# Presentation: 727419

## Improving Health Literacy to Improve the Health of Rural Elders 

- Marilyn M. Gardner
- Susan Jones
- Jan Peeler

## Slide 2

**Notes:**

According to 2000 census data, approximately 42% of the people aged 65 or older lived in a rural area – a proportion double that of what is observed nation wide (nationally, the proportion is 21.7%) 

## Compared to Urban Elderly, Rural Elders ...

- have a greater prevalence of chronic diseases and health risk behaviors
- engage less in preventative care
- have poorer health-related quality of life and functional status

**Notes:**
Existing literature indicates that when compared to their urban counterparts, rural elderly have a higher prevalence of chronic diseases, that they engage in less healthful behaviors and preventive care, and that they have a lower functioning and quality of life. 

## Rural elders’ perception 
of their health-status 
is significantly worse than their 
actual 
health status

- of their health-status
- is significantly worse than their
*actual*
- health status

**Notes:**
Curiously, though, rural elders’ PERCEPTION of their health status is far worse than their ACTUAL health status

## 
Could it be that inadequate health literacy, which is also common among rural elders, contributes to this dissonance?

- Could it be that inadequate health literacy, which is also common among rural elders, contributes to this dissonance?

## Health Literacy

- “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”
*Healthy People 2010*

**Notes:**
Health literacy, as defined by Healthy People 2010, is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions8.” 
Functional health literacy -- the ability to read, understand, and act on health information14 

## Inadequate Health Literacy

- Negative health outcomes
- Increased length and frequency of hospitalizations
- Increased health care expenditures

**Notes:**

Research indicates that health literacy is directly related to health outcomes, length and frequency of hospitalizations, and health care expenditures.

## Health Enhancement of the Rural Elderly

**Notes:**
Today I’ll be providing an the pilot findings of one part of a three-year, multi-component health promotion and outreach demonstration project designed to enhance the health of rural elderly by improving their health literacy and through building supporting community partnerships.  

The project, known as Health Enhancement of the Rural Elderly (HERE), was funded by the Office of Rural Health Policy and was approved in all phases by the Human Subject Review Board at Western Kentucky University.

## Areas of Need

- Medications
- Medical terminology
- Basic anatomy and physiology
- Orientation to medical forms
- Patient-provider communication skills
- 		*woven throughout each module*

**Notes:**
During the needs assessment phase, five areas of need were identified based on focus group findings  with rural elders and health care professionals. Educational modules were developed by an interdisciplinary team of students, faculty, and health care professionals to address these needs.

## Slide 10

**Notes:**
The targeted population for HERE consisted of men and women, ages 65 and older, living in two non-contiguous south-central Kentucky counties identified as rural and poor. Census data estimated 11,000 residents in each county, approximately fifteen percent of whom are age 65 or older.  Twenty percent of residents in these counties are living below the poverty level and one-third report having less than a high school education.  Both counties are classified as health professional shortage areas (HPSA).

## Methods

- Participants recruited through churches, senior centers, PSAs/fliers
- Self-selected into one of 5 groups
- Four intervention groups
- One attention-control group
- Met two consecutive weeks, 2.5 hours per session
- Interactive educational modules geared toward low literacy level
- Health Resource Guide

**Notes:**
Fliers were

## Measures: pre & 6 mo. post

- Demographics
- Medical Behaviors
- Semantic Differential Scales (SD, SA)
- Perception of Knowledge
- Beliefs regarding patient-provider relationship
- Patient Communication
- Provider Communication

**Notes:**
Four scales that measured the participant’s level of agreement using a 5 point semantic differential

Knowledge – perception of understanding medical terminology, body systems, understanding forms, etc.

Beliefs –

Patient Communication – 

Provider Communication – statements such as “During an office visit, my HCP spends enough time with me”

## Results

*No differences noted at pretest between intervention and comparison groups*

## Demographics

- 73.6 years (SD= 6.463)
- 71% female
- 32% less than High School education
- 96.8% lived independently
- 53.6% alone

**Notes:**
Complete pre and post data were collected on 37 people. These are those data.

ResultsAt pretest, participants tended to take a fairly passive role in their health care and omst were embarrassed to ask health-related questions and intimidated by the health-care system. Many reported being confused by medical terminology, health insurance forms, and prescription instructions. Data from the six-month posttest revealed positive changes among participants in the intervention group on several health-related practices as compared to participants in the attention-control condition. DiscussionImproving health literacy has the potential to empower rural elderly to become more active participants in their health care. In doing so, there is the potential to realize improved health outcomes.

## Medical Behaviors

- (Χ2 = 7.369 , p<.001)

- (Χ2 = 2.198, p<.05)

**Notes:**
There were two medical behaviors that were significantly different between groups at posttest 

Having a living will and enrollment into a prescription program

- At post-test, the intervention group reported feeling significantly less intimidated by the health care system  (t35=2.999, p<..05)

## Perception of Knowledge

- Less confusion with:
- Medical terminology (t34=2.455, p<.05)
- Medical forms (t34=2.455, p<.05)
- Rx instructions (t34=2.455, p<.05)

- (t35=9.455)

**Notes:**
Although there were no significant differences at post-test on the overall knowledge scale, there were a few items that were:

## Patient Communication

- More frequently:
- Asking HCP to write down instructions for meds or medical treatments (t34=2.455, p<.05)
- Talking to HCP about side  effects of meds   (t34=1.925, p<.1)
- Calling HCP if they forgot medical instructions (t34=1.938, p<.1)

- (t35=2.455)

**Notes:**
Similarly, while there were no significant differences in the overall scale of patient communication, there were some items that were significantly different at post test

## (t35= -2.113, p<.05) 

- (t35= -2.113, p<.05)

- (t35= -2.020, p <..1)

**Notes:**
There were significant difference at post-test on two of the scales: beliefs regarding pt-provider relationship and the provider communication scale. On the belief scale, higher scores reflect a greater passivity with regard to medical care and greater trusting of the HCP to make decisions,   

## Conclusions

- Intervention was effective at making participants less trusting of their HCPs and less satisfied with their service...
- ... but there was also a shift toward more active participation in and responsibility for health care

**Notes:**
So, basically, the intervention was effective at making participants less trusting of their HCPs and less satisfied with their service...

And while this may sound like a bad thing, it seems to have occurred in tandem with a shift in taking a more active role in their health care.

## Questions?

- Thank you!