Patients with limited health literacy often fail to understand verbal and written discharge instructions, and they frequently return to the emergency department (ED) for care. Patients returning to the ED and 30-day readmission rate are core quality performance measures. The purpose of this project was to decrease repeat visits and readmissions to the ED by implementing components of health literacy programs within the ED on patient education and written discharge instructions. Change implementation consisted of (a) use of teach back method (b) modifying medical terminology to language that patient could understand (c) limiting use of words with more than three syllables and (d) discouraging nursing practice of copying and pasting other completed clinician notes in discharge notes. Following the tenets of the logic model and Watson's caring theory, ED nurses (n=45) at a veteran's healthcare facility participated in the modification of the ED discharge note design. A retrospective quantitative design was used to obtain data from 5,474 records related to each patient's language preference, educational level, and the readability index of the discharge note pre-and post-modification of the note. The comparative analysis of the descriptive statistics before and after modification of the discharge note indicated a decrease of 1.75% in the readability index of the discharge note, a 24% decrease in return visits within 30 days and a 40% decrease in readmission rate within 30 days. Healthcare costs and health disparities associated with health literacy decrease if patients comprehend discharge instructions. Understanding verbal and written discharge instructions correlates with healthy communities. Health literacy policies and technological innovation can promote health literacy and research on health literacy.

Hypertension is a major public health issue in the United States that affects approximately 70 million adults; the high blood pressure of nearly half is considered to be uncontrolled. Uncontrolled hypertension is especially true in the incarcerated population. Due to low health literacy on hypertension in the inmate population, there are recurrent hospital visits, an increase in the admission rate and an increased length of stay in hospitals, all of which may lead to an increase in the cost of healthcare. The purpose of this scholarly project was to develop an expertly reviewed, evidence-based, self-paced, computerized, educational module to promote health literacy on hypertension for inmates within a correctional institution. The module was developed using guidelines offered by the American Heart Association and the 8th National Joint Commission. The readability of the module was at a 5th grade level. The educational module was disseminated to 10 content experts in the field of cardiology and family practice, who work in the correctional institution health service department. The expert evaluated the educational module using a Likert-scale evaluation. An open- and close-ended questionnaire was use to evaluate the module's efficacy and its ability to promote health literacy on hypertension for inmates. Data from the questionnaire were coded according to the experts' response. The data revealed a median of 4.5 out of 5 for all categories which demonstrate the appropriateness of the educational module for inmates. The implications for social change was that inmates could improve their health outcomes by improving their health literacy on hypertension, with the potential to lower healthcare costs.

This capstone project is a training program development and evaluation project. The purpose of the project was to develop, pilot, and evaluate an evidence-based health literacy training program for occupational therapy professionals. Occupational therapy strives to be a science-driven profession, which provides client-centered care. Health literacy is a client-centered factor for which occupational therapy professionals require additional training to best serve their clients in all settings and across the lifespan. A review of health literacy literature was used in this project to develop the training program and offers a science-driven approach to this client-centered factor for occupational therapists to better serve their clients and their families. This program development project included pilot presentations of the training program at two locations, followed by the collection of feedback from the participants. The feedback was used to conduct a training program evaluation, which offered a platform for enhancements for future versions of the training program. The final objective of the project is to offer a program improvement plan and subsequently publish the evidence-based health literacy training program to make it available to all practicing occupational therapy professionals.

Background: Prelicensure nursing programs prepare generalists with essential knowledge, skills, and attitudes to practice in complex health care environments. Nurse educators determine which teaching strategies will best prepare the nurse generalist. Purpose: The purpose of this study was to determine the effectiveness of a teaching plan that combined the strategies of pretest/posttest, classroom activities, and a problem-based learning activity: a clinical immersion experience. The skill of "teach-back" was taught and evaluated. Theoretical framework: Two theories guided the teaching plan for this research. Adult learning theory (Knowles, 1975, 1980, 2012) addressed how and why adults learn, and social cognitive theory (Bandura, 1977, 1986) described teaching strategies that assisted the adult learner to gain knowledge. Methods: A non-experimental design divided consenting participants were into intervention (n = 21) and control groups (n = 11). The Health Literacy Knowledge and Experience Survey (Cormier, 2006) was used to pretest/posttest for attainment of knowledge related to teach-back. The Communication Assessment Tool (Makoul, Krupat, & Chang, 2007) was used by standardized patients to evaluate the participants' ability to perform a teach-back. Results: The results of this study provided evidence that posttest scores improved for both intervention and control groups (n = 32). Twenty-seven participants performed a teach-back with evaluation. The results did not indicate a significant difference between groups in performing the skill of teach-back. Conclusion: There was little difference in posttest scores for groups and participants' ability to perform a teach-back, indicating that both groups gained knowledge and skill from the teaching strategies.

Librarians at the East Tennessee State University (ETSU) Quillen College of Medicine Library have provided consumer health outreach services to rural and underserved populations at Remote Area Medical (RAM) clinics since 2009. These outreach services heavily depend upon and promote consumer health websites and National Library of Medicine (NLM) resources in order to reach the largest number of people at the lowest possible cost. This article will provide a brief overview of RAM clinics in Wise, VA, and Gray, TN, served by ETSU librarians for years. Additionally, this article will discuss the evolution of ETSU QCoM librarian outreach initiatives relating to these clinics over the past decade. This article includes a list of online consumer health resources used to support these initiatives as well as a list of most commonly addressed consumer health topics.

East Tennessee State University Quillen College of Medicine Library (ETSUQCOML) developed a training program to enable public libraries, public health workers, and rural hospital staff to be consumer health information providers. Four NN/LM-developed classes were taught to public libraries. Regional public library directors were invaluable in obtaining the concurrence of their boards for release time for class attendance. Classes were also developed for the public health workforce and rural hospital staff. Five-hundred thirty-three students attended the classes. Fifty-two public library workers will receive the MLA's Consumer Health Information Specialist certification. Thirty-one public libraries have joined NN/LM. All ordered MedlinePlus marketing materials for their libraries from InformationRx.org.

The following thesis will set out to argue that misinformation, disinformation, and conspiracies, in tandem with today’s advanced communication technology, pose a dire threat to the future of public health, biotechnological advancement, safe medical procedures, and ethical evidence-based legislation and policy. Each chapter will explore different points in public health and medicine that misinformation, disinformation, and conspiracies have already begun to shift or disrupt in ways that are eroding safe and effective care. Misinformation, disinformation, and conspiracy theories should be seen more broadly outside of the spheres of Big Tech and First Amendment discourse, and instead understood as a public health concern of which there are ways to inoculate, treat, and mitigate public spread. Much as we have come to understand that gun violence requires more than a judicial approach, so too must we come to understand misinformation, disinformation, and conspiracy theories as an indicator of failing health in a population. / Urban Bioethics

The University of Ottawa (UO) has been dealing with a mental health crisis. The purpose of this study was to evaluate UO students’ knowledge, awareness, and use of mental health services (MHS) and to address limited research on knowledge of on-campus MHS. A cross-sectional online, bilingual, survey was administered to 235 UO students over 18 years old and registered at the university since Fall 2019. Data analysis included descriptive data, categorical analysis, and inductive thematic analysis. Awareness and use of services varied depending on the services in question. 48.9% of students only heard about the services but could not explain them. 57.4% would use a service if in distress and those who would not mainly point to Use of other methods and Lack of information as their reasons. This study contributes to the ongoing efforts of improving UO community’s mental wellbeing.

Bakgrund: Att leva med hjärtsvikt innebär att leva med en allvarlig kronisk sjukdom, vilket ställer höga krav på patienten. Konsekvensen av låg följsamhet kan bli att symptomen förvärras vilket i sin tur leder till sjukhusvistelse. För att förbättra följsamheten hos dessa patienter behöver alternativa strategier lyftas fram. Som bakgrund till detta tar studien upp hjärtsvikt och dess behandling, hälsolitteracitet som begrepp och användningsområde, låg följsamhet och låg hälsolitteracitet samt sjuksköterskans omvårdnadsperspektiv. Syfte: Syftet med litteraturstudien var att undersöka upplevda orsaker till låg följsamhet hos patienter med hjärtsvikt. Metod: Studien genomfördes som en litteraturstudie med kvalitativ ansats, inriktad på patienter med hjärtsvikt och deras perspektiv. Databassökning genomfördes med blocksökningar i CINAHL och PubMed. 12 artiklar granskades med en granskningsmall för kvalitativa artiklar, utformad av SBU. En enkel form av innehållsanalys enligt Forsberg och Wengström, användes vid analysförfarandet. Resultat: Patienter upplevde sig ha svårt att förstå sin sjukdom, de kände att stort ansvar lades på dem, saknade stöd, fick bristfällig information och upplevde otydlig kommunikation med hälso- och sjukvården. De hade även svårt att ändra vanor och upplevde sig gå miste om sociala situationer till följd av känslan av den begränsning som rekommendationerna medförde. Detta ledde i sin tur till låg följsamhet. Resultatet presenterades i fyra teman: att inte förstå sin sjukdom, upplevelse av bristande stöd, upplevelse av bristande kommunikation och information och upplevelse av bristande välbefinnande. Slutsats: Resultatet visade på de svårigheter som patienter upplever i att leva med hjärtsvikt. De fyra teman diskuterades utifrån hälsolitteracitet, sjuksköterskans omvårdnadsperspektiv och personcentrerad vård. Studien lyfte fram patienters perspektiv av orsaker till låg följsamhet men även hur sjuksköterskan skulle kunna påverka patienter till ökad följsamhet. Ett personcentrerat perspektiv och kunskap om hälsolitteracitet lyfts fram som alternativa sätt att nå patienter med låg följsamhet. / Background: To live with heart failure means living with a severe cronic disease, this requires a lot of the patients. The consequence of low compliance can result in worsened symptoms which leads to hospitalization. To improve patients’ compliance alternative strategies needs to be highlighted. The background in this study contains four parts: heart failure and its treatment, health literacy as a concept and its usability, low compliance and low health literacy, and a nursing perspective. Aim: The aim was to explore perceived reasons for low compliance in patients with heart failure. Method: The study was conducted as a literature review with a qualitative approach, with a focus on patients with a heart failure and their perspective. The database search was performed with searches in CINAHL and PubMed. 12 articles were reviewed with a template by SBU. A simple form of content analysis was used for analysing the articles. Result: Patients experienced that it was difficult to understand their disease, they felt a large responsibility were imposed on them, they experienced a lack of support, inadequate information and experienced inexplicit communication with the health care. Patients also experienced difficulty changing habits and to miss out on social occasions because of the limitations the recommendations imposed. All this led to low compliance. The results were presented in four themes: to not understand one’s disease, experience of a lack of support, experience of inadequate communication and information, and experience of insufficient wellbeing. Conclusion: The results show the difficulties that patients experience when living with heart failure. The four themes were discussed from a health literacy perspective, a nursing perspective and patient-centered care. The study highlights the patient perspective on reasons for low compliance but also how the nurse can influence patients to increase their compliance. Health literacy and patient-centered care are discussed as alternative ways to reach patients with low compliance.

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