PLAIN Health Indicators from an intercultural study in Health Literacy & Adherence by Lauten

PLAIN Health Indicators from an intercultural study in Health Literacy & Adherence

Indiana Center for Intercultural Communication, IUPUI

International Conference on Communication in Healthcare (ICCH)

Miami, FL, October 5, 2009

Presenter:

Kathryn Lauten, PhD, Associate Director, ICIC, IUPUI

Additional Research Team Members:

Marta Antón, Applied Linguistics, Spanish Linguistics, IUPUI

Julie Belz, Applied Linguistics, English, IUPUI

Ulla Connor, Applied Linguistics, English, Director ICIC, IUPUI

Elizabeth Goering, Communication, IUPUI

Paris Roach, Endocrinology, IUPUI

James Wolf, Sociology, IUPUI

Stephanie Balunda, ICIC

Amir Hayat, ICIC

With thanks to the Eli Lilly & Co. Foundation’s generous grant support

Funding

Project Title: The Project for Health Literacy and Patient Adherence

Funding Source: Eli Lilly and Co. Foundation

Project Duration: Aug. 2007 – July 2010 Grant Amount: $480,000

©Indiana Center for Intercultural Communication

Goal To develop a model of health literacy – PLAIN

Health – that explains (non)adherence among Diabetes Type 2 patients by determining the sources of information used by

patients about their disease by determining how that information is obtained,

processed and turned into practice by examining the construct of adherence through the

lens of patients’ life stories


Health Literacy

“Health Literacy” is an accepted umbrella term defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”

-- Ratzan and Parker (2000)


Restructuring the “Health Literacy” conversation

“Health Literacy” should be used to encompass reading, numeracy, speaking and listening ability, knowledge of medical terms, ability to navigate the health system, and ability to manage one’s health

ICIC aims to remove the confusion around the term “health literacy”, turn energy less toward explaining a term and more toward acting on meaning; suggests the use of “PLAIN Health indicators” as an umbrella term



PLAIN Health

Process -- of turning information into knowledge

Literacy -- functional literacy

Action -- turning knowledge into action

Intercultural Interactive Communication -- with health care providers, family and friends

Numeracy

Advocates idea of using plain language

“Understanding the relative contributions of direct and indirect pathways [between health literacy and health outcomes] is crucial for the development of effective interventions to improve health outcomes [...] First, it is clear that low literacy is not universally associated with poor self-reported adherence to medications for the few conditions examined to date. Other research, however, suggests that patients with low literacy may have initial difficulty with learning self-care behaviors and enacting them, but that with ongoing support and additional training, they can overcome these barriers.”

Pignone, M. P., & DeWalt, D. A. (2006). Literacy and health outcomes: Is adherence the missing link? Journal of General Internal Medicine, 21(8), 896-897.

Understanding the link to adherence



Working Model

Variables Operationalization

Dependent Variable

Adherence to Medication 3 Questions (see page 2 of hand-out)

Independent Variables

Literacy variables• Patient Information Leaflet (PIL) Comprehension• General Health Literacy• Information Sources

Psychological Construct Variables• Life Orientation (from Locus of Control: Rotter, 1966;

Wallston, Wallston & DeVellis, 1978; Ferraro, Price, Desmond, & Roberts, 1987; Stënström, Wikby, Per-Olof, Rydén, 1998; O’Hea, Grothe, Bodenlos, Bourdreaux, White, Brantley, 2005)

• Agency (Bandura, 1982 & 1986; duPre, 2004; Chou, 2004)

• Affect (Martin and White, 2005; Martin, 2000)

Comprehension test (see page 3)

3 Questions (see page 4 of handout)

Survey (see page 3 of handout)

Agency Model: Ordered Probit Analysis

Control Variables

Age *

Ethnicity (non-Hispanic White)

Gender

Household Income

Years of Education

High Agency – Food *

High Agency – General Diabetes Management *

“No Comprehension” score on PIL test **

+

+

Perfect Adherence

to Medication

+

* = p < 0.05** = p < 0.1

Affect Insecurity Model: Ordered Probit Analysis

Control Variables

Age *


Gender

Household Income

Years of Education

Total Instances of Insecurity *

Perfect Adherence

to Medication

-

* = p < 0.05

Affect Dissatisfaction Model: Ordered Probit Analysis

Control Variables

Age *


Gender

Household Income

Years of Education

Total instances of Dissatisfaction *

Perfect Adherence

to Medication

-

* = p < 0.05

Next Steps Examine relationships between Life Orientation, Agency, and

Affect

Examine relationship of information sources to knowledge and action

Finish analysis of Spanish-language data (see next slides)

Operationalize the PLAIN Health Indicators modelProcess, Literacy, Action, Interaction, Numeracy

Poster presentation gives more details as well as practical application in the session immediately following this panel.

Percentage of Respondents Who Rate Various Sources of Information for Managing Diabetes as "Poor" or "Don't use"

0% 10% 20% 30% 40% 50% 60% 70% 80%

Doctors

TV/Radio News

TV/Radio Ads

Family

Brochures

Diabetes Education Programs

Labels on Prescriptions

Magazine Articles

Friends

Books

Print Ads

Written Info from Pharmacists

Spoken Information from Pharmacists

Other Health Care Providers

Internet

SpanishEnglish

Percentage of Respondents Who Rate Various Sources of Information for Managing Diabetes as "Excellent" or" Very Good"

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Internet

Friends

Spoken Info from Pharmacists


Written Information from Pharmacists

Print Ads

Magazine Articles

Family

Books

TV News

TV Ads

Prescription Labels

Brochures

Diabetes Education Programs

Doctors

SpanishEnglish

Percentage of Respondents Who Rate Various Sources of Infomation for Managing Diabetes as "Poor" or "Don't use"

0% 10% 20% 30% 40% 50% 60% 70% 80%

Brochures

Diabetes Education Program

Books

Print Advertisements

Written Information fromPharmacists


Internet

SpanishEnglish

Spanish 27% 27% 41% 41% 41% 45% 68%

English 7% 12% 21% 21% 14% 29% 44%

BrochuresDiabetes Education Program

BooksPrint

Advertisements

Written Information from

Pharmacists


Internet

Percentage of Respondents Who Rate Various Sources of Information for Managing Diabetes as "Excellent" or "Very Good"

0% 10% 20% 30% 40% 50% 60%

Print Advertisements

TV Advertisements

Brochure

SpanishEnglish

Spanish 36% 45% 55%

English 14% 21% 30%

Print Advertisements TV Advertisements Brochure

PLAIN Health Indicators from an intercultural study in Health Literacy & Adherence by Lauten

Health & Medicine

Transcript of PLAIN Health Indicators from an intercultural study in Health Literacy & Adherence by Lauten