Nikki Keene Woods

Health Literacy and Older Adults A Systematic Review

Objective: The objective of this review was to assess published literature relating to health literacy and older adults. Method: The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Results: Eight articles met inclusion criteria. All studies were conducted in urban settings in the United States. Study sample size ranged from 33 to 3,000 participants. Two studies evaluated health-related outcomes and reported significant associations between low health literacy and poorer health outcomes. Two other studies investigated the impact of health literacy on medication management, reporting mixed findings. Discussion: The findings of this review highlight the importance of working to improve health care strategies for older adults with low health literacy and highlight the need for a standardized and validated clinical health literacy screening tool for older adults.

Health Literacy Assessment of the STOFHLA: Paper Versus Electronic Administration Continuation Study

Low health literacy is associated with poor health outcomes. Research is needed to understand the mechanisms and pathways of its effects. Computer-based assessment tools may improve efficiency and cost-effectiveness of health literacy research. The objective of this preliminary study was to assess if administration of the Short Test of Functional Health Literacy in Adults (STOFHLA) through a computer-based medium was comparable to the paper-based test in terms of accuracy and time to completion. A randomized, crossover design was used to compare computer versus paper format of the STOFHLA at a Midwestern family medicine residency program. Eighty participants were initially randomized to either computer (n = 42) or paper (n = 38) format of the STOFHLA. After a 30-day washout period, participants returned to complete the other version of the STOFHLA. Data analysis revealed no significant difference between paper- and computer-based surveys (p = .9401; N = 57). The majority of participants showed “adequate” health literacy via paper- and computer-based surveys (100% and 97% of participants, respectively). Electronic administration of STOFHLA results were equivalent to the paper administration results for evaluation of adult health literacy. Future investigations should focus on expanded populations in multiple health care settings and validation of other health literacy screening tools in a clinical setting.

Describing Adolescent Breastfeeding Environments Through Focus Groups in an Urban Community

Purpose: Breastfeeding is a potential solution to improve health outcomes for adolescent mothers and infants. Adolescence is a risk factor for low breastfeeding rates and is associated with a higher risk for perinatal complication. This study investigated facilitators and barriers to adolescent breastfeeding initiation and duration in an urban setting. Methods: Four, 1-hour focus groups were conducted. Twenty-nine (N = 29) adolescent mothers and pregnant adolescents participated and described attitudes toward breastfeeding, attitudes among family and friends, current knowledge, and barriers and facilitators for breastfeeding. Results: Four themes emerged, including the following: behavioral histories of breastfeeding, community assets, social support, and barriers. Participants identified positive histories and community resources such as local hospitals and social services as facilitators. Lifestyle, independence, lack of support from family and primary care providers, social stigma/embarrassment, and difficulty with breastfeeding techniques were described as barriers. Conclusion: A comprehensive and integrated primary care and public health community effort is needed to support and improve adolescent breastfeeding. Further examination of integrated interventions focused on adolescent breastfeeding behaviors through an environmental approach is needed.

Validation of a Single Question Health Literacy Screening Tool for Older Adults

Objectives: Health Literacy skills are important for people of all ages. Older adults have the lowest health literacy rates. The purpose of this study was to assess health literacy rates and validate the use of a screening tool with older adults. Methods: Participants included a convenience sample, age 65 years or older, English speaking with corrected vision of 20/100 or better and typical cognitive skills. Participants completed the 36-item Short Test of Functional Health Literacy Assessment (STOFHLA) and a single item screening (SIS) tool. Results of STOFHLA and SIS were compared using nonparametric statistics. Results: Of the 64 participants, 94% had adequate scores on the STOFHLA, while 64% self-reported confidence in filling out medical forms, p = .006, χ2 = 7.606, df(1). Conclusion: Results suggest that use of health literacy screening tools for older adults may be of value. Additional studies are needed to expand the study sample and validate the findings of this study.

An Empirical Case Study of the Effects of Training and Technical Assistance on Community Coalition Functioning and Sustainability

The case study analyzes the effects of training and technical assistance on the amount of community changes facilitated by members of a community coalition to prevent adolescent substance use. The study examines the sustainability of these changes in the community over time. The coalition implemented a Community Change Intervention that focused on building coalition capacity to support implementation of community changes—program, policy, and practice changes. Over the 2-year intervention period, there were 36 community changes facilitated by the coalition to reduce risk for adolescent substance use. Results showed that the coalition facilitated an average of at least 3 times as many community changes (i.e., program, policy and practice changes) per month following the intervention. Action planning was found to have accelerated the rate of community changes implemented by the coalition. After the intervention there was increased implementation of three key prioritized coalition processes: Documenting Progress/Using Feedback, Making Outcomes Matter, and Sustaining the Work. A 1-year probe following the study showed that the majority of the community changes were sustained. Factors associated with the sustainability of changes included the continued development of collaborative partnerships and securing multiyear funding.

Infant Mortality and Race in Kansas Associations With Women, Infants, and Children Services

Background: Racial and ethnic minority infants and mothers have worse birth outcomes than Caucasian infants and mothers, specifically infant mortality. The purpose of this pilot study was to compare infant mortality rates from vital statistic data between mothers who participated in the Women, Infants, and Children (WIC) Program and the general population in Kansas. Methods: A retrospective secondary analysis of data received from the Kansas Department of Health and Environment (KDHE) was conducted. Data were provided on all mothers who delivered a child in the state of Kansas from 2009 to 2011. The data received from KDHE included maternal demographics, infant deaths, infant gestational age, infant weight at birth, and WIC program participation. Results: The overall infant mortality rate was 6.4 per 1000 births. Infant mortality for Caucasians was lower than for non-Caucasians. Infant mortality for blacks was greater than for non-blacks. Being Hispanic was not statistically associated with a difference in infant mortality. WIC program participation was associated with lower infant mortality in both blacks and Hispanics. After adjusting for WIC, infants born to black mothers were still more than twice as likely to die when compared with Caucasian infants. WIC services were not statistically associated with a reduction in infant mortality. Mother’s education showed a significant protective effect on the likelihood of infant death. Conclusion: The WIC program is associated with positive outcomes at the national level. However, widespread reductions in health disparities have not been reported. Differences in education levels between mothers affected infant mortality to a greater degree than WIC program participation alone in the analysis. The infant mortality rate for black and Hispanic mothers was lower for WIC program participants. The WIC program may be beneficial for reducing infant mortality racial disparities but program participation should be expanded to affect maternal health disparities at the population level.

Comparing Self-Reported Infant Safe Sleep From Community- and Health Care–Based Settings

Objective: To compare self-reported safe sleep data from a community social service agency and primary care centers. Design, Settings, and Participants: Cross-sectional Pregnancy Risk Assessment Monitoring System (PRAMS)–based survey data from a community social service agency and survey data from primary care centers were compared using descriptive statistics. There were 166 community survey respondents, average age of 25 years (SD = 5.4 years), and 79 primary care center respondents, average age of 24 years (SD = 5.4 years). Two binary logistic regressions were performed to examine the association between demographic differences and safe sleep position/bed sharing. Results: Safe sleep position responses did not differ significantly between the community-based (n = 126, 85%) and primary care center–based (n = 62, 79%) samples, χ2(1) = 0.79, P = .372. Reported bed sharing was significantly higher in the community sample (n = 54, 36%) than the health care center sample (n = 4, 5%), Fisher’s exact test, P< .001. Black race was determined to be significantly associated with increased unsafe sleep positioning (OR = 2.86, P = .022). The community center cohort was the only significant predictor of bed sharing (OR = 25.40, P = .002). Conclusion:Differences in reported safe sleep environments may be due to knowledge variances of safe sleep guidelines, or clinic-based respondents may have been more likely to provide socially desirable responses. The comparison data further highlight the need for continued targeted effort to improve safe sleep behaviors to improve infant health outcomes.

Becoming a Mom: Improving Birth Outcomes through a Community Collaborative Prenatal Education Model

Purpose: Maternal/infant health outcome disparities continue to exist within the United States despite years of research and intervention. The need for collaborative community-based efforts was identified as an important strategy to improve birth outcomes. Objective: Evaluate the impact of a group prenatal education curriculum at increasing maternal health knowledge and decreasing negative maternal/infant health outcomes. Methods: Pregnant women were referred to the program by community obstetric providers. The group prenatal education program was delivered by the local health department through a series of six classes to groups of women with varied due dates. Participants completed pre and post knowledge assessments and health outcome data was abstracted from medical records. Results: The majority of participants (N=103) were Caucasian (n=83, 83%), English speaking (n=89, 86%), 21-30 years of age (n=71, 71%). Participants significantly increased knowledge in topics of preterm labor (85% vs. 95%, p<.0001), postpartum symptoms (80% vs. 89%, p<.0001), and safe sleep (84% vs. 99%, p=.0003). Participants used tobacco at a lower rate during pregnancy than regional comparisons (8% vs. 20%, p<.05). Conclusion: This study increased the number of pregnant women attending group prenatal education classes and was associated with positive knowledge and health outcomes. The program was offered as a compliment to existing prenatal care services, suggesting the collaboration resulted in a better utilization of existing community resources.

“Same Room, Safe Place” The Need for Professional Safe Sleep Unity Grows at the Expense of Families

There are many different professional stances on safe sleep and then there is the reality of caring for a newborn. There is a debate among professionals regarding safe sleep recommendations. The continum of recommendations vary from the American Academy of Pediatrics (AAP) Safe Sleep Guidelines to the bed-sharing recommendations from the Mother-Baby Behavioral Sleep Laboratory. The lack of consistent and uniform safe sleep recommendations from health professionals has been confusing for families but has more recently raised a real professional ethical dilemma. Despite years of focused safe sleep community education and interventions, sleep-related infant deaths are on the rise in many communities. This commentary calls for a united safe sleep message from all health professionals to improve health for mothers and infants most at-risk, “Same Room, Safe Place.”

“Same Room, Safe Place”

There are many different professional stances on safe sleep and then there is the reality of caring for a newborn. There is a debate among professionals regarding safe sleep recommendations. The continum of recommendations vary from the American Academy of Pediatrics (AAP) Safe Sleep Guidelines to the bed-sharing recommendations from the Mother-Baby Behavioral Sleep Laboratory. The lack of consistent and uniform safe sleep recommendations from health professionals has been confusing for families but has more recently raised a real professional ethical dilemma. Despite years of focused safe sleep community education and interventions, sleep-related infant deaths are on the rise in many communities. This commentary calls for a united safe sleep message from all health professionals to improve health for mothers and infants most at-risk, “Same Room, Safe Place.”