1. School of Nursing Health Literacy: A Factor in Translation of Evidence Jacqueline Dunbar-Jacob, PhD, RN, FAAN J. Erlen, L. Burke, C. Stilley, C. Bender, J. Lingler, M. Styn, M. McCall, & S. Sereika University of Pittsburgh School of Nursing Supported by NIH NINR P01NR010949

2. School of Nursing Objectives 1.Describe health literacy of community samples which were recruited for research studies examining factors associated with translation of adherence interventions 2.Describe the relationship of health literacy to adherence and regimen conduct

3. School of Nursing Health Literacy is an Important Factor in Translating Evidence-Based Interventions What Do We Know?

4. School of Nursing 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

5. School of Nursing Health Literacy “The capacity of individuals to obtain, interpret and understand basic health information and services and the competence to use such information and services in ways which enhance health” Joint Committee on National Health Education Standards (1995)

6. School of Nursing Health Literacy “A constellation of skills that constitute the ability to perform basic reading and numerical tasks for functioning in the health care environment and acting on health care information.” AHRQ Evidence Report/Technology Assessment: Number 87 (2004)

7. School of Nursing National Assessment of Adult Literacy (NAAL) 2003 12% Proficient 53% Moderate 22% Basic 14% Below Basic National Center for Education Statistics, 2003 Health Literacy Level

8. School of Nursing Adherence and HRQOL: Translation of Interventions (NIH NINR P01-NR010949) 4 RCTs with Cognitive Behavior Interventions Common Assessment of Factors which Potentially Would Affect Their Translation in Practice Settings

9. School of Nursing Health Literacy Assessment Newest Vital Sign – brief screening tool –Prose: understand and use written information –Numeracy: use numbers found in written materials –Documents: understand and use forms, charts, graphs Internal Consistency  =.76 Prediction of TOFHLA.88 area under ROC Curve Score <2 sensitivity 72%, specificity 87% Weiss et al, Annals of Family Medicine, 2011 Medical Futures Forum, New York, NY, 2005

10. School of Nursing We Will Report on Health Literacy in 3 Studies: Stilley/Bender et al: Medication Adherence in Diabetes Burke et al: Weight Reduction in Healthy Adults Erlen/Lingler et al: Medication Management by Caregivers

11. School of Nursing Overall Sample of 296 S s 44% - Obese 30% - Diabetic 26% - Caregivers

12. School of Nursing Pooled Sample Socio-demographics & Between Study Differences Male 83 (28.4%)  2 = 18.4 df=2p =.000 Married 181 (61.1%)  2 = 17.05 df=2p =.000 White 221 (71.3%)  2 = 22.9 df=2 p =.003 Employed 160 (56.6%)  2 = 74.2 df=2 p =.000 Health Ins. 288 (97.3%)  2 = 3.3 df=2 p =.193 Age M 59.4 + 12.3F = 46.7p =.000 Education M 15.0 + 3.1F = 12.56p =.000 # in Household M 2.4 + 3.7F = 1.83p =.163

13. School of Nursing Study Differences in Socio-demographics ObeseDiabeticCaregiver Male22 (16.9%)39 (43.3%)22 (28.9%) Married75 (57.7%)45 (50%)61 (80.3%) White92 (70.8%)55 (61.1%)64 (84.2%) Employed107 (82.3%)37 (42.2%)16 (21.9%) Health Ins.129 (99.2%)86 (95.6%)73 (96.1%) Age53.01 + 9.5661.97 + 10.467.38 + 12.73 Education15.88 + 3.0713.8 + 2.514.97 + 3.5 # in Household 2.82 + 5.37 1.87 +.87 2.4 + 1.03  2 = 17.02 df = 2 p =.000

14. School of Nursing Study Samples Differed on All Socio-Demographic Variables EXCEPT Health Insurance

15. School of Nursing Pooled Sample Literacy Scores & Between Study Differences  2 = 30.467 df = 4 p =.000 F = 18.685 p =.000 PooledObesityDiabeticCaregiver High Likelihood of Limited Literacy 4.7% 3.1% 2.2%10.5% Possible Limited Literacy28.9% 9.2%33.3%28.9% Adequate Literacy73.6%87.7%64.4%60.5%

16. School of Nursing Prose M = 1.6 +.7(1.47 – 1.75) Numeracy M = 1.4 +.8( 1.0 – 1.76) Document M = 1.4 +.7 (1.09 – 2.0) *Where 1 = high likelihood of limited literacy 3 = adequate literacy Pooled Sample Specific Literacy & Between Study Differences* F = 18.69 p =.000

17. School of Nursing Different Studies May Yield Different Findings We were just as surprised by the test results as you. We’re still scratching our heads over it.

18. School of Nursing Overall, the Health Literacy Was Higher Than The Population Data Would Predict

19. School of Nursing However, Data Variation Across Studies Raises Questions: 1.Are Patients With Higher Literacy More Likely to Participate in Research Studies? 2.Will Literacy Impact Success of Intervention in Research Studies? 3.How Do Studies of Interventions Conducted in a Higher Literacy Population Translate to Populations with Lower Literacy?

20. School of Nursing Presenters in the Symposium: Lora E. Burke, PhD, RN, Professor Descriptive Study of Health Literacy Among Adults Seeking Weight Loss Treatment Catherine M. Bender, PhD, RN, Professor Health Literacy and Chronic Disease Management Judith A. Erlen, PhD, RN, Professor Health Literacy among Informal Caregivers of Persons with Memory Loss