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PLAIN Health Indicators from an intercultural study in Health Literacy & Adherence
Indiana Center for Intercultural Communication, IUPUI
International Conference on Communication in Healthcare (ICCH)
Miami, FL, October 5, 2009
Presenter:
Kathryn Lauten, PhD, Associate Director, ICIC, IUPUI
Additional Research Team Members:
Marta Antón, Applied Linguistics, Spanish Linguistics, IUPUI
Julie Belz, Applied Linguistics, English, IUPUI
Ulla Connor, Applied Linguistics, English, Director ICIC, IUPUI
Elizabeth Goering, Communication, IUPUI
Paris Roach, Endocrinology, IUPUI
James Wolf, Sociology, IUPUI
Stephanie Balunda, ICIC
Amir Hayat, ICIC
With thanks to the Eli Lilly & Co. Foundation’s generous grant support
Funding
Project Title: The Project for Health Literacy and Patient Adherence
Funding Source: Eli Lilly and Co. Foundation
Project Duration: Aug. 2007 – July 2010 Grant Amount: $480,000
©Indiana Center for Intercultural Communication
Goal To develop a model of health literacy – PLAIN
Health – that explains (non)adherence among Diabetes Type 2 patients by determining the sources of information used by
patients about their disease by determining how that information is obtained,
processed and turned into practice by examining the construct of adherence through the
lens of patients’ life stories
©Indiana Center for Intercultural Communication
Health Literacy
“Health Literacy” is an accepted umbrella term defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”
-- Ratzan and Parker (2000)
©Indiana Center for Intercultural Communication
Restructuring the “Health Literacy” conversation
“Health Literacy” should be used to encompass reading, numeracy, speaking and listening ability, knowledge of medical terms, ability to navigate the health system, and ability to manage one’s health
ICIC aims to remove the confusion around the term “health literacy”, turn energy less toward explaining a term and more toward acting on meaning; suggests the use of “PLAIN Health indicators” as an umbrella term
©Indiana Center for Intercultural Communication
©Indiana Center for Intercultural Communication
PLAIN Health
Process -- of turning information into knowledge
Literacy -- functional literacy
Action -- turning knowledge into action
Intercultural Interactive Communication -- with health care providers, family and friends
Numeracy
Advocates idea of using plain language
“Understanding the relative contributions of direct and indirect pathways [between health literacy and health outcomes] is crucial for the development of effective interventions to improve health outcomes [...] First, it is clear that low literacy is not universally associated with poor self-reported adherence to medications for the few conditions examined to date. Other research, however, suggests that patients with low literacy may have initial difficulty with learning self-care behaviors and enacting them, but that with ongoing support and additional training, they can overcome these barriers.”
Pignone, M. P., & DeWalt, D. A. (2006). Literacy and health outcomes: Is adherence the missing link? Journal of General Internal Medicine, 21(8), 896-897.
Understanding the link to adherence
©Indiana Center for Intercultural Communication
©Indiana Center for Intercultural Communication
Working Model
Variables Operationalization
Dependent Variable
Adherence to Medication 3 Questions (see page 2 of hand-out)
Independent Variables
Literacy variables• Patient Information Leaflet (PIL) Comprehension• General Health Literacy• Information Sources
Psychological Construct Variables• Life Orientation (from Locus of Control: Rotter, 1966;
Wallston, Wallston & DeVellis, 1978; Ferraro, Price, Desmond, & Roberts, 1987; Stënström, Wikby, Per-Olof, Rydén, 1998; O’Hea, Grothe, Bodenlos, Bourdreaux, White, Brantley, 2005)
• Agency (Bandura, 1982 & 1986; duPre, 2004; Chou, 2004)
• Affect (Martin and White, 2005; Martin, 2000)
Comprehension test (see page 3)
3 Questions (see page 4 of handout)
Survey (see page 3 of handout)
Agency Model: Ordered Probit Analysis
Control Variables
Age *
Ethnicity (non-Hispanic White)
Gender
Household Income
Years of Education
High Agency – Food *
High Agency – General Diabetes Management *
“No Comprehension” score on PIL test **
+
+
Perfect Adherence
to Medication
+
* = p < 0.05** = p < 0.1
Affect Insecurity Model: Ordered Probit Analysis
Control Variables
Age *
Ethnicity (non-Hispanic White)
Gender
Household Income
Years of Education
Total Instances of Insecurity *
Perfect Adherence
to Medication
-
* = p < 0.05
Affect Dissatisfaction Model: Ordered Probit Analysis
Control Variables
Age *
Ethnicity (non-Hispanic White)
Gender
Household Income
Years of Education
Total instances of Dissatisfaction *
Perfect Adherence
to Medication
-
* = p < 0.05
Next Steps Examine relationships between Life Orientation, Agency, and
Affect
Examine relationship of information sources to knowledge and action
Finish analysis of Spanish-language data (see next slides)
Operationalize the PLAIN Health Indicators modelProcess, Literacy, Action, Interaction, Numeracy
Poster presentation gives more details as well as practical application in the session immediately following this panel.
Percentage of Respondents Who Rate Various Sources of Information for Managing Diabetes as "Poor" or "Don't use"
0% 10% 20% 30% 40% 50% 60% 70% 80%
Doctors
TV/Radio News
TV/Radio Ads
Family
Brochures
Diabetes Education Programs
Labels on Prescriptions
Magazine Articles
Friends
Books
Print Ads
Written Info from Pharmacists
Spoken Information from Pharmacists
Other Health Care Providers
Internet
SpanishEnglish
Percentage of Respondents Who Rate Various Sources of Information for Managing Diabetes as "Excellent" or" Very Good"
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Internet
Friends
Spoken Info from Pharmacists
Other Health Care Providers
Written Information from Pharmacists
Print Ads
Magazine Articles
Family
Books
TV News
TV Ads
Prescription Labels
Brochures
Diabetes Education Programs
Doctors
SpanishEnglish
Percentage of Respondents Who Rate Various Sources of Infomation for Managing Diabetes as "Poor" or "Don't use"
0% 10% 20% 30% 40% 50% 60% 70% 80%
Brochures
Diabetes Education Program
Books
Print Advertisements
Written Information fromPharmacists
Other Health Care Providers
Internet
SpanishEnglish
Spanish 27% 27% 41% 41% 41% 45% 68%
English 7% 12% 21% 21% 14% 29% 44%
BrochuresDiabetes Education Program
BooksPrint
Advertisements
Written Information from
Pharmacists
Other Health Care Providers
Internet
Percentage of Respondents Who Rate Various Sources of Information for Managing Diabetes as "Excellent" or "Very Good"
0% 10% 20% 30% 40% 50% 60%
Print Advertisements
TV Advertisements
Brochure
SpanishEnglish
Spanish 36% 45% 55%
English 14% 21% 30%
Print Advertisements TV Advertisements Brochure