1. Health Literacy and Healthcare System Navigation Skills of the Older Adult Population
Michael Martinez, BSN-RN
A Capstone Presented to the Nursing Faculty of Western Governors University
in Partial Fulfillment of the Requirements
for the Degree:
Master of Science in Nursing, Education
Capstone Evaluator: Venessa Lee, Ed.D

2. Project Overview Overview and Purpose of the Study
A total of 52 older adults participated in this cross-sectional, population- based, quantitative descriptive study for the purpose of examining their perceptions in relation to their healthcare system navigation skills. This was conducted through an online platform using a structured, 12-item Likert scale survey, focusing on critical skills needed to effectively navigate the healthcare system as well as the identification of potential barriers to self-management of health.
Findings revealed that higher levels of education and socioeconomic status do not necessarily equate to greater confidence in navigating the healthcare system. This suggests that the U.S. healthcare system is too complex, placing unreasonably high demands on the older adult population. Furthermore, participants reported that interpreting accurate healthcare information is most challenging when disseminated by the media.
Specific and broad recommendations on how the healthcare system could be made easier to navigate were formulated for the general older adult population. The goal is to advocate for social justice and aid in the amelioration of health disparities in this vulnerable and marginalized population.

3. Development Process Chosen Project Topic Presentation
The Plight of Older Adults in Navigating the Healthcare System
Rationale for Chosen Project
The Increasing Number of Older Adults
The Resulting Health Disparities and Social Injustice
Consequences of Ineffective Healthcare System Navigation
Significance of the Chosen Project
Significance to the Nursing Profession

4. Development Process Chosen Project Problem Statement Possible Causes
There are various programs available to the older adult population. Unfortunately, the healthcare system is too complex that it may be preventing full access to such programs.  Therefore, the healthcare system should be streamlined to the point where most older adults are able to efficiently navigate the healthcare system. 
Possible Causes
Knowledge Providers and Knowledge Seekers
Research Question
How do older adults perceive their healthcare system navigation skills?

5. Existing Body of Knowledge
Best Practices in Healthcare System Navigation
Healthcare System Navigation and the Role of the U.S. Government
Plain Writing Act
Healthcare System Navigation and the Role of Healthcare Providers
Teach-back Technique
Healthcare System Navigation and the role of Older Adults
Overcome the Stigma of Illiteracy

6. Existing Body of Knowledge
Professional Literature Summary
Healthcare System Navigation and Reading Comprehension
The use of Grade-Level to Measure Comprehension
Rapid Estimate of Adult Literacy in Medicine (REALM)
Test of Functional Health Literacy in Adults (TOFHLA)
The Newest Vital Sign (NVS)
Healthcare System Navigation, Health Insurance Literacy, and Numeracy
Health insurance Terms
Complexities of the Medicare System
Healthcare System Navigation and Other Important Factors
Senescent Changes
Language Barrier
Cultural Factors

7. Methodology Setting Participants Research Design Instruments and Tools
SurveyMonkey Audience Platform
Participants
Total of 52 Older Adults
Study Criterion and Implied Criteria
Research Design
Population-Based, Cross-Sectional, Quantitative Descriptive Study
Instruments and Tools
Sociodemographic Data
Researcher Developed, 12-Item, Likert Scale Survey

8. Methodology Data Collection Research Method Implementation
Formulation of Problem Statement
Literature Review Process
Formulation of Research Question
Selection of Research Design
Approval Process
Survey Deployment
Cleaning the Raw Data
Data Analysis to Answer Research Question
Rationale for Adopting Research Method
Deviation from the Normative Process of Survey Research
Benefits of Online Survey

9. Methodology Protection of Human Subjects Maintaining Confidentiality
Coding and Time-Stamp
Protection of Identifiable Information
Maintaining Data Integrity
Protection of Data
Archiving the Data
Disposal of Data
Permissions
SurveyMonkey Audience Organizational Letter of Approval
WGU IRB Study Approval
Informed Consent Form

10. Results and Conclusions
Analysis of Data
Analysis of Participants’ Sociodemographic Composition
Racial, Cultural, and Ethnic Background
Distribution by Geographical Region
Relationship Status
Employment Status
Household Income
Education

11. Results and Conclusions
Analysis of Data
Analysis of the Likert Scale and the Measure of Central Tendency
Categories
Values
Mode 36
Median 38
Mean
38.71
Standard Deviation
6.61

12. Results and Conclusions
Analysis of Data
Analysis of the Likert Scale and the Measure of Central Tendency
Five-Number Summary

13. Results and Conclusions
Analysis of Data
Analysis of Individual Likert Items
Accessing Healthcare Information
Understanding Healthcare Information
Interpreting Healthcare Information
Applying Healthcare Information

14. Results and Conclusions
Discussion
Process of Obtaining Results
Raw Data Collection
Data Cleaning
Frequency Tables
Central Tendency
Sociodemographic Analysis
Likert Scale and Likert Item Analysis
Answering the Research Question
Education Levels and Confidence Navigating the HealthCare System
Difficulties with Interpreting Healthcare-Related Information
Self-Management of Health

15. Challenges and Issues
Challenges and Issues with Project Implementation
The Need for more Sociodemographic Characteristics
Racial, Cultural, or Ethnic Backgrounds
Relationship Status
Employment Status
The Lack of Age-Range Stratification
Miscommunication Issue
Skewed Findings
Single Outlier Affected the Mean
The Variable Remains Unknown

16. Strategies for Challenges and Issues
Solutions to Challenges and Issues
The Need for more Sociodemographic Characteristics
Strategy: The Addition of Sociodemographic Questions
The Lack of Age-Range Stratification
Strategy: The Limiting Factor for not Intervening
Skewed Findings
Strategy: The use of the Median as the Measure of Central Tendency
Strategy: Minimizing the Issue of Acquiescence Prior to Survey Deployment

17. Effectiveness of Strategies
Issue: The Need for more Sociodemographic Characteristics
Strategy: The Addition of Sociodemographic Questions
Effectiveness: Minimal due to homogeneity of racial or ethnic backgrounds
Issue: The Lack of Age-Range Stratification
Strategy: The Limiting Factor for not Intervening
Effectiveness: Unknown. Avoidance of issue
Issue: Skewed Findings
Strategy: The use of the median as the measure of central tendency
Effectiveness: Highly effective
Minimizing the Issue of Acquiescence Prior to Survey Deployment
Effectiveness: Unknown. Precautionary strategy

18. Strategy Predictions for Other Projects
Comprehensive Sociodemographic Questionnaire
Usefulness Depending on the Platform
Age-Range Stratification
The Critical Importance of Age-Range Stratification
Median as the Measure of Central Tendency
The Importance of Using the Mean for an Inferential Study
Likert Scale in Multiple-Choice Format
Acquiescence in Long Surveys

19. Weakness Identification
Generalizability of Study Findings to the Older Adult Population
Lack of Qualitative Data for In-Depth Analysis of Older Adults’ Perceptions on Healthcare System Navigation
Homogeneity in Relation to Racial, Culture, and Ethnic Backgrounds

20. Revisions to Strengthen the Study
Redesign the Research Study to Meet Inferential Study Requirements
Redesign as a Mixed-Method Study to Determine Reasoning Behind Perceptions
Random Stratified Sampling Mirroring the Racial, Ethnic, and Cultural Composition of Medicare Beneficiaries

21. Strength Identification
Population-Based National Study
Recommendations’ Applicability to the Majority of U.S. Older Adults
Recommendations Focusing on Health Systems Rather Than Older Adults

22. Strength Predictions to Other Projects
Population-Based Studies Allow the Input of Older Adults from Differing Sociodemographic and Socioeconomic Backgrounds.
Broad Recommendations and the use of Safety-Net Approach to Assist Disadvantaged and Marginalized Subpopulations.
Health Systems Recommendations Benefit the Majority of U.S. Older Adults Irrespective of General Literacy Levels.

23. Future Study Recommendations for Future Study
Qualitative Analysis of Older Adults’ Distrust Toward the Media
Correlation Studies Between Healthcare System Navigation and Sociodemographic and Socioeconomic Determinants of Health
Skills of Older Adults in Accessing Healthcare Information and Social Support Systems Through the Internet

24. Professional Work Environment
Holistic Care of Older Adults in a Public Health Setting Focused on Prevention
Incorporating Social Gerontology Issues in Teaching Settings
Advancing the Causes of Older Adults in the Health Policy Arena