1 Rachel Torres, MPH, CHES Department of Health & Behavior Studies Teachers College, Columbia University Relationships between Health Literacy, Self- efficacy and Knowledge of Hormone Replacement Therapy

2 Health Literacy  “…the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” »Healthy People 2010

3 Significance  National objectives that may be addressed by the study include: –Institute of Medicine Health Literacy: A Prescription to End Confusion, 2004Health Literacy: A Prescription to End Confusion, 2004 Priority Areas for Nation Action: Transforming Health Care Quality, 2003Priority Areas for Nation Action: Transforming Health Care Quality, 2003 –Healthy People 2010 –Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

4 Cost of Poor Health Literacy  $73 billion dollars estimated –Because of More hospitalizationsMore hospitalizations Ineffective use of prescriptionsIneffective use of prescriptions Misunderstanding of treatment plansMisunderstanding of treatment plans

5 Research Design  Cross-sectional design utilizing survey methods  Measurement tools included: –Knowledge about hormone replacement therapy tool –Decision self-efficacy –Efficacy beliefs and outcomes expectations –Shortened Test of Functional Health Literacy in Adults (sTOFHLA)  Instrument reliability –Cronbach’s alpha for all instruments was well above.70

6 Research Aims  Explore the role of health literacy in a woman’s knowledge about hormone replacement therapy  Identify whether health literacy is an important factor in decision self-efficacy regarding hormone replacement therapy  Explore whether there are differences among efficacy beliefs and outcome expectations between the inadequate, marginal and adequate functional literacy subgroups

7 Data Collection  English and Spanish speaking women between the ages of at the Nagle Family Health Center  Distributed questionnaire after study information sheet  Data collected between August and September 2005  All collected data was collected by principal investigator and entered into SPSS 13

8 Data Analysis  Correlation analysis to determine association between health literacy and: –knowledge –decision self-efficacy  Chi square tests to examine differences in categorical data

9 Select Demographic Characteristics N (%) Education (n=102) Highschool or less Highschool or less Greater than Highschool Greater than Highschool 77 (73) 25 (27) Ethnicity (n=106) Black Black Caucasian Caucasian Hispanic Hispanic 2 (2) 24 (23) 80 (75) Health literacy category (n=106) Inadequate (0-16) Inadequate (0-16) Marginal (17-22) Marginal (17-22) Adequate (23-36) Adequate (23-36) 49 (46) 19 (18) 38 (36)

10 Aim #1: Explore the role of health literacy in a woman’s knowledge about hormone replacement therapy (n=106) Ho: There is a positive relationship between health literacy and knowledge about hormone replacement therapy r =.819, p<.01 Participants with higher health literacy have higher knowledge about hormone replacement therapy

11 Ho: There is a positive relationship between health literacy and decision self-efficacy Aim #2: Identify whether health literacy is an important factor in decision self-efficacy regarding HRT (n=106) r =.695, p<.01 Participants with higher health literacy have higher decision self-efficacy

12 Limitations  Sample of women at one particular clinic in Northern Manhattan  Study only examined associations between variables of interest  Individuals with low health literacy may have been more likely to refuse participation because of possible literacy burden

13 Conclusions  Association between health literacy and: –Knowledge about hormone replacement therapy –Decision self-efficacy  Differences with efficacy beliefs but not with outcomes expectations between the three categories of health literacy

14 Recommendations for Future Research  Patient education materials need to focus on more creative ways of communication instead of just reliance on written materials  Further explore the role of health literacy and decision self-efficacy on actual behavior  Design programs that focus on health literacy and self-efficacy

15 Implications for Health Education  May highlight the importance of low health literacy on knowledge of risks and benefits in disease management or prevention efforts  May add to limited body of research regarding health literacy and self-efficacy as this affects hormone replacement therapy  May identify areas where effective tools and interventions can be developed to make health care information more accessible to individuals with low literacy levels