Health Literacy and Blood Pressure Control in Older Adults Holly Heaton, RN, BSN Washington State University NUR 519 Spring 2014

Objectives Students will be able to define the following terms: health literacy, blood pressure control and older adult. Students will be able to synthesize these definitions to identify how they relate to one another. Students will be able to apply information from two research articles related to health literacy and blood pressure control to nursing practice. Students will identify further research to be done in this area.

Definitions Health Literacy Navigate to and watch the following You Tube video. m/watch?v=39A9oU- gOOA m/watch?v=39A9oU- gOOA Write a succinct definition of Health Literacy.

Blood Pressure Control Read the guidelines for blood pressure control on page 4 of The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) v/guidelines/hypertensio n/express.pdf v/guidelines/hypertensio n/express.pdf

Older Adults In JNC 7, all people ought to be monitoring their blood pressure, but adults age 50 years and older ought to be watching even more closely

Putting Definitions Together Factors that affect health literacy are listed below. For each one consider how blood pressure control could be affected by these factors. Reading level of written instructions Basic math skills Understanding medical terms Cultural barriers Age Economic status Brainstorm your ideas before going on to the next slides.

Reading level of written material : It is suggested that materials need to be at 6 th grade level or lower (NIH, 2013) Microsoft Word has a function for figuring the reading level of material using this program. Open this hyperlink for a tutorial on how to use this function in Microsoft Word 2010:

Basic math skills Understanding decimals Figuring doses i.e. the patient has 10mg tabs of blood pressure medication and is told to start taking 15mg per day Understanding how to spread out “take three times a day” evenly

Medical Terms Translate each phrase below into wording that a lay person would more easily understand. 1. This antihypertensive medication may cause polyuria. 2. It is important that you adhere to a low sodium diet. 3. Your medication could cause orthostatic hypotension so be careful when changing position. 4. There are some interactions with your medications and some NSAIDS that will change the effectiveness of your medications, so it is more advantageous to take acetaminophen for any pain.

Cultural Barriers Being aware of cultural differences regarding health and illness helps the provider to find talking points with patients that will help them to be more successful in managing their hypertension. Read through Madeleine Leinenger’s Transcultural Nursing Theory at the following website: theory.org/nursing-theorists/Madeline-Leininger.phphttp://nursing- theory.org/nursing-theorists/Madeline-Leininger.php In what ways will culture influence the management of one’s hypertension? What talking points would you suggest to a healthcare provider in order to navigate these cultural influences for the patient’s best health?

Age According to JNC 7, those with normal blood pressure at 50 yrs old are still at risk of developing high blood pressure as they age. (USDHHS, 2003) Age related changes including decreased visual acuity for reading medication labels, increasing effort necessary to learn new things, and likelihood of having other prescriptions may make managing high blood pressure challenging. Consider: How can healthcare providers specifically help the older adult be successful in managing his/her high blood pressure?

Economic Status Does the patient live on a fixed income? Will adding new medications stress that income? What resources are available to the older adult to help pay for medications?

Connections in the Research Read the following articles and make note of connections between health literacy and health outcomes: Pandit, A.U., Tang, J.W., Bailey, S.C., Davis, T.C., Bocchini, M.V., Persell, S.D….& Wolf, M.S. (2009) Education, literacy, and health: mediating effects on hypertension knowledge and control. Patient Educational Counseling,75, doi: /j.pec /j.pec Willens, D.E., Kripalani, S., Schildcrout, J.S., Cawthon, C., Wallston, K., Mion, L.C….& Roumie, C.L. (2013). Association of brief health literacy screening and blood pressure in primary care. Journal of Health Communications: International Perspectives, 18, doi: /

Your Conclusions On the discussion board, include your answers to these questions: 1)Define health literacy. 2)Choose two factors of health literacy and discuss how they relate to control of high blood pressure in the older adult population. 3)In what ways can a nurse influence these factors of health literacy with an older adult to facilitate better high blood pressure control? 4)How did the articles describe the relationship between health literacy and high blood pressure control? 5)Give an example of a research question that would result in more evidence based practice for nurses to better understand how to promote health literacy among older adults in order to support them in controlling their high blood pressure.

References US Department of Health and Human Services (USDHHS). (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Retrieved May 1, 2014 from ss.pdf ss.pdf NIH. (2013). How to write easy-to-read health materials. Retrieved May 1, 2014 from