Date of Award

2016

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Charlene Pope

Second Advisor

Gayenell S. Magwood

Third Advisor

Bonnie P. Dumas

Fourth Advisor

Kevin Harris

Abstract

Background. Patients with limited health literacy (HL) are use fewer preventive services, access more emergent care and report poorer health outcomes than those with adequate literacy. Nurse have little consistent preparation to use HL competencies in practice, thus exacerbating risks for miscommunication and harm with patients of diverse literacy levels. Purpose. The purpose was crafting educational interventions to compare effects of two contrasting theoretical approaches on HL practice uptake including initial assessments of a HL competencies tool. Problem/Aims. For nine nurses and nursing faculty, did use of multidimensional versus functional HL educational strategies lead to changes in HL knowledge and HL- related behaviors in recorded standardized patient- nurse interactions? The four aims were to develop the Health Literacy Patient-Nurse Interaction Competencies Evaluation or HLP-NICE tool, craft two contrasting HL curricula and teaching approaches, evaluate intervention effects on HL knowledge and HL-related behaviors of participants, and then identify future research directions. Design/Theoretical Basis. A sequential mixed methods feasibility study design compared effects of the contrasting implementations on HL knowledge and HL-related behavior changes of the nine randomly assigned participants. Zarcadoolas, Pleasant & Greer’s multidimensional HL theoretical framework was integrated through HLP-NICE items and multidimensional teaching activities Procedures. Preliminary qualitative case study methodology shaped standardized patient, teacher and HLP-NICE development through individual cognitive, focus group and expert panel interviews. A quantitative two group between subjects design assessed study feasibility. HL experiences and changes in HL knowledge were based on the Health Literacy Knowledge and Experiences Survey or HLK-ES scores. Kalamazoo Essential Elements Communication Competencies-Adapted or KEECC-A and HLP-NICE ratings evaluated communication and HL-related behavior changes. Findings. HL knowledge did not increase overall for participants, nor was prior HL educational experience associated with HL knowledge gains. Increases in communication and HL-related behaviors were noted for both groups, although functional group gains were greater for KEECC-A communication ratings. Study implementation was feasible for enhancing short-term HL– related behavior changes although challenges existed in recruitment. Conclusions. Improving acceptability for participation, creating additional standardized HL training resources, enhancing educational strategies and strengthening HLP-NICE psychometric support is warranted to advance HL integration in nursing educational and clinical practice.

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All rights reserved. Copyright is held by the author.

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