Shaping Core Health Messages: Rural, Low-Income Mothers Speak Through Participatory Action Research.

Rural, low-income families are disproportionately impacted by health problems owing to structural barriers (e.g., transportation, health insurance coverage) and personal barriers (e.g., health literacy). This paper presents a Participatory Action Research (PAR) model of co-created Core Health Messages (CHMs) in the areas of dental health, food security, health insurance, and physical activity. The research project engaged a multi-disciplinary team of experts to design initial health messages; rural, low-income mothers to respond to, and co-create, health messages; and stakeholders who work with families to share their insights. Findings reveal the perceptions of mothers and community stakeholders regarding messages and channels of message dissemination. By using PAR, a learner engagement approach, the researchers intend to increase the likelihood that the CHMs are culturally appropriate and relevant to specific populations. The CHM-PAR model visually illustrates an interactive, iterative process of health message generation and testing. The paper concludes with implications for future research and outreach in a technological landscape where dissemination channels are dynamic. This paper provides a model for researchers and health educators to co-create messages in a desired format (e.g., length, voice, level of empathy, tone) preferred by their audiences and to examine dissemination methods that will best reach those audiences.

Single Female Breast Cancer Patients' Perspectives on Intimate Relationships.

This qualitative study examined how female breast cancer patients without partners conceptualized their relationship status. Qualitative data were collected from 20 participants who did not have partners during diagnosis and treatment. Phenomenology informed the methodology and thematic analysis. Breast cancer patients without partners discussed how they made meaning of their relationship status within the context of their cancer experience and barriers they faced dating post-diagnosis or treatment. Oncology care providers, public health professionals, and family scientists can use the study results to better understand the specific concerns and experiences of breast cancer patients without partners. Additional implications of these findings for patients, practice, and research are discussed.

Assessing health literacy and oral health: preliminary results of a multi-site investigation.

OBJECTIVES: To introduce a multi-site assessment of oral health literacy and to describe preliminary analyses of the relationships between health literacy and selected oral health outcomes within the context of a comprehensive conceptual model. METHODS: Data for this analysis came from the Multi-Site Oral Health Literacy Research Study (MOHLRS), a federally funded investigation of health literacy and oral health. MOHLRS consisted of a broad survey, including several health literacy assessments, and measures of attitudes, knowledge, and other factors. The survey was administered to 922 initial care-seeking adult patients presenting to university-based dental clinics in California and Maryland. For this descriptive analysis, confidence filling out forms, word recognition, and reading comprehension comprised the health literacy assessments. Dental visits, oral health functioning, and dental self-efficacy were the outcomes. RESULTS: Overall, up to 21% of participants reported having difficulties with practical health literacy tasks. After controlling for sociodemographic confounders, no health literacy assessment was associated with dental visits or dental caries self-efficacy. However, confidence filling out forms and word recognition were each associated with oral health functioning and periodontal disease self-efficacy. CONCLUSIONS: Our analysis showed that dental school patients exhibit a range of health literacy abilities. It also revealed that the relationship between health literacy and oral health is not straightforward, depending on patient characteristics and the unique circumstances of the encounter. We anticipate future analyses of MOHLRS data will answer questions about the role that health literacy and various mediating factors play in explaining oral health disparities.

Smart Choice Health Insurance©: A New, Interdisciplinary Program to Enhance Health Insurance Literacy.

Smart Choice Health Insurance© is a consumer education program based on the definition and emerging measurement of health insurance literacy and a review of literature and appropriate theoretical frameworks. An interdisciplinary team of financial and health educators was formed to develop and pilot the program, with the goal of reducing confusion and increasing confidence in the consumer's ability to make a smart health insurance decision. Educators in seven states, certified to teach the program, conducted workshops for 994 consumers. Results show statistically significant evidence of increased health insurance literacy, confidence, and capacity to make a smart choice health insurance choice. Discussion centers on the impact the program had on specific groups, next steps to reach a larger audience, and implications for educators, consumers, and policymakers nationwide.

Empowerment in the process of health messaging for rural low-income mothers: an exploratory message design project.

Rural, low-income mothers face challenges to their health equal to or greater than those of low-income mothers from urban areas. This study put health message design into the hands of low-income rural mothers. The current study filled a research gap by analyzing a participatory process used to design health messages tailored to the everyday lives of rural low-income mothers. A total of forty-three mothers participated in nine focus groups, which were held from 2012 to 2013, in eight states. The mothers were from different racial and ethnic backgrounds. Participants discussed food security, physical activity, and oral health information. They created messages by considering several elements: visuals, length of message, voice/perspective, self-efficacy and personal control, emotional appeals, positive and negative reinforcements, and steps to health behavior change. This study was innovative in its focus on empowerment as a key process to health message design.

What do health literacy and cultural competence have in common? Calling for a collaborative health professional pedagogy.

Limited health literacy is recognized as contributing to racial/ethnic and other health disparities through mechanisms of poor understanding and adherence, as well as to limited access to health care. Recent studies have focused on interventions to address literacy gaps between patients and health care providers, focusing on communication techniques and redefining the responsibility for closing gaps. Cultural differences between patient and provider, if left unaddressed, have been shown to contribute to poor health outcomes through misunderstanding, value conflicts, and disparate concepts of health and illness. The dual challenges of limited health literacy and cultural differences are likely to increase with an expanding, increasingly diverse, and older population. There is evidence that training providers to attend to both issues can reduce medical errors, improve adherence, patient-provider-family communication, and outcomes of care at both individual and population levels. The two fields continue to have separate trajectories, vocabularies, and research agendas, competing for limited curricular resources. This article presents a conceptual framework for health professions education that attends simultaneously to limited health literacy and cultural differences as a coherent way forward in training culturally competent providers with a common skill-set to deliver patient-centered care that focuses on health disparities reduction.

Oral health literacy: at the intersection of K-12 education and public health.

The link between a student's health and their ability to learn is well-established. Schools are the intersection of public health programs, dental care, and self-care. This position affords them a unique role and opportunity to enhance health literacy, including oral health literacy. This paper explores the potential of K-12 school programs and the dental profession to address oral health literacy, and, in so doing, provide future participants with essential skills to promote their oral health.

Family influence: key to fruit and vegetable consumption among fourth- and fifth-grade students.

OBJECTIVE: To assess social and familial environmental influences on fruit and vegetable (FV) consumption of fourth- and fifth-graders living in a culturally diverse, urban setting. DESIGN: In 2006, students from 9 fourth- and fifth-grade classrooms from a public school in the Washington-Baltimore Metropolitan Region were recruited as part of the Food Stamp Nutrition Education's initiative to increase FV consumption among school-aged children in low-income schools. This intervention was conducted in partnership with the school. PARTICIPANTS: Ninety-three fourth- and fifth-grade students and their parents. MAIN OUTCOME MEASURE: The average daily FV consumption of elementary school students was the dependent variable. Home engagement (eg, student participation in menu planning and food selection at home), parental modeling, school environment, peer influences, and individual characteristics were the independent variables. ANALYSIS: Multiple regression analysis. RESULTS: Family and home environment factors explained more than 50% of the variance in students' FV consumption. CONCLUSIONS AND IMPLICATIONS: Interventions designed to influence school-aged children's FV consumption should target family members and consider incorporating strategies to reach families and promote meal planning activities with the children in their homes.

Health needs and health care utilization among rural, low-income women.

This study examined the correlates of health service utilization in a sample of low-income, rural women. Self-reported data were from Rural Families Speak (N = 275), a multi-state study of low-income, rural families in the U.S. collected in 2002. Findings indicated that women with health insurance, a regular doctor, and poorer overall physical health had higher incident rates of physician visits. Women who were divorced, separated or widowed and had more chronic health problems had higher incidence rates of emergency department (ED) use, while women living in counties with higher primary care physician rates had lower incidence rates of ED use. Future research and policies should focus on improved access to health insurance, increasing physician availability in rural areas, and providing rural women with a usual source of care, so as to reduce emergency services utilization for non-emergent needs and improve health status for this population.

Depression and poverty among rural women: a relationship of social causation or social selection?

CONTEXT AND PURPOSE: Depression among rural women is a major public health concern. The purpose of this study was to test the competing theories of social causation and social selection to assess the relationship between depression and economic status for a sample of rural, low-income women in the United States. METHODS: Structural equation modeling was used to analyze data from Rural Families Speak, a US Department of Agriculture-funded multi-state, longitudinal study of rural low-income families (N = 413). FINDINGS: Results indicated that the social causation theory yielded a better approximation of the relationship between economic status and depression (RMSEA = 0.50 for a model based on this theory) than the social selection theory (RMSEA = 0.067). CONCLUSIONS: The association between lesser economic status and depressive symptoms is pressing in rural areas, given the high prevalence of both depression and poverty. These findings further emphasize the need for improved mental health services in this vulnerable population.

Religious beliefs, faith community involvement and depression: a study of rural, low-income mothers.

The current study investigated the connection between religion and mental health of 131 rural, low-income mothers. Two dimensions of religion, beliefs and faith community involvement, were included and depression was assessed by the CES-D. The sample consisted of mothers who participated in Wave 2 of a multi-state research project. As hypothesized, both religious beliefs and faith community involvement were negatively related to depressive symptoms indicating that mothers with stronger religious beliefs and more involvement in religious activities may experience less depressive symptoms. The results of the current study confirm previous work and support a multifaceted view of religion.