This document summarizes a study on improving health literacy for older adults through an interactive program delivered by Meals on Wheels drivers. The study found that measuring patients' ability to seek health information in conversations better predicted their health status and self-efficacy, compared to standard reading-based health literacy tests. The program trained drivers to have health literacy coaching sessions with clients over 12 months, measuring outcomes like information seeking behaviors. Preliminary results showed interactive health literacy was a stronger indicator of health outcomes for vulnerable older adults than traditional health literacy tests.

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. What is interactive health literacy?
Health Literacy as information
transmission:
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Center for Health & Risk Communication

3. What is interactive health literacy?
Health Literacy as interactive
process:
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Center for Health & Risk Communication

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
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Center for Health & Risk Communication

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
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Center for Health & Risk Communication

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. Health Literacy on Wheels
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Center for Health & Risk Communication

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. 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. 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. 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. 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
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Center for Health & Risk Communication

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
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Center for Health & Risk Communication

14. Preliminary finding #1: Information seeking
utterances predict health status; S-TOFHLA does not
R=.58 R=.10
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Center for Health & Risk Communication

15. Preliminary finding #2: Information seeking utterances
predict health self-efficacy; S-TOFHLA does not
R=.36 R=.13
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Center for Health & Risk Communication

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. 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. Questions?
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Center for Health & Risk Communication