Monday, October 24, 10:30
a.m.-noon
Improving Health Literacy To Improve the Health of Rural
Elders
Authors
M. Gardner1; S. Jones2; J. Peeler2.
1Western Kentucky University, Bowling Green, KY;
2Western Kentucky University, KY.
Background
In Kentucky, roughly 15 percent of the rural
population is age 65 or older. Elders in rural areas are more
likely to be poorer than their metropolitan counterparts, and
are at risk for being underinsured or uninsured. Access to care
is also limited. While rural elders are shown to have a higher
rate of chronic disease conditions, they have poorer perceptions
of their actual health status as well. The significant
dissonance that exists between rural elder's perception of their
health and their actual health status can be lessened by
improving their health literacy status. Research indicates that
health literacy is directly related to health outcomes, length
and frequency of hospitalizations, and health care expenditures.
Methods
The Health Enhancement of the Rural Elderly (HERE)
project was designed to improve the health literacy of rural
elderly living in two counties in south central Kentucky
identified as rural and poor. Educational modules were
developed, tested, and refined to address these deficiency areas
identified in a needs assessment: medications; medical
terminology; basic anatomy and physiology; orientation to
medical forms including advance directives; and communication
skills. A quasi-experimental pre-post design with an attention
control group was used to test the effectiveness of the modules
on improving variables related to functional health literary.
Results
At pretest, participants tended to take a fairly
passive role in their health care and most were embarrassed to
ask health-related questions and intimidated by the health-care
system. Many reported being confused by medical terminology,
health insurance forms, and prescription instructions. Data from
the six-month posttest revealed positive changes among
participants in the intervention group on several health-related
practices as compared to participants in the attention-control
condition.
Discussion
Improving health literacy has the potential to
empower rural elderly to become more active participants in
their health care. In doing so, there is the potential to
realize improved health outcomes.
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Raising Health Literacy Sensitivity Throughout the Healthcare
System and the Community: A Way To Maximize the Effectiveness
of Current Health Promotion and Disease Prevention Practices
Authors
K.C. Vergara1; P.E. Sokol1; J.G.
Schwartzberg1.
1American Medical Association, Chicago, IL.
Background
Low health literacy poses a challenge to disease prevention
and health promotion efforts. Health information is
distributed in complicated language, consent forms are written
at a literacy level that exceeds that of the majority of adult
Americans, and prescription instructions pose a lethal threat
if misunderstood. Limitations in the degree to which
individuals have the capacity to obtain, process, and
understand basic health information and services have been
identified as a barrier to effective diagnosis and treatment.
Practices that are insensitive to health literacy create an
environment that hinders health promotion efforts and
threatens patient safety.
Methods
In order to maximize the effectiveness of current
health promotion and disease prevention efforts and break the
dangerous continuum of confusion that may exist for patients,
the healthcare community must engage in the issue of health
literacy. To improve healthcare delivery to persons with
inadequate health literacy, the American Medical Association
designed and implemented the Health Literacy Training Program.
Objectives of this educational program were to increase
awareness amongst health care professionals and community
stakeholders of the problems of patients with low health
literacy, and to offer techniques that would improve
communication, efficiency, and patient safety.
Results
Of nineteen multidisciplinary teams trained,
participants ranged from physicians, nurses and administrative
staff to lay community organizations such as adult learner
program directors, literacy teachers, and patient advocates.
Thus far, over 200 training programs have reached 10,000
people invested in improving healthcare and health outcomes.
Seventy percent of clinicians report changing communication
practices within six months.
Discussion
Techniques and best practices in the training
program are a direct response to evidence that low health
literacy plagues our nation, makes current disease prevention
practices ineffectual and inefficient, and poses a threat to
safety of the patient and the public.
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A Model for Promoting Health Literacy and Chronic Disease
Prevention Through the 2004 Surgeon General's Report on
Smoking "People's Piece"
Authors
S. Gregory1; P. Xiques2; V. Reddick2.
1Centers for Disease Control and Prevention (CDC),
Atlanta, GA;
2Science Applications International Corporation,
Oak Ridge, TN.
Background
The 2004 SGR, which was prepared by 19 of the nation's top
public health experts, took more than 3 years to complete and
is targeted for a narrow scientific audience. Recognizing that
these findings must be communicated directly to the public to
have a broad impact on this national health problem, Surgeon
General Richard Carmona directed the Office on Smoking and
Health to prepare a "people's piece" for general audiences.
Methods
A structured approach was developed for creating and
testing material at a level that could be understood by low
literacy and aging audiences, but was still appropriate for
the general public. The methodology included visual design
standards, reading measurements, and assessments of draft
material, cultural appropriateness, and message clarity.
Reviews included ESL specialists, minorities, youth, and older
smokers and non-smokers.
Results
What It Means to You is a resource that explains the
findings of 2004 SGR to everyone. It clearly describes how
smoking causes disease in nearly every organ of the body. The
publication received regional and international awards for
technical communication, and offers lessons-learned that are
useful to a broad public health audience on issues of
low-literacy populations and the impact on health message
assimilation.
Discussion
After publication, participatory research
interviews after 3 months and 1 year assessed effectiveness in
communicating key ideas and influencing perspectives on health
consequences.
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USDA Elderly Nutrition Demonstrations: A Description and
Evaluation of Results
Authors
C. Kissmer1; E. Dagata2.
1Agricultural Research Service (ARS) - U.S. Department of
Agriculture (USDA), Alexandria, VA;
2Agricultural Research Service (ARS) - U.S. Department of
Agriculture (USDA), Washington, DC.
Background
Food Stamp Program (FSP) benefits provide additional
purchasing power that low-income elderly can use to improve
their diets and nutrient intakes. Yet nearly two-thirds of
low-income seniors ages 60 and older who qualify for FSP
benefits do not receive them.
Methods
To identify effective strategies for raising
participation among this population and improve their diets and
nutrient intakes, USDA solicited grant proposals for three
models, each using different techniques to reduce the barriers
that seniors face in FSP participation. The techniques involve
reducing the time and effort of applying for benefits, aiding
seniors in navigating the application process, and giving
seniors the option of receiving commodity packages instead of
getting benefits through electronic benefits transfer cards. The
models were tested as county demonstrations in six States
between 2002 and 2004.
Results
Findings from this study show that reducing the burden
of applying for food stamps or enhancing benefits appears to
increase participation of the elderly in the FSP. The most
successful demonstrations increased the number of participating
seniors by 20-35 percent more than in matched control counties
after 21 months of operation. The simplified eligibility model
which altered the application process was the least costly of
the demonstrations, since monthly costs consist primarily of
outreach. The application assistance model which utilized
persons within the community was more expensive because of the
monthly costs of providing services to potential elderly
participants. The commodity alternative was the most expensive
because of the cost of distributing food packages to clients
each month.
Discussion
The demonstration showed that community efforts
could make a difference in increasing participation in Food
Stamps by the elderly. Unfortunately, resources were unavailable
to measure the nutritional impact of participation in these
demonstrations, but, in general, food stamps increases the
nutritional availability in participating households.
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