School of Nursing

Health Literacy:

A Factor in

Translation of

EvidenceJacqueline Dunbar-Jacob, PhD, RN, FAAN

J. Erlen, L. Burke, C. Stilley, C. Bender, J. Lingler, M. Styn, M. McCall, & S. Sereika University of Pittsburgh School of Nursing

Supported by NIH NINR P01NR010949

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Objectives

1. Describe health literacy of community samples which were recruited for research studies examining factors associated with translation of adherence interventions

2. Describe the relationship of health literacy to adherence and regimen conduct

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Health Literacy is an

Important Factor in

Translating Evidence-Based

InterventionsWhat Do

We Know?

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Health Literacy

“ The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions”

Healthy People, 2010

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Health Literacy

“The capacity of individuals to obtain, interpret and understand basic health information and services and the competence to use such information and services in ways which enhance health”

Joint Committee on National Health Education Standards (1995)

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Health Literacy

“A constellation of skills that constitute the ability to perform basic reading and numerical tasks for functioning in the health care environment and acting on health care information.”

AHRQ Evidence Report/TechnologyAssessment: Number 87 (2004)

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National Assessment of Adult Literacy (NAAL) 2003

• 12% Proficient

• 53% Moderate

• 22% Basic

• 14% Below Basic

National Center for Education Statistics, 2003

Health Literacy Level

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Adherence and HRQOL:Translation of Interventions

(NIH NINR P01-NR010949)

• 4 RCTs with Cognitive Behavior Interventions

• Common Assessment of Factors which Potentially Would Affect Their Translation in Practice Settings

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Health Literacy Assessment

Newest Vital Sign – brief screening tool

– Prose: understand and use written information

– Numeracy: use numbers found in written materials

– Documents: understand and use forms, charts, graphs

Internal Consistency = .76

Prediction of TOFHLA .88 area under ROC Curve

Score <2 sensitivity 72%, specificity 87%Weiss et al, Annals of Family Medicine, 2011Medical Futures Forum, New York, NY, 2005

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We Will Report on Health Literacy

in 3 Studies:

• Stilley/Bender et al: Medication Adherence in Diabetes

• Burke et al: Weight Reduction in Healthy Adults

• Erlen/Lingler et al: Medication Management by Caregivers

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Overall Sample of 296 Ss

• 44% - Obese

• 30% - Diabetic

• 26% - Caregivers

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Pooled Sample Socio-demographics & Between Study Differences

Male 83 (28.4%) 2 = 18.4 df=2 p = .000

Married 181 (61.1%) 2 = 17.05 df=2 p = .000

White 221 (71.3%) 2 = 22.9 df=2 p = .003

Employed 160 (56.6%) 2 = 74.2 df=2 p = .000

Health Ins. 288 (97.3%) 2 = 3.3 df=2 p = .193

Age M 59.4 + 12.3 F = 46.7 p = .000

Education M 15.0 + 3.1 F = 12.56 p = .000

# in Household M 2.4 + 3.7 F = 1.83 p = .163

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Study Differences in Socio-demographics

Obese Diabetic Caregiver

Male 22 (16.9%) 39 (43.3%) 22 (28.9%)Married 75 (57.7%) 45 (50%) 61 (80.3%)White 92 (70.8%) 55 (61.1%) 64 (84.2%)Employed 107 (82.3%) 37 (42.2%) 16 (21.9%)Health Ins. 129 (99.2%) 86 (95.6%) 73 (96.1%)Age 53.01 + 9.56 61.97 + 10.4 67.38 + 12.73Education 15.88 + 3.07 13.8 + 2.5 14.97 + 3.5# in Household 2.82 + 5.37 1.87 + .87 2.4 + 1.03

2 = 17.02 df = 2 p = .000

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Study Samples Differed on All Socio-Demographic Variables

EXCEPT Health Insurance

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Pooled Sample Literacy Scores & Between Study Differences

2 = 30.467 df = 4 p = .000 F = 18.685 p = .000

Pooled

Obesity Diabetic Caregiver

High Likelihood of Limited Literacy

4.7% 3.1% 2.2% 10.5%

Possible Limited Literacy 28.9% 9.2% 33.3% 28.9%Adequate Literacy 73.6% 87.7% 64.4% 60.5%

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Prose M = 1.6 + .7 (1.47 – 1.75)

Numeracy M = 1.4 + .8 ( 1.0 – 1.76)

Document M = 1.4 + .7 (1.09 – 2.0)

*Where 1 = high likelihood of limited literacy 3 = adequate literacy

Pooled Sample Specific Literacy & Between Study Differences*

F = 18.69 p = .000

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Different Studies May Yield Different Findings

We were just as surprised by the test results as you. We’re still scratching our heads over it.

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Overall, the Health Literacy Was Higher Than

The Population Data Would Predict

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However, Data Variation Across Studies Raises Questions:

1. Are Patients With Higher Literacy More Likely to Participate in Research Studies?

2. Will Literacy Impact Success of Intervention in Research Studies?

3. How Do Studies of Interventions Conducted in a Higher Literacy Population Translate to Populations with Lower Literacy?

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Presenters in the Symposium:

• Lora E. Burke, PhD, RN, ProfessorDescriptive Study of Health Literacy Among Adults Seeking Weight Loss Treatment

• Catherine M. Bender, PhD, RN, ProfessorHealth Literacy and Chronic Disease Management

• Judith A. Erlen, PhD, RN, ProfessorHealth Literacy among Informal Caregivers of Persons with Memory Loss