Barriers, enablers and patient design ideas for health literacy responsive hospital outpatient rehabilitation waiting areas: a framework analysis

Ms Cassie McDonald1,2, A/Prof Louisa Remedios1, Ms Kate Cameron1,3, A/Prof Catherine Said1,4,5, A/Prof Catherine Granger1,2

1The University Of Melbourne, Carlton, Australia, 2The Royal Melbourne Hospital, Parkville, Australia, 3Murdoch Children’s Research Institute, Parkville, Australia, 4Western Health, St Albans, Australia, 5Australian Institute of Musculoskeletal Sciences, St Albans, Australia

Background: Health services which offer health information, resources and supports that are responsive to the health literacy needs of consumers can contribute to improved health knowledge, health behaviours and outcomes.

Aim: 1) To investigate the barriers and enablers experienced by patients to accessing and engaging with health information, resources and supports in hospital outpatient rehabilitation waiting areas when attending appointments; 2) To describe patients’ ideas for the design of effective health information and a health literacy responsive waiting area.

Design: Qualitative study using framework analysis method

Method: Multi-centre study set in the waiting areas of hospital outpatient rehabilitation services. Semi-structured in-person interviews with 33 adult patients attending hospital outpatient allied health rehabilitation appointments for any health condition. Data were analysed using the seven stages of framework analysis.

Results: Six themes were identified which explained barriers and enablers from the perspective of patients. The barriers were: accessibility issues; personal factors – physical condition, emotional state and preferences; and poorly presented and outdated resources. The enablers were: design suits patient needs and preferences; usable in available time or portable; and compatible environment for engaging and sharing. Patients shared design ideas which fit within four typologies.

Conclusion: A range of barriers and enablers exist which impact on patients’ ability to engage with available health information, resources and supports in outpatient waiting areas. These barriers and enablers should be considered when designing and offering health information in waiting areas to ensure that it is accessible and useful to patients.


Cassie McDonald is a full time PhD candidate at the University of Melbourne studying the health literacy responsiveness of hospital environments. She is scheduled to complete her PhD in December 2021. Ms McDonald works clinically as a physiotherapist at The Royal Melbourne Hospital in outpatient rehabilitation. She also holds positions as a Research Assistant and Teaching Support/Educator in the Department of Physiotherapy at The University of Melbourne. She has volunteered as an APA Educators Group committee member in Victoria for 4.5 years.

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