Registered nurses (RNs) have a significant role in communicating health information to patients. The problem addressed in this study was RNs roles with health literacy and communicating health information using words that the patient understands. This study found that ambulatory RN perspectives on their roles in health literacy and patient communication may improve health outcomes and optimal wellness. The purpose of this qualitative study was to examine and describe ambulatory RN perspectives on their roles in health literacy and patient communication, as these are necessary components linked to better health outcomes. The conceptual framework for this study was the nurse role effectiveness model. Fifteen RNs participated in face-to-face, structured, interviews using open-ended questions to contribute perspectives on health literacy roles and nurse-patient communication. Data analysis consisted of Miles and Huberman's methodology to code, extract, sort, review, generalize, and examine for themes. Emergent themes and key findings of this study may improve the gap in knowledge regarding ambulatory RN perspectives on health literacy roles and patient communication, as well as more awareness of the term health literacy, increased formal training on the concepts of health literacy, and techniques to formally assess patients' understanding of health information. An opportunity exists to bridge the gap between RN knowledge of health literacy roles and patient communication. Positive social change implications for health services include promoting RN health literacy roles and strategies for effective communication to promote patient behavior changes for optimal wellness.

According to the CDC, each year approximately 0.06 % of the world's population dies in infancy. The March of Dimes indicated that the leading causes of infant mortality include birth defects, preterm birth, low birth weight, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome, most of which are considered preventable with access to adequate prenatal care by mothers. The goal of this study was to examine the association between maternal health literacy levels and preterm birth. This research was based on the theoretical framework of the Interaction Model of Client Health Behavior. The hypothesis for this study was that reproductive-age women with low levels of maternal health literacy would be more likely to experience a preterm birth. In this case control study, cases were defined as women delivering before 37 weeks gestation. The REALM health literacy assessment tool was used in a sample of 169 women meeting the criteria; 56 fit the case criteria and 113 fit the control criteria. The data were analyzed in SPSS using logistic regression, with preterm birth as the dependent variable, and health literacy levels as the independent variable. When comparing mothers who delivered preterm to mothers that delivered term, there was no significance difference (p = 0.112) with respect to maternal health literacy. There was no association between low maternal health literacy levels, as assessed by the REALM instrument, and preterm birth for English-speaking women between the ages of 18 and 35 within the metropolitan Atlanta area. This study reinforces the need to reengage health practitioners to achieve a modest understanding of the principals of health literacy and the health literacy levels of their patients to assist in maternal health improvements. A focus on the development and implementation of educational competencies for clinicians on maternal health literacy would attribute to a positive social change.

Managing heart failure patients in the outpatient setting can pose a challenge for nurses and health care staff due to the need to educate patients on self-care skills and management of disease. Several factors, including health literacy and numeracy, need to be considered when developing an education program for heart failure patients to promote self-care management. The purpose of this project was to provide nursing staff with a clinical practice guideline (CPG) that incorporated health and numeracy literacy assessment into an individualized education program. The Johns Hopkins nursing evidence-based practice (EBP) model, the situation-specific theory of heart failure (HF) self-care, and Wagner's chronic care model guided the development and implementation of this project. The practice-focused question for this project asked whether evidence informs a CPG intended to assess health literacy and numeracy assessment and promote an enhanced individualized education intervention in an outpatient HF population. A literature review using 20 articles from 2006-2018 was completed. Five articles were selected to review levels of evidence, and three articles were chosen to support the development of the CPG. The CPG was reviewed, refined, and validated by an expert panel of HF nurses and physicians. The CPG might support a positive social change in the practice setting by improving the tools for nurses to assess health literacy in the HF patient population and provide individualized education to influence self-care interventions.

AUTHORS: Stella Chukwu DDS, Daniel Caplan, DDS, PhD, Michelle R. McQuistan, DDS, MS, Alice M. Horowitz, PhD, Christopher Squier PhD, Fang Qian, PhD TITLE: KNOWLEDGE OF RISK FACTORS FOR ORAL CANCER AMONG ADULT IOWANS OBJECTIVE: To gather baseline data from adult Iowans regarding their knowledge, opinions and practices about oral cancer (OC) prevention and early detection; with a focus on their knowledge of risk factors for OC. METHODS: A statewide, computer assisted random-digit dial telephone survey was conducted to gather information about OC prevention and early detection among Iowans age 18 and older. The survey contained 36 questions and lasted about ten minutes per respondent. Telephone numbers included landline and cell phone sampling lists provided by a private survey research firm. RESULTS: Of the 89 % of respondents that answered "yes" when asked if they had ever heard of OC, 54% had high OC risk factor knowledge; while of the eleven percent of those who said they had never heard of OC, 33% had high knowledge (p=0.003). Those that had an OC exam were more likely to have high OC risk factor knowledge (59%) compared with those that answered "no or don't know" to having had an OC exam (45%; p=0.002). Those that were "very or extremely" confident filling out medical forms were more likely to have high OC risk factor knowledge compared to respondents who were "not at all, slightly or moderately" confident filling out forms (54% vs. 45 %; p=0.097). CONCLUSIONS: The results suggest strongly that educational interventions are needed to increase knowledge of OC risk factors, early signs of OC, and the need to promote comprehensive OC examinations by healthcare providers. SOURCE OF FUNDING: Delta Dental of Iowa Foundation

The focus of this research was to: 1) study the perceptions of female students attending the university Student Health Center, concerning available services, 2) learn how they describe their decisions to obtain care, and 3) identify perceived barriers to reproductive health care and contraception. This exploratory study used a mixed-methods approach that included clinic public-space observations, interviews with health care providers and staff at Student Health Services (SHS), surveys distributed to clients of the campus clinic, and in-depth interviews to contextualize emergent themes. Topics addressed included sexual health behaviors and perceptions, influence of peers and partners, the propagation of health myths, and past experiences with SHS. Gathering practitioner perspectives on student barriers to care, goals of the clinic, and perceived health needs of the student community, allowed for measurement of incongruence between student and staff, thereby adding greater context to results. SHS sought recommendations in order to improve student's use of the Sexual Health and Gynecology clinic, increase accuracy of student's sexual health knowledge, and guide future clinic operations. SHS is now working with the College of Public Health to create improvement projects based on my results, including a peer education program. Research such as this can result in greater student awareness of available services, and more productive communication between patients and provide. Implications on the larger issues of gender and the search for health care, acceptance and knowledge of STI testing, and client comfort are addressed, and provide opportunity for future work in this area.

Health literacy affects caregivers' ability to engage in preventive health care behaviors for themselves and their children. Studies suggest that health literacy among low income families needs improvement, and this possibly contributes to disparities in preventive health care rates. Additionally, parents and caregivers may not be able to provide or seek preventive health care for their children because of lack of knowledge and skills to do so effectively. This study designed and piloted an intervention that delivered to parents of young children, 1) health literacy information in an experiential manner, and 2) practical skills to engage their families in healthy lifestyle choices, with the decisions for healthy lifestyle choices being based on the health knowledge provided in the intervention. Specifically, the intervention focused on diet/nutrition, physical activity, sleep hygiene, parenting skills, and mental wellness. The intervention was successful at improving diet/nutrition knowledge at least one month post-intervention and more immediate changes were found for participants' overall beliefs about diet/nutrition, children's vegetable consumption, and parents' fruits and vegetable consumption. Immediate improvements were also found for factual knowledge about physical activity, sleep, and the relationship between mental health and stress. Additionally, the intervention was successful at improving general knowledge and beliefs about sleep, knowledge about the relationship between sleep and health, and knowledge about common childhood sleep problems at least one month post-intervention. The intervention also reduced participants' bedtime interactions with children that are indicative of sleep problems at least one month post-intervention. Future research should conceptualize the intervention as a multiple health behavior intervention and reflect this in the evaluation.

Lack of patient adherence with medication results in health care costs and adverse clinical outcomes. Although fear of side effects can contribute to non-adherence, being informed about them can actually improve matters. Nonetheless, questions persist as to the most efficient way to convey that type of information to patients for a given medication. Information on side effects is largely limited to a simple list in medication leaflets, often without frequency data (that is, lacking detail as to how often they might occur). The decision-making literature suggests that the interpretation of information varies depending on the presentation format or the frame used. This study examined the impact of providing numerical information for side effect frequency, levels of illness severity, and side effect framing on the likelihood of taking an OTC medicine.<p> Participants received a headache scenario with three drug options (X, Y and Z) to consider for use. These painkillers had three levels of potency (defined as 50, 75, and 100% effective) and were accompanied with three levels of side effects (two, four, and six items). When considering their drug choice for the headaches, participants received drug information written without side effect frequency data, then again with side effect frequency data. Subjects rated their likelihood of taking Drug X, Y and Z on a scale of 1 (very unlikely) to 100 (very likely). Participants were also asked to show their likelihood of taking a different set of two medications for headaches (coined Drug N and P) based on positively-slanted or negatively-slanted wording in relation to chances of experiencing a side effect (heartburn).<p> Thirty subjects from Saskatoon over 50 years of age participated. The average age was 66.6 years and 63.3 percent of participants were female. Less than half of participants (n=11) had previous experience with side effects. Most participants were using at least one medicine (whether OTC or prescribed) and described themselves as knowledgeable or somewhat knowledgeable.<p> Participants were more likely to take the hypothetical drugs in the situations described when they received frequency data for side effects (p<0.05). Also, there was a significant higher mean likelihood of use when the drug was framed positively (p<0.01).<p> When considering decisions involving drug effectiveness and their side effects, the provision of frequency data increased patient likelihood of use. Framing the context in positive format also increased patient likelihood to use a medicine. This information could be important for pharmacists counseling on medication side effects, especially for those patients with medication adherence problems.

Introduction: The mass print media are a widely-distributed, and often primary, source of health information for the public. Health information in newspapers can amplify or attenuate readers’ perceptions of risk depending on how it is presented. This thesis examines how health information related to wind energy was communicated in Ontario newspapers and includes separate analyses for the presence of fright factors, readability, emergent themes, and emotional tone and sensationalism. As an emerging technology, public understanding of and response to associated health risks and uncertainties towards wind energy can be influenced by media coverage. Methods: Five geographically discontinuous wind energy installations in Ontario and their surrounding communities were selected based on 2006 Canadian Census data. Newspapers serving each community were identified and searched for articles from May 2007-April 2011 on the topic of health effects from wind energy developments. A total of 421 articles from 13 community and 4 national/provincial newspapers were retrieved. In Study #1, a directed content analysis was used to develop a coding instrument based on fright factors known to affect the public’s perception of risk. In Study #2, each newspaper article was analyzed for text readability using the Simple Measure of Gobbledygook (SMOG) readability formula. In Study #3, and as a qualitative component, a semi-directed content analysis was used to find emerging themes and subthemes. Finally, in Study #4, a list of loaded and positive words, informed from previous studies on sensationalism in media reporting and a random sample of newspaper articles included in this study, and the frequency of their appearance was used as a quantitative measure of sensationalism. Results: Study #1: The most commonly reported fright factors were ‘dread’, ‘poorly understood by science’, ‘involuntary exposure’, and ‘inequitable distribution’, occurring in 94% (n=394), 58% (n=242), 45% (n=188), and 42% (n=177) of articles, respectively. The fright factors of ‘dread’, ‘poorly understood by science’, ‘inequitable distribution’, and ‘inescapable exposure’ occurred more frequently in community newspaper articles than in national/provincial ones (p<0.001). Although the total number of occurrences of each fright factor increased following the Green Energy Act, only ‘dread’ (p<0.05) and ‘poorly understood by science’ (p<0.01) increased significantly. Study #2: The mean reading grade level (RGL) of 421 articles on wind turbines and health was at the post-secondary education level (X±SEM; 13.3±0.1). Articles from community and provincial newspapers were written at almost a full RGL lower (13.2±0.2 and 13.1±0.2) than those from national newspapers (13.9±0.2) (p<0.05). Additionally, opinion pieces such as editorial columns were written at a lower RGL than fact-based news articles (13.0±0.2 and 13.5±0.1, respectively; p<0.01). Study #3: The majority of newspaper articles described health effects of wind turbines in general, rather than specific, terms. The most commonly cited causes of health complaints were inadequate setbacks (27%, n=114), noise (21%, n=90), shadow flicker and vibrations (12%, n=49), and electrical exposure (6%, n=27). Other, non-health concerns such as environmental damage (28%, n=117), property values (20%, n=86), aesthetic concerns (18%, n=77), financial burden (18%, n=74), were prevalent and juxtaposed with health issues in 28% of articles (n=118). Concerns with the quality and availability of scientific evidence were frequent in the newspaper articles (34%, n=143), with many articles promoting a moratorium on wind energy developments until further research is conducted (25%, n=103). Study #4: Newspaper articles emphasized negative rather than positive/neutral tone, with community newspapers publishing a higher proportion of negative articles than provincial or national newspapers (X2=6.11, df=1, p<0.05). Conclusion: These findings suggest that the health information related to wind turbines in Ontario newspapers contains a large quantity of fright factors that may produce fear and anxiety in readers, is written at a reading grade level that is too complex for the majority of the Ontario population to fully understand, contains inconsistent information on health effects that often links health concerns with non-health concerns, and is often negative in tone. The influence of the Ontario newspaper media on reader’s risk perceptions of wind energy in Ontario will be important to determine empirically.

This study analyses warehoused data collected by Georgia State University and Centers for Disease Control and Prevention (GSU/CDC) researchers after developing an HIV testing message for urban adults with low functional health literacy. It expands previous work by examining data collected when 202 primarily African-American homeless clients of an urban community based organization (CBO) reviewed both the low literacy brochure (Wallace et. al., 2006) and a standard HIV brochure (Georgia Department of Human Resources, 1997). Participants’ health literacy was assessed using 2 measures; the Rapid Estimate of Adult Literacy in Medicine or REALM (Davis, Crouch, Long & Green) and the Test of Functional Health Literacy Assessment or TOFHLA (Nurss, Parker & Baker, 2001). HIV risk was determined using an interview questionnaire developed by the research group (Belcher, Deming, Hunter & Wallace, 2005) which allowed participants to self-report recent alcohol and drug use, sexual behavior, sexually transmitted disease (STD) history and exposure to abuse and sexual coercion. Open-ended response questions regarding readability, understanding, main message, and importance for each brochure provided the qualitative data.This analysis confirms previous work showing accessibility, readability, cultural sensitivity and user-friendly formatting are important when attempting to engage at-risk adults with varying levels of functional health literacy in an HIV testing message. The visual aspects of the brochure can be essential in capturing the reader’s attention and should be relevant to the target audience (Wallace, Deming, Hunter, Belcher & Choi, 2006). Mono-colored graphics may be perceived as dated and irrelevant or worse yet, threatening to some readers. Whenever possible culturally appropriate color photos of people depicting relevant content should replace excess text and difficult medical terms should be eliminated. Wording on the cover and within the brochure should be used to focus the reader on a single main message.This data also shows that many participants considered the quantity of information just as important. For reasons not elucidated here, many respondents equated quantity of information with message quality. Based on these results it is important to further clarify how much information is enough to maintain legitimacy and the reader’s attention while simultaneously avoiding confusing mixed messages.

The prevalence of hypertension (HTN) is high in Latinos (Latino/Latina) Americans due to social and ecological factors. Increased migration of Latino migrant/seasonal farmworkers (MSFW) to the U.S. augments the social, economic, environmental, and psychosocial factors associated with health and illness. Bronfenbrenner’s Ecological Systems Theory was used to guide this study. The purposes of this cross-sectional, correlational study were to explore Latino MSFWs’ adherence to HTN treatment (medication adherence, blood pressure [BP] self-care, and BP control) and to examine the influence of BP knowledge, perceived stress, acculturation, health literacy, and health care access (HCA) on adherence to HTN treatment. A total of 45 Latino (mean age 45 + 9) MSFWs receiving HTN treatment participated in this study. Spanish and English questionnaires were available for participants to measure adherence to HTN treatment and the five independent variables. Analysis included correlations, t-tests, hierarchical multiple regression, and hierarchical logistic regression. The majority of MSFWs were from Mexico, female (55.6%), had less than a 6th grade education. Most (82%) of the MSFWs had uncontrolled BP, and were not adherent to medications (42%), even with high BP knowledge scores (M = 6.5 ±1.3). MSFWs perceived a high level of stress (M = 16 + 6.9), low acculturation level (Anglo orientation: M = 2.9 + 0.9), and no employer-provided health insurance for personal illnesses or injuries (93%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and HCA accounted for 49% of the variance in the BP self-care; however, only higher BP knowledge was a significant predictor of better BP self-care (p < .001). Furthermore, acculturation was a significant predictor of BP control (p < .01). This study explored select determinants of adherence to HTN treatment in Latino MSFWs in a culturally informed way. Although BP self-care behaviors appeared to be a consequence of BP knowledge, this study found low medication adherence in Latino MSFWs and uncontrolled BP explained by the two predictors, acculturation and health literacy. Perceived stress and health care access did not influence the adherence to HTN treatment. MSFWs had poor BP control and HTN treatment adherence. A culturally appropriate educational program is needed to help the MSFWs adherence to HTN treatment.