1. Promoting Health Literacy and
Self-Care Management with
Inmates
D. Young, C. Weinert, G. Kouame, J. Keery
& I. Frye
College of Nursing, Gallatin County Detention
Center & National Network of Libraries of
Medicine
dyoung@montana.edu

2. Bozeman, Montana

3. Gallatin County Detention Center

4. Definition of Health Literacy
“The degree to which individuals have the
capacity to obtain, communicate, process, and
understand basic health information and
services needed to make appropriate health
decisions.”
- Affordable Care Act (ACA)

5. What is the Greatest Predictor of
Health Outcomes?
• Age
• Race
• Income
• Education
• Employment
• Health literacy

6. Why Promote Health Literacy?
• Nearly 9 out of 10 adults have difficulty using
everyday health information
• Health literacy is the #1 predictor of health
outcomes
• Inmates have high incidence of chronic health
conditions (80-90% vs 50% for all US)
• Chronic health conditions account for 75% of
all health care expenditures and 70% of all
deaths

7. Poor Health Literacy Leads to:
• Lower use of preventive care services
• Greater use of emergency care
• Frequent hospitalizations
• Poor self-care management
• Unhealthy behaviors
• Poor health outcomes & premature deaths
• Higher health care costs (loss of $238
billion/yr)

8. Why Inmates & Health Literacy?
• Poor health literacy = poor health outcomes
• Low literacy levels
• High incidence of chronic health conditions
• Poor self-care management
• 9 out of 10 have no health insurance
• Frequent users of high cost emergency
services upon release

9. Why Inmates & Health Literacy?

10. Inmates Have High Incidence of
Chronic Health Conditions
• Asthma
• Hypertension
• Tuberculosis
• Diabetes
• Hepatitis
• HIV/AIDS
• Substance Abuse & Mental Health Issues

11. Inmates Have High Mortality Rates
After Release
• Drug overdose
• Cardiovascular disease
• Homicide
• Suicide
• Cancer
• Liver disease
• HIV

12. Goal of the Project
To improve the health literacy, self-care
management skills and personal health care
decision-making of inmates incarcerated in
the county jail

13. Objectives of the Project
• To enhance the capacity of inmates in their
understanding of locating, evaluating and
using basic health information
• To motivate inmates to take more
responsibility for their own health care
• To increase the inmate’s understanding of the
importance in seeking assistance from local
librarians after release

14. Experimental Design
• Target Population – adult men scheduled to be
housed in the jail more than 21 days
• Timetable – 10 weekly sessions, seven inmates
per session, involving a total of 70 inmates
• Class Format –
– Six handouts provided on day one
– Instructed classes 2.5 hrs/day – M, W, F
– Self study classes 2 hrs/day – T & Th

15. What was the Biggest Challenge?

16. Constructing a Health Information
Internet-in-a-Box Offline System
• MedlinePlus
• Understanding Medical Words: A Tutorial
from the National Library of Medicine
• USDA SuperTracker
• Plain Language Medical Dictionary
• 12 Power Point Presentation
• 42 videos

17. Internet-in-a-Box Offline System

20. 12 PPT Presentations on the CD
• Computer Basics
• What is Health Literacy?
• My Health Companion © & Other Resources
• Advocacy and Self-Care
• Prevention and Screening
• Sexually Transmitted & Infectious Diseases

21. 12 PPT Presentations (con’t)
• Tobacco Epidemic
• Mental Illness
• The Science of Addiction
• Nutrition
• Oral Health
• Library Resources

22. Experimental Design
• Project announced to inmates
• Participating inmates selected
• Informed Consent forms signed
• Pre-Survey Questionnaires filled out

23. Experimental Design (con’t)
• Six Handouts:
– My Health Companion ©
– Staying Healthy Student Resource Book
– Coping with Stress Student Book
– Talking with Your Doctor
– Seeking Drug Abuse Treatment: Know What to
Ask
– the List – Community Resources for Gallatin
County

24. General Population Pod

25. Inmate Meeting Room

26. Results
• 55 participants recruited
• 39 completed all class session and pre-and
post-surveys
• Age range – 19-69 (mean of 35.4 years)
• Marital status
– 13 % married
– 41 % divorced
– 39 % never married
– 7 % other (2 % widowed; 5 % common law)

27. Results (con’t)
• Likelihood to use handout materials:
– “the List” – 49 %
– Seeking Drug Abuse Treatment - 44 %
– Coping with Stress – 44 %
– Talking with your Doctor – 36 %
– Staying Healthy – 33 %
– My Health Companion © – 29 %
• Strengths and Weaknesses
• Other Comments

28. Results (con’t)
• Unfortunately with the small number of 39,
we cannot say anything definite about the
outcomes
• There was a noted increase in confidence in
seeking health care and understanding the
health care system
• There was a noted increase in knowledge of
using My Health Companion © & Staying
Healthy

29. Local Key Collaborators
• Gallatin County Detention Center (County Jail)
• Montana State University (Extension, College
of Nursing, & Library)
• Gallatin City-County Health Department
• Gallatin Mental Health Center
• Bozeman Public Library
• Healthy Roads Media

30. National Key Contributors
• National Network of Libraries of Medicine,
Pacific Northwest Region, Uof WA
• National Library of Medicine, NIH, DHHS
– MedlinePlus
– Understanding Medical Words
• United States Department of Agriculture
– SuperTracker
• Taubman Health Sciences Library, University
of Michigan
– Plain Language Medical Dictionary

31. The Future of ACA and Inmates

32. Who’s Eligible for ACA Health
Insurance Marketplaces?
• The only requirements to get insurance through
the Marketplace are:
– You must live in the U.S.
– You must be a U.S. citizen or national (or lawfully
present)
– You can’t be currently incarcerated
http://www.healthcare.gov/marketplace/about/eligibility/

33. ACA Ten Essential Health Benefits
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease
management
• Pediatric services, including oral and vision care

35. Q & A Time

36. Contact Information
• David Young
• Extension/College of Nursing
• P.O. Box 172230
• Bozeman, MT 59717-2230
• E-mail: dyoung@montana.edu
• Phone: (406) 994-5552