Cervical cancer incidence in the United States has declined for the past 40 years, yet the odds of developing cervical cancer is much higher among marginalized women, particularly African American and Hispanic American women. Although preventable through vaccination against the human papillomavirus (HPV) prior to infection, uptake and completion rates of the vaccine among African American and Hispanic American women are low. The purpose of the study was to determine if a significant relationship existed between the health literacy levels of African American and Hispanic American women, ages 18-26, and the low HPV vaccination uptake. The integrated behavioral model, which identifies factors antecedent to behavioral intention, as well as the motivating variables, was the theoretical framework. Secondary data from the 2015 National Health Interview Survey were used to examine the relationships among the variables of interest. A logistic regression (n = 2093) showed that health literacy is a strong determinant of HPV vaccine behavior intention, and that there was a significant relationship between health literacy and HPV vaccine initiation. Health literacy mediated the relationships between the motivating variables and the vaccine uptake, and completely mediated the relationship between ethnicity and HPV vaccine uptake. Health literacy did not independently predict the vaccine initiation. The findings from this study might (a) provide public health practitioners with enough information to guide health promotion activities to increase the vaccination coverage to the level expected in Healthy People 2020, (b) save economic resources through cancer prevention, and (c) improve lives by curbing the excess deaths among racial minority women.

Many college students are in a developmental period in which they are transitioning from pediatric to adult health care. This time period can be challenging for all college students and especially for students with a chronic condition. The current study investigated the association between various health-related factors (health locus of control [HLOC], health literacy, health self-efficacy, and health-related quality of life [HRQOL]) and health behaviors in college students, as well as the moderating effect of having a chronic condition on those associations. These health behaviors were further operationalized as healthy lifestyle behaviors (preventative and wellness behaviors, dietary behaviors, physical activity) and risky behaviors (substance use and risky sexual behaviors). A total of 393 undergraduate students (66.1% female, 24.8% White, 26% chronic condition) completed electronic questionnaire packets. Findings suggested HLOC, health literacy, and HRQOL were significant predictors of engagement in healthy lifestyle and risky behaviors. Chronic condition status moderated a number of associations between HLOC, health literacy, health self-efficacy and both healthy lifestyle behaviors and risky behaviors. Based on these findings, researchers and practitioners should focus on improving and managing these health-related factors, especially among college students with chronic conditions, in order to help students achieve better health outcomes.

Many people in the United States have untreated dental disease due to a lack of dental insurance, a lack of oral health knowledge, and a lack of priority placed on dental health. Despite an increase in dental service use by Medicaid recipients as a result of local programs, children enrolled in Medicaid often have low rates of use of dental services. Using the health literacy framework of the Paasche-Orlow and Wolf (POW) model, the purpose of this study was to explore to the relationship between oral health literacy of parents and dental service use for children enrolled in Medicaid and the differences in use rates between preventive and restorative services. A cross-sectional research design was employed within a convenience sample of parents who presented to a nonprofit clinic for a medical appointment. Participants completed a demographic profile, an oral health questionnaire, and REALD-30 survey. Responses were correlated with dental claims retrieved from 1 reference child for each parent. Pearson's correlation revealed no significant relationship between oral health literacy and dental service utilization, r = -.056 (p = .490). An ANOVA revealed no difference in utilization between preventive and restorative services, F (2, 149) = .173, p = .841, ç2 = .002. However, high rates of use for restorative services were observed, suggesting a high prevalence of tooth decay in children. Although this study did not find a significant relationship between oral health literacy and dental utilization, barriers continue to exist that contribute to the high rates of tooth decay in children enrolled in Medicaid. This study impacted social change by highlighting the importance of preventive care in reducing the prevalence of tooth decay.

Nurses play a central role in preparing patients for discharge. Diabetes affects one-third of all hospitalized patients, with readmission rates 20% higher for patients with diabetes. Low health literacy affects patients' ability to understand education provided during a hospitalization, especially in diabetic patients who are required to perform complex self-care activities. The rehabilitation nurses within the practicum site struggled to provide adequate diabetes education, leading to patients' readmissions and frequent calls to the nursing unit post discharge. The purpose of this project was to educate nurses on an inpatient unit about survival skills and teach-back approaches to improve inpatient diabetes education. Orem's self-care nursing deficit theory guided the project. Nursing literature provided current evidence-based practice guidelines on diabetes education for the staff education program. An expert panel was used to evaluate the effectiveness of the project in improving rehabilitation nurses' knowledge, skills, and ability to administer patient education to diabetic patients using the teach-back method. All 6 expert panel members agreed that the in-service content was relevant to the environment and would improve the nurses' ability to deliver diabetic education on the rehabilitation unit using the teach-back method. Current knowledge of diabetes education practices and strategies to overcome low health literacy can bring positive social change and improve nursing practice by advancing the nurses' ability to provide inpatient diabetes education.

Low health literacy (LHL)--when patients do not understand their treatment or medications--has been linked to poor healthcare outcomes. Nurses need to know how to assess health literacy (HL) and teach pediatric patients and their families to help ensure that patients and family members can understand and follow health education messages. Evidence-based HL tools were obtained from a literature search and used to create a nursing staff education program on pediatric patient HL assessment and education. The project answered the practice-focused question that asked whether a staff education program on HL assessment and management would improve nursing knowledge of HL for pediatric patients and families. Piaget's theory was used to guide the development of the education program on age-specific literacy needs; Kotter's theory of change was used to inform the plan for using HL assessment, which was presented to 34 participants in the local practice setting. Participants were randomly chosen from local professionals in nursing education and participation was voluntary. A panel of 3 experts, including a nurse expert on HL, reviewed and approved the education program, quiz questions, and participant survey. Pretest results (N = 32) showed a mean score of 6.53, and the posttest mean score was 7.66. Results of the paired t test showed significant improvement (t = -4.378, p = .000) in participant knowledge of HL after the education program. The project findings can promote positive social change through improvement in nurses' knowledge about HL and health outcomes for pediatric patients.

Adult residents in rural communities have a higher incidence of chronic diseases. This fact coupled with low health literacy and a lack of primary and specialty care services makes the management of diseases such as diabetes difficult. The purpose of this doctoral project was to develop a diabetic health literacy program for staff of a rural federally qualified health care center (FQHC) that is the largest primary care center within a 5-county area in a rural mid-Atlantic region of the United States. Most residents have difficulty understanding diabetic information as it is presented to them, which leads to an increase in nonadherence to treatment plans, decreased health stature, increased comorbidities, and an increase in utilization of emergency room and acute care resources. A prior study of 140 randomized adult diabetic patients was the basis for the need of this project. Designed as a staff development in-service to educate nursing and the care provider team, this program integrated health literacy and therapeutic communication techniques into diabetic care. Using the health literate care model universal precautions approach, the project began as a pilot at one of the FQHC's clinical sites by assessing all patients for health literacy using the Newest Vital Sign screening tool. Staff were instructed on the validity of using health literate therapeutic communications as a bridge to adherence to diabetic treatment regimens. The project has potential to improve the overall health and promote positive social change in the rural community.

Low health literacy is a problem the U.S. faces and, like health care itself, is a complex issue stemming from patient demographics and the healthcare providers being very diverse. Tools have been developed to mitigate the risks of low health literacy, however, without formal policy. The purpose of this qualitative case study was to explore and compare commonalities in health literacy best practices of organizations that are recognized as leaders in health literacy and are addressing low health literacy in their communities. By comparing the organizations' abilities to implement standards of plain language and health literacy tools/guidelines, best practice and policy recommendations could be made to various organizations regardless of level (local, state, federal, or nonprofit). The theoretical framework was based on the Evans and Stoddart framework of determinants of health and the health behavioral theories. The conceptual framework was based on health literacy best practices and policy. The research questions focused on how organizations implement health literacy tools/guidelines, the impact of health literacy best practices on policy development and addressing health literacy through formal policy. The qualitative multiple case study used open-ended interview questions via telephone conferencing, with 13 participants from health literacy organizations. The analysis was done by coding and bracketing the responses manually and with NVivo software. Results indicate that health literacy policy development and involvement exists but it is not derived from the health literacy best practices. The implications for positive social change for this study impacts the patient (individual), community, organization, and society through best practices and recommendations for policy development.

This purpose of this quality improvement project was to develop an educational training curriculum designed for staff nurses to use the teach-back method with patients with low health literacy during discharge instructions. Health literacy is associated with the ability to read, comprehend, and make appropriate healthcare decisions; the teach-back method asks patients to restate or explain health information in their own words, aiding retention and literacy. Effective staff education plays a critical role in the education of patients during discharge teaching: Nurses must help to ensure that patients and their families understand healthcare information and apply this information in their daily lives. The program was planned in an ambulatory care setting and used conceptual frameworks including the Iowa model and the Plan-Do-Study-Act cycle for quality improvement. The program was informed by evidence in the peer-reviewed literature. The curriculum was contextualized by needs of the care setting. The evidence was organized and analyzed using a review matrix to identify common findings among major studies that were applicable to the context. As an aid to operationalization of the program, an implementation plan and an evaluation plan were developed for use by the institution to move the program forward without additional planning. This project may effect positive social change by addressing a health care need that exists throughout the population and is prevalent in those of lower socioeconomic status. Increasing health literacy among patients is likely to promote improved health outcomes among those who are most vulnerable to illness.

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.