Revising Recruitment for Focus Groups to Meet Shifting Needs During COVID-19.

BACKGROUND: The COVID-19 pandemic forced researchers to modify recruitment strategies to meet accrual goals for qualitative studies. Traditional methods of in-person recruiting and using paper marketing material were eliminated almost overnight at the onset of the pandemic. Researchers quickly adapted their recruitment strategies, but researchers had to shift local, in-person recruitment efforts to solely using online platforms. The shifting recruitment strategies were accompanied with unexpected challenges, but we were able to meet our accrual goal for focus groups. OBJECTIVES: The objective of this brief report is to explore new recruitment strategies that developed during the COVID-19 pandemic and offer suggestions for future online-based qualitative studies. RESULTS: Prior to COVID-19, we designed four main strategies (research registry, marketing material, social media, and provider endorsement) to recruit potential participants for focus groups as part of a qualitative, descriptive study involving young women breast cancer survivors. After the onset of COVID-19, we successfully adapted each of our initial four strategies to recruit potential participants in an incremental process. Using these adapted strategies, a total of 62 young women completed the first part of the data collection process prior to participating in a focus group. Thirty-three women participated in the focus groups, and the remaining 29 participants were lost to follow-up. The vast majority of participants were recruited through marketing material and social media after making strategic changes to recruitment. DISCUSSION: The most effective method of recruitment was the strategic use of marketing material and social media, and we offer suggestions for researchers considering online recruitment methods. We recommend that researchers use various social media platforms and specific hashtags and target their sample population at the onset of the study. The data collection changes initiated by the effects of COVID-19 may remain, and researchers can consider implementing permanent recruitment strategies to best meet the needs of this new landscape of conducing online focus groups.

What's in Between the Lines: Assessing the Readability, Understandability, and Actionability in Breast Cancer Survivorship Print Materials.

Educational print materials for young women breast cancer survivors (YBCS) are supplemental tools used in patient teaching. However, the readability of the text coupled with how well YBCS understand or act upon the material are rarely explored. The purpose of this study was to assess the readability, understandability, and actionability of commonly distributed breast cancer survivorship print materials. We used an environmental scan approach to obtain a sample of breast cancer survivorship print materials available in outpatient oncology clinics in the central region of a largely rural Southern state. The readability analyses were completed using the Flesch-Kincaid (F-K), Fry Graph Readability Formula (Fry), and Simple Measure of Gobbledygook (SMOG). Understandability and actionability were analyzed using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). The environmental scan resulted in a final sample of 14 materials. The mean readability of the majority of survivorship materials was "difficult," but the majority scored above the recommended 70% in both understandability and actionability. The importance of understandability and actionability may outweigh readability results in cancer education survivorship material. While reading grade level cannot be dismissed all together, we surmise that patient behavior may hinge more on other factors such as understandability and actionability. Personalized teaching accompanying print material may help YBCS comprehend key messages and promote acting upon specific tasks.

Health Literacy Evaluation of Opioid Patient Education Materials for Orthopaedic Surgery.

Increased opioid use in the United States has resulted in greater incidence of misuse. Orthopaedic patients are more likely to be prescribed opioids for pain. Low health literacy is related to opioid misuse; therefore, orthopaedic patient education tools on use of opioids must be easy to read, understand, and use for patients of all skill levels to be effective. This project aimed to review a broad array of opioid patient education tools and evaluate them from a health literacy perspective. Content evaluation revealed that not all tools expressed the same essential messaging. The mean readability score of the tools assessed was 9.5 grade; higher than the national and recommended 8th-grade reading level. Therefore, many opioid patient education tools may be difficult for patients to read and understand. Improvements in readability and other health literacy best practices are recommended to improve reading, comprehension, and use of opioid patient education tools. (Journal of Surgical Orthopaedic Advances 28(3):232-236, 2019).

Health Literacy Among a Formerly Incarcerated Population Using Data from the Transitions Clinic Network.

Health literacy is increasingly understood to be a mediator of chronic disease self-management and health care utilization. However, there has been very little research examining health literacy among incarcerated persons. This study aimed to describe the health literacy and relevant patient characteristics in a recently incarcerated primary care patient population in 12 communities in 6 states and Puerto Rico. Baseline data were collected from 751 individuals through the national Transitions Clinic Network (TCN), a model which utilizes a community health worker (CHW) with a previous history of incarceration to engage previously incarcerated people with chronic medical diseases in medical care upon release. Participants in this study completed study measures during or shortly after their first medical visit in the TCN. Data included demographics, health-related survey responses, and a measure of health literacy, The Newest Vital Sign (NVS). Bivariate and linear regression models were fit to explore associations among health literacy and the time from release to first clinic appointment, number of emergency room visits before first clinic appointment and confidence in adhering to medication. Our study found that almost 60% of the sample had inadequate health literacy. Inadequate health literacy was associated with decreased confidence in taking medications following release and an increased likelihood of visiting the emergency department prior to primary care. Early engagement may improve health risks for this population of individuals that is at high risk of death, acute care utilization, and hospitalization following release.

Readability of Patient Educational Materials for Total Hip and Knee Arthroplasty.

This study aimed to evaluate patient education materials that are focused on total hip arthroplasty (THA) and total knee arthroplasty (TKA) using health literacy best practices and plain language principles as frameworks. Readability assessments were conducted on a sample of nine patient education documents that are commonly given to THA and TKA surgery patients. Mean readability scores were compared across the sample. The mean readability grade level for the nine arthroplasty educational documents analyzed in this study was 11th grade (10.5). The mean readability ranged from 9th to 12th grade. The documents in this study were written at levels that exceed recommendations by health literacy experts. Health literacy best practices and plain language principles were suggested to reduce the demands on patients so that the documents are easier to understand. Incorporating health literacy best practices into patient education materials for THA and TKA can contribute to improved communication with patients that is necessary for patient understanding and satisfaction. (Journal of Surgical Orthopaedic Advances 27(1):72-76, 2018).

A Perioperative Patient Support System Was Unable to Mitigate the Risk of Hospital Readmission for Total Hip Arthroplasty Patients With High American Society of Anesthesiologists Grades.

BACKGROUND: Utilization of a patient support system including a patient "navigator" to maintain patient engagement upon discharge home has successfully reduced the number of hospital readmissions after arthroplasty procedures. Although successful in a general patient population, the ability of the support system to reduce readmissions in subsets of "high-risk" patients has not been evaluated. METHODS: We identified 878 primary total hip arthroplasties (THAs) performed at a single institution between 2013 and 2015. A binary regression was used to determine if a model of patient factors could accurately predict readmission, and the individual effects of each factor on readmissions were assessed. RESULTS: No combination of patient factors was able to accurately predict the need for hospital readmission. However, those with American Society of Anesthesiologists (ASA) grades 3 or 4 (32/375 [8.8%]) were twice as likely to be readmitted than those with ASA grades 1 or 2 (23/503 [4.4%], P = .02; odds ratio = 2.0 [95% CI = 1.2-3.6], P = .01). CONCLUSION: Maintaining routine communication with the patient and surgeon's office throughout the postoperative period successfully reduced readmission rates for those with low ASA grades; however, implementing this program did not lessen the risk of readmission for patients with greater comorbidity burdens. Future studies are necessary to determine if interventions to medically optimize patients with high ASA grades can reduce readmission rates, but until such time, risk adjustment methodologies are necessary to avoid financial penalties for readmissions for high-ASA grade patients that have been repeatedly demonstrated to be at an inherently increased risk.

Effect of Total Joint Arthroplasty Surgical Day of the Week on Length of Stay and Readmissions: A Clinical Pathway Approach.

BACKGROUND: The demand for total joint arthroplasty (TJA) is increasing at the same time that alternative payment models place increased scrutiny on the cost of these procedures. Using a clinical pathway model, this study aimed to examine the effect of day of surgery on length of stay (LOS). METHODS: A retrospective electronic chart review was conducted on 2968 cases over 20 months at a single hospital. Least square means analysis of the effect of surgical day of the week on LOS was conducted using Statistical Analysis Software 9.3, followed by Tukey's multiple comparison test. Logistic regression assessed the effect of surgical day of week on readmission. RESULTS: Within the primary TJA group, there was no significant difference in mean LOS for each day of the week (1.17, 1.32, 1.29, 1.27, and 1.27 for Monday through Friday, respectively). Of all days, mean LOS for revision TJA (1.51, 1.57, 1.57, 2.49, and 2.03) only differed significantly for Thursday (P < .0001), although in adjusted analysis with age and American Society of Anesthesiologist, this difference was no longer significant (P = .3954). Readmission was likewise not significantly affected by surgical day of week (chi sq = 1.426, P = .8396) in the sample. CONCLUSION: As the volume of joint arthroplasties increases and alternative payment models are implemented, programs that promote decreased LOS regardless of operative day of the week are critical. Practices can use clinical pathway models to reduce costs related to LOS while maintaining a high level of patient care.

Health Literacy and Opioid Use in Orthopaedic Patients.

Opioid misuse has been linked to patient health literacy. This study aimed to estimate the prevalence of low health literacy in a sample of orthopaedic patients on opioids. Data were extracted from an electronic medical record database using queries that included an 8-month time frame, active status in an orthopaedic clinic, ICD-10 codes for opioids, and health literacy screening results. In the study sample of 8963 orthopaedic patients, 7103 had opioids in their current chart. Of those patients with opioids in their chart, 1547 had inadequate health literacy as measured by a validated health literacy screening question. Because approximately 22% of orthopaedic patients on opioids may also be at high risk for low health literacy, practices should consider identifying these patients and following national recommendations to tailor patient education so that these patients can better understand the risks, benefits, and dosing of opioids.

Implementation of a health-literate patient decision aid for chest pain in the emergency department.

OBJECTIVE: The aim of this study was to investigate the implementation of a new health-literacy-tested patient decision aid for chest pain in Emergency Department (ED) patients. Outcomes included disposition, knowledge, decisional conflict and satisfaction prior to discharge. Patient health literacy was explored as a factor that may explain disparities in sub-group analysis of all outcomes. METHODS: A health-literacy adapted tool was deployed using a pre/post intervention design. Patients enrolled during the intervention period were given the adapted chest pain decision aid that was used in conversation with their emergency medicine physician to decide on their course of action prior to being discharged. RESULTS: A total of 169 participants were surveyed and used in the final analysis. Patients in the usual care group were 2.6 times more likely to be admitted for chest pain than patients in the intervention group. Knowledge scores were higher in the intervention group, while no significant differences were observed in decisional conflict and patient satisfaction, or by patient health literacy level. CONCLUSION AND PRACTICE IMPLICATIONS: Using the adapted chest pain decision tool in emergency medicine may improve knowledge and reduce admissions, while addressing known barriers to understanding related to patient health literacy.

Barriers and solutions to implementing a pragmatic diabetes education trial in rural primary care clinics.

INTRODUCTION: The purpose of this report is to describe barriers and solutions to the implementation and optimization of a pragmatic trial that tests an evidence-based, patient-centered, low literacy intervention promoting diabetes self-care in rural primary care clinics. METHODS: The two-arm pragmatic trial has been implemented in six rural family medicine clinics in Arkansas. It tests a self-management education and counseling intervention for patients with type 2 diabetes compared to enhanced usual care. Barriers and solutions were identified as issues arose and through interviews with clinic directors and clinic administrators and a focus group, interviews, and tracking reports with clinic health coaches who delivered the intervention. RESULTS: Barriers to optimizing enrollment, intervention delivery, and data collection were addressed through targeted education of and relationship building with leadership, changing enrollment oversight, and ongoing training of health coaches. CONCLUSIONS: Successful implementation and optimization of this pragmatic clinical trial in rural primary care clinics was achieved through establishing common goals with clinic leadership, minimizing demands on clinic staff and administration, frequent contact and ongoing support of health coaches, and collaborative troubleshooting of issues with delivering the intervention.

Evaluating the Effectiveness of the How to Talk to Your Doctor HANDbook Program.

BACKGROUND: Millions of Americans have low health literacy, potentially leading to a number of issues including medication errors, hospital admissions, unnecessary emergency department visits, skipped screenings and shots, and misinterpretation of treatment plans. People with low health literacy have less knowledge of illness management, less ability to share in decision-making, and poorer self-reported health status. Addressing health literacy is necessary to improve health care quality, reduce costs, and reduce disparities. OBJECTIVE: The How to Talk to Your Doctor (HTTTYD) HANDbook Program addresses health literacy among rural participants who have low incomes, with a focus on improving health communication among populations that are medically vulnerable by using the HANDbook tool. METHODS: Participants were recruited from 55 rural counties by county extension agents (CEA) to participate in the 1-hour HTTTYD session. Pre- and post-test surveys were completed. A subset of the sample completed a 3-month follow-up survey. KEY RESULTS: Of the 548 participants who fully completed the survey, a Wilcoxon Signed-Rank Test was performed on 484 of the participants who completed both the pre- and post-test. A statistically significant median increase in overall confidence among the participants from pre- (M = 15.99) to post-test (M = 17.76), (z = 13.454, p = .000), was noted. A subset of 166 participants also completed the 3-month follow-up survey. A significant increase in health literacy after participation in the HTTTYD HANDbook program from pre-test to 3-month follow-up was noted; effect sizes ranged from moderate to large. CONCLUSION: The HTTTYD HANDbook program meets recommendations for successful health literacy programs; significant positive outcomes demonstrate program effectiveness. HTTTYD HANDbook program delivery in rural communities by CEAs demonstrates access to understudied and often difficult-to-reach populations. [HLRP: Health Literacy Research and Practice. 2019;3(2):e103-e109.]. PLAIN LANGUAGE SUMMARY: The How to Talk to Your Doctor HANDbook program delivered by county extension agents in rural communities showed capacity to access understudied and often difficult-to-reach populations. The significant, sustained improvement in health literacy noted among program participants demonstrated program effectiveness among those with low health literacy.

Development and Implementation of the How to Talk to Your Doctor HANDbook Health Literacy Program in Rural Counties.

BACKGROUND: Improvements in health literacy are unlikely without intervention in community settings. However, interventions appropriate for delivery in these settings are lacking, limiting reach to rural adults who are disproportionately affected by low health literacy and poor health outcomes. The How to Talk to Your Doctor (HTTTYD) HANDbook Program was developed through a research-practice partnership to educate rural residents to effectively advocate and participate in their own health care. BRIEF DESCRIPTION OF ACTIVITY: We describe development of the HTTTYD HANDbook Program delivered through the Cooperative Extension Service to educate adults who are eligible for Medicaid and have low health literacy. HTTTYD HANDbook implementation is described using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework (and specifically the reach, adoption, implementation, and maintenance dimensions). IMPLEMENTATION: The HTTTYD HANDbook was developed using health literacy best practices with user-centered design, and it was field tested with community members with varying levels of health literacy. Reach, adoption, implementation, and maintenance of the HTTTYD HANDbook were assessed by tracking distribution of HTTTYD HANDbook Program materials, return submission of evaluation and tracking instruments, adherence to program and data collection/submission protocols, and program continuation. RESULTS: Overall reach into the population was 6 per 10,000; about 25% were Medicaid recipients and 28.2% had low health literacy. Most participants were age 65 years or older. Of the 72 counties with program access, 52.7% requested HTTTYD HANDbook Program materials; 31% adopted the program, but only 30% of these counties adhered to program implementation and data collection protocols. Reach and adoption were higher among rural counties, and rural counties were more likely than nonrural counties to maintain the HTTTYD HANDbook Program. LESSONS LEARNED: The HTTTYD HANDbook Program addresses barriers to engagement in patient-provider communication for rural, low-income community members. Programs can be implemented in community settings through established local organizations, such as county extension offices, to increase access for rural adults. Implementation barriers included staff turnover and transportation of program materials. Online facilitator training availability had little impact on adherence to program protocols. Organizational context and established procedures for program delivery and evaluation should be considered in adoption decisions and integrated into implementation protocols. [HLRP: Health Literacy Research and Practice. 2019;3(3):e205-e215.]. PLAIN LANGUAGE SUMMARY: The How to Talk to Your Doctor HANDbook Program was created with people from the community to help patients prepare for doctor visits. The How to Talk to Your Doctor HANDbook Program helps patients to overcome barriers to talking to their doctor so that they can better understand how to get healthy and stay healthy.

Screening Patients Who Speak Spanish for Low Health Literacy.

BACKGROUND: Inadequate health literacy is a national health problem that affects about 90 million people from all racial and ethnic groups in the United States. Conceptual and empirical models of health literacy position language as one of the most significant contributors to health literacy. OBJECTIVE: A validated Spanish health literacy screening question asks how confident patients are at filling out medical forms, but it does not clarify whether the forms are in English or in Spanish, contributing to ambiguity and potentially affecting validity. The purpose of this study was to compare responses to questions that clarified the language of the forms referenced in the validated screening question; to explore how the clarified items predicted scores on a measure of health literacy; and to compare the predictive ability of the clarified health literacy items to that of a question about patients' self-reported English proficiency. METHODS: Participants who speak Spanish (N = 200) completed the following surveys: Spanish Health Literacy Screening Question that clarified "English forms" (HLSQ-E) and that clarified "Spanish forms" (HLSQ-S), self-reported English proficiency (SEP), demographic questions, the Short Test of Functional Health Literacy for Adults Spanish (S-TOFHLA-S), and the Newest Vital Sign-Spanish (NVS-Spanish). KEY RESULTS: Participants reported less confidence with English medical forms than Spanish forms. The sensitivity of screening approaches varied; each predicted inadequate health literacy on the NVS-Spanish and S-TOFHLA-S with different levels of sensitivity, specificity, and accuracy. In general, the HLSQ-E was a better predictor of inadequate health literacy than the HLSQ-S; however, the SEP performed nearly as well as the HLSQ-E. CONCLUSION: "How confident are you at filling out medical forms in English…" more appropriately identified patients with inadequate health literacy who speak Spanish. Health literacy screening practices should consider the patient's language and the language of the health care system and use questions that are less ambiguous. [HLRP: Health Literacy Research and Practice. 2019;3(2):e110-e116.]. PLAIN LANGUAGE SUMMARY: This project focused on patients who speak Spanish and who have a hard time understanding health information. We wanted to find out the best ways to identify these patients so that doctors and nurses can be sure to give them information in ways that they can understand. We tested screening questions that can identify these patients.

Readability of Human Subjects Training Materials for Research.

Institutions are required to ensure that persons involved in human subjects research receive appropriate human subjects protections training and education. Several organizations use the Collaborative Institutional Training Initiative (CITI) program to fulfill training requirements. Most researchers find the CITI program too complex for community members who collaborate with researchers. This study aimed to determine the readability of CITI modules most frequently used in community-based participatory research (CBPR). The mean readability level of the CITI modules is 14.8 grade; CBPR readability levels ranged from 11.6 to 12.0 grade (sixth- to eighth-grade reading level is recommended). With a baseline objective measure, modifications can be made to improve the plain language quality and understandability of human subjects training modules for community members.

An Assessment of Organizational Health Literacy Practices at an Academic Health Center.

BACKGROUND: Organizational health literacy is the degree to which an organization considers and promotes the health literacy of patients. Addressing health literacy at an organizational level has the potential to have a greater impact on more health consumers in a health system than individual-level approaches. OBJECTIVE: The purpose of this study was to assess health care practices at an academic health center using the 10 attributes of a health-literate health care organization. METHODS: Using a survey research design, the Health Literate Healthcare Organization 10-Item Questionnaire was administered online using total population sampling. Employees (N = 10 300) rated the extent that their organization's health care practices consider and promote patients' health literacy. Differences in responses were assessed using factorial analysis of variance. RESULTS: The mean response was 4.7 on a 7-point Likert scale. Employee training and communication about costs received the lowest ratings. Univariate analyses revealed that there were no statistically significant differences (P = .05) by employees' health profession, years of service, or level of patient contact. There were statistically significant differences by highest education obtained with lowest ratings from employees with college degrees. CONCLUSIONS: Survey responses indicate a need for improvements in health care practices to better assist patients with inadequate health literacy.

Health literacy and surgery expectations in total hip and knee arthroplasty patients.

OBJECTIVES: This study assessed patients' health literacy and expectations for total hip (THA) and total knee (TKA) replacement surgery, and compared health literacy levels of patients and their caregivers. METHODS: A convenience sample of 200 THA/TKA participants, patients and their caregivers, participated in this study. RESULTS: Results demonstrated no statistical difference in health literacy between patients and their caregivers. However, patients with lower health literacy had significantly lower expectations for walking after surgery. CONCLUSIONS: Practices should be aware that caregivers may not be any better equipped to consume and use complicated patient education materials than the patient they are assisting. Additionally, lower health literacy, rather than or in addition to race or social factors, may contribute to disparities in opting for THA/TKA because of lower expectations for walking after surgery. PRACTICE IMPLICATIONS: Healthcare practices should develop patient educational materials that are easy for all patients and caregivers to understand, especially those with low health literacy. Additional patient education and counseling may help patients with low health literacy realistically align their expectations and mitigate barriers to consenting to surgery due to low expectations.

Rationale and development of a randomized pragmatic trial to improve diabetes outcomes in patient-centered medical homes serving rural patients.

Proper diabetes self-care requires patients to have considerable knowledge, a range of skills, and to sustain multiple health behaviors. Self-management interventions are needed that can be readily implemented and sustained in rural clinics with limited resources that disproportionately care for patients with limited literacy. Researchers on our team developed an evidence-based, patient-centered, low literacy intervention promoting diabetes self-care that includes: 1) the American College of Physicians (ACP) Diabetes Guide that uses plain language and descriptive photographs to teach core diabetes concepts and empower patients to initiate behavior change; 2) a brief counseling strategy to assist patients in developing short-term, explicit and attainable goals for behavior change ('action plans'); and 3) a training module for health coaches that prepares them to assume educator/counselor roles with the Diabetes Guide as a teaching tool. While the intervention has previously been field tested and found to significantly improve patient knowledge, self-efficacy, and engagement in related health behaviors, its optimal implementation is not known. This project took advantage of a unique opportunity to modify and disseminate the ACP health literacy intervention among patients with type 2 diabetes cared for at rural clinics in Arkansas that are Patient-Centered Medical Homes (PCMH). These practices all had health coaches that could be leveraged to provide chronic disease self-management mostly via phone, but also at the point-of-care. Hence we conducted a patient-randomized, pragmatic clinical trial in 6 rural PCMHs in Arkansas, targeting individuals with uncontrolled type 2 diabetes.

Improving readability of informed consents for research at an academic medical institution.

INTRODUCTION: The final rule for the protection of human subjects requires that informed consent be "in language understandable to the subject" and mandates that "the informed consent must be organized in such a way that facilitates comprehension." This study assessed the readability of Institutional Review Board-approved informed consent forms at our institution, implemented an intervention to improve the readability of consent forms, and measured the first year impact of the intervention. METHODS: Readability assessment was conducted on a sample of 217 Institutional Review Board-approved informed consents from 2013 to 2015. A plain language informed consent template was developed and implemented and readability was assessed again after 1 year. RESULTS: The mean readability of the baseline sample was 10th grade. The mean readability of the post-intervention sample (n=82) was seventh grade. CONCLUSIONS: Providing investigators with a plain language informed consent template and training can promote improved readability of informed consents for research.

Promoting Tdap immunization in pregnancy: Associations between maternal perceptions and vaccination rates.

OBJECTIVE: Tdap vaccine uptake among US pregnant women is low despite current recommendations. This study evaluated if a Tdap vaccine information statement (VIS) affected overall perception, vaccination intention, and components of a health behavior model associated with Tdap vaccination rates. METHODS: A randomized, prospective study was conducted among pregnant women receiving care at two women's clinics in May-August 2014. Verbally consented participants were randomized to receive either the standard CDC Tdap VIS (sVIS) or a modified version (mVIS) before completing the first multi-part survey (T1). After T1, participants read their assigned VIS then completed the second part (T2). A 2015 chart review identified vaccinated participants. A health behavior model was hypothesized using the Reasoned Action Approach and Health Belief Model. Logistic regression, path analysis, and chi-square tests were used in the analysis. RESULTS: 279 surveys were analyzed. Average age of the participants was 26.4 years (SD=5.7) with average gestational age of 25.9 weeks (SD=9.2). 13% self-reported receiving Tdap vaccine prior to the survey. Overall perception scores significantly increased (3.1-3.4, p<0.001) after VIS review. A chart review showed that 131 (47%) received the vaccine post study. There was no significant difference in vaccination rates between the sVIS and mVIS groups (45% vs. 49%). Perceived benefits (B=0.315) and self-efficacy (B=0.197) were positively associated with the overall perception (T1), while perceived barriers (B=-0.191) were negatively associated with the overall perception (T1). Social norms (B=0.230), self-efficacy (B=0.213), and perceived benefits (B=0.117) were positively associated with vaccination intention (T1). The vaccination intention (T2) was positively associated with participants' decision to receive Tdap vaccine (B=0.223). CONCLUSION: A VIS improved overall perception of the Tdap vaccine. Vaccination intention was a predictor of Tdap vaccination. It is crucial to provide information about immunization benefits to promote maternal Tdap vaccination.

Health literacy training for health professions students.

OBJECTIVE: This pilot project assessed the effectiveness of training health professionals in (1) readability assessment of written health materials, (2) plain language editing, and (3) formatting materials so they are easy to understand and use. METHODS: Over six semesters, five students participated in the project. Students were trained to assess document readability, confirm and interpret readability results and "stamp" the documents with results. Students then edited documents under supervision, via revised documents were re-assessed for readability and approved. Training was assessed through readability score comparison and exit interviews with students. RESULTS: Most original readability scores were 10th grade to college level. After editing, the average reading level of 73% was 6th grade or better. Students and supervisor rated skill levels as "proficient" at the end of the semester. CONCLUSION: To address the gap between document reading level and patients' reading ability, health documents should be assessed and edited for plain language. Working with patient documents from various health fields, our program effectively trained health professions students in these skills. PRACTICE IMPLICATIONS: Training health professions students in readability assessment and plain language editing can reduce literacy demands on patients and address the need for professionals with these skills.