Erin E. Donovan

Sharing Health Information and Influencing Behavioral Intentions: The Role of Health Literacy, Information Overload, and the Internet in the Diffusion of Healthy Heart Information

Low health literacy remains an extremely common and problematic issue, given that individuals with lower health literacy are more likely to experience health challenges and negative health outcomes. In this study, we use the first three stages of the innovation-decision process found in the theory of diffusion of innovations (Rogers, 2003). We incorporate health literacy into a model explaining how perceived health knowledge, information sharing, attitudes, and behavior are related. Results show that health information sharing explains 33% of the variance in behavioral intentions, indicating that the communicative practice of sharing information can positively impact health outcomes. Further, individuals with high health literacy tend to share less information about heart health than those with lower health literacy. Findings also reveal that perceived heart-health knowledge operates differently than health literacy to predict health outcomes.

“The Uncertainty Is What Is Driving Me Crazy”: The Tripartite Model of Uncertainty in the Adolescent and Young Adult Cancer Context

Building on scholarship indicating that uncertainty is a fundamental component of the cancer experience, this study focuses on an understudied population: adolescents and young adults (AYAs) with cancer. Because AYAs’ health outcomes lag behind those of older and younger people with cancer, scholars have recommended that the subjective experiences of AYAs be better understood. Using the tripartite model of uncertainty sources as a guiding framework, we analyzed naturally occurring messages from an online discussion forum for AYA cancer survivors. The majority of messages communicating uncertainty expressed medical uncertainty regarding the complexities of understanding treatment options and sequelae. Results indicated that several overarching areas of AYA uncertainty correspond to themes reported by other cancer populations, but that some distinctive concerns arise amid the normative complexities of late adolescence and young adulthood.

Online Friends, Offline Loved Ones, and Full-Time Media: Young Adult “Mass Personal” Use of Communication Resources for Informational and Emotional Support

As Web 2.0 technologies proliferate, patient education is changing dramatically. Information about prevention and survivorship arrives from a mix of sources. The present manuscript describes a study to shed light on how young adults (YAs) affected by cancer manage the digital world. Our investigation was guided by a research question asking how young adults affected by cancer engage in communication work in an environment of mass personal communication. The sample for this research consisted of 500 posts comprising 50 complete threads from an online support community for young adults affected by cancer. Threads were purposively sampled in a multi-stage process. Researchers used constant comparison to define themes, examining text in increments. Individuals harnessed assets of various communication tools for the purposes of message preparation and credibility checking. YAs demonstrated the multi-channel way they move between channels for different purposes, driven by preparation for future interactions. The result is a process that allows co-creation of knowledge in a trusted community. Findings indicate that completing communication work through multiple channels in a deliberate and savvy way is normal for YAs, particularly for message preparation and credibility checking. The multidirectional nature of digital tools plays an important role for YAs, as interactive resources appear to be the first or second stop for information after key events in the cancer trajectory. Results from this study are important as guidance to help manage the volume and depth of information common to the cancer experience in the Web 2.0 world.

Stigma and health literacy: An agenda for advancing research and practice

OBJECTIVES To propose a framework addressing various factors contributing to stigma associated with low health literacy, how stigma is manifested, and how it may contribute to adverse health consequences. METHOD The framework incorporated concepts found in existing empirical research on stigmatized health conditions with an emphasis on concealable conditions such as mental health, HIV status, and some chronic illnesses. RESULTS Pursuing the proposed research agenda would provide a better understanding of the various factors contributing to stigma associated with low health literacy, how that stigma is manifested, and how it may contribute to adverse health consequences. CONCLUSION The goal of proposing a wide-ranging research agenda is to encourage research that will inform the development of a comprehensive framework that addresses factors that influence stigma associated with health literacy from multiple levels: micro, meso, and macro.

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

BackgroundIn the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits.Questions/purposes(1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit?MethodsWe audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0–3) and adequate (4–6) health literacy as done by the tool’s creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter.ResultsPatients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, −4; 95% CI, −7 to −1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; mean difference, −2; 95% CI, −4 to −1]; p < 0.001) and condition (2 ± 2 versus 3 ± 3; mean difference, −1; 95% CI, −3 to 0; p = 0.022). Nonwhite patients asked fewer questions than did white patients (5 ± 4 versus 9 ± 7; mean difference, −4; 95% CI, −7 to 0; p = 0.032). No other patient characteristics were associated with the number of questions asked. Surgeons only occasionally (29%; 24/84) asked patients if they had questions during the encounter, but when they did, most patients (79%; 19/24) asked questions.ConclusionsLimited health literacy is a barrier to effective patient engagement in hand surgery care. In the increasingly tangled health-information environment, it is important to actively involve patients with limited health literacy in the decision-making process by encouraging question-asking, particularly in practice settings where most decisions are preference-sensitive. Instead of assuming that patients understand what they are told, orthopaedic surgeons may take “universal precautions” by assuming that patients do not understand unless proved otherwise.Level of EvidenceLevel II, therapeutic study.

Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information:

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low (n = 13) and adequate (n = 14) health literacy patients, and health professionals (n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

An Experimental Test of Medical Disclosure and Consent Documentation: Assessing Patient Comprehension, Self-Efficacy, and Uncertainty

Effectively conveying risks and hazards in medical disclosure and informed consent documentation is a crucial type of communication. However, existing protocols typically do not meet the needs of patients or practitioners. In the present study, we advance a reconceptualization of obtaining written informed consent by analyzing it as a process of uncertainty management rather than a matter of document readability and recall. Results of this randomized trial indicated that patients who reviewed a simplified consent document reported greater comprehension of medico-legal terminology and lower uncertainty about the document, although they did not evince greater self-efficacy. Health literacy was a significant moderator of the relationship between consent form version and comprehension.

Boosting Healthy Heart Employer-Sponsored Health Dissemination Efforts: Identification and Information-Sharing Intentions

Health information dissemination options have expanded to include workplaces and employer-sponsored efforts. This study focuses on a core relational concept found in workplaces, organizational identification—the feeling of belongingness—and the impact of partnering with employers and health clinics in health information dissemination. We use social-identity theory and multiple identification to test our predictions from a sample of working adults representing more than 100 different employers. We found that when people strongly identify with their employer, they have increased health behavioral intentions and they intend to talk about the health information with coworkers. The significant models explain more than 50% and 30% of the variance in these two outcomes. The experimental results examining single and multiple organizational sources revealed no differences on any outcomes. These findings offer a contribution to health information dissemination research by articulating how identification with an employer functions to affect behavioral intentions.

Engaging Men in Prenatal Health Promotion: A Pilot Evaluation of Targeted e-Health Content:

Pregnancy outcomes in the United States continue to rank among the worst in the developed world. Traditional maternal–child health promotion tends to focus exclusively on women, leaving men out of programs that can affect family health. Scholars advocate including men in prenatal health to reduce maternal and infant mortality and morbidity. This study explored the perceived role of men in prenatal health, the use of an e-health application, and participant-suggested ways of improving the application moving forward. This study interviewed men in a large Southwestern U.S. city with an average age of 26.0 years (N = 23). The sample was 52% White, 26% Hispanic, 9% Asian, 9% multiracial or other, and 4% Black. Participants were asked about pregnancy health and used a pregnancy-related e-health application on a tablet computer. Participants provided opinions on content, ease of use of tablets, and recommendations for a stronger application. Despite perceived barriers such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. Most found the application to contain useful and interesting information. Participants recommended the addition of videos and interactive modules to make the application stronger. This study explored the use of a targeted e-health application to introduce men to prenatal health education. Results indicate men feel favorable to this type of intervention. Additional refinement of the application could include interactive tools or “push content” to further engage men in this important topic.

Colorectal cancer prevention and intentions to use low-dose aspirin: A survey of 1000 U.S. adults aged 40–65

OBJECTIVE The Translating Research into Action (TRIA) study was initiated to gather dissemination information on emerging cancer control recommendations. Daily, low-dose aspirin has been identified as a promising means of preventing colorectal cancer, and stakeholders are already calling for research to facilitate dissemination. Thus, the current study sought to identify factors related to intention to use aspirin for colorectal cancer prevention. METHODS In April 2014, U.S. adults aged 40-65 (N=1000) were recruited to participate in a survey grounded in the health belief model. RESULTS Older, Black males were more likely to intend to use low-dose aspirin to prevent colorectal cancer. Smokers, and those with a history of polyps, were also more receptive to initiating daily, low-dose aspirin use. Five psychosocial factors were related to intention including self-efficacy, response efficacy, perceived barriers, perceived susceptibility to colorectal cancer, and cancer information overload. CONCLUSION Initial campaigns/interventions designed to increase daily, low-dose aspirin for colorectal cancer prevention may be more effective if they target receptive populations (older, Black males) using messages informed by the health belief model.