Chapter 10: Experiential Learning Project: Proposal
Important Course Information
- Health Literacy
- Health Literacy Assessment Tools
- Personal health literacy assessment tools
- Organizational health literacy assessment tools
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Learning Process for Knowledge Acquisition
- The three domains of learning
- Factors That Influence Learning and Knowledge Acquisition
- Health Literacy Assessment Tools
10.1 Health Literacy
Nurses working in the community regularly use health education to help clients promote, maintain, and restore health. Effective educators assess the individual or community for learning needs and health literacy, understand how people learn, utilize one or more learning theory models, promote factors that influence learning, and attempt to decrease factors that hinder learning and knowledge acquisition. Assessment of individual and community needs for health education may occur during the CHA process, but a more in-depth assessment is often needed. Identifying community health education needs, including personal and organizational health literacy, is a necessary part of assessment. Limited health literacy is associated with greater emergency care use, increased hospitalizations, reduced preventative screening, lower vaccination rates, poorer ability to interpret health-related messages and labels, and poorer ability to take medications appropriately (Berkman et al., 2011).
Health Literacy
Only 12 percent of U.S. adults have the health literacy skills to manage the complex U.S. health care system (Agency for Healthcare Research and Quality, 2020). This leads to mismanagement of client conditions, increased risk for disease and disability, reduced health promotion and disease prevention behaviors, and negative client outcomes. One overarching goal of Healthy People 2030 is to “eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all” (Office of Disease Prevention and Health Promotion, 2021, para 1). Healthy People 2030 defines two types of health literacy, personal and organizational. Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
These definitions emphasize an individual’s ability to understand and use health information to make well-informed decisions. Health literacy also involves acting on the understanding of health information in all situations, such as making decisions regarding voting on health-related policy, choosing a health care provider, or even choosing where to live (Santana et al., 2021). The organizational definition acknowledges that organizations are responsible for addressing health literacy and ensuring equity of health literacy.
Health Literacy Assessment Tools
Including health literacy assessment as a component of the CHA helps the nurse understand the health education needs of individuals and communities. CHA teams can include health literacy assessment questions in CHA surveys, interviews with key community partners, and focus groups. Individual assessment of health literacy of targeted, high-risk populations can occur using a personal health literacy assessment tool. Organization health literacy assessment tools are available to assess community health systems. Including the results of this information in the final CHA report will highlight a community’s educational health literacy needs and changes needed within community health systems to enhance the health literacy of consumers. Health literacy assessment tools are available to assess health literacy skills at the personal and organizational levels.
Personal Health Literacy Assessment Tools
Personal health literacy assessment tools measure an individual’s ability to find, understand, and use health-related information and services and help the nurse determine a client’s health literacy level. The client’s health literacy level will guide interventions, including educational tools the nurse uses to provide health information and to improve health literacy.
Multiple tools are available that measure different aspects of health literacy. For example, The Health Literacy Tool Shed (Boston University, 2023) is an online database that contains information about health literacy assessment tools. Over 200 free and paid tools are available to measure terminology comprehension, application, information seeking and eHealth, and media comprehension of medicine, dentistry, genetic, and general health literacy. Tools are available for adults and youth in a variety of languages and for specific diagnoses such as cancer, diabetes, high blood pressure, HIV, infectious disease, intellectual disability, kidney transplant, mental health, oral health, and vascular surgery.
Organizational Health Literacy Assessment Tools
Organizational health literacy assessment guides health promotion and disease prevention activities at the organizational and systems level. Organizational health literacy assessment tools identify areas of strength and areas for improvement. These findings guide the organization in health literacy improvement efforts at the systems level. Assessment findings should be reported to the organization’s committee that deals with health literacy and key organization administrators. For example, the Health Literacy Environment of Hospitals and Health Centers (HLE2) tool measures organizational policies, institutional practices (resources, staff orientation and development, and expectations), navigation within the organization (signage and staff assistance), culture and language (respect for diversity, language serves, and staff training), and communication (print materials, forms, websites, and patient portals). The HLE2 suggests focusing on percentage scores for each section of the assessment tool as a way to identify strengths and weaknesses, select priority areas, and generate ideas for action (Rudd et al., 2019).
The Agency for Healthcare Research and Quality (2020) created the AHRQ Health Literacy Universal Precautions Toolkit to help organizations take steps to simplify communication and confirm client comprehension, improve navigation of the environment and health care system, and support efforts to improve health. The CDC (n.d) provides additional resources for health literacy.
10.2 Learning Process for Knowledge Acquisition
Disease prevention and health promotion begin with education of the individual and communities. Education is the establishment and arrangement of events to facilitate learning and skill development. Learning is the process of gaining knowledge and skills that lead to behavioral changes. Effective evidence-based community education programs are needed to increase health literacy, decrease health disparities, promote disease prevention, and promote health.
The Three Domains of Learning
To provide effective health education to individuals and communities, nurses must understand the three domains of learning—cognitive, affective, and psychomotor. The cognitive domain is related to knowledge and includes thinking, memory, recognition, understanding, and application, moving from simple to complex. An example is the learner stating three signs of diabetes. The affective domain is related to perceptions and feelings, including changes in attitudes and development values. An example is a client with diabetes stating they feel as if they can manage their symptoms. The psychomotor domain is the performance of skills that require neuromuscular coordination. Learning in this domain depends on ability, a sensory image of how to carry out the skill, and practice. An example is self-administration of insulin.
Factors That Influence Learning and Knowledge Acquisition
Nurses must consider factors that influence learning and knowledge acquisition when planning disease prevention and health promotion community educational programs. Age, culture, language, reading and comprehension skills, technology, and learner characteristics and experiences influence learning and knowledge acquisition, as do educator characteristics, experiences, and preparation. Learner characteristics include health literacy, self-efficacy, and motivation. Educator characteristics and preparation are public speaking, teaching or classroom/group management, choice of learning theory and teaching strategy, and planning.
Educator preparation and planning significantly impact the factors that influence learning and knowledge acquisition. Following the steps in the development of community education programs and choosing effective, evidence-based theories and strategies decrease both learner-related and educator-related barriers to learning. The educational method chosen should meet the learning needs of the population and have the greatest impact.
Reference
Agency for Healthcare Research and Quality. (2020). AHRQ Health Literacy Universal Precautions toolkit. https://www.ahrq.gov/health-literacy/improve/precautions/index.html
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., Viera, A., Crotty, K., Holland, A., Brasure, M., Lohr, K. N., Harden, E., Tant, E., Wallace, I., & Viswanathan, M. (2011). Health literacy interventions and outcomes: An updated systematic review. Evidence Report/Technology Assessment, 199. Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.
Boston University. (2023). Health Literacy Tool Shed: A database of health literacy measures. http://healthliteracy.bu.edu/
Centers for Disease Control and Prevention. (n.d.). Health literacy. https://www.cdc.gov/health-literacy/index.html
Office of Disease Prevention and Health Promotion. (2021). Health literacy in Healthy People 2030. https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030
Rudd, R. E., Oelschlegel, S., Grabeel, K. L., Tester, E., & Heidel, E. (2019) HLE2: The Health Literacy Environment of Hospitals and Health Centers. Harvard T. H. Chan School of Public Health. http://files.eric.ed.gov/fulltext/ED606503.pdf
Santana, S., Brach, C., Harris, L., Ochiai, E., Blakey, C., Bevington, F., Kleinman, D., & Pronk, N. (2021). Updating health literacy for Healthy People 2030: Defining its importance for a new decade in public health. Journal of Public Health Management and Practice, 27(6), S258–S264. doi:10.1097/PHH.0000000000001324
Content in this chapter is an adaptation of chapter section 17.2, Population Health Nursing by Jessica Ochs, Sherry L. Roper, and Susan M. Schwartz in OpenStax, licensed CC BY.
