Promoting Health Literacy and Self-Care Management with

Inmates

D. Young, C. Weinert, G. Kouame, J. Keery & I. Frye

College of Nursing, Gallatin County Detention Center & National Network of Libraries of

Medicine

dyoung@montana.edu

Bozeman, Montana

Gallatin County Detention Center

Definition of Health Literacy

“The degree to which individuals have the capacity to obtain, communicate, process, and understand basic health information and services needed to make appropriate health decisions.”

- Affordable Care Act (ACA)

What is the Greatest Predictor of Health Outcomes?

• Age• Race• Income• Education• Employment• Health literacy

Why Promote Health Literacy?

• Nearly 9 out of 10 adults have difficulty using everyday health information

• Health literacy is the #1 predictor of health outcomes

• Inmates have high incidence of chronic health conditions (80-90% vs 50% for all US)

• Chronic health conditions account for 75% of all health care expenditures and 70% of all deaths

Poor Health Literacy Leads to:• Lower use of preventive care services• Greater use of emergency care• Frequent hospitalizations• Poor self-care management• Unhealthy behaviors• Poor health outcomes & premature deaths• Higher health care costs (loss of $238

billion/yr)

Why Inmates & Health Literacy?

• Poor health literacy = poor health outcomes• Low literacy levels• High incidence of chronic health conditions• Poor self-care management• 9 out of 10 have no health insurance• Frequent users of high cost emergency

services upon release

Why Inmates & Health Literacy?

Inmates Have High Incidence of Chronic Health Conditions

• Asthma• Hypertension• Tuberculosis• Diabetes• Hepatitis• HIV/AIDS• Substance Abuse & Mental Health Issues

Inmates Have High Mortality Rates After Release

• Drug overdose• Cardiovascular disease• Homicide• Suicide• Cancer• Liver disease• HIV

Goal of the Project

To improve the health literacy, self-care management skills and personal health care decision-making of inmates incarcerated in the county jail

Objectives of the Project

• To enhance the capacity of inmates in their understanding of locating, evaluating and using basic health information

• To motivate inmates to take more responsibility for their own health care

• To increase the inmate’s understanding of the importance in seeking assistance from local librarians after release

Experimental Design• Target Population – adult men scheduled to be

housed in the jail more than 21 days• Timetable – 10 weekly sessions, seven inmates

per session, involving a total of 70 inmates • Class Format – – Six handouts provided on day one– Instructed classes 2.5 hrs/day – M, W, F– Self study classes 2 hrs/day – T & Th

What was the Biggest Challenge?

Constructing a Health Information Internet-in-a-Box Offline System• MedlinePlus• Understanding Medical Words: A Tutorial

from the National Library of Medicine• USDA SuperTracker• Plain Language Medical Dictionary• 12 Power Point Presentation• 42 videos

Internet-in-a-Box Offline System

12 PPT Presentations on the CD

• Computer Basics• What is Health Literacy?• My Health Companion © & Other Resources• Advocacy and Self-Care• Prevention and Screening• Sexually Transmitted & Infectious Diseases

12 PPT Presentations (con’t)

• Tobacco Epidemic• Mental Illness• The Science of Addiction• Nutrition• Oral Health• Library Resources

Experimental Design

• Project announced to inmates• Participating inmates selected• Informed Consent forms signed• Pre-Survey Questionnaires filled out

Experimental Design (con’t)

• Six Handouts:–My Health Companion ©– Staying Healthy Student Resource Book– Coping with Stress Student Book – Talking with Your Doctor– Seeking Drug Abuse Treatment: Know What to

Ask– the List – Community Resources for Gallatin

County

General Population Pod

Inmate Meeting Room

Results• 55 participants recruited• 39 completed all class session and pre-and

post-surveys• Age range – 19-69 (mean of 35.4 years)• Marital status– 13 % married– 41 % divorced– 39 % never married– 7 % other (2 % widowed; 5 % common law)

Results (con’t)

• Likelihood to use handout materials: – “the List” – 49 %– Seeking Drug Abuse Treatment - 44 %– Coping with Stress – 44 %– Talking with your Doctor – 36 %– Staying Healthy – 33 % – My Health Companion © – 29 %

• Strengths and Weaknesses• Other Comments

Results (con’t)

• Unfortunately with the small number of 39, we cannot say anything definite about the outcomes

• There was a noted increase in confidence in seeking health care and understanding the health care system

• There was a noted increase in knowledge of using My Health Companion © & Staying Healthy

Local Key Collaborators

• Gallatin County Detention Center (County Jail)• Montana State University (Extension, College

of Nursing, & Library)• Gallatin City-County Health Department• Gallatin Mental Health Center• Bozeman Public Library• Healthy Roads Media

National Key Contributors• National Network of Libraries of Medicine,

Pacific Northwest Region, Uof WA• National Library of Medicine, NIH, DHHS–MedlinePlus– Understanding Medical Words

• United States Department of Agriculture– SuperTracker

• Taubman Health Sciences Library, University of Michigan– Plain Language Medical Dictionary

The Future of ACA and Inmates

Who’s Eligible for ACA Health Insurance Marketplaces?

• The only requirements to get insurance through the Marketplace are:– You must live in the U.S.– You must be a U.S. citizen or national (or lawfully

present)– You can’t be currently incarcerated

http://www.healthcare.gov/marketplace/about/eligibility/

ACA Ten Essential Health Benefits• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services• Prescription drugs• Rehabilitative and habilitative services and devices• Laboratory services• Preventive and wellness services and chronic disease

management• Pediatric services, including oral and vision care

Q & A Time

Contact Information

• David Young• Extension/College of Nursing• P.O. Box 172230• Bozeman, MT 59717-2230• E-mail: dyoung@montana.edu• Phone: (406) 994-5552