Health Literacy, Health Outcomes and Equity: A Trend Analysis Based on a Population Survey.

Health literacy continues to be an issue among minority groups. Population surveys are one strategy used to help better understand health disparities. The Behavioral Risk Factor Surveillance System (BRFSS) in Kansas added health literacy questions to the survey in 2012. This study examined population health literacy levels and health trends from 2012 to 2018. The health status variables included health care coverage status, general health rating, presence of chronic conditions, and length of time since the last check-up. The percentage of individuals reporting low health literacy decreased from 67% in 2012 to 51% in 2018. The percentage of participants with income levels less than $15 000 was 9% in 2012 and 7% in 2018. Health literacy was lowest among the age group 18 to 24-year-olds, those who identified as multiracial, separated, not graduated from high school, out of work for more than 1 year, income less than $10 000, with other living arrangements, and living in a suburban county of metropolitan statistical area. Additionally, many health conditions improved, and those reporting health insurance increased slightly. The study demonstrates how health literacy continues to be an issue, and how education and primary prevention are necessary to improve limited health literacy and health outcomes. Findings from both state-level and national BRFSS population surveys can help educate the public health and clinical health services workforce to provide better care and address health disparities for highrisk populations.

Assessment of COVID-19 Knowledge Among University Students: Implications for Future Risk Communication Strategies.

The purpose of this study was to describe population knowledge and beliefs about COVID-19 and current social media coverage to address a gap in what is known about risk communication during health crises. A survey with 27 questions was developed. Twenty-three percent (N = 1,136) of respondents started the survey. Less than half of the students reported a high health literacy level (43%, n = 365/855). When asked where students have heard about COVID-19, the majority reported the Internet and social media. Students reported a basic level of COVID-19 knowledge, but few students (18%, n = 173/966) correctly identified all three signs and/or symptoms of COVID-19. Results highlight the need for an increased public health presence on social media and the urgent need to remain diligent in educating community members about COVID-19 myths.

Identifying Health Literacy in Kansas Using the Behavioral Risk Factor Surveillance System.

Health literacy continues to be an important research topic as part of population-based assessments for overall health issues. The objective of this continuation study was to examine the health literacy rates and health outcomes as measured by the Kansas Behavioral Risk Factor Surveillance System (BRFSS) survey. A cross-sectional research design was used. Health literacy data were extracted from the state-specific module of the BRFSS telephone survey. Demographic and health status variables were extracted from the core BRFSS dataset. The association between demographic and health status characteristics with health literacy was obtained using weighted samples in multivariable logistic regression models. As in the previous study, most respondents had moderate health literacy (61.1%), followed by high health literacy (31.4%) and low health literacy (7.5%). The demographic variables of interest included race, marital status, home ownership, insurance status, metropolitan status code, survey language, veteran status, education, employment, income, sex, and age. The health status variables included general health rating, presence of chronic conditions, and length of time since last check-up. Findings include individuals with low levels of health literacy were nearly 7 times as likely to be unsure of at least one health condition than those with high health literacy and demonstrate a broad gap in people's ability to communicate accurate information to health-care providers. Results can inform future efforts to build programs that address health disparities issues including low health literacy to provide equitable health-care services. There is a continued need for support for the creation of health literate programs.

Improving Latino Health Equity Through Spanish Language Interpreter Advocacy in Kansas.

INTRODUCTION: Federal law requires any agency receiving federal aid to take "reasonable steps" to provide meaningful access to qualified limited English proficient (LEP) individuals. However, policies for the provision of language access services, including medical interpretation, vary substantially by state. The Latino population and the number of LEP individuals in the U.S. state of Kansas have grown substantially over the past 20 years, necessitating increased attention to the state's language access policies. METHOD: Though a review of previous research, we present health disparities affecting Latinos in Kansas, examine the state's language access policies for health care, and argue that health disparities could be reduced through improved language access. FINDINGS: While Kansas reimburses health care entities for interpreter services associated with Medicaid, the state has no health care interpreter competency requirements. As a result, LEP persons, primarily Spanish speakers, may be left to navigate through complex hospital systems with inadequate guidance in their language and may be at an increased risk for medical errors due to language barriers. CONCLUSION: We suggest changes that could be implemented to improve access and reduce health disparities affecting Latinos in Kansas and across the United States, and we describe work that is currently underway to support these changes.

Validation of a Single Question Health Literacy Screening Tool for Older Adults.

Objectives: Health Literacy skills are important for people of all ages. Older adults have the lowest health literacy rates. The purpose of this study was to assess health literacy rates and validate the use of a screening tool with older adults. Methods: Participants included a convenience sample, age 65 years or older, English speaking with corrected vision of 20/100 or better and typical cognitive skills. Participants completed the 36-item Short Test of Functional Health Literacy Assessment (STOFHLA) and a single item screening (SIS) tool. Results of STOFHLA and SIS were compared using nonparametric statistics. Results: Of the 64 participants, 94% had adequate scores on the STOFHLA, while 64% self-reported confidence in filling out medical forms, p = .006, χ2 = 7.606, df(1). Conclusion: Results suggest that use of health literacy screening tools for older adults may be of value. Additional studies are needed to expand the study sample and validate the findings of this study.

Promoting Health for All Kansans Through Mass Media: Lessons Learned From a Pilot Assessment of Student Ebola Perceptions.

OBJECTIVE: We aimed to assess student knowledge of Ebola virus disease (EVD) and opinions about media coverage of EVD. METHODS: We conducted a pilot study with a cross-sectional survey and a convenience sample. RESULTS: Sixty-five college students participated in the survey and reported a low level of basic knowledge of EVD, high health literacy levels, and Internet and health professionals as sources for health information. CONCLUSION: This pilot study was an important first step to understanding students' knowledge of Ebola, common sources of health information, and health literacy levels. Results from this study highlight the need to improve health communication training and further evaluate the quality of health information dissemination via all communication sources. (Disaster Med Public Health Preparedness. 2016;10:641-643).

Infant Mortality and Race in Kansas: Associations With Women, Infants, and Children Services.

BACKGROUND: Racial and ethnic minority infants and mothers have worse birth outcomes than Caucasian infants and mothers, specifically infant mortality. The purpose of this pilot study was to compare infant mortality rates from vital statistic data between mothers who participated in the Women, Infants, and Children (WIC) Program and the general population in Kansas. METHODS: A retrospective secondary analysis of data received from the Kansas Department of Health and Environment (KDHE) was conducted. Data were provided on all mothers who delivered a child in the state of Kansas from 2009 to 2011. The data received from KDHE included maternal demographics, infant deaths, infant gestational age, infant weight at birth, and WIC program participation. RESULTS: The overall infant mortality rate was 6.4 per 1000 births. Infant mortality for Caucasians was lower than for non-Caucasians. Infant mortality for blacks was greater than for non-blacks. Being Hispanic was not statistically associated with a difference in infant mortality. WIC program participation was associated with lower infant mortality in both blacks and Hispanics. After adjusting for WIC, infants born to black mothers were still more than twice as likely to die when compared with Caucasian infants. WIC services were not statistically associated with a reduction in infant mortality. Mother's education showed a significant protective effect on the likelihood of infant death. CONCLUSION: The WIC program is associated with positive outcomes at the national level. However, widespread reductions in health disparities have not been reported. Differences in education levels between mothers affected infant mortality to a greater degree than WIC program participation alone in the analysis. The infant mortality rate for black and Hispanic mothers was lower for WIC program participants. The WIC program may be beneficial for reducing infant mortality racial disparities but program participation should be expanded to affect maternal health disparities at the population level.

Health Literacy and Older Adults: A Systematic Review.

Objective: The objective of this review was to assess published literature relating to health literacy and older adults. Method: The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Results: Eight articles met inclusion criteria. All studies were conducted in urban settings in the United States. Study sample size ranged from 33 to 3,000 participants. Two studies evaluated health-related outcomes and reported significant associations between low health literacy and poorer health outcomes. Two other studies investigated the impact of health literacy on medication management, reporting mixed findings. Discussion: The findings of this review highlight the importance of working to improve health care strategies for older adults with low health literacy and highlight the need for a standardized and validated clinical health literacy screening tool for older adults.

Health Literacy Assessment of the STOFHLA: Paper versus electronic administration continuation study.

Low health literacy is associated with poor health outcomes. Research is needed to understand the mechanisms and pathways of its effects. Computer-based assessment tools may improve efficiency and cost-effectiveness of health literacy research. The objective of this preliminary study was to assess if administration of the Short Test of Functional Health Literacy in Adults (STOFHLA) through a computer-based medium was comparable to the paper-based test in terms of accuracy and time to completion. A randomized, crossover design was used to compare computer versus paper format of the STOFHLA at a Midwestern family medicine residency program. Eighty participants were initially randomized to either computer (n = 42) or paper (n = 38) format of the STOFHLA. After a 30-day washout period, participants returned to complete the other version of the STOFHLA. Data analysis revealed no significant difference between paper- and computer-based surveys (p = .9401; N = 57). The majority of participants showed "adequate" health literacy via paper- and computer-based surveys (100% and 97% of participants, respectively). Electronic administration of STOFHLA results were equivalent to the paper administration results for evaluation of adult health literacy. Future investigations should focus on expanded populations in multiple health care settings and validation of other health literacy screening tools in a clinical setting.

"Necesita una vacuna": what Spanish-speakers want in text-message immunization reminders.

Appointment reminders help parents deal with complex immunization schedules. Preferred content of text-message reminders has been identified for English-speakers. Spanish-speaking parents of children under three years old were recruited to develop Spanish text-message immunization reminders. Structured interviews included questions about demographic characteristics, use of technology, and willingness to receive text reminders. Each participant was assigned to one user-centered design (UCD) test: card sort, needs analysis or comprehension testing. Respondents (N=54) were female (70%) and averaged 27 years of age (SD=7). A card sort of 20 immunization-related statements resulted in identification of seven pieces of critical information, which were compiled into eight example texts. These texts were ranked in the needs assessment and the top two were assessed for comprehension. All participants were able to understand the content and describe intention to act. Utilizing UCD testing, Spanish-speakers identified short, specific text content that differed from preferred content of English-speaking parents.

Content of text messaging immunization reminders: what low-income parents want to know.

OBJECTIVE: The purpose of this project was to gather preliminary data on preferred content for text reminders sent to low-income parents. METHODS: A brief, IRB-approved survey was administered to 200 consecutive English-speaking parents of children under 6 years old at a Pediatric Residency clinic. Because text messages can hold only limited content, parents were given three example texts ranging from very basic to very specific information and asked to select the information they would wish to receive. RESULTS: Of the 190 parents (95%) who responded, 22.1% (42) were Hispanic and 76.3% (145) were non-Hispanic. Over 80% (153) received Medicaid. Of the 79.5% (151) of respondents interested in receiving text messages who responded to the question regarding content, nearly 50% (74) preferred Option 2, with the remaining respondents divided between Option 1 (43) and Option 3 (35). Results differed significantly between Hispanic and non-Hispanic respondents (χ(2)(2)=6.36, p=0.042). CONCLUSION: The majority of parents preferred a message containing the child's name, specific immunization information and physician information. However, Hispanic respondents were significantly more likely to endorse an option that included additional information. PRACTICE IMPLICATIONS: Text messaging may be an optimal vehicle for provider-patient communication, however cultural differences should be considered when developing messages.

Preparedness needs assessment in a rural State: themes derived from public focus groups.

Recent studies have assessed preparedness training and the resource needs of public health and clinical professionals in responding to a crisis, but few have assessed the needs of the general public, especially in rural areas. The present study, based in a risk assessment and information-seeking theoretical framework, assessed the preparedness awareness, knowledge, and attitudes of the general public in a rural state through a series of focus groups. Six focus groups were conducted with 34 participants in 4 locations in Kansas (2 urban and 2 rural). Focus group interviews followed a standardized script. Participants from all 4 locations reported training and knowledge needs and desired training, knowledge, and emergency preparedness plans. Certain groups also reported a lack of familiarity with preparedness terminology, as well as different ideas about trusted sources and agencies responsible for providing preparedness training or information. Some diverging opinions from these focus groups were stratified by urban/rural status, indicating possible implications for future all-hazards training in rural regions of the nation. These results may be used for planning and improving training for the general public in both urban and rural areas.