge into this how-to resource.

Helen Osborne: Thank you. That’s really interesting that you took a program that’s been running for decades now and then worked in that gradual transition where some were streaming it or it was being filmed, taped or whatever was done, and now you move to 100% virtual.

How many people on average might attend one of those programs? You said that they’re large.

Melissa Yan: Sometimes during the livestream, we would have upwards of about 100 different people watching the talks. We shifted to a more user-friendly platform, so they’re now all on YouTube. Recently, we did an evaluation of all these sessions. We’ve run, I believe, 14 sessions, and we’ve had over 17,000 views altogether.

Helen Osborne: Oh my goodness.

Melissa Yan: It’s really cool to see. These are viewers from all around the world, too, so not just in Ontario. We’ve had people in the US watch the talks, parts of Asia, Australia, Europe. It’s really neat to see the reach because we’ve shifted to online completely.

Helen Osborne: That’s fascinating. I wasn’t expecting that. I’m thinking of my old model when I would teach stress management skills to a few patients in the hospital. You’re on a whole other scale for doing that, and YouTube on top of it.

Tedi, tell us a story. What’s it like at your facility now?

Tedi Brash: At our facility, we have, again, education programs that have been running forever. Because both of our hospitals are in larger main centers, they have a really strong focus on community.

For us, it was really about that shift from what had been heavily in-person education sessions to moving to that virtual environment.

The diabetes clinic would be a huge example where education has always been provided in person, and we didn’t want to lose that. We didn’t want to lose that personal touch and that ability to communicate with our patients and families as they go along their journey.

That was our real impetus. It was looking at clinical programs that had longstanding education. How could we roll them into the virtual environment? And not just move them over to the virtual environment, but really think about what that looked like in the virtual environment.

Helen Osborne: It’s working?

Tedi Brash: It’s working very well, yes. It’s allowing us to reach a much bigger patient population, and also, it’s giving them tools to be able to learn over time.

As opposed to in-person learning where you sit down and try to grasp concepts, this way, because we’re recording them, they’re able to view them over and over again. It’s that reinforcement of learning and the ability to revisit concepts.

It’s really embedding key principles of learning in our patients and families, as well as our clinicians to think about learning in a new way.

Helen Osborne: I’m really impressed. Thank you both for sharing your experiences there. It sounds like your reach has expanded manyfold, and it reinforces learning, too.

Podcast listeners. I want to get some tips and your good advice for them. Our podcast listeners might be clinicians. We may or may not be patient educators. Perhaps we work in public health, are part of community organizations or just care about communicating clearly. What tips and strategies have you learned that you think they might want to know?

Tedi Brash: The reason we wrote the guide the way we did was to give those individuals who don’t have access to the tools that we do. Our third author, Rashmi, is from the telemedicine team. We have digital education. We have all of these teams that we can create this holistic approach for.

The biggest tip that we can give you is that we looked at this from a holistic perspective so that you don’t have to. You don’t have to think so much about the different elements. They’re there for you.

Don’t worry if you’re not super technical, because the information is there for you to be able to follow through.

Melissa, do you want to add to that?

Melissa Yan: That was perfect, Tedi. Thank you for starting us off.

For us, I think what we realized is a lot of the people were coming to us with different experiences and familiarity with what online education and online facilitation looked like.

This guide, no matter where you are on that spectrum, is here to provide those tips, resources, ideas and even some questions that maybe you hadn’t thought about before.

We definitely echo those feelings and hear you when it comes to feeling maybe intimidated about running virtual education, but as Tedi mentioned, this guide will provide all those tips, questions and information that you would need to be able to run an effective education program online.

Tedi Brash: I think the biggest thing for anyone who’s starting out on this journey and may not have a lot of resources is to give yourself the freedom to create something new.

We heard a lot, “We’re going to take this and move it online.” But really think about you have the opportunity to do something new, innovative and dynamic, so use the guide to do that and give yourself permission to think outside the box.

Helen Osborne: Thank you. I think now might be a good time to give the URL for that guide. It’s available for free, correct?

Melissa Yan: Yes, that’s right. Anyone is welcome to contact us directly and we can email that guide to you. That’s one way of doing that. Please email pfep@uhn.ca, or you can access it through our Bit.ly link. It’s www.bit.ly/lvgpe-guide.

Helen Osborne: Thank you. For all those people who might be listening to the podcast, as I often do while I’m walking, and can’t write all this down, we will have this on your Health Literacy Out Loud web page with a link to this. Thank you for that.

We’ll also include your email information. Thank you. That’s very generous that people can contact you.

I’m just going to ask you to put on your future hats. You went from doing what you did before, the pandemic hits and now it’s like, “Yikes. Everything has to change in how we were working with our patients and doing patient education.” You created something, and I hear the excitement from both of you.

Putting on your future hat, a few years down the road, where do you see all this heading?

Melissa Yan: I can start off. I think it will grow. As Tedi mentioned earlier, I think the virtual component is here to stay. As we’ve seen, it’s made education much more accessible for people, but also our patients.

I even think with this guide specifically, we see it as a living document. The link that we had provided earlier will always have the most updated or up-to-date version or edition of this guide.

We’ve also mentioned in this guide that we would love to hear feedback, your experiences as users and how we can improve this guide and make sure it reflects the work that you’re all doing. We imagine other people are doing this work and would love to learn from you as well.

Helen Osborne: You’re really making this a dynamic, interactive group learning project, just in “How do we provide this kind of education?”

Melissa Yan: Yes.

Helen Osborne: Tedi, putting on your future hat, where do you see all this going?

Tedi Brash: To echo Melissa, I just think it’s going to get bigger and better as we learn, grow and develop best practices in the virtual environment.

It was never meant to be a replacement for clinical care. It’s a nice complement, and it just opens up a world of possibilities that we’ve never had before.

Again, just thinking about that ability to reinforce learning over time and how incredible that opportunity is. We just see it getting bigger, better and more dynamic.

I think as everybody develops comfort in this arena as well, it’s just such a lovely way to collaborate.

Helen Osborne: Thank you both. You brought up such beautiful terms of collaboration and learning over time. I think that’s what health literacy is about, too. We are all learning over time, we’re adapting to today’s needs, and through it all, we are being true to our core mission of communicating in ways that patients and the public can understand.

Thank you both for doing all you do to help us adapt to this new environment and new way of teaching, and for sharing it with us on Health Literacy Out Loud.

Tedi Brash: Thank you.

Melissa Yan: Thank you for having us, Helen.

Helen Osborne: As we just heard from Tedi Brash and Melissa Yan, virtual group patient education matters, too. It’s a whole new way of providing what we’ve always been doing to communicate about health. But learning to do things in a new way is not always easy.

For help clearly communicating your health message, please take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud podcast interviews come out the first of every month. You can get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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