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Health Literacy on Wheels: Interactive
  Health Literacy for Older Adults

                  Don Rubin
                Vicki Freimuth
              Mumbi Okundaye
                 John Parmer
                  Terry Kaley
                  Sarah Mink                       Presented at
             The University of Georgia             American Academy
                                                   on Communication in
                                                   Healthcare
                                                   October, 2010



                              The University of Georgia


                              Center for Health & Risk Communication
What is interactive health literacy?

Health Literacy as information
transmission:




                      The University of Georgia


                      Center for Health & Risk Communication
What is interactive health literacy?
Health Literacy as interactive
process:




                      The University of Georgia


                      Center for Health & Risk Communication
“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



                                                     The University of Georgia


                                                      Center for Health & Risk Communication
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



                                                                  The University of Georgia


                                                                  Center for Health & Risk Communication
Objectives for patient/consumer
interactive health literacy
•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)                 The University of Georgia


                               Center for Health & Risk Communication
Health Literacy on Wheels




              The University of Georgia


              Center for Health & Risk Communication
Why Meals on Wheels?

• MOW drivers are trusted and
  welcomed visitors
• Know clients
• E.g., MOWAA smoke alarms
• E.g., Maximizing Brief Encounters




                     The University of Georgia


                     Center for Health & Risk Communication
Health Literacy on Wheels
  Driver            Drivers deliver intervention                      Booster
Training &                                                            Training
                                                                      & Post-
 Pretests
                                                                       testing



               Zero      • Meals as usual
             Coaching
  Client                                                                                 Post-
Informed                                                                                testing
consent &                                                              Video
 Pretests                • Ask-Me-3 materials Good Health
                           Good Questions for
               Health                                                    2
              Literacy   • Videos
             Coaching
                         • Coaching


                         1st Coaching       2nd Coaching      3rd Coaching           Capstone

                            •Post-             •Post-            •Post-                •No data
                             appointment        appointment       appointment           collection
                             analysis           analysis          analysis



                             Moths 1-8
                                                                             Month        Month
                                 Months 1-8
                                                                               9           12
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)               The University of Georgia


                             Center for Health & Risk Communication
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)             The University of Georgia


                           Center for Health & Risk Communication
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
                         The University of Georgia


                         Center for Health & Risk Communication
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
                         The University of Georgia


                         Center for Health & Risk Communication
Preliminary finding #1: Information seeking
utterances predict health status; S-TOFHLA does not




                  R=.58                                    R=.10



                              The University of Georgia


                              Center for Health & Risk Communication
Preliminary finding #2: Information seeking utterances
    predict health self-efficacy; S-TOFHLA does not




                     R=.36                                  R=.13


                                The University of Georgia


                                Center for Health & Risk Communication
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.
                            The University of Georgia


                            Center for Health & Risk Communication
Questions/Contact
Don Rubin
drubin@uga.edu


Center for Health & Risk
 Communication
www.chcr.uga.edu
                   The University of Georgia


                   Center for Health & Risk Communication
Questions?




      The University of Georgia


      Center for Health & Risk Communication

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Health Literacy on Wheels: Interactive Health Literacy for Older Adults

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