AN INTERVENTION FOR NURSES' HEALTH LITERACY KNOWLEDGE AND EXPERIENCE
Rationale/Conceptual Basis/Background: HL is a critical determinant of health status and mortality with low HL in ~50% of adults. Low HL is associated with poorer preventive services use and later entry to health-care (HC), decreased knowledge, self-care ability, and medication adherence, and increased rates of preventable ER/hospital admissions, and costs. A conceptual model describes HL and outcomes as being affected by providers’ teaching ability. In a HL study of RNs accessed through the Georgia Board of Registered Nursing, RNs had poor HL knowledge suggesting that RNs may not be adequately prepared to provide effective HL intervention. No HLKE intervention studies for RNs were found. In a community-hospital-based, RN sample, what: 1) are the sociodemographic characteristics, HLKE and relationships; and 2) is the effect of an online/educational intervention on HLKE?
Methods: Following IRB approval, a prospective, pretest–posttest, quasi-experimental design and convenience sample (n=47) of all RNs over 18-years old working in a hospital, patient care role were used. Eligible RNs received nurse manager emails explaining the study, facilitating consent, and providing the link for surveys and intervention completion. RNs completed two on-line surveys (demographic/HL) using Qualtrics® at enrollment (n=263) and within two-weeks following self-reported intervention completion (n=104). The intervention was an on-line HL-education program created/made available by the Unites States Department of Health and Human Services, Quick Guide to Health Literacy. The module provides: a definition/information about HL prevalence, risk factors, and related outcomes; strategies; and resources. The minimum required per-group sample size for a one-tailed t-test with p=.05, Cohen’s d=0.5, and power = 0.8 is 51.
Results: The majority of RNs were female (46, 97.9%), white (35, 74.5%), had an Associates or Bachelor's degree in Nursing (13, 27.7%; 17, 36.2%, respectively) with an average age of 46.3 (+11.4) years and 16.1 (+11.3) years of RN experience. At enrollment, RNs demonstrated low HL knowledge (19.3+2.8), and the majority had never used a HL screening tool (35, 74.5%) nor evaluated educational materials’ reading level (23, 48.9%) although use of written material to provide HC information was frequent (20, 42.6%). Age, ethnicity, years worked as an RN and in HC, and the highest level of non-nursing education were related to HLKE. Using a paired-analysis, HL knowledge was improved generally, (t=-7.346, p<.001) and specifically regarding HL basic facts and guidelines for written HL materials (t=-7.03, p<.001; t=-2.36, p=.02). The frequency was increased with which a HL screening tool was used and illustrations used in written HC materials were evaluated (χ²=23.0, p=.001; χ²=49.2; p=<.001, respectively).
Implications: Findings demonstrate a readily available, online, educational intervention improved hospital-based RNs HL knowledge (basic facts/guidelines for written HL materials) and changed practice (frequency with which HL screening tool was used/illustrations used in written HC materials were evaluated). The enhanced HL knowledge and practice of RNs may ultimately affect patient knowledge and outcomes.