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Rachel Torres, MPH, CHESRachel Torres, MPH, CHES

Department of Health & Behavior Studies Department of Health & Behavior Studies

Teachers College, Columbia UniversityTeachers College, Columbia University

Relationships between Health Literacy, Relationships between Health Literacy, Self-efficacy and Knowledge of Hormone Self-efficacy and Knowledge of Hormone

Replacement Therapy Replacement Therapy

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Health LiteracyHealth Literacy

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

» Healthy People 2010Healthy People 2010

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Significance Significance

National objectives that may be addressed by the National objectives that may be addressed by the study include:study include:

– Institute of Medicine Institute of Medicine • Health Literacy: A Prescription to End ConfusionHealth Literacy: A Prescription to End Confusion, ,

2004 2004

• Priority Areas for Nation Action: Transforming Health Priority Areas for Nation Action: Transforming Health Care Quality, 2003 Care Quality, 2003

– Healthy People 2010 Healthy People 2010

– Joint Commission on Accreditation of Healthcare Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Organizations (JCAHO)

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Cost of Poor Health LiteracyCost of Poor Health Literacy

$73 billion dollars estimated $73 billion dollars estimated

– Because of Because of

• More hospitalizationsMore hospitalizations

• Ineffective use of prescriptions Ineffective use of prescriptions

• Misunderstanding of treatment plans Misunderstanding of treatment plans

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Research Design Research Design

Cross-sectional design utilizing survey methods Cross-sectional design utilizing survey methods

Measurement tools included: Measurement tools included:

– Knowledge about hormone replacement therapy toolKnowledge about hormone replacement therapy tool

– Decision self-efficacy Decision self-efficacy

– Efficacy beliefs and outcomes expectations Efficacy beliefs and outcomes expectations

– Shortened Test of Functional Health Literacy in Adults Shortened Test of Functional Health Literacy in Adults (sTOFHLA)(sTOFHLA)

Instrument reliability Instrument reliability

– Cronbach’s alpha for all instruments was well above .70 Cronbach’s alpha for all instruments was well above .70

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Research AimsResearch Aims

Explore the role of health literacy in a woman’s Explore the role of health literacy in a woman’s knowledge about hormone replacement therapy knowledge about hormone replacement therapy

Identify whether health literacy is an important Identify whether health literacy is an important factor in decision self-efficacy regarding hormone factor in decision self-efficacy regarding hormone replacement therapy replacement therapy

Explore whether there are differences among Explore whether there are differences among efficacy beliefs and outcome expectations between efficacy beliefs and outcome expectations between the inadequate, marginal and adequate functional the inadequate, marginal and adequate functional literacy subgroups literacy subgroups

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Data Collection Data Collection

English and Spanish speaking women between the English and Spanish speaking women between the ages of 45-65 at the Nagle Family Health Centerages of 45-65 at the Nagle Family Health Center

Distributed questionnaire after study information Distributed questionnaire after study information sheet sheet

Data collected between August and September Data collected between August and September 20052005

All collected data was collected by principal All collected data was collected by principal investigator and entered into SPSS 13investigator and entered into SPSS 13

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Data AnalysisData Analysis

Correlation analysis to determine association Correlation analysis to determine association between health literacy and:between health literacy and:

– knowledgeknowledge

– decision self-efficacydecision self-efficacy

Chi square testsChi square tests to examine differences in to examine differences in categorical data categorical data

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Select Demographic CharacteristicsSelect Demographic Characteristics

N (%)

Education (n=102) Education (n=102) Highschool or less Highschool or less Greater than Highschool Greater than Highschool

77 (73)77 (73)25 (27)25 (27)

Ethnicity (n=106)Ethnicity (n=106) Black Black CaucasianCaucasian HispanicHispanic

2 (2)2 (2)24 (23)24 (23)80 (75)80 (75)

Health literacy category (n=106)Health literacy category (n=106) Inadequate (0-16)Inadequate (0-16) Marginal (17-22)Marginal (17-22) Adequate (23-36)Adequate (23-36)

49 (46)49 (46)19 (18)19 (18)38 (36) 38 (36)

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Aim #1: Explore the role of health literacy in a woman’s Aim #1: Explore the role of health literacy in a woman’s knowledge about hormone replacement therapyknowledge about hormone replacement therapy (n=106) (n=106)

Ho: There is a Ho: There is a positivepositive relationship between relationship between health literacy and health literacy and knowledge about knowledge about hormone replacement hormone replacement therapytherapy

r = .819, p<.01Participants with higher health literacy have higher Participants with higher health literacy have higher

knowledge about hormone replacement therapy knowledge about hormone replacement therapy

1111

Ho: There is a Ho: There is a positivepositive relationship relationship between health between health literacy and decision literacy and decision self-efficacy self-efficacy

Aim #2: Identify whether health literacy is an important factor in Aim #2: Identify whether health literacy is an important factor in decision self-efficacy regarding HRT (n=106)decision self-efficacy regarding HRT (n=106)

r = .695, p<.01 Participants with higher health literacy have Participants with higher health literacy have higher decision self-efficacy higher decision self-efficacy

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Limitations Limitations

Sample of women at one particular clinic in Northern Sample of women at one particular clinic in Northern Manhattan Manhattan

Study only examined associations between variables Study only examined associations between variables of interest of interest

Individuals with low health literacy may have been Individuals with low health literacy may have been more likely to refuse participation because of more likely to refuse participation because of possible literacy burdenpossible literacy burden

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Conclusions Conclusions

Association between health literacy and: Association between health literacy and:

–Knowledge about hormone Knowledge about hormone replacement therapyreplacement therapy

–Decision self-efficacy Decision self-efficacy

Differences with efficacy beliefs but not Differences with efficacy beliefs but not with outcomes expectations between the with outcomes expectations between the three categories of health literacythree categories of health literacy

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Recommendations for Future ResearchRecommendations for Future Research

Patient education materials need to focus on more Patient education materials need to focus on more creative ways of communication instead of just creative ways of communication instead of just reliance on written materials reliance on written materials

Further explore the role of health literacy and Further explore the role of health literacy and decision self-efficacy on actual behaviordecision self-efficacy on actual behavior

Design programs that focus on health literacy and Design programs that focus on health literacy and self-efficacy self-efficacy

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Implications for Health EducationImplications for Health Education

May highlight the importance of low health literacy on May highlight the importance of low health literacy on knowledge of risks and benefits in disease knowledge of risks and benefits in disease management or prevention efforts management or prevention efforts

May add to limited body of research regarding health May add to limited body of research regarding health literacy and self-efficacy as this affects hormone literacy and self-efficacy as this affects hormone replacement therapy replacement therapy

May identify areas where effective tools and May identify areas where effective tools and interventions can be developed to make health care interventions can be developed to make health care information more accessible to individuals with low information more accessible to individuals with low literacy levelsliteracy levels