Health literacy-listening skill and patient questions following cancer prevention and screening discussions.

OBJECTIVE: Patient question-asking is essential to shared decision making. We sought to describe patients' questions when faced with cancer prevention and screening decisions, and to explore differences in question-asking as a function of health literacy with respect to spoken information (health literacy-listening). METHODS: Four-hundred and thirty-three (433) adults listened to simulated physician-patient interactions discussing (i) prophylactic tamoxifen for breast cancer prevention, (ii) PSA testing for prostate cancer and (iii) colorectal cancer screening, and identified questions they would have. Health literacy-listening was assessed using the Cancer Message Literacy Test-Listening (CMLT-Listening). Two authors developed a coding scheme, which was applied to all questions. Analyses examined whether participants scoring above or below the median on the CMLT-Listening asked a similar variety of questions. RESULTS: Questions were coded into six major function categories: risks/benefits, procedure details, personalizing information, additional information, decision making and credibility. Participants who scored higher on the CMLT-Listening asked a greater variety of risks/benefits questions; those who scored lower asked a greater variety of questions seeking to personalize information. This difference persisted after adjusting for education. CONCLUSION: Patients' health literacy-listening is associated with distinctive patterns of question utilization following cancer screening and prevention counselling. Providers should not only be responsive to the question functions the patient favours, but also seek to ensure that the patient is exposed to the full range of information needed for shared decision making.

Training meals on wheels volunteers as health literacy coaches for older adults.

Homebound older adults constitute a "hardly reached" population with respect to health communication. Older adults also typically suffer from health literacy challenges, which put them at increased risk of adverse health outcomes. Suboptimal interactions with providers are one such challenge. Interventions to improve interactive health literacy focus on training consumers/patients in question preparation and asking. Meals on Wheels volunteers are uniquely suited to coach their clients in such interaction strategies. Seventy-three Meals on Wheels volunteers participated in workshops to train as health literacy coaches. The 3- to 4-hour workshops included units on communicating with older adults, on the nature of health literacy, and on the process of interactive health literacy coaching. Participants viewed and discussed videos that modeled the targeted communication behaviors for older adult patients interacting with physicians. They role-played the coaching process. After 9 months, coaches participated in a "booster" session that included videos of ideal coaching practices. Evaluation questionnaires revealed that participants had favorable reactions to the workshops with respect to utility and interest. They especially appreciated learning communication skills and seeing realistic videos. A measure of knowledge about the workshop material revealed a significant increment at posttest. Fidelity of coaching practices with respect to workshop curriculum was confirmed. This training in interactive health literacy for community-based lay volunteers constitutes one way to implement the National Action Plan to Improve Health Literacy for one "hardly reached" population. An online tool kit containing all workshop materials is available.

Listenability as a tool for advancing health literacy.

Health literacy research and practice has focused mainly on the readability of written documents. Yet oral communication plays at least as important a role in the interpersonal ecology in which people make real decisions about their health. Moreover, the single-minded quest for short sentences and simple vocabulary inherent in the readability paradigm can subvert the effort to engage in patient- or consumer-centered communication. Listenability is the quality of discourse that eases the cognitive burden that aural processing imposes. Listenability is a function of oral-based language plus "considerate" rhetorical structures. The Listenability Style Guide presented in this article offers evidence-based recommendations for producing listenable discourse. A study testing the applicability of the Listenability Style Guide to postsurgical discharge instructions was conducted. College students either heard or read discharge instructions composed in either high or moderate listenability. Comprehension was higher for this population in reading than in listening. Across modalities, the high listenability version was easiest to comprehend. Incorporating listenability concerns in research and practice is consistent with emerging, broad conceptions of health literacy and with the dictates of the National Action Plan to Improve Health Literacy.

Education Abroad and College Completion.

While some stakeholders presume that studying abroad distracts students from efficient pursuit of their programs of study, others regard education abroad as a high impact practice that fosters student engagement and hence college completion. The Consortium for Analysis of Student Success through International Education (CASSIE), compiled semester-by-semester records from 221,981 students across 35 institutions. Of those students, 30,549 had studied abroad. Using nearest-neighbor matching techniques that accounted for a myriad of potentially confounding variables along with matching on institution, the analysis found positive impacts of education abroad on graduation within 4 and 6 years and on cumulative GPA at graduation. A very small increase in credit hours earned emerged, counterbalanced by a small decrease in time-to-degree associated with studying abroad. Overall, the results warrant conclusions that studying abroad does not impede timely graduation. To the contrary, encouraging students to study abroad promotes college completion. These results held similarly for students who had multiple study abroad experiences, and who have studied abroad for varying program lengths.

Associations between older adults' spoken interactive health literacy and selected health care and health communication outcomes.

Recent trends in the conceptualization of health literacy lead toward expansive notions of health literacy as social practice, rather than as a narrower cognitive capacity to understand health-related texts and materials. These expansive and complex constructions of health literacy demand tools for assessing individuals' propensities to actively seek information in their interactions with health care professionals and other health information sources. This study proposes a measure of this information-exchange component of health literacy and examines its capacity to predict outcomes and processes such as satisfaction with health care and comprehension of spoken health messages. Results for this sample ( n = 334) of low socioeconomic status older adults (mean age = 74.70 years) reveal that indices derived from the Measure of Interactive Health Literacy (MIHL) do contribute unique variance-apart from document-based health-literacy--on several criterion measures such as satisfaction with health care services. Comprehension checking improved health message listening comprehension, but for White participants only. These findings invite further investigations of interactive health literacy involving different populations, message topics, and elicitation methods.

Associations of Health Literacy and Menu-Labeling Usage With Sugar-Sweetened Beverage Intake Among Adults in Mississippi, 2016.

PURPOSE: Examine association of health literacy (HL) and menu-labeling (ML) usage with sugar-sweetened beverage (SSB) intake among adults in Mississippi. DESIGN: Quantitative, cross-sectional study. SETTING: 2016 Mississippi Behavioral Risk Factor Surveillance System data. PARTICIPANTS: Adults living in Mississippi (n = 4549). MEASURES: Outcome variable was SSB intake (regular soda, fruit drinks, sweet tea, and sports/energy drinks). Exposure variables were 3 HL questions (find information, understand oral information, and understand written information) and ML usage among adults who eat at fast-food/chain restaurants (user, nonuser, and do not notice ML). ANALYSIS: Multinomial logistic regressions were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for SSB intake ≥1 time/d (reference: 0 times/d) associated with HL and ML. RESULTS: In Mississippi, 46.8% of adults consumed SSB ≥1 time/d, and 26.9% consumed ≥2 times/d. The odds of consuming SSBs ≥1 time/d were higher among adults with lower HL (aOR = 1.7; 95% CI = 1.3-2.2) than those with higher HL. Among adults who ate at fast-food/chain restaurants, the odds of consuming SSBs ≥1 time/d were higher among nonusers of ML (aOR = 2.3; 95% CI = 1.7-3.1) and adults who did not notice ML (aOR = 1.8; 95% CI = 1.3-2.6) than ML users. CONCLUSION: Adults with lower HL and adults who do not use or notice ML consumed more SSBs in Mississippi. Understanding why lower HL and no ML usage are linked to SSB intake could guide the design of interventions to reduce SSB intake in this population.

Factors leading to self-disclosure of a positive HIV diagnosis in Nairobi, Kenya: people living with HIV/AIDS in the Sub-Sahara.

Understanding why, how, and to whom people living with HIV/AIDS disclose their diagnosis to others is a critical issue for HIV prevention and care efforts, but previous investigations of those issues in sub-Saharan Africa have been limited to one or two questions included in quantitative studies of social support or stigma. Instruments and findings on serostatus disclosure based on U.S. populations are likely to be at best only partially relevant because of Africa's primarily heterosexual transmission vectors and highly communalistic social structures. This qualitative analysis of two male and two female focus groups comprised of persons living with HIV/AIDS (PLWHAs) in Nairobi, Kenya, revealed several HIVstatus disclosure patterns that appear distinctive to Africa. These include (a) intermediaries as vehicles for disclosure to family, (b) indirectness as a communication strategy, and (c) church pastors as common targets for disclosure.

Improving Interactive Health Literacy Skills of Older Adults: Lessons Learned From Formative Organizational Research With Community Partners.

BACKGROUND: Meals on Wheels (MOW) organizations are ideal community partners for delivering social support relating to health information exchange for vulnerable and home-bound older adults. OBJECTIVES: This article illustrates how formative organizational evaluation can be used to adapt health literacy interventions delivered by community partners. METHODS: Key informant interviews and ethnographic observations were conducted as part of a formative organizational evaluation of potential community partners. LESSONS LEARNED: The observed brevity of volunteer-client interaction led program planners to incorporate substantial emphasis on communicating with older adults into the health literacy coach training curriculum. Ethnographic observations made clear that program materials had to be portable and fit it in with the mobile nature of MOW delivery. CONCLUSIONS: Formative organizational research can greatly increase the chance of successful implementation of public health interventions when those interventions will be implemented in partnerships with community-based organizations in diverse settings and with varying practices.

Couples' communication on sexual and relational issues among the Akamba in Kenya.

A large portion of HIV transmission in sub-Saharan Africa occurs among married couples, yet the majority of research on safer-sex communication has focused on communication between couples in casual relationships. This paper explores how committed Kamba couples in Machakos District, Kenya, communicate about sensitive relational issues. The findings from focus group discussions with five groups of males and five groups of females are presented. The couples freely shared their thoughts about daily and economic issues and certain aspects of family planning and sexuality. Methods for raising sensitive issues with partners included monitoring the spouse's mood, gradual or indirect revelation, mentioning topics during sex, and use of third-party intermediaries. Interference by extended family members, especially husbands' mothers, and male authoritarian roles emerged as hindrances to effective communication between couples. The implications for HIV prevention regarding gender differences and the role of families in couples' communication are discussed.

Motivations and methods for self-disclosure of HIV seropositivity in Nairobi, Kenya.

This study employed structured interviews with 307 people living with HIV (PLHIVs) in Nairobi, Kenya to investigate their serostatus disclosure with respect to four types of relationships in their lives: partners, friends, family members, and religious leaders/clergy. Regarding motivations for disclosure, it was found that a sense of duty and seeking material support motivated disclosure to family and partners, fear of loss of confidentiality inhibited disclosure to friends, and the need for advice encouraged disclosure to religious leaders. The method of disclosure most frequently mentioned was direct, with males less likely than females to use direct methods when disclosing to spouses or partners. Intermediated disclosure was common in partner/spouse relationships with around one-third of partners preferring to disclose through a third party. Methods used to disclose as well as reasons for doing so varied by relationship type.