Focusing on Health Literacy to Improve Outcomes

Holland Porter, BSN, RN

Kathy Jo Ellison, PhD, RN, Faculty advisor
BACKGROUND

REVIEW OF EVIDENCE

Health Literacy- the degree to which people

have the capacity to obtain, process, and
understand health information and services
needed to make appropriate health decisions.

Grade B recommendation: Initial diagnosis

and medication teaching using a geragogybased format. Geragogy is the art and science
of helping older adults learn. This method of
teaching is often used in older adult patients
due to their declining physical condition,
low-literacy level, poor education, and
increasingly complex medication regimens.
This method of using large bold printed
materials presented in a well-lit environment
with adequate time provided for questions
has proven to improve patient retention and
understanding of information taught.

Our healthcare society is tailored to the healthliterate consumer. Healthcare providers often
assume that patients are competent enough to
complete the instructions they give them. The
term low health literacy not only indicates an
individuals inability to read instructions, it
also involves the lack of ability to perform
them. Research shows that there are over 80
million Americans with limited health literacy.
Demographics-of--those-with-limited-health-literacy-

Grade B recommendation: Following up

with patients by telephone periodically to
reinforce teaching and clarify information
has shown to improve patient outcomes.

Non$Hispanic+Whites+
Non$Hispanic+Blacks+
American+Indian/Alaskan+Na9ve+
La9no+

PICO
What best practice strategies improve
health literacy in hypertensive African
Americans living in the rural setting?
Search Strategy
The Auburn University Librarys
online databases were used to search
for articles. Most of the information
regarding the health literacy epidemic
was obtained from The Institute of
Medicines book Health Literacy, A
Prescription to End Confusion.

PURPOSE
The purpose of this small test of change
is to evaluate the effectiveness of two
interventions: hypertension and
antihypertensive specific education using
a geragogy-based format in conjunction
with a follow-up telephone call to
reinforce teaching two weeks later. The
interventions will be determined
successful if the patients blood pressure
is lowered and their confidence in
performing situation-specific tasks in
relation to their antihypertensives is
increased.

Small Test of Change

Target population: African American
adults diagnosed with hypertension with
elevated blood pressure upon
assessment.
Setting: Lake Martin Family Medicine,
rural health clinic
Measures: Short-form of the Test of
Functional Health Literacy (STOFHLA); Medication Administration
Self-Efficacy Scale (MASES); Blood
pressure measurements.
Intervention: Initial teaching using a
geragogy-based format in conjunction
with a follow-up telephone call at two
weeks post initial teaching. Patients
returned to clinic at five weeks post
initial teaching to have blood pressure
and MASES repeated.

RESULTS
Demographics
Mean

St. Deviation

Age

48.14

8.896

Weight (lbs.)

212.86

46.034

S-TOFHLA

53.14

7.755

Gender

Males = 3
Females = 4

48%
52%

Pre-Intervention Data
Mean

SD

S-TOFHLA

53.1

7.75

Pre-MASES

48.3

Pre-systolic
BP
Pre-diastolic
BP

Post-Intervention Data
Mean

SD

11.6

53.5

10.72

-4.05

.007

163

11.7

155

9.730

3.69

.01

98.4

15.8

92

10.53

2.54

.04

CONCLUSIONS
Findings suggest:
Using a geragogy-based approach to teaching in combination with a follow-up
telephone call is effective in increasing patients self-confidence in this setting.
Using a geragogy-based approach to hypertension education in combination with a
follow-up telephone call is effective in lowering patients systolic and diastolic blood
pressure in this setting.
In order to determine if health literacy scores were improved the project would need
a duration of six months. Follow-up telephone calls would occur every two weeks
with repeat blood pressure measurements monthly and a repeat of the MASES and STOFHLA at six months post initial teaching.

Key Reference:
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy.
Washington, DC: Author. Retrieved from http://www.health.gov/communication/HLActionPlan/pdf/Health_Literacy_Action_Plan.pdf

A special thanks to
Lake Martin Family Medicine