Older adults constitute a growing population in the United States. A disproportionate percentage of this population experience chronic illnesses and need to recall information important to prevent complications of illness and to self-manage their condition. One example of the need to retain information is to recall the risk factors for ischemic stroke to prevent the damaging effects of stroke.Factors that could influence the recall of health information include age-related changes in cognition, specifically working memory capacity. Research supports that older adults have working memory capacity limitations. Older adults may also experience low health literacy that in combination with declines in working memory could further influence recall of health information.The purpose of this study was to describe the predictive relationships of working memory capacity and health literacy on the recall of the warning signs of stroke in a sample of older community dwelling elders.Fifty-six participants, ranging in age from 68-99 years of age (M= 80 years of age) were recruited from two sites, a Senior Center and Retirement Residence. A brochure published by the American Heart and Stroke Association, "Let's Talk About Stroke" was the tool used to deliver the health information regarding the five warning signs of stroke. Personal factors including demographic and medical variables were collected in this study. Working Memory was assessed using the Wechsler Adult Intelligence Scale III, Working Memory Index (WMI). Health literacy was determined using the Short Test of Functional Health Literacy in Adults (STOFHLA). Participants were asked to recall the health information they were asked to read regarding the five warning signs of stroke at the conclusion of the study visit.Findings indicated that the key variables working memory and health literacy were independently and positively correlated to recall (p < .01); however, regression analysis did not demonstrate an interaction between the two key variables and recall.The findings from this study explore the associations between working memory, health literacy and personal factors and support that these key predictors may be related to the older adults ability to successfully recall health information.

Class of 2012 Abstract / Specific Aims: The objective of this study is to first assess whether student pharmacist interns feel they can gauge patient health literacy levels with confidence, second to assess which methods are used most commonly in practice by student pharmacists to assess patient health literacy, and third to determine what techniques student pharmacist interns most often employ to communicate more effectively to patients with low health literacy. Methods: The questionnaire consisted of questions about demographics, and knowledge/experiential based questions. Key questions were: How well do you feel you are able to assess patient health literacy? How often do you use the following techniques to assess patient health literacy? (Observe contextual clues, Observe patient word pronunciation, Observe patient willingness to talk, Assess by demographics) When counseling low health literacy patients, how often do you use the following communication techniques? (Speak slowly, Give extra written material, Repeat information, Ask patient to repeat information, Ask if patient understands English, Avoid complicated medical terms). The answers to these questions are measured on a likert scale. Data from the questionnaire was analyzed using one sample t tests and paired t tests. Main Results: Regarding the first primary objective, on a scale of 1 to 5, with confidence measured 3 or greater and no confidence measured 2 or less, student intern pharmacists are statistically significantly confident in their ability to gauge patient health literacy (p< 0.001). There is no statistically significant difference in confidence in ability to gauge patient health literacy between males and females. The method student pharmacist interns used for assessing patient health literacy with the highest average use was observing patient willingness to talk (3.65 +/- 1.01) followed by observing patient word pronunciation (3.57 +/- 0.97), assessing patient demographics (race, age, ability to pay, culture, gender) (3.23 +/- 1.16) and observing contextual clues (patients identify pills by color, asks to be read to, etc) (3.04 +/- 1.04). There was no statistically significant difference between observing patient willingness to talk versus observing patient word pronunciation (p=0.55). There is a statistically significant difference between observing patient willingness to talk versus assessing patient demographics (p=0.011). The technique for improving communication with patients with low health literacy with the highest average use was avoiding complicated medical terms (3.97 +/- 0.95) followed by speaking slowly (3.91 +/- 0.89), repeating information (3.85 +/- 0.73), giving extra written material (3.02 +/- 1.36), asking patients if they understand English (2.85 +/- 1.21) and asking patients to repeat information. (2.39 +/- 1.02). There is a statistically significant difference between avoiding complicated medical terms and giving out extra written material (p<0.001) and speaking slowly and giving out extra written material (p<0.001). Conclusions: We conclude that students pharmacists working as interns are quite confident in their ability to assess patient health literacy, that observing patient willingness to talk is be the most commonly used method to assess patient health literacy, and that avoiding complicated medical terms is be the most commonly used technique student pharmacist interns use to communicate more effectively with patients who have low health literacy.

Low literacy remains a problem across the developed world. Health literacy has emerged as a specialist literacy, although its conceptualisation and measurement overlap with those of functional literacy. The social practice view, which conceptualises literacy as an activity rather than a skill, is useful in examining literacy-related practices and demands in healthcare contexts. Associations between low functional or health literacy and poorer health outcomes have been established in the research literature but studies have included participants whose low literacy may be obvious to healthcare providers and others. This thesis presents first a systematic review that focuses on literacy and health outcomes in the ‘hidden population’ with low literacy, defined as those of working age whose first language is that of their resident country but who score low on literacy measures. The review concludes that there is a link between low literacy and poorer health in this ‘hidden population’ but that potential pathways have not been explored to any extent. The thesis then presents a primary research study which sought to explore links between low literacy and poor health from the perspectives of people with low literacy; and how the health service might respond to address the issues raised. The findings from 25 in-depth interviews and 2 focus groups with adult learners highlighted the various ways that people with low literacy struggle with written and spoken communication in clinical encounters and in self-care activities. They further revealed that stigma frequently plays a central role in the social practices of those with low literacy, affecting their mental wellbeing and social relationships, including those with healthcare staff. The potential solutions identified for service providers would benefit from piloting and evaluation to help create a literacy-sensitive health service, which could improve engagement; enable self-care and enhance capabilities for health in those with low literacy.

Background: Health literacy has become an important public health concern. However, a limited number of studies have investigated health literacy in Jiangsu Province of China. Methods: A total of 12,450 residents aged 15-69 years in Jiangsu Province were interviewed face-by-face through multi-stage cluster random sampling. The 2009 questionnaire of health literacy designed by the Ministry of Health of China was used to measure health literacy. The subjects were divided into low grade group (the comprehensive health literacy grade <34 points) and high grade group (the comprehensive health literacy grade ≥ 34 points). Multiple logistic regression was used for the analysis. Results: The knowledge rates about science concept of health, literacy of preventing acute infectious disease, literacy of preventing non-communicable chronic disease, safety and first aid, obtaining and making use of basic medical care, and comprehensive literacy knowledge were 60.02%, 66.80%, 51.85%, 66.84%, 55.27% and 52.46%, respectively. Multiple logistic regression showed that living in rural area, more numbers of household, increased age, less education, agricultural or rural migrant occupation workers, and lower family income were all risk factors for poor status of health literacy (all p values <0.01). Conclusion: The general health literacy level of the residents in Jiangsu Province was low. At least 40% of residents in Jiangsu Province were deficient in health literacy. Health education and promotion intervention may be targeted in this high risk population to improve health literacy.

Health literacy is recognized as a contributor to health outcomes and maternal health literacy is important to the health and wellbeing of children and families. Of particular interest are mothers seeking immunization services for their children. The complexity of the recommended immunization schedule and the care management of children receiving immunizations have the potential to create negative health outcomes in the low health literate population. Assessment of maternal health literacy and provision of effective patient education adapted to the health literacy level of the individual is important for information transfer. The Teach-Back provides an opportunity to both assess understanding and reinforce teaching. This study used an experimental design to study two groups of women for a total of 90 participants in a public health department setting. The control group received the usual immunization patient education using Vaccination Information Sheets. The intervention group also received patient education in this manner plus use of the Teach-Back. Immunization knowledge was assessed prior to and after patient education. Immunization currency was assessed as well. The Newest Vital Sign was used to assess the maternal health literacy for 90 mothers bringing their children for immunizations. A demographic survey addressing both individual characteristics and social determinants of health variables was also administered. Most of the participants were low health literate (84%) and low health literacy was related to lower immunization knowledge and poor immunization currency. Social determinants of health variables were related to maternal health literacy, immunization knowledge and immunization currency. The results demonstrated an improvement of immunization knowledge scores with the use of the Teach-Back method of patient education. Additional research is needed in the area of patient education interventions specific to the low health literate population. The development of instruments to measure interactive and critical health literacy are needed and interventions to promote growth in health literacy are also needed. Clinically, improved patient education interventions for low health literate mothers has the potential to improve health outcomes and decrease health care costs of these women, their children and their families.

Health literacy is demonstrated when individuals can obtain, process, and understand basic health information and services needed to make appropriate health decisions. Veteran health literacy is believed to be lower than the general population due to the aging and culturally diverse population. Veterans require adequate health literacy to manage their diverse high acuity physical injuries, psychological conditions, and chronic diseases. Clear communication between the clinician and veteran patient is essential to provide high quality health services. The objective of this quality-improvement project was to evaluate the ability of nurses in the ambulatory environment to identify low health literacy patients and to deliver an educational intervention focused on health literacy awareness and communication strategies. A pre-intervention Clear Communications Questionnaire (CCQ), a validated instrument, was delivered to 299 ambulatory nurses with a 20% response rate. The results from this questionnaire informed the development of a 40-minute educational program, multimedia and discussion format, provided to 200 nurses. Following the education program, the post-intervention CCQ was sent to the nurses, with a 30% response rate. Survey Monkey was utilized to collect the CCQ data and Minitab for the statistical analysis, including a pre- and post-intervention data analysis with a t test. While this project was unable to show a significant difference between the pre- and post-intervention CCQ, the individual survey items indicated increased awareness about the importance of health literacy and the ability to locate patient health literacy level in the medical record. Further work needs to be undertaken to assure veteran patients can actively engage in clear communication with clinicians, discern between treatment options, adhere to treatment recommendations, and develop health-seeking behaviors across their lifespans.

Disparities in medication adherence (MA) associated with African American (AA) adults may be related to a dynamic interplay between personal factors, behavioral capability, and environmental factors. The purpose of the study was to examine this relationship in AA adults with metabolic syndrome (MetS). A cross-sectional, correlational analysis was conducted from baseline data from a larger intervention study. Constructs from the Social Cognitive Theory were used to predict MA. The sample of 91 AA adults with MetS was primarily middle-aged (age range 45-70 years old; M 53, SD 6.3), female (79%), relatively well-educated, and married. Despite being on antihypertensive medications, 53% of the participants presented with uncontrolled high blood pressure (≥130/90 mmHg). Although the vast majority (95%) of the sample displayed adequate health literacy (HL), 30% of the sample was non-adherent to their medication regimen. A positive significant relationship was found between age and MA [χ2 (1, n = 90) = 6.71, p = .01)]. Stress [χ2 (1, n = 90) = 6.28, p = .012)] and social support (SS) [χ2 (1, n = 90) = 4.10, p = .04)] were the only significant relationships among environmental factors, barriers and hypertension MA. Highly stressed AA adults were significantly more likely to be non-adherent or had a 15% reduction in the odds of hypertension MA. Similarly, adults with a low income were 5.8 times more likely to be non-adherent (OR 5.828, 95% CI, 1.014-33.493, p= .0482), while those with low SS had a 9% reduction in the odds of MA; SS trended toward significance (OR.914. 95% CI .823-1.016, p =.09). With increasing age, AA adults were more likely to be non-adherent (OR 1.12, 95% CI 1.028-1.220, p =.0096). Most of the participants reported a high degree of autonomy, satisfaction with their health care climate, and the availability of SS. Although increasing age, adequate SS, high stress, and adequate HL appeared to influence MA in AA adults with MetS, the research questions were only partially answered. Further investigation of the relationships and potential mediating pathways between personal characteristics, environmental factors, behavioral capability and hypertension MA in AA adults with MetS is needed.

Health educators are expected to serve as resource of health knowledge and being e-health literate enable health educators to perform that function. However, the e-health literacy level of health education undergraduate students is rarely explored. A systematic literature review was conducted in order to investigate the e-health literacy levels of undergraduate students. The Research Readiness Self-Assessment-health (RRSA-h) was used to measure the ability of health education majors to find and evaluate electronic health information and a Q-study was conducted to investigate student characteristics that distinguish between those with high, middle, and low levels of e-health literacy. A convenience sample of 77 health education majors completed the RRSA-h. A MANOVA revealed that e-health literacy levels differed among classification level [F(4,140) = 2.597, p = .039]. Thirteen health education majors participated in the Q-study. An exploratory factor analysis revealed three types of e-health literate students exist among the majors. The literature revealed that college students have limited ability to find and evaluate electronic health information. The RRSA-h indicated that lower-level college students have less ability to find and evaluate e-health information than upper level students. The Q-study suggested that three types of health education majors exist and could be differentiated by their scores on the RRSA-h. The results of the study have implications for the development of instructional techniques to improve the e-health levels of health education majors. Specifically, the RRSA-h can be used to measure e-health literacy levels among health education majors and learning opportunities can be tailored to improve their e-health literacy levels.

This article reports on consumer interactions with and impressions of self-administered online genetic testing results through a direct-to-consumer (DTC) genetic testing service, 23 and Me. Participants in this study point out a clear need for greater education about genetic testing services, increased considerations of health literacy barriers in results communication, and point to larger marketing, advertising, and public health industry implications as they relate to DTC genetic testing. / text

Aims: This study addressed the challenge of evaluating and improving patient education material as well as recall of information from a tinnitus counselling session. The first aim was to examine the readability and suitability of two tinnitus patient education brochures provided by an audiology clinic to new tinnitus patients. If the readability of the brochures were higher than international recommendations for reading grade level (RGL), then an attempt to rewrite a brochure to a suitable RGL would be made. The second aim was to investigate a) the amount of information tinnitus patients can successfully recall directly following their initial appointment, b) the amount of information that is retained one to two weeks following their appointment, c) whether the amount of information recalled is related to patient variables, and d) the themes that arose from interviews with the patients. Method: To address study aim 1, readability analyses were completed for two patient tinnitus brochures provided to new patients at a private hearing aid clinic using several readability formulas. If found to have a readability level over 5th grade level one brochure would be rewritten to an acceptable readability level while attempting to maintain the initial level of content. The suitability of the brochures was assessed by two experts in the area of health literacy using the Suitability Assessment of Material (SAM). To address study aim 2, eight participants consulting for tinnitus services were prospectively identified by a clinical audiologist at a private hearing aid clinic. Immediately following the initial tinnitus counselling session, participants took part in a digitally-recorded seven-item open-ended interview and provided demographic and audiological information. One to two weeks later, a second interview using the same questions was conducted. Results: After analyzing the readability of the brochures it was evident that both exceeded the recommended RGL on the Flesch-Kincaid (F-K), Fry, Fog, and Simple Measure of Gobbledygook (SMOG). The experts rated Brochure 1 as “unsuitable” for patient education and Brochure 2 as “adequate” for patient education using the SAM. Brochure 1 was revised and was within the internationally recommended RGL as measured by the F-K, Fry, and Fog, whilst keeping the content similar to the original. Overall, participants correctly recalled only a small amount of information in the immediate (36.8%) and one to two weeks later (33.7%). There was no significance difference in amount of correctly recalled information between appointments, and none of the correlations performed for recall and participant variables were statistically significant. Effect sizes were calculated and no trend was found for audiometric variables, although demographic variables did tend to explain more of the variance in recall in the short-term than immediately. The most notable themes identified in the interview immediately after the appointment were: Hearing aids, Understanding/Empowerment, and Masking/Music therapy. At the short-term follow up interview, Hearing aids, Cost, and Hope/Positive were commonly reported. Conclusions: As over half of New Zealanders do not have adequate health literacy skills to meet the demands of life and work (Ministry of Health, 2010) it follows that written and verbal health information should be easy understandable to allow patients to take an active role in their health care and experience the best possible health outcomes. Overall, participants only remembered modest amounts, only one brochure was adequate for patient education, and the RGL of both brochures were higher than recommended. There is a great need for more studies examining suitability, readability, and patient recall not only in tinnitus, but in all areas of healthcare.