CHRC | Research Projects

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Mar 30, 2014 - Center Publications ... literacy coaches for vulnerable older adults. Meals on ... (e.g., re-calling the provider or calling a health information line).
CHRC | Research Projects

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This research project tests a model of Meals on Wheels (MOW) volunteers/drivers as health literacy coaches for vulnerable older adults.   Meals on Wheels volunteers/drivers are providing patient communication tools—“Good Questions for Good Health” which are based on the widely endorsed Ask-Me-3 protocol--to improve their elderly clients’ ability to interact with health care providers.  Interpersonal communication with providers is an element of health literacy that yields the most credible and actionable information for patients, yet it is too rarely addressed in health literacy improvement programs.  Poor interactional health literacy results in low utilization of health services, lack of satisfaction with physicians and other health professionals, incomplete or erroneous comprehension of one’s health status, low rates of compliance with medical orders, and low self-efficacy for health.  Elderly individuals, many of whom suffer chronic illness, and for whom the linkage between health literacy and health status is especially strong, are particularly at risk for several of these negative outcomes. Most commonly, efforts to improve interactional health literacy are proceeded by training health professionals in communication skills.  The complementary approach, educating patients about health communication and preparing them in advance of medical encounters, is less well developed.  “Good Questions for Good Health” advance health literacy by helping patients to become more participative in consultations with their doctor.  They learn to prepare and ask questions, to paraphrase, and to assert their health narratives and negotiate their health agendas.  Meals on Wheels volunteers/drivers possess several characteristics that make them ideal health literacy coaches for their clients.  First, they interact with their elderly and largely homebound clients regularly in the intimate setting of their homes (though some clients dine at congregate sites), where they provide a vital and appreciated service.    The volunteer becomes a part of the elderly client’s social support network, a network which is central to health literacy.  Considerable evidence documents the importance of receiving health information from trusted messengers.  Second, given repeated visits to the homes of clients, it is very likely a volunteer/driver will know when clients face a prospective medical encounter (e.g., an upcoming physician consult, a dental or podiatric treatment, or a nutrition education session).  Volunteers thus have the opportunity to prepare clients to communicate with their providers quite proximally to the point of need. Finally, Meals on Wheels volunteers have opportunities to coach interactional health literacy over time and at various levels of involvement. Rather than one-shot training, they can continuously reinforce their clients’ health communication behaviors and can also encourage certain follow up action (e.g., re-calling the provider or calling a health information line).  Previous studies by key personnel confirm that Meals on Wheels volunteers can indeed monitor and deliver health and safety information to their clients. Thus, this project pursues the following objectives: Evaluate the effectiveness of Meals on Wheels volunteers/drivers as health literacy coaches to improve elderly patients’ skills in communicating with their providers. Evaluate effects of patient communication tools on elderly patients’ satisfaction, comprehension, compliance, health self-efficacy, and interactional health literacy. Investigate barriers to effective patient-provider communication among the elderly. Revise current conceptions of health literacy to better represent the central role of interpersonal interaction in health information seeking and decision making. This project initially works with Meals on Wheels in selected metropolitan and rural counties in Georgia, but has national applicability. Meals on Wheels programs operate in all 50 states and serves well over three million individual clients, most of them with daily contact. 

http://chrc.uga.edu/research/[30/03/2014 10:53:38 PM]

CHRC | Research Projects  The research design is primarily a pretest/posttest randomized control treatment study with two conditions: (1) Zero Coaching; and (2) On-going Health Literacy Coaching.  Following each of four medical encounters spaced throughout the 12-month intervention, participants in the on-going coaching group will be interviewed about the impact of the Health Literacy Coaching on each of those events. Figure One shows the sequence of activities in each of the groups over the twelvemonth intervention. Pretest/Posttest measures for clients in both conditions are collected in face-to-face sessions and include the following: a. Assessment of written health literacy--short form of the Test of Functional Health Literacy in Adults (Parker, Baker, Williams & Nurss, 1995) b. Assessment of interactional health literacy—an investigator-devised measure in which the participant responds interactively to a telephone call conveying information regarding vaccination recommendations for older adults.  Measures of health literacy participation include (1) proportion of time in which client speaks, (2) number of implicit and explicit questions which the client spontaneously asks (see Cegala, et all, 2001), (3) number of explicit questions the client asks upon prompting,  and (4) client comprehension checking (Robinson & Whitfield, 1985). c. General satisfaction with health care professional interactions and health status— 12 items from the Medicare Current Beneficiary Survey (Adler, 1994) that have been shown in at least two other studies (see Wolff & Roter, 2008) to factor into three subscales: (1) provider technical skills, (2) provider information giving, and (3) provider interpersonal skills d. Barriers to getting health questions answered by health care providers—six items from the HINTS questionnaire (see National Cancer Institute, 2006). e. Self-rated health status and presence of 14 chronic conditions—items from the Medicare Current Beneficiary Survey. f. “Good Questions for Good Health” recall (post-test only) Participants in Condition 2 (On-going Health Literacy Coaching) will provide health professional interaction evaluations following each of four coached interactions.  The following measures are being used: a. Satisfaction with the recent health care professional interaction—adapted from the 12 satisfaction items from the Medicare Current Beneficiary Survey.  These items will factor into three subscales: (1) provider technical skills, (2) provider information giving, and (3) provider interpersonal skills. b. Usefulness of the “Good Questions for Good Health” (three Likert-type items). c. Self-reported comprehension of the provider’s orders (three items) d. Self-reported intention to comply with the provider’s orders (three items) e. Open-ended narrative of communication barriers and facilitators during the interaction back to top

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http://chrc.uga.edu/research/[30/03/2014 10:53:38 PM]

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