Kristie B. Hadden

A need for health literacy curriculum: Knowledge of health literacy among us audiologists and speech-language pathologists in Arkansas

CONTEXT We assessed the general knowledge of health literacy and the impact of limited health literacy on patients and to society in United States (US) audiologists and speech-language pathologists in Arkansas. METHODS A 10-item survey was completed by 198 professionals and students in communication sciences and disorders in Arkansas. The 10-items were divided into one demographic question, six patient-related health literacy questions, and three systems-related health literacy questions. RESULTS Most professionals and students were aware that limited health literacy can be an obstacle for patients, but they were only somewhat or not aware of existing data on the average US adult reading grade level, the readability of clinic forms, or the estimated economic healthcare cost as a result of low health literacy. DISCUSSION Increasing the awareness of health literacy and the impact of limited health literacy among all healthcare providers would be a worthwhile endeavor. More work is needed to study health literacy in various patient populations and to develop effective approaches to combat low health literacy in the field of communication sciences and disorders, as well as other healthcare disciplines, across the globe. This study suggests that health literacy awareness training may be needed, not only in Arkansas, but also throughout the US and other countries. The outcome should bridge the health literacy and communication gap between providers and their patients.

Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement

PURPOSE This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. METHODS A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. RESULTS The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. CONCLUSIONS Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. CLINICAL RELEVANCE Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients.

Development of a Faith-Based Stress Management Intervention in a Rural African American Community

Background: Faith-based mental health interventions developed and implemented using a community-based participatory research (CBPR) approach hold promise for reaching rural African Americans and addressing health disparities.Objectives: To describe the development, challenges, and lessons learned from the Trinity Life Management, a faith-based stress management intervention in a rural African American faith community.Methods: The researchers used a CBPR approach by partnering with the African American faith community to develop a stress management intervention. Development strategies include working with key informants, focus groups, and a community advisory board (CAB).Results: The community identified the key concepts that should be included in a stress management intervention.Conclusions: The faith-based “Trinity Life Management” stress management intervention was developed collaboratively by a CAB and an academic research team. The intervention includes stress management techniques that incorporate Biblical principles and information about the stress–distress–depression continuum.

Patient Health Literacy and Perception of Provider Communication: Is there a Link?

Inadequate health literacy is a common problem that contributes to poor patient-provider communication. Health literacy screening and specific provider communication practices may be important in clinics where patients are at high risk for inadequate health literacy. This study assessed patients’ health literacy and their perception of provider communication practices in a primary care residency program clinic serving an urban multi-ethnic population. A convenience sample of 324 patients in an urban-based primary care practice was surveyed for health literacy and their perception of physician communication using validated instruments. Of the patients surveyed, 37% had inadequate health literacy. There was high internal consistency of our validated screening questions for health literacy (p < .0001). Overall, the patients surveyed rated the quality of their provider’s communication very highly. We found no statistically significant relationship between patients’ health literacy and their perception of provider communication, suggesting provider communication may be independent of patient understanding in this cohort. Effective communication from providers may compensate for lack of understanding with patients with inadequate health literacy in urban primary care practices.

Health Literacy Among a Formerly Incarcerated Population Using Data from the Transitions Clinic Network

Health literacy is increasingly understood to be a mediator of chronic disease self-management and health care utilization. However, there has been very little research examining health literacy among incarcerated persons. This study aimed to describe the health literacy and relevant patient characteristics in a recently incarcerated primary care patient population in 12 communities in 6 states and Puerto Rico. Baseline data were collected from 751 individuals through the national Transitions Clinic Network (TCN), a model which utilizes a community health worker (CHW) with a previous history of incarceration to engage previously incarcerated people with chronic medical diseases in medical care upon release. Participants in this study completed study measures during or shortly after their first medical visit in the TCN. Data included demographics, health-related survey responses, and a measure of health literacy, The Newest Vital Sign (NVS). Bivariate and linear regression models were fit to explore associations among health literacy and the time from release to first clinic appointment, number of emergency room visits before first clinic appointment and confidence in adhering to medication. Our study found that almost 60% of the sample had inadequate health literacy. Inadequate health literacy was associated with decreased confidence in taking medications following release and an increased likelihood of visiting the emergency department prior to primary care. Early engagement may improve health risks for this population of individuals that is at high risk of death, acute care utilization, and hospitalization following release.

Readability of Human Subjects Training Materials for Research

Institutions are required to ensure that persons involved in human subjects research receive appropriate human subjects protections training and education. Several organizations use the Collaborative Institutional Training Initiative (CITI) program to fulfill training requirements. Most researchers find the CITI program too complex for community members who collaborate with researchers. This study aimed to determine the readability of CITI modules most frequently used in community-based participatory research (CBPR). The mean readability level of the CITI modules is 14.8 grade; CBPR readability levels ranged from 11.6 to 12.0 grade (sixth- to eighth-grade reading level is recommended). With a baseline objective measure, modifications can be made to improve the plain language quality and understandability of human subjects training modules for community members.

Maternal knowledge of pertussis and Tdap vaccine and the use of a vaccine information statement

Objective: This study explored maternal knowledge of pertussis and Tdap vaccine and the use of a Tdap Vaccine Information Statement (VIS) to improve that knowledge. Design: Prospective cohort study. Setting: Two outpatient obstetric clinics at a US academic medical centre. Methods: An electronic survey was administered to pregnant women who received care at the clinics. The survey included a test of knowledge of pertussis and Tdap vaccine, a health literacy instrument and demographic questions. A chart review was conducted to determine Tdap vaccination status. The knowledge test was administered before and immediately after participants read the VIS. Differences between pre- and post-knowledge test scores were determined using the Wilcoxon signed-rank test. The effects of two different versions of the VIS on participants’ knowledge gained and associated factors were examined using a repeated-measures mixed model with random effects. Results: In total, 279 participants were analysed with an average age of 26.4 ± 5.7 years. The average post-test knowledge score was higher than the pre-test score (6.4 vs 4.2, p < .001). Health literacy score (p < .001), White race/ethnicity (p = .007) and higher education level (p < .001) were positively associated with improved knowledge scores. Both VIS versions improved participants’ knowledge scores to a similar degree. However, knowledge scores were not a predictor of Tdap vaccination in our population. Conclusion: A Tdap VIS improved maternal knowledge and is an economical and easily accessible educational tool in clinical practice for promoting Tdap vaccine to pregnant women.

Systematically Addressing Hospital Patient Education

ABSTRACT This study evaluated patient education materials at a large hospital. In this online field survey study, subjective plain language quality of patient materials was determined by health professionals’ perceptions of patients’ understanding of materials; objective quality was assessed using Fry and Flesch-Kincaid readability assessments. Subjectively, 74% of surveyed employees rated patient understanding of resources identified as very good or good. Objective plain language quality assessment revealed between 9th and 10th grade readability levels of materials. Improving patient education with attention to readability can help hospitals address the ten attributes of health literate healthcare organizations and improve patient experiences.

Improving readability of informed consents for research at an academic medical institution

Introduction The final rule for the protection of human subjects requires that informed consent be “in language understandable to the subject” and mandates that “the informed consent must be organized in such a way that facilitates comprehension.” This study assessed the readability of Institutional Review Board-approved informed consent forms at our institution, implemented an intervention to improve the readability of consent forms, and measured the first year impact of the intervention. Methods Readability assessment was conducted on a sample of 217 Institutional Review Board-approved informed consents from 2013 to 2015. A plain language informed consent template was developed and implemented and readability was assessed again after 1 year. Results The mean readability of the baseline sample was 10th grade. The mean readability of the post-intervention sample (n=82) was seventh grade. Conclusions Providing investigators with a plain language informed consent template and training can promote improved readability of informed consents for research.

Application of nonlinear methods for analyzing rate of speech production

This pilot study has examined the rate of repetitive speech production through use of nonlinear methods. Durational measures were obtained from a normal subject who was required to produce a stimulus word in four speaking conditions: normal, controlled-normal, accelerated, and controlled-accelerated. Phase plots and accumulated time series plots were utilized to display intra-subject variability. Attractors were observed in each of the four phase plots and of particular interest was the direction of their shift for the different speaking conditions. The accumulated time series plots also revealed patterns of intra-subject variability across time. In summary, these two forms of nonlinear representation successfully characterized qualitative changes within, and across, the four speaking conditions. The observed spectral distributions and patterns of variability have implications for differentiating normal from abnormal speaking conditions.