Health Literacy (HL) and Adult Learning (AL) Essay

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Health Literacy (HL) and Adult Learning (AL) Essay

Integrating health literacy in adult learning is a promising strategy to increase the health equity of individuals facing ethnic and racial disparities. In this paper, the author explores the health literacy and adult learning concept. The paper describes the attributes, antecedents, consequences, and empirical referents of health literacy; presents a model case, and discusses the role of the DNP prepared APRN nurse to the concept. The author will also provide a critical appraisal of the reviewed literature including strengths, weaknesses, and knowledge gaps. This analysis purposes to improve the understanding of HL and AL and decrease ambiguities it is associated with, to promote consistency in its use in nursing practice, research and dialogue. Analyzing the concept of health literacy and adult learning is an integral process that increases nurse’s capacity to assess patient’s HL needs, while identifying those at high risk of shame, misunderstanding, and failure to comply with healthcare recommendations.

Concept Identification: Health Literacy in Adult Learning

The concept of health literacy began as an outcome associated with patient empowerment and compliance with healthcare recommendations. AMA defines HL as the capacity to undertake numerical and reading tasks for optimal functioning in the health environment (Parnell, 2015). According to Chesser et al. (2016), HL is reading, comprehension, and communication competency within a healthcare context. Health literacy has a broad scope. Healthy People (2020) describes HL as the extent a person acquires, processes and comprehends healthcare information and uses it to make informed decisions. This description suggests that a person uses a higher level of thinking to process, understand, and make well-informed health-related decisions. Health Literacy (HL) and Adult Learning (AL) Essay.

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Literature Search

The author conducted an initial search for literature in PubMed, Cochrane, CINAHL, and Medline databases using the keywords concept analysis and health literacy. After performing a critical appraisal of the literature, there were different domains and attributes of health literacy that became apparent. These domains are individual characteristics, and health outcomes. AMA defines HL as the capacity to perform numerical and reading tasks that promote optimal outcomes in a health context (Parnell, 2015). According to Chesser et al. (2016), HL refers competency to read, write, listen, and numerate to understand information within a healthcare context. However, health literacy does not include the wider scope beyond healthcare settings such as the community, neither does it address concepts associated with the ability to act, social interaction, and verbal communication. According to CDC (2020), it however does not include the wider scope beyond healthcare settings such as the community, neither does it address concepts associated with the ability to act, social interaction, and verbal communication.

Healthy People (2020) describes HL as the extent that a person acquires processes and comprehends health information and use it to make well-versed decisions. This description suggests that a person uses a higher level of thinking to process, understand, and make well-informed health-related decisions. The literature search findings revealed the following defining attributes: reading, comprehension, and numeracy skills, and ability to use the data to make healthcare-related decisions for optimal functioning.

Defining Attributes

Attributes are the most frequent concept characteristics associated with a concept and repeatedly appear about a concept. The attributes that define health literacy as it consistently appears in literature are comprehension, numeracy and reading skills, and ability to utilize information for decision-making (Parnell, 2015). Reading skills comprise of a wide range of meta-cognitive behaviors. These behaviors include concentration, the use of contextual analysis, texture, word recognition, organizing, and integrating new information to promote understanding. Numeracy skills define a person’s capacity to comprehend, and perform basic mathematical computations (Parnell, 2015). Numeracy is an integral component of health literacy defined as the essential skills and knowledge needed to communicate mathematical ideas and information in adult learning.

Parnell (2015) defines comprehension as a person’s ability to utilize prior knowledge and context to make sense of information read. Most people use comprehension synonymously with understanding or being familiar with health-related experiences or a language. Generally, the literature associates a person with sufficient skills of health literacy with patient empowerment and the ability to make informed healthcare-related decisions (Crondahl & Eklund, 2016). Over the years, this has been a persistent objective of efforts of health promotion. The recurrent theme that emerged from literature is the ability of an individual with sufficient health literacy skills to function successfully in health-related consumer roles. As highlighted by Rudd (2015), they can solve issues, and utilize new information to make decisions, or successfully traverse a healthcare system function.

Empirical Referents, Antecedents, and Consequences of Health Literacy

Empirical Referents

Empirical referents describe the categories of actual phenomena whose presence indicates the occurrence of a concept. They provide nurses with the most observable and significant phenomena to measure health literacy levels or identify potential health-related risks. They provide healthcare providers with phenomena to observe and measure in particular patients or identify areas with the highest risks. The most commonly known empirical referents for health literacy are TOFHLA (Test of Functional Health Literacy) and NAAL (National Assessment of Adult Literacy) (Hersh, Salzman & Snyderman, 2015). The former is the currently most reliable and valid health literacy measure developed the year 1995 by researchers and healthcare providers to assess adults for health literacy where a score of 75-100 is a referent for health literacy.

The NCES (National Centre for Education Statistics) developed the NAAL and it measures the following three clusters of health literacy: to understand prevention information, clinical information, and navigate information on a healthcare system (Rikard et al., 2016). Assessing these clusters produces index scores for health literacy, which demonstrate the capacity individuals or specific populations to understand the most basic health data.

Antecedents and Consequences

Antecedents are events that precede a concept’s existence. As highlighted by Parnell (2015), the antecedents in this context are health-related experience and literacy. Literacy in this context refers to the use of written and printed information to function, attain goals and develop skills, knowledge, and potential and comprises meta-cognitive comprehension, reading, and numeracy skills. Literacy also requires previous experiences with a healthcare delivery system, illness, or medical vernacular that defines a healthcare-related experience (Parnell, 2015). Within a person’s cognitive framework, literacy includes the presence of a logical context of health-related information.Health Literacy (HL) and Adult Learning (AL) Essay. This implies that a person with sufficient skills for health literacy has a previous health-related experience that provided exposure to healthcare language, and a cognitive framework that improves the logic of the shared health information.

Consequences are incidents that happen due to a concept’s occurrence. The consequences of HL are low health-associated costs, less-frequent use of healthcare services, an improved health status from self-reports, shorter hospital admissions, and increased health-related knowledge (Rasu et al., 2015).

Concepts Related To Health Literacy

The concept of social capital is related to HL. Social capital is the existence of norms, organization and trust networks in a community that individuals can use to solve common problems. Social capital elements are fundamental contributors to health literacy and have been associated with education, environment, and occupation, commonly referred to as the SDOH (Social Determinants of Health) (Rowlands et al., 2017). It is for the same reason that current healthcare models seek to address components of health literacy in three key areas namely; patient-provider interactions, healthcare access and utilization, and competency in patient self-care activities. This concept is also associated with and social, individual, and physiological health determinants such as healthcare access, individual responses, behavior, physical and social environment, well-being, and prosperity (Levy & Janke, 2016). These determinants are integral to promoting linguistic and cultural competency of healthcare providers in healthcare delivery to improve health literacy and subsequently reduce healthcare disparities.

Model Case

It incorporates all attributes that define a concept and provides a real example of how to use a concept. The following is a perfect example of a model case of this concept.

SK is a 76-year-old African American reached college level, active, and functions optimally. Although she uses corrective lenses, she reads a great deal. A year ago, SK sustained a tibia fracture that caused her hospitalization at a time when the doctor also diagnosed her with osteomalacia. Over the months after discharge from hospital, she continuously read about it

Clearly comprehends that it is preventable. SK discusses with an NP and informs her that she understands daily calcium and vitamin D. SK also does low impact aerobics five days a week as advised. SK is an active participant in discussions regarding her health status during follow-up clinics, she asks focused questions and shares her concerns. SK has numeracy, and reading skills demonstrated by her taking supplements as prescribed. She has also decided to modify her lifestyle by engaging in regular physical activity as recommended among other preventive actions. Besides, she is functioning optimally and regularly informs her immediate healthcare provider about her actions.

Concept Definition Based On Individual Reading and Thinking

Based on the author’s reading and thinking, health literacy a person-centered capacity to understand, comprehend and communicate in a healthcare context.

How the Nursing Model of Care Fits With the Created Definition

The nursing model of care encourages nurses and other partners in care to use a universal standard approach to assess patients for their health literacy levels using plain language strategies. As suggested by Greenhalgh (2015), nurses can assume that every patient does not comprehend medical information, and terminologies, and address health literacy at every stage of care starting with diagnosis, treatment, and discharge. During patient-provider interactions, nurses integrate efforts for patient health literacy to create an environment free from judgment by reviewing medical terms, using non-clinical terms, and teach-back method to emphasize literacy assessments. Batterham et al., (2016) highlights the teach-back method as a strategy for communication that was endorsed by the AMA and has proven to improve patient-centric communication and increases patient participation during interactions with healthcare providers.

Concept Map Linking Health Literacy to Phenomenon and Population of Interest

Role of DNP Prepared APRN in Health Literacy

The DNP prepared APRN has an integral role in urging healthcare providers to use the universal precautions approach of health literacy as well as advocate for all patients at a high risk of not comprehending health-related information. This includes integrating practice elements of patient-centered nursing which maximize the engagement of patients and health literacy in interprofessional models of practice and promoting healthcare environments that are shame-free that health literacy can flourish. When communicating with patients, Batterham et al., (2016) recommends that the DNP prepared APRN nurse should use simple and plain language and the teach-back method.

Within healthcare organizations, the DNP prepared APRN should collaborate and advocate to build HL organizations. According to Farmanova, Bonneville & Bouchard (2018) building a health literate organization requires the implementation of universal strategies that make the process of navigation, comprehending, and utilizing information easy for patients. DNP prepared ARNSs can also increase the utilization of HIT (health information technology), health communication strategies to improve and monitor the healthcare quality and health outcomes to attain equity (Navarro-Rubio et al., 2016).

To ensure sustainability and consistency of health literacy through policy formulation, the DNP prepared APRN can partner with other healthcare organizations and nursing to integrate health literacy nursing care models in the Nursing Alliance for Quality Care, QSEN among other healthcare initiatives. Further, the DNP prepared APRN should encourage nurse leaders and educators to utilize the conceptual model of Health Literacy Tapestry in practice and education to define health literacy across the continuum of care.

Critical Appraisal of Literature-Strengths, Weaknesses, and Knowledge Gaps

The most significant strength of literature is that it provided an empirically consistent and clear definition, defining attributes, referents, and consequences of health literacy and engendered all aspects of health literacy giving a conceptual clarity of the concept. A major weakness is that most of the literature reviewed generated findings and discussions from disciplines outside nursing. There still existed potential knowledge gaps in the literature that remain unexplored to date. Most studies focused on individual patient characteristics and patient’s capability, communication and comprehension. Although patient factors are significant when analyzing this concept, the linguistic and cultural competency of healthcare providers to deliver health-related information is also instrumental in promoting health literacy. Further studies should therefore examine how the communication skills of healthcare providers influence health literacy and adult learning.

References

Batterham, R. W., Hawkins, M., Collins, P. A., Buchbinder, R., & Osborne, R. H. (2016). Health literacy: applying current concepts to improve health services and reduce health inequalities. Public health, 132, 3-12.

Chesser, A. K., Keene Woods, N., Smothers, K., & Rogers, N. (2016). Health literacy and older adults: a systematic review. Gerontology and geriatric medicine, 2, 2333721416630492.

Crondahl, K., & Eklund Karlsson, L. (2016). The nexus between health literacy and empowerment: A scoping review. Sage Open, 6(2), 2158244016646410.

CDC (2020). Health Literacy. Retrieved from September 11, 2020 https://www.cdc.gov/healthliteracy/learn/index.html

Farmanova, E., Bonneville, L., & Bouchard, L. (2018). Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues. Inquiry: a journal of medical care organization, provision, and financing, 55, 46958018757848. https://doi.org/10.1177/0046958018757848

Greenhalgh, T. (2015). Health literacy: towards system-level solutions.

Healthy People.gov (2020).Health Literacy. Retrieved September 11, 2020 from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/health-literacy

Hersh, L., Salzman, B., & Snyderman, D. (2015). Health literacy in primary care practice. American family physician, 92(2), 118-124.

Levy, H., & Janke, A. (2016). Health literacy and access to care. Journal of Health Communication, 21(sup1), 43-50.

Navarro-Rubio, M. D., Rudd, R., Rosenfeld, L., & Arrighia, E. (2016). Health literacy: Implications for the health system. Medical Clinics (Barc), 147(4), 171-175. Health Literacy (HL) and Adult Learning (AL) Essay.

Parnell, T. A. (2015). Health literacy in nursing: Providing person-centered care. Springer Publishing Company. Retrieved from http://zu.edu.jo/UploadFile/Library/E_Books/Files/LibraryFile_91636_32.pdf

Rasu, R. S., Bawa, W. A., Suminski, R., Snella, K., & Warady, B. (2015). Health literacy impacts on national healthcare utilization and expenditure. International journal of health policy and management, 4(11), 747.

Rikard, R. V., Thompson, M. S., McKinney, J., & Beauchamp, A. (2016). Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL). BMC Public Health, 16(1), 975.

Rowlands, G., Shaw, A., Jaswal, S., Smith, S., & Harpham, T. (2017). Health literacy and the social determinants of health: a qualitative model from adult learners. Health promotion international, 32(1), 130-138.

Rudd, R. E. (2015). The evolving concept of health literacy: new directions for health literacy studies.

Practice Innovation Project

Topic: Prediction of Recidivism to the Hospitals by Use of Clinical Readmission Risk Assessment Methodology for Patients with a Psychiatric Diagnosis.

Chosen concept: Health literacy and adult learning

Minimum of 15 scholarly references. References may be from peer-reviewed journals within the past five years or textbooks (latest edition). Governmental websites such as the CDC, US Census Bureau, AHRQ may be used sparingly. Lay websites and publications may not be used.

APA format, 7^th edition. Times New Roman font, 12 points, double spaced. Must include title page and references.

Discussion Questions:

Write the following:

Identify and name the concept of interest.
Identify and select an appropriate realm for the literature search.
Identify attributes of the concept.
Identify the references, antecedents, and consequences of the concept.
Identify concepts related to the concept of interest.
Identify the model case of the concept.
Develop a definition of the concept based on your reading and thinking.
Describe how the nursing model of care fits with the definition you created.
Create a concept map that links the concept to the phenomenon and population of interest
Discuss the role of the DNP-prepared APRN as it relates to the concept. What opportunities did you discover?
Critically appraise the literature you reviewed. What were the strengths, weaknesses, and gaps in knowledge?

References

Boaz, T. L., Becker, M. A., Andel, R., & McCutchan, N. (2017). Rehospitalization risk factors for psychiatric treatment among elderly Medicaid beneficiaries following hospitalization for a physical health condition. Aging & Mental Health, 21(3), 297–303.

Donisi, V., Tedeschi, F., Salazzari, D., & Amaddeo, F. (2016). Pre- and post-discharge factors influencing early readmission to acute psychiatric wards: Implications for quality-of-care indicators in psychiatry. General Hospital Psychiatry, 39, 53–58.

Donisi, V., Tedeschi, F., Wahlbeck, K., Haaramo, P., & Amaddeo, F. (2016). Pre-discharge factors predicting readmissions of psychiatric patients: A systematic review of the literature. BMC Psychiatry, 16.

Donzé, J. D., Williams, M. V., Robinson, E. J., Zimlichman, E., Aujesky, D., Vasilevskis, E. E., Kripalani, S., Metlay, J. P., Wallington, T., Fletcher, G. S., Auerbach, A. D., & Schnipper, J. L. (2016). International Validity of the HOSPITAL Score to Predict 30-Day Potentially Avoidable Hospital Readmissions. JAMA internal medicine, 176(4), 496–502. https://doi.org/10.1001/jamainternmed.2015.8462

Greenwood, K. L., LaMori, J. C., Smith, B., Doshi, D., & Davis, C. (2018). Impact of Behavioral Health Screening on Proactive Identification of Patients at Risk for Hospital Readmission. Population Health Management.

Kalseth, J., Lassemo, E., Wahlbeck, K., Haaramo, P., & Magnussen, J. (2016). Psychiatric readmissions and their association with environmental and health system characteristics: A systematic review of the literature. BMC Psychiatry, 16.

Lorine K, Goenjian H, Kim S, Steinberg AM, Schmidt K, Goenjian AK. Risk factors associated with psychiatric readmission. The Journal Of Nervous And Mental Disease. 2015;203(6):425-430. doi:10.1097/NMD.0000000000000305.

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Molfenter, T., Connor, T., Ford, J. H., 2nd, Hyatt, J., & Zimmerman, D. (2016). Reducing Psychiatric Inpatient Readmissions Using an Organizational Change Model. WMJ: Official Publication Of The State Medical Society Of Wisconsin, 115(3), 122–128.

Rieke K, McGeary C, Schmid KK, Watanabe-Galloway S. Risk Factors for Inpatient Psychiatric Readmission: Are There Gender Differences? Community Mental Health Journal. 2016;52(6):675-682. doi:10.1007/s10597-015-9921-1.

Robinson R. (2016). The HOSPITAL score as a predictor of 30 day readmission in a retrospective study at a university affiliated community hospital. PeerJ, 4, e2441. https://doi.org/10.7717/peerj.2441

Sfetcu, R., Musat, S., Haaramo, P., Ciutan, M., Scintee, G., Vladescu, C., Katschnig, H. (2017). Overview of post-discharge predictors for psychiatric re-hospitalizations: A systematic review of the literature. BMC Psychiatry, 17.

Shameer, K., Perez-Rodriguez, M. M., Bachar, R., Li, L., Johnson, A., Johnson, K. W., … Dudley, J. T. (2018). Pharmacological risk factors associated with hospital readmission rates in a psychiatric cohort identified using prescriptome data mining. BMC Medical Informatics And Decision Making, 18(Suppl 3), 79.

Šprah, L., Dernovšek, M. Z., Wahlbeck, K., & Haaramo, P. (2017). Psychiatric readmissions and their association with physical comorbidity: a systematic literature review. BMC Psychiatry, 17(1), 2.

Taylor, C., Holsinger, B., Flanagan, J. V., Ayers, A. M., Hutchison, S. L., & Terhorst, L. (2016). Effectiveness of a Brief Care Management Intervention for Reducing Psychiatric Hospitalization Readmissions. The Journal Of Behavioral Health Services & Research, 43(2), 262–271.

Vigod SN, Kurdyak PA, Seitz D, Herrmann N, Fung K, Lin E, et al. READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units. J psychiatry Res. 2015; doi:10.1016/j.jpsychires.2014.12.003.

Practice Innovation Project

Topic: Prediction of Recidivism to the Hospitals by Use of Clinical Readmission Risk Assessment Methodology for Patients with a Psychiatric Diagnosis.

Chosen concept: Health literacy and adult learning

APA format, 7^th edition. Times New Roman font, 12 points, double spaced. Must include title page and references.

Discussion Questions:

Write the following:

Identify and name the concept of interest.
Identify and select an appropriate realm for the literature search.
Identify attributes of the concept.
Identify the references, antecedents, and consequences of the concept.
Identify concepts related to the concept of interest.
Identify the model case of the concept.
Develop a definition of the concept based on your reading and thinking.
Describe how the nursing model of care fits with the definition you created.
Create a concept map that links the concept to the phenomenon and population of interest
Discuss the role of the DNP-prepared APRN as it relates to the concept. What opportunities did you discover?
Critically appraise the literature you reviewed. What were the strengths, weaknesses, and gaps in knowledge? Health Literacy (HL) and Adult Learning (AL) Essay.

References

Health Literacy (HL) and Adult Learning (AL) Essay

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