The Hannover Patient University: Advanced Mini-Med School concept and evaluation results

Abstract

Objective:

To determine whether Hannover Medical School’s Patient University, which was developed as the first university-based health education institution in Germany, offers a valuable means of conveying health-related knowledge, competencies and the ability to reflect on health information to its participants.

Design:

Participatory health education formats included interactive lectures, learning stations and practical training with tutors.

Setting:

The Patient University was conducted at the facilities of Hannover Medical School, a major German maximum-care hospital and research institution.

Methods:

To evaluate the programme, data were prospectively collected from participants from 2007 to 2009 using standardised and anonymous questionnaires. One questionnaire included information on sociodemographic data, such as health status, age, gender and post code. A second questionnaire evaluated levels of participant satisfaction, new knowledge and skills gained and understanding of the information provided.

Results:

Approximately 1,935 participants enrolled in at least one of 60 events from 2007 to 2009. The response rate from the questionnaire collecting sociodemographic data was 61.4%. A total of 35.2% of participants responded to the event evaluation. After matching both questionnaires, 1,188 person-specific data sets were available for analysis. Most respondents were women (74.7%), and the median age was 62 years (range: 16–88 years). Satisfaction with the events was rated very positive (average 1.7 on a scale of 1 = excellent to 6 = poor). Nearly two-thirds of the participants acquired new health-related knowledge and were highly satisfied with the quality of the information received. Participants who self-rated their health status as ‘poor’ tended to be more critical of what they had received than those in good health.

Conclusion:

We consider the approach a viable health education advance, and future Mini-Med School programmes may benefit from its methodological and evaluative insights. The development of target group-specific information should be the focus of prospective initiatives and related research.

Keywords

Germany health competence health education programme health literacy Mini-Med School

Introduction

Patients and the public are often challenged when seeking healthcare services, including but not limited to finding good quality information, understanding and assessing therapeutic risks and benefits, and knowledge about their rights. The World Health Organization assumes that even a well-educated public has difficulties accomplishing such tasks, given the complexity of Western healthcare systems (Kickbusch et al., 2013).

Health literacy (HL) should contribute to a person’s ability to address the demands mentioned above. HL uses an individual’s cognitive abilities and social skills to access, understand and use health-related information to sustain and improve health. This process includes the individual’s ability and self-reliance to manage health issues in daily life, make informed health decisions, communicate health concerns and thus optimally participate in healthcare systems (Dierks et al., 2012; Feufel et al., 2011; Nutbeam, 2000b; Parker et al., 2003; Ratzan, 2001). Various definitions of HL currently exist (Chinn, 2011; Sørensen et al., 2012). HL includes three main levels: functional, interactive and critical (Nutbeam, 2000a). The ‘functional’ level describes the basic skills of reading, writing, comprehension and dealing with numbers. The ‘interactive’ level refers to the advanced cognitive abilities and social skills that enable people to take an active role in their health care. This level enables individuals to obtain information and engage in dialogue with professionals about their health and health care. The third level (the ‘critical’ level) addresses the skills necessary to critically evaluate information concerning health and disease. It is also important to understand the likelihood of treatment success and thus numerical probabilities (‘health numeracy’) (Donner-Banzhoff et al., 2011; Nutbeam, 2000a).

Previous research has associated weak HL skills with riskier behaviour, poorer health, less self-management and more hospitalisation and costs (Kickbusch and Hartung, 2014). Recent assessments in Germany indicated that 46.3% of the surveyed population have limited (35.3%) or insufficient (11%) HL (Sørensen et al., 2015). Given this background, activities and programmes are required to provide people with adequate skills. Here, the methodological challenge may lie in the fact that HL cannot easily be improved using one-dimensional approaches because these approaches cannot engage with its multiple (i.e. functional, interactive and critical) components. Inspired by the well-established Mini-Med Schools in the USA (e.g. at the Universities of Colorado and New Jersey (Cohen, 2003; Lindenthal and DeLisa, 2012)), Hannover Medical School (HMS) initiated a Patient University (PU) programme (www.patienten-universitaet.de) in Germany in 2007. The PU programme set a precedent for university-based HL initiatives in Germany and Europe.

Building on existing initiatives, the PU focuses on interactive education, practical training and empowerment instead of more traditional ‘top-down’ activities, such as the written or oral presentation of information (Dierks et al., 2007). Its mission is to provide the general public with self-management skills in health and health care, such as communication skills to interact with healthcare professionals, rather than solely and passively educating them about certain aspects of disease.

Because the PU is affiliated with a university hospital (HMS), it provides an extensive quality-oriented, evidence-based health information resource and benefits from established expertise in research, medical treatment and education networks. Approximately 200 healthcare professionals from 37 HMS departments and many outside institutions were involved. These professionals included physicians, dietary advisers, medical technical assistants, nurses and medical school students. Health advisory services, government agencies, pro bono and self-help organisations and the police provide further complementary support.

The objective of this paper is to present the results of an evaluation of all PU events between 2007 and 2009 to determine the acceptance and usefulness of this new approach to improving health-related knowledge, competencies and reflection. Clarifying acceptance is an important first step because the outlined approach is applied for the first time, and insights are needed to determine its follow-up. Methodological insights and large-scale participant evaluation may help future PU organisers build upon the findings to set up or advance their own initiatives and to address respective research questions.

Methods

Participants

All interested individuals were eligible to attend PU events. No explicit inclusion or exclusion criteria were applied, and participants were accepted until a maximum number of 350 participants per one event was reached. Advertisements in local newspapers and flyers encouraged the participation of the general public. The mandatory fee for the complete lecture series was collected prior to admission. The regular fee was €95 for 10 lectures; low-income participants paid a reduced rate of 50%. However, the major costs of teaching, professionals and lecture halls needed to conduct the PU were covered by sponsorship from HMS. The revenues gained from participant fees (for which no explicit cost calculation was made beforehand) were spent on teaching materials and advertising and the marketing of the programme.

Programme content and structure

From 2007 to 2009, the PU provided a total of 12 event series (one series lasted approximately 11 weeks), including 59 individual evening events throughout the year, each lasting 2.5 hours. Events took place in a major lecture hall of the university and in extra space provided for individual ‘learning stations’ (LSs; see Table 1).

Table 1.

Themes of the first three series entitled ‘Health Education for Everyone’.

2007	2008	2009
The cardiovascular system and blood-pressure	The central and the peripheral nervous system	Natural teeth and dentures over a lifetime
The digestive and excretory system	The eye – sense of vision	The digestive system and digestive juices
The kidney – detoxification and regulation	The ear – sense of hearing and balance	The aging male from a urological perspective
The lung – ‘How do respiratory problems develop?’	The nose – sense of smell	Spring 2009: Human genetics Fall 2009: Citizens as patients: self-reliant, informed and competent?
The heart – ‘What drives the body?’	The skin – protective barrier	The human body – plastic reconstruction and function
Diagnostic methods in primary care	The hormone system – regulatory body	Radiology: an image says more than 1000 words
The brain and nervous system – ‘How do humans think and feel?’	The female hormones	The female sex organs
Psyche and pain	Pain and pain perception	Psyche and diseases
The musculoskeletal system – ‘Why can humans walk?’	Sport and movement	Vasculature – lymph vessels, arteries, and veins
Medication – effects and side effects	The immune system – the bodyguard	Naturopathic methods and complementary medicine

The first series was held in 2007. The main subject was Health Education for Everyone. The series focused on the Human Organ System and explained important organ systems with two integrated cross-sectional subjects (Table 2).

Table 2.

Learning stations in event entitled ‘The lung – How do respiratory problems develop?’

Learning station	Description
Microscopy	Lung tissue under the microscope
Macroscopy – structure of the lung and respiratory tract	Structure of the upper respiratory tract, lung and diaphragm Dissection of a pig’s lung
Physiology	Function of the upper respiratory tract and lung How does normal and abnormal breathing sound?
Models	Model of the lung and torso; wall chart
A look into the body I	Bronchoscopy Imaging procedures Breathing under stress (bicycle ergometry)
A look into the body II	Movie: ‘Structure and Function of the Lung’ – approximately 25 minutes
Medications	How do I use asthma spray sensibly?
Common diseases and their treatment	Snoring – Does breathing stop? Chronic obstructive lung disease (COLD) How do I breathe properly? Breathing therapy – autogenous drainage
Experiments	The ambulatory spirometer
Prevention	Tobacco use: disease prevention, smoking cessation, smoking and lung cancer
Empowerment	How do I check out books from the Hannover Medical School library? Self-help groups for COPD and asthma First aid for foreign bodies in the trachea and oesophagus and insect bites in the oral cavity
Meet the expert	Participant dialogue with a healthcare professional
Test methods	Lung volume measurement
Quiz	Quiz

COPD: chronic obstructive pulmonary disease

The event series held in 2008 covered the sense organs, the immune system and the hormone system. The series in 2009 covered additional essential body systems (e.g. the teeth and secretory organs of the digestive system) as well as psychological illness and alternative healing methods. The PU repeated the spring events in the fall of the same year due to the high demand for participation.

Each PU event was structured around a series of 10 appointments. A leading expert (usually an HMS department head) launched the event in a 45-minute opening lecture followed by a question and answer (Q&A) session. Because an important PU principle is the active involvement of participants and learning on-site, 90-minute full-immersion programmes were held at various LSs following the lecture. Participants split up into small groups distributed among the LSs to ask questions, inspect anatomical models, participate in practical presentations and meet the experts. The content of the LSs differed by event subject, but the structure of a given LS was the same every evening:

LS: learning objectives and questions addressed

Microscopy

What do specific cells look like under a microscope?

What structures do villi, crypts or muscles have?

How are bones, sinews and cartilage cells built?

Macroscopy models

Participants examine the structure of an animal organ.

Human skeleton, heart or other organs

Body structure and location of internal organs

Physiology

How do the internal organs work?

A look into the body I

Participants look into the body via diagnostic imaging (radiographs and ultrasound), deepen their understanding of complex bodily processes and learn about the function, usage and operation of medical devices such as ultrasound and dialysis machines, bicycle ergometers for exercise electrocardiogram (ECG), colonoscopes and rehabilitation sports equipment.

A look into the body II

Special videos and simulation programmes illustrate bodily functions and processes.

Test methods

Participants learn about various testing methods associated with the LS subject (e.g. stress test, blood sugar test, allergy test, blood pressure test, hand force measurement, peak flow measurement and depression test).

Experiments

Because experiments enable participants to grasp body processes more easily, the participants have the opportunity to perform different experiments (e.g. to measure the amount of blood pumped by the heart per minute and to demonstrate how blood pressure changes when it passes through narrowed vessels).

Common diseases

Common (chronic) diseases and their symptoms, causes and treatment options are explained; benefits and risks are discussed; possible prognoses are described; and information on disease progression and management is presented.

Medications

Special information on the types and effects of medications used to treat diseases in the respective body system, advice on critical publications and advice on pharmaceutical information services.

Prevention

Through practical exercises, the participants learn what they can do for their health in terms of prevention. For example, they receive nutritional advice or try relaxation and locomotor exercises.

Meet the expert

Participants provided with the opportunity to engage in conversation with healthcare professionals, get answers to their questions regarding the presentations and ask individual health-related questions.

Quiz

The quiz includes questions related to the evening’s event. This refreshes the participants’ memory and gives them the potential to discuss questions they have not understood with the tutors.

Empowerment

Provides an opportunity for learning en passant important aspects of HL, such as health system knowledge. The Empowerment LS provides information and advice on a wide range of subjects, for instance, regarding patient rights, counselling institutions and evidence-based health information.

Each single event included 15–18 LSs depending on the event-specific subjects and the number of LSs required to comprehensively address a subject. Table 3 describes the structure of a representative LS event called ‘The lung – How do respiratory problems develop?’

Table 3.

Sociodemographic characteristics of the study population.

Characteristic		N	Female	n	Male	n
Sample size
		1,188	74.7%	888	25.3%	300
Age (years)	≤35		5.0%	863	4.5%	288
	36–45		10.3%		5.2%
	46–55		17.8%		8.3%
	56–65		35.2%		36.8%
	66–75		28.0%		39.2%
	76–88		3.6%		5.9%
	Average age**		58.5		62.1
	Median age		61.0		65.0
	Age range		16–86		18–88
Education level*	High		42.1%	857	57.0%	293
	Average		46.4%		32.4%
	Low		11.4%		10.6%
German citizen			97.9%	884	99.3%	292
In a self-help group*			9.7%	873	12.5%	297
Health
Has known disease*			51.0%	858	61.2%	294
Subjective health rating	Excellent		3.6%		2.3%
	Very good		22.3%		16.1%
	Good		54.9%		60.4%
	Rather poor		17.9%		19.5%
	Poor		1.3%		1.7%
Health insurance*	SHI		70.1%	854	54.1%	290
	PHI		21.4%		37.6%
	Both		8.5%		8.3%

SHI: statutory health insurance; PHI: private health insurance.

Significant difference between women and men, calculated via chi-squared test (p < .05).

Significant difference between women and men, calculated via t-test (p < .05).

Experienced practitioners and tutors supervise the LS tutors who received advance training from experienced physicians and teachers to ensure well-developed tutoring skills. Training was included in elective subjects as part of the tutors’ regular medical studies and lasted for a total of 17 hours. During the conduct of the PU, tutors were also supervised by experienced staff.

Data collection and analysis

All PU series and events were evaluated using two partially standardised and anonymous questionnaires as follows. During the first event of each series, one instrument assessed relevant sociodemographic data, including health status, age, gender and postal code. A second instrument recorded participant satisfaction with each event via 15 multiple choice and three itemised questions. Scores ranged from 1 = excellent to 6 = poor. Age, gender and postal code were also recorded.

During 2007–2009, all data were regularly entered into an Access database (Microsoft Corporation, Redmond, WA, USA). Sociodemographic questionnaire data were matched with the event evaluation data via participant information on age, gender and post code. Educational level was defined as follows:

Low: no high school degree or general secondary school/polytechnic school;

Average: high school degree, intermediate secondary school, vocational school or A-level degree/general entrance qualification for university or technical school;

High: higher education degree or training.

The presence and types of known diseases were defined as follows. In the sociodemographic questionnaire, participants were asked in a closed question whether they had a known illness or disability at the time of participation. This divided the population into two groups (participants with or without a known disease). Those with a known disease were then asked to indicate the type of disease as a free text entry. This information was coded using the 10th Revision of the International Classification of Diseases and Related Health Problems (ICD-10) codes.

After data collection had been completed, statistical analyses were performed using SPSS Statistics 22. Bivariate analyses of levels of satisfaction, learning effects and comprehension contrasted with sociodemographic participant data were performed using chi-squared and t-tests (p < .05). The initial evaluation presented here was followed by a retrospective survey. The survey was distributed by mail to participants 6 months after participation at the 2007 event series to assess attitudes to and benefits from the programme. Its results are published elsewhere (Dierks and Seidel, 2014; Weithe, 2011).

Results

Between 2007 and 2009, 1,935 participants registered for 60 events in a total of six series, with one series including 10 events. All participants applied for the whole series and approximately 80% attended a second one in the following year.

Over the 3-year period, a total of 1,935 questionnaires on sociodemographic participant characteristics and 15,810 event evaluation questionnaires were distributed. By matching the returned questionnaires on sociodemographic data (61.4%; n = 1,188) and event evaluation (35.2%; n = 6,995), 1,188 person-specific data sets were identified and included in the present analysis (Tables 3 and 4). Participant structures of the two data sets were fundamentally similar.

Table 4.

Event evaluation – characteristics of the study population.

Characteristic		Female	Male	N
Sample size		n = 4,077	n = 1,491	5,568
		73.1%	26.9%
Age (years)	⩽35	4.4%	3.5%	5,545
	36–45	10.4%	5.7%
	46–55	18.6%	8.0%
	56–65	37.4%	37.0%
	66–75	26.3%	40.7%
	76–88	2.9%	5.1%
	Average age	58.3	62.3
	Median age	61.0	65.0
	Age range	16–85	18–84
Education level	High	39.8%	54.1%	5,520
	Average	45.9%	37.0%
	Low	14.2%	8.9%
German citizen		97.8%	99.2%	5,518
In a self-help group		13.2%	12.2%	5,494
Health
Has known disease		63.3%	67.7%	5,423
Self-reported health rating	Excellent	3.5%	2.4%	4,039
	Very good	21.5%	15.5%
	Good	53.0%	61.6%
	Rather poor	20.7%	18.2%
	Poor	1.3%	2.3%
Health insurance	SHI	71.7%	54.6%	5,333
	PHI	20.3%	38.5%
	Both	8.0%	6.9%

SHI: statutory health insurance; PHI: private health insurance.

Participant characteristics

The majority of the surveyed population was women (74.7%). In both groups (men and women), the average age was 60.3 years (range: 16–88 years), whereas adults who were aged 35 years or less made up only 4.8% of the participants. Non-German citizens accounted for 1.7% of the entire group surveyed. Participants with a high education level comprised 45.8%, those with a middle level 42.9% and those with low education level 11.3%. Of all participants surveyed, 10.4% belonged to a self-help group.

Regarding the health status of the surveyed participants, approximately half (53.5%) had a known disease. Known diseases were reported significantly more often among men than among women (61.2% vs 51.0%, p < .05). Additionally, disease sufferers were 4.7 years older than healthy subjects (61.2 years vs 56.5 years, p < .05). Among those with a known disease, most were chronic conditions (86.3%). Here, the most commonly reported types of chronic conditions were cardiovascular diseases (14.6%, n = 173) and musculoskeletal disorders (14.6%, n = 173). Regardless of the prevalence of known diseases, most participants stated that they were satisfied with their health at the time of the survey. Just over half of the respondents rated their subjective health as ‘good’ (56.4%). Approximately one in four described their health as ‘excellent’ (3.3%) or ‘very good’ (20.7%), and approximately one-fifth of the surveyed population described their subjective health as ‘rather poor’ (18.2%) to ‘poor’ (1.4%) (Table 3).

Event evaluation

Participants generally rated the events as very positive, with an average score of 1.7 on a scale from 1 (excellent) to 6 (poor). A total of 46% of participants rated the events as ‘excellent’, 44.8% as ‘good’ and 72.8% as well-structured.

Regarding participant satisfaction with the teaching and tutoring staff, 64.7% of participants appreciated the mixture of teaching methods (lectures and hands-on LSs). Women rated this aspect as positive more frequently than men (women 66.4% vs men 60%, p < .05) as did older people compared to those who were younger (≥60 years 68% vs < 60 years 59.8%, p < .05). Participants with multiple chronic diseases tended to appreciate the mixture of teaching methods somewhat more than those with fewer chronic conditions (two to three chronic diseases 68.3% vs four to six chronic diseases 72.9%).

Interaction with tutors was rated particularly positively. Most participants felt respected by the tutors (83.7%) and considered them competent (73.1%) and friendly (84.4%). Participants also stated that the explanations by tutors were comprehensible (70.1%) and thorough (70.1%).

The lectures and LS events received high ratings (41%) when they were ‘lively and vivid’. Some were critical of the ‘brisk’ pace of the language (3%) and subject-specific orientation of the lectures (2.4%). The most common criticisms were related to incomprehensible speech of some speakers, the use of unfamiliar words and technical terms and the lack of time to visit all LSs. Apart from this, the majority of explanations by the experts (65.4%) and explanatory images were rated comprehensible (62.5%).

In addition to the ratings for close-ended questions regarding the above aspects, participants provided handwritten comments in plain text passages of the evaluation questionnaire. Of all comments, 2.099 were positive, and 1.700 provided critical feedback. Regarding the former, overall intelligibility (7.2%), dialogue with professionals (4.2), high practical relevance of the LS (7.2%) and LS methodology (4.2%) were mentioned most often as positive aspects (among a large range of different comments). Handwritten comments also revealed that the experts adequately adapted their technical information to the target group. Regarding critical comments, the most frequently mentioned aspect was the difficulty of turning medical jargon into plain language.

In terms of knowledge development as a result of PU participation, nearly two-thirds of the respondents reported that they acquired new knowledge that was useful for dealing with their health concerns. Likewise, satisfaction with the information received was independent of whether participants had a current disease (Figure 1). However, people in poor health were less satisfied with the acquired knowledge and its utility and rated respective aspects less positively than those in excellent health (strongly agree, satisfied with the information: 59% vs 75.3%; acquired new knowledge: 52.4% vs 80.4%; can use the knowledge to address health issues: 45.1% vs 70.4%).

Figure 1.

Knowledge acquisition, utility and satisfaction as a result of participating in the Patient University events.

Discussion

This study outlined an innovative PU model to comprehensively and interactively provide health-related knowledge, skills and reflection. We also provide the results from a large-scale evaluation of PU events, which offer an overview of levels of participant satisfaction with the programme and identify opportunities to adapt future PU methods and research accordingly.

The approach presented may encourage prospective university-based HL initiatives in Germany, which are needed because a considerable part of the German population has problematic or even insufficient HL levels (Sørensen et al., 2015). Research has associated this lack with low education, bad health state, frequent use of health care, little health-related knowledge, lack of understanding of health-related issues or physicians’ instructions and a general disinterest in health-related topics (Bachmann et al., 2007; Berkman et al., 2011; Eriksson-Backa et al., 2012; Nielsen-Bohlman, 2004; Wolf et al., 2005). Surveys and studies reveal that HL is unequally distributed among the population (Berkman et al., 2011; Bostock and Steptoe, 2012; Mensing, 2012; Nielsen-Bohlman, 2004; Pelikan et al., 2012). Only a small fraction of the public has experience with evidence-based medicine and comprehends its intricacies (Carman et al., 2010; Gaissmaier and Gigerenzer, 2011). Many individuals make either uninformed healthcare choices or defer decision-making to physicians. Only a minority of the public has an extensive knowledge of patient rights and generally makes little use of this knowledge (Horch et al., 2011). Additionally, most people have limited ability to effectively communicate with healthcare professionals and understand medical advice (Castro et al., 2007).

Future interventions to improve HL in line with the issues and dimensions outlined above need to consider three linked and important processes: understanding, communication and action. Programmes should support the process of lifelong learning and seek to develop basic HL skills. Their pedagogic underpinnings should reflect the idea that health education works at different levels of learning, including functional knowledge acquisition, self-perception, the application of normative standards and developing competencies to act (Siebert, 1990). In this sense, HL initiatives should recognise that the acquisition of cognitive, social and communicative skills is crucial for individuals not only to gain knowledge but also to reflect and evaluate on it and apply it in practice (Bloom, 1974).

The PU aimed to address these aspects through the above-described methods. Its activities were designed as constructive, self-regulated, topic-specific processes and experiences. Participants autonomously decided which and how many LSs to visit and in what order. This freedom of choice fostered their motivation to learn, with participants drawing on previous experience to apply what they learned to everyday life situations. This approach is an important condition for lifelong learning, especially in adulthood.

A retrospective survey of persons who participated in PU events in 2007 confirmed the evaluation findings presented in this study. Six months after completion of the PU programme, almost all respondents (96.9%) expressed satisfaction with the information received. Most participants (87.3%) would highly recommend the PU programme, and 79% wanted to participate in follow-up series. One in four felt better prepared for visits to the doctor, and one in five had the feeling of being better able to talk to doctors about health. Men rated the programme a bit more critically than women. Approximately half of all participants (men and women) felt that they were able to apply the acquired knowledge in everyday life (women: 63%, men: 58.2%). This confidence primarily manifested itself in conversations in their social networks or with physicians (52.6%) (Dierks and Seidel, 2014; Weithe, 2011).

The results of a 2010 semi-standardised follow-up survey of participants who attended a Mini-Med programme in Austria from 2000 to 2009 supported the hypothesis that similar health education measures increased HL (Seidel, 2010). Almost all respondents were satisfied with the quality of information received (95%, n = 420). Most respondents (86.3%) would highly recommend the Mini-Med programme, and 83.3% stated that they would participate again.

The percentage of female participants at the PU in Hannover was relatively high (74.7%). Considering the generally low participation of men (16%) in health education events at adult education centres in Germany (Hoh and Barz, 2010), male participation in the PU programme was also relatively high (23.3%). Most of the men who participated in the PU events were senior citizens and/or patients with a known disease. The PU events may relate better to the health orientation of some men and/or confirm the hypothesis that most men only start caring for their health once an illness occurs (Hoh and Barz, 2010).

The PU also reached out to young adults and adults with low levels of education. Health education for prevention should focus on specific target groups (e.g. men) in such a way that also includes and addresses low education and younger adults. The finding that participants in poor health tended to be more critical of the programme than those in good health, however, suggests the need for target group-specific information. Future research and development of mini-medical school programmes should consider this aspect.

Study limitations

Our study has a number of limitations. First, our evaluation could not determine which factors ultimately influenced the changes observed in PU participants. Answering this question would require a different study design and a series of different questions. A second potential limitation of the evaluation of the PU programme relates to the prospective survey data because a large proportion of the PU participants were older and highly educated. Thus, our evaluation may provide insights into this specific (sub)group without necessarily reflecting perspectives held by the population more generally (Bedke, 2015). Related to this limitation, follow-up surveys are often subject to ‘follow-up reluctance’ (i.e. fewer participants submit follow-up questionnaires over time, even if they are actively reminded). The high percentage of respondents involved in self-help groups confirms the fact that highly motivated participants are especially prone to provide feedback.

The evaluation rests upon insights of the participants alone and does not provide insights into the satisfaction of the various professionals involved in the PU. Evaluating the satisfaction levels of the professionals could have contributed to a better appraisal of the results of this study by contrasting them to those held by members of another group (the professionals), thereby contributing to higher validity. This potential limitation could also hold for the perceived and subjective benefits of HL expressed by the participants.

Finally, the assessed benefits in this study may differ from actual benefits (i.e. real improvements in participants’ ability to obtain, process and apply knowledge and information on health and health care). Hence, the on-going development and validation of specific survey instruments to measure effects and differences in patient self-evaluations compared to evaluations by experts require further research.

Conclusion

With respect to future HL initiatives, a key priority is to enhance access by reaching out more actively to target groups in their living environments. PU organisers have recently developed a new programme called the Mobile PU. In this programme, affiliated experts and medical students visit schools and businesses to reach out to young people and adults as well as employers and workers (Seidel et al., 2009). Experience with this mobile form of health education in Germany and at a Mini-Med School in Ireland shows that it offers a successful way of improving HL and communications skills (Shaikh et al., 2013). Another innovative approach is to establish networks of cooperation to share available knowledge and resources. For instance, when launched in 2006, the PU programme was the first of its kind in Germany. It now enjoys cooperative agreements with universities in three German cities, one partner in Switzerland (Dierks et al., 2012) and a specialist university in the Netherlands. To conclude, based on the inadequate levels of HL found in a considerable portion of the population by the European Health Literacy Survey (Pelikan et al., 2012), further similar HL initiatives seem strongly warranted to build on the approach.

Footnotes

Data protection

The authors confirm that all patient names and/or personal identifiers have been removed or disguised to protect confidentiality and anonymity.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

References

Bachmann

Gutzwiller

Puhan

. (2007) Do citizens have minimum medical knowledge? A survey. BMC Medicine 5: 14.

Bedke

(2015) Die Patientenuniversität der Medizinischen Hochschule Hannover. Eine Evaluation der Veranstaltungsreihen ‘Gesundheitsbildung für Jedermann’ aus den Jahren 2007 bis 2009-Unterschiede in der Bewertung des Angebotes vor dem Hintergrund der soziodemographischen Charakteristika und des Gesundheitszustandes mit Fokussierung auf die Krankheitslast der Teilnehmenden. Dissertationsschrift, Medizinische Hochschule Hannover, Hannover. Monography.

Berkman

Sheridan

Donahue

. (2011) Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine 155(2): 97–107.

Bloom

(1974) Taxonomie von Lernzielen im kognitiven Bereich. Weinheim: Beltz.

Bostock

Steptoe

(2012) Association between low functional health literacy and mortality in older adults: Longitudinal cohort study. British Medical Journal 344(7852): e1602.

Carman

Maurer

Yegian

. (2010) Evidence that consumers are skeptical about evidence-based health care. Health Affairs 29(7): 1400–1406.

Castro

Wilson

Wang

. (2007) Babel babble: Physicians’ use of unclarified medical jargon with patients. American Journal of Health Behaviour 31(Suppl. 1): s85–s95.

Chinn

(2011) Critical health literacy: A review and critical analysis. Social Science & Medicine 73(1): 60–67.

Cohen

(2003) How to start and conduct a Mini-Med-School. Available at: http://www.ucdenver.edu/academics/colleges/medicalschool/community/MiniMed/Pages/CreateyourownMiniMedSchool.aspx

10.

Dierks

Seidel

(2014) Gesundheitskompetenz fördern: Souveränität der Bürger und Patienten im Gesundheitswesen stärken. In: Pundt

(ed.) Patientenorientierung: Wunsch oder Wirklichkeit? Bremen: Apollon University Press, pp. 153–171.

11.

Dierks

Diel

Schwartz

(2012) Stärkung der Gesundheitskompetenz: Bildung, Information und Beratung. In: Schwartz

Walter

Siegrist

. (eds) Public Health Gesundheit und Gesundheitswesen; [mit dem Plus im Web; Zugangscode im Buch]. München: Elsevier; Urban & Fischer, pp. 379–389.

12.

Dierks

Seidel

Lingner

. (2007) Die Patientenuniversität an der Medizinischen Hochschule Hannover. Managed Care 7–8: 34–40.

13.

Donner-Banzhoff

Bastian

Coulter

. (2011) How can better evidence be delivered? Envisioning health care (2020). In: Gigerenzer

Gray

JAM

(eds) Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020. Cambridge, MA: The MIT Press, pp. 215–233.

14.

Eriksson-Backa

Niemelä

. (2012) Health information literacy in everyday life: A study of Finns aged 65–79 years. Health Informatics Journal 18(2): 83–94.

15.

Feufel

Antes

Steurer

. (2011) What is needed for better health care: Better systems, better patients or both? In: Gigerenzer

Gray

JAM

(eds) Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020. Cambridge, MA: The MIT Press, pp. 117–134.

16.

Gaissmaier

Gigerenzer

(2011) When misinformed patients try to make informed health decisions. In: Gigerenzer

Gray

JAM

(eds) Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020. Cambridge, MA: The MIT Press, pp. 29–43.

17.

Hoh

Barz

(2010) Weiterbildung und Gesundheit. In: Tippelt

Von Hippel

(eds) Handbuch Erwachsenenbildung/Weiterbildung. Wiesbaden: Springer, pp. 729–746.

18.

Horch

Ryl

Hintzpeter

. (2011) Kompetenz und Souveränität im Gesundheitswesen – Die Nutzerperspektive. GBE Kompakt 2(2): 1–7.

19.

Kickbusch

Hartung

(2014) Die Gesundheitsgesellschaft: Konzepte für eine gesundheitsförderliche Politik. Bern: Huber.

20.

Kickbusch

Pelikan

Apfel

. (2013) Health Literacy. The Solid Facts. Geneva: WHO.

21.

Lindenthal

DeLisa

(2012) Promoting appreciation of the study and practice of medicine: Inner workings of a Mini-Med program. Advances in Medical Education and Practice 3: 73–78.

22.

Mensing

(2012) HLS EU Ergebnisse für Nordrhein-Westfalen. Bielefeld: Landeszentrum Gesundheit Nordrhein-Westfalen.

23.

Nielsen-Bohlman

(2004) Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press.

24.

Nutbeam

(2000a) Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International 15(3): 259–267.

25.

Nutbeam

(2000b) Health Promotion Glossary. Geelong, VIC, Australia: School of Health Sciences, Deakin University.

26.

Parker

Ratzan

Lurie

(2003) Health literacy: A policy challenge for advancing high-quality health care. Health Affairs 22(4): 147–153.

27.

Pelikan

Rothlin

Ganahl

(2012) Comparative Report on Health Literacy in Eight EU Member States, 2012. Maastricht: Maastricht University.

28.

Ratzan

(2001) Health literacy: Communication for the public good. Health Promotion International 16(2): 207–214.

29.

Seidel

Forstreuter-Künstler

Dierks

(2009) “Gesundheitstag” - Gesundheitsbildung in der Schule. Erfahrungen einer Berufsbildenden Schule. Schulverwaltung 20(10): 273–276.

30.

Seidel

(2010) Auswertung der Abschlussbefragung der Teilnehmerinnen und Teilnehmer des MINI MED Studiums Österreich., 2010. Hannover: Medizinische Hochschule Hannover.

31.

Shaikh

Babar

Cross

(2013) Mini-Med School: Promoting awareness of medicine as a career for suburban and rural high-school students. ANZ Journal of Surgery 83(6): 481–486.

32.

Siebert

(1990) Didaktik der Gesundheitsbildung. Oldenburg: Arbeitskreis Universitaere Erwachsenenbildung.

33.

Sørensen

Pelikan

Rothlin

. (2015) Health literacy in Europe: Comparative results of the European health literacy survey (HLS-EU). European Journal of Public Health 25: 1053–1058.

34.

Sørensen

Van Den Broucke

Fullam

. (2012) Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 12(1): 80

35.

Weithe

(2011) Effekte und Nachhaltigkeit von Gesundheitsbildungsmaßnahmen am Beispiel der Patientenuniversität der Medizinischen Hochschule Hannover, Masterarbeit Medizinische Hochschule Hannover, Hannover.

36.

Wolf

Gazmararian

Baker

(2005) Health literacy and functional health status among older adults. Archives of Internal Medicine 165(17): 1946–1952.