Health Literacy on Wheels: Interactive Health Literacy for Older Adults

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Health Literacy on Wheels presentation by Rubin et al at 2010 AACH conference

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Health Literacy on Wheels: Interactive Health Literacy for Older Adults

  1. 1. Health Literacy on Wheels: Interactive Health Literacy for Older Adults Don Rubin Vicki Freimuth Mumbi Okundaye John Parmer Terry Kaley Sarah Mink Presented at The University of Georgia American Academy on Communication in Healthcare October, 2010 The University of Georgia Center for Health & Risk Communication
  2. 2. What is interactive health literacy? Health Literacy as information transmission: The University of Georgia Center for Health & Risk Communication
  3. 3. What is interactive health literacy? Health Literacy as interactive process: The University of Georgia Center for Health & Risk Communication
  4. 4. “All the sources you turn to when you need information or assistance in dealing with health or medical issues…" Ask a health professional 86% Ask a friend or family member 68% Use the internet 57% Use books or other printed reference material 54% Contact insurance provider 33% Other option 5% Source: Pew Internet & American Life Project Survey, November-December 2008. N=2253. Margin of error is +/-2%. *American adults 18 years and over The University of Georgia Center for Health & Risk Communication
  5. 5. Interpersonal Processing of Internet Health Information • The pursuit of health information does not occur in a social vacuum. • Two-thirds of e-patients talk with someone else about what they find online, most often a friend or spouse. • Health information-seeking/validation interactions occur with a variety of lay information sources as well as with health providers…in informal as well as in formal encounters Source: Pew Internet & American Life Project Survey, November-December 2008. N=2253. Margin of error is +/-2%. *American adults 18 years and over The University of Georgia Center for Health & Risk Communication
  6. 6. Objectives for patient/consumer interactive health literacy •Health literate patients/ have agency •Can articulate own health goals •Persistent in pursuing those goals •Health literate patients/ prepare ahead for challenging situation •Emotionally charged •Extreme time pressure •Power and knowledge differential •Health literate patients/ are verbally resourceful •Know scripts for interacting (e.g., requests teach-back) The University of Georgia Center for Health & Risk Communication
  7. 7. Health Literacy on Wheels The University of Georgia Center for Health & Risk Communication
  8. 8. Why Meals on Wheels? • MOW drivers are trusted and welcomed visitors • Know clients • E.g., MOWAA smoke alarms • E.g., Maximizing Brief Encounters The University of Georgia Center for Health & Risk Communication
  9. 9. Health Literacy on Wheels Driver Drivers deliver intervention Booster Training & Training & Post- Pretests testing Zero • Meals as usual Coaching Client Post- Informed testing consent & Video Pretests • Ask-Me-3 materials Good Health Good Questions for Health 2 Literacy • Videos Coaching • Coaching 1st Coaching 2nd Coaching 3rd Coaching Capstone •Post- •Post- •Post- •No data appointment appointment appointment collection analysis analysis analysis Moths 1-8 Month Month Months 1-8 9 12
  10. 10. Measuring Interactive Health Literacy Elicitation script design • High salience topic – HPV (age<30) – Shingles (age>60) – Pneumonia (age>60) • Conversational framing • Deliberate information gaps • Scripted long pauses (10 seconds) • Scripted prompts for questions (repeated to satiation) The University of Georgia Center for Health & Risk Communication
  11. 11. Measuring Interactive Health Literacy MIHL Outcome Indices • Information-Seeking – Unprompted ISUs (per minute) – Prompted ISUs (per minute) – Comprehension Checks (per minute) • Interactivity – Conversational Turns (per minute) • Conversational Assertiveness – InterviewEE vocalization time (percent total talk time) The University of Georgia Center for Health & Risk Communication
  12. 12. Correlative Measures • Self Reported Health Status – 8 items from MCBS • Self Efficacy for Managing Chronic Disease (Lorig et al, 2001) • Barriers to Health Information – 4 items from HINTS • Satisfaction with Health Providers – 12 items from MCBS • S-TOFHLA The University of Georgia Center for Health & Risk Communication
  13. 13. Participants • Meals on Wheels Recipients – Urban and Rural • N=36 • Mage = 73.4 (SD=8.6) • Must qualify for MOW via − Income and/or disability The University of Georgia Center for Health & Risk Communication
  14. 14. Preliminary finding #1: Information seeking utterances predict health status; S-TOFHLA does not R=.58 R=.10 The University of Georgia Center for Health & Risk Communication
  15. 15. Preliminary finding #2: Information seeking utterances predict health self-efficacy; S-TOFHLA does not R=.36 R=.13 The University of Georgia Center for Health & Risk Communication
  16. 16. Conclusions • Health Literacy in oral interaction is not the same as document-based Health Literacy. • For a population of older, vulnerable adults, information seeking in oral interaction predicts health status and self-efficacy better than does the reading-based S-TOFHLA. • Progress in Health Literacy research and practice demands development and refinement of measures of interactive health literacy. The University of Georgia Center for Health & Risk Communication
  17. 17. Questions/Contact Don Rubin drubin@uga.edu Center for Health & Risk Communication www.chcr.uga.edu The University of Georgia Center for Health & Risk Communication
  18. 18. Questions? The University of Georgia Center for Health & Risk Communication

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