Assessing Health Literacy in Diverse Primary Care Settings.

Abstract

Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills. This study employed a mixed methods design to examine provider-staff awareness of patient HL status, measure provider-staff KAB HL change after implementing a web-based educational intervention, and test feasibility of implementing a standardized HL measure (the Newest Vital Sign or NVS). Patient HL sampling per clinic measured clinic workflow time impact, identified demographic associations to low patient HL, and documented patient perspective of the NVS.Using the Institute of Medicine’s Health Literacy Intervention Points model,providers/staff (N=47) in seven primary care centers (five nurse managed and two physician-led) all serving diverse populations in five Michigan cities were enrolled in the study. Providers/staff completed a socio-demographic survey, pre/post-survey (HL/ KAB questions) and estimated the percentage of limited literacy patients in their practice. Focus groups with providers/staff followed within 3-6 months after initial data collection. A convenience sample of patients (N=282) was recruited during visit intake or in the clinic waiting room. Patients verbally consented and completed a socio-demographic survey, NVS, and three NVS perception questions. Quantitative data were analyzed using descriptive, correlational, and paired t-test methods. Multiple regression analysis was used to identify socio-demographic associations to low health literacy. Qualitative data were analyzed using grounded theory and comparative analysis identifying thematic responses. The NVS proved to be time efficient and integrated well into clinic routine. The strongest associations to low NVS score were primary language, race/ethnicity, education level and health insurance status. Provider/staff data analysis regarding health literacy KAB revealed no significant change overall pre/post- survey. Focus group responses demonstrated four themes: Use of HL Assessment Tool, Value of HL Screening, Health System, and Study Impact on Provider/Staff/Patient Interactions. The study demonstrated the NVS was easy to administer and well received by patients. Consistent with the literature, provider/staff awareness of health literacy was mixed and challenges in addressing health literacy in busy primary care practices were identified.