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Health literacy is not only the ability to read, but also the ability of an individual to obtain, process, and understand the basic health information needed to make appropriate health decisions. Over time the concept of health literacy has evolved from considering it a risk factor to be managed to considering it an asset which can be continually built upon. With this in mind health professionals should continue to communicate in simple language, but should also provide their patients with high-quality educational materials and aid them in making the best choices about their health. One way to do this could be with the use of symptom-checking and decision-aiding smartphone apps. In this study, the primary caretakers of children aged 30 months and younger with publicly funded health insurance will be randomized to receive a pediatric symptom-checking smartphone app or a developmental milestone smartphone app. Caretaker health literacy will be measured, and data will be collected on emergency department and primary care office sick visits. It is hypothesized that the use of the pediatric symptom-checking smartphone app will decrease non-urgent visits to the pediatric emergency department. / Urban Bioethics

ABSTRACT Many older African American adults have inadequate health literacy and are more likely to have chronic illnesses needing medication therapy. African Americans continue to experience significant health disparities in the incidences of cardiovascular disease and diabetes. It was postulated that ethnic disparities in medication compliance are related to a dynamic interplay between low health literacy and health locus of control. Thirty older African Americans taking at least one prescription medication were interviewed. Although the vast majority was well-educated, only 53% displayed adequate health literacy. Most of the participants believed they controlled their health, and over half were noncompliant with their medications. Poor health literacy and health locus of control appeared to influence medication compliance in older African Americans.

ABSTRACT Many older African American adults have inadequate health literacy and are more likely to have chronic illnesses needing medication therapy. African Americans continue to experience significant health disparities in the incidences of cardiovascular disease and diabetes. It was postulated that ethnic disparities in medication compliance are related to a dynamic interplay between low health literacy and health locus of control. Thirty older African Americans taking at least one prescription medication were interviewed. Although the vast majority was well-educated, only 53% displayed adequate health literacy. Most of the participants believed they controlled their health, and over half were noncompliant with their medications. Poor health literacy and health locus of control appeared to influence medication compliance in older African Americans.

Health literacy is a social determinant of health and health disparity and low health literacy contributes to poor health outcomes in ethnic minority young adults (EMYAs). There is a gap in the literature regarding the health literacy readiness (HLR) of EMYAs transitioning to adulthood. The overarching research question concerned the perspectives of EMYAs on HLR for the transition to adulthood. A phenomenological study design was used with a theoretical framework that integrated concepts from the socioecological and health belief models. Twelve purposefully selected EMYAs ages 18-22 from a southern U.S. county participated in the study. Data were collected by telephone using semistructured interviews. The interview questions centered on EMYAs' self-assessed HLR for the transition to adulthood, attitudes and beliefs about HLR, barriers to and benefits from HLR, and facilitators of HLR for the transition to adulthood. Recorded data were transcribed and analyzed, spirally coded, and reduced into overarching themes. Three categories emerged: deficient acumen, access problems, and application challenges. Results showed that EMYAs viewed HLR as vital for the transition to adulthood, though 92% reported low HLR. EMYAs reported individual factors; available time and deficient knowledge; and social factors, family support, and deficient school education as influencing their HLR. The study findings revealed poor HLR in EMYAs but identified areas that can be targeted to improve HLR. Results may contribute to positive social change by providing health educators with knowledge they can use to enhance community health engagement strategies and develop culturally sensitive interventions aimed at improving HLR in EMYAs.

Health literacy (HL) is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Low HL has been associated with poorer self-reported health status, inability to manage chronic conditions, and less use of preventive services. More research is needed to explore the relationship between HL and sugar-sweetened beverage (SSB) intake and physical activity (PA). Although numerous HL interventions are evident in the literature, those that test HL as a moderator of effectiveness are lacking. Additionally, it has been recognized that systems-level HL efforts are necessary to lessen the burden of low HL. This dissertation addresses these needs with three unique studies that took place within the rural, medically underserved southwest Virginia region. Study 1 was a secondary analysis that examined the relationship and responsiveness of the Stanford Leisure-Time Activity Categorical Item (L-Cat) and adapted Godin Leisure-Time Exercise Questionnaire (GLTEQ) and determined if baseline HL status moderated intervention effects. There was high agreement L-Cat and adapted GLTEQ for classifying individuals as meeting PA recommendations. Baseline HL status did not moderate change in L-Cat or adapted GLTEQ measures. Study 2 was a secondary analysis that determined if 6-month change in SSB intake predicted 6-month change in body mass index (BMI), weight, and quality of life (QOL), and determined if HL moderated these relationships. The regression models for weight and QOL were not significant. The BMI model was significant. Six-month change in SSB intake, experimental condition, and age were significant predictors for the BMI model. As hypothesized, HL did not moderate relationships in any models. Study 3 details a multilevel mixed-methods needs assessment and collaboratively developed organizational HL improvement plan within the Virginia Department of Health (VDH). Staff responses revealed about half reported doing well across HL domains (written communication, oral communication, self-management and empowerment, supportive systems). However, needs were observed across all domains, with most improvement needed in written communication domain. There were significant correlations between clients' HL status and their perceptions of VDHs' HL practices, indicating potential areas of improvement within VDH. / Ph. D. / Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Low health literacy has been associated with poorer self-reported health status, inability to manage chronic conditions, and less use of preventive services. More research is needed to explore the relationship between health literacy and sugar-sweetened beverage intake and physical activity. Specifically, interventions that test the moderation of health literacy (i.e., how health literacy affects the strength of a relationship) are needed. Additionally, it has been recognized that systems-level health literacy efforts are necessary to lessen the burden of low health literacy. This dissertation addresses these needs within the rural, medically underserved southwest Virginia region. Study 1 aimed to test the utility of two physical activity measures (Stanford Leisure-Time Activity Categorical Item and adapted Godin Leisure-Time Exercise Questionnaire) with a population of varying health literacy status with hopes of coming closer to identifying pragmatic standardized assessment of and detection of clinically meaningful change in physical activity behaviors, and to determine if health literacy moderated this change. Study 2 expanded upon existing research that has determined that a decrease in sugar-sweetened beverage intake can result in a decrease in weight and body mass index (BMI), and improvement in quality of life (QOL) by aiming to determine if six-month change in SSB intake predicted six-month change in BMI, weight, and QOL and if health literacy moderated these relationships. Study 3 responds to national and state-wide initiatives by detailing the first use of the AHRQ Toolkit within a public health setting, Virginia Department of Health, to conduct a needs assessment and organizational health literacy improvement plan.

Purpose: The purpose of this study is to examine parental Functional Health Literacy and their child’s subsequent utilization of dental services. Methods: This was a prospective cohort study of children (n=1175) enrolled in the Child Health Investment Partnership of Virginia (CHIP). Descriptive statistics and separate multivariate logistic regressions were used to determine the relationship between functional health literacy measures; 1) Health Care Literacy (HCL), 2) Personal Health Literacy (PHL), and 3) LSP 22 scale, with utilization as measured as number of dental visit/s. Results: Descriptive analysis of the cohort reveals: 45% black, 40% white, 10% Hispanic, 5% other, 41% of parents not having a high school diploma or GED, >75% were enrolled in CHIP by the age of one, 90% had Medicaid, 80% lived in Roanoke City, 87% had a normal birth weight, 86% were term pregnancies, and 91% did not have asthma. All literacy measures, PHL, HCL, LSP 22, and LSP 22 Target Range were positively associated with having dental utilization. Hispanic race had a less likely chance of having multiple dental visits even when within target range of LSP 22. Conclusion: Parents of children enrolled in CHIP with higher levels of functional health literacy as measured by the Life Skills Progression Instrument demonstrated an increased likelihood of dental utilization for their children.

Ensuring that teachers have high mental health literacy (MHL) is paramount, particularly because the prevalence rate for mental illness among children and adolescents is 10-20% (Mental Health Commission of Canada, 2013). Currently, there are few programs designed to increase the MHL of teachers, and the research base examining these is scant. As a result, more research is required to find effective methods of improving MHL among teachers. The current study explored the influence of a new, interactive MHL learning module on the MHL levels of B.Ed. candidates. A questionnaire largely adapted from existing measures was developed and factor analysis was conducted. Pre- and post-module MHL scores were analyzed using descriptive approaches and a repeated-measures MANOVA. Results indicate that pre-service teachers have high knowledge and non-stigmatizing beliefs in relation to MHL which did not change post- module completion; self-efficacy levels did show a small, non-significant increase.

Many individuals with low health literacy (LHL) and limited English proficiency (LEP) have poor experiences consuming health information: they find it unengaging, unappealing, difficult to understand, and un-motivating. These negative experiences may blunt, or even sabotage, the desired effect of communicating health information: to increase engagement and ability to manage health. It is imperative to find solutions to improve poor experiences of health information, because such experiences heighten vulnerability to poor health outcomes. We aimed to address a gap in the health literacy literature by studying the patient experience of health information and how visualization might be able to help. Our four studies involved patients presented with health information in various settings to improve understanding and management of their care. We used semi-structured interviews and observations to understand patient experiences of receiving personal health information in the hospital. We learned that the return of results is desired and has the potential to promote patient engagement with care. We developed a novel method to analyze LHL, LEP caregiver experience and information needs in the community setting. The novel method increased our understanding and ability to detect differences in experiences within the same ethnic group, based on language preference. Next, we interrogated the literature for a solution to easily communicate complicated health information to disinterested, LHL, LEP individuals. We found that visualizations can help increase interest, comprehension, support faster communication, and even help broach difficult topics. Finally, our findings were used to develop a novel prototype to improve experiences of consuming genetic risk information for those having LHL and LEP. Unlike traditional approaches that focus on communicating risk numbers and probabilities, the novelty of our approach was that we focused on communicating risk as a feeling. We achieved this by leveraging vicarious learning via real patient experience materials (e.g., quotes, videos) and empathy with an emotive relational agent. We evaluated and compared the prototype to standard methods of communicating genetic risk information via a mixed methods approach that included surveys, questionnaires, interviews, observations, image analysis, and facial analysis. Main outcome variables were perceived ease of understanding, comprehension, emotional response, and motivation. We employed t-tests, ANOVAs, directed content analysis, correlation, regression, hierarchical clustering, and Chernoff faces to answer the research questions. All variables were significantly different for the prototype compared to the standard method, except for motivation as rated by 32 LHL, LEP community members. Findings revealed that LHL, LEP individuals have difficulty appropriately processing standard methods of communicating risk information, such as risk numbers supported by visual aids. Further, appealing visuals may inappropriately increase confidence in understanding of information. Visualizations affected emotions, which influenced perceived ease of understanding and motivation to take action on the information. Comprehension scores did not correlate with perceived ease of understanding, emotional response, or motivation. Findings suggest that providing access to comprehensible health information may not be enough to motivate patients to engage with their care; providing a good experience (taking into account the aesthetics and emotional response) of health information may be essential to optimize outcomes.

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