health literacy on wheels: interactive health literacy for older adults
DESCRIPTION
Health Literacy on Wheels presentation by Rubin et al at 2010 AACH conferenceTRANSCRIPT
Center for Health & Risk Communication
The University of Georgia
Health Literacy on Wheels: Interactive
Health Literacy for Older Adults
Don Rubin
Vicki Freimuth
Mumbi Okundaye
John Parmer
Terry Kaley
Sarah Mink
The University of Georgia
Presented at
American Academy
on Communication in
Healthcare
October, 2010
Center for Health & Risk Communication
The University of Georgia
Health Literacy as information
transmission:
What is interactive health literacy?
Center for Health & Risk Communication
The University of Georgia
Health Literacy as interactive
process:
What is interactive health literacy?
Center for Health & Risk Communication
The University of Georgia
“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
Center for Health & Risk Communication
The University of Georgia
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
Center for Health & Risk Communication
The University of Georgia
•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)
Objectives for patient/consumer interactive health literacy
Center for Health & Risk Communication
The University of Georgia
Health Literacy on Wheels
Center for Health & Risk Communication
The University of Georgia
Why Meals on Wheels?
• MOW drivers are trusted and welcomed visitors
• Know clients
• E.g., MOWAA smoke alarms
• E.g., Maximizing Brief Encounters
Driver Training & Pretests
Client Informed consent & Pretests
• Meals as usualZero Coaching
• Ask-Me-3 materials
• Videos
• Coaching
Health Literacy
Coaching
Video 2
Booster Training & Post-testing
Post-testing
Moths 1-8
Months 1-8Month
9Month
12
Health Literacy on Wheels
Drivers deliver intervention
1st Coaching
•Post-appointment analysis
2nd Coaching
•Post-appointment analysis
3rd Coaching
•Post-appointment analysis
Capstone
•No data collection
Good Questions for Good Health
Center for Health & Risk Communication
The University of Georgia
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)
Center for Health & Risk Communication
The University of Georgia
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)
Center for Health & Risk Communication
The University of Georgia
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
Center for Health & Risk Communication
The University of Georgia
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
Center for Health & Risk Communication
The University of Georgia
Preliminary finding #1: Information seeking utterances predict health status; S-TOFHLA does not
R=.58 R=.10
Center for Health & Risk Communication
The University of Georgia
Preliminary finding #2: Information seeking utterances predict health self-efficacy; S-TOFHLA does not
R=.36 R=.13
Center for Health & Risk Communication
The University of Georgia
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.
Center for Health & Risk Communication
The University of Georgia
Questions/Contact
Center for Health & Risk Communication
www.chcr.uga.edu
Center for Health & Risk Communication
The University of Georgia
Questions?