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      Registered Nurses' Knowledge of and Experience with Health Literacy

      research-article
      , PhD, RN, , PhD, RN, FAAN, , PhD, RN, , PhD, RN, FAHA
      HLRP: Health Literacy Research and Practice
      SLACK Incorporated

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          Abstract

          Background:

          Limited skill in health literacy is a global issue. Variation in health literacy skills within societies is a source of health inequality unless health care providers apply health literacy practices to effectively communicate with all clients.

          Objective:

          This study examined Iranian registered nurses' knowledge of and experience with health literacy practices. Methods: This cross-sectional study provides a quantitative description of knowledge of and experience with health literacy practices. Using a rigorous process, we adapted the Health Literacy Knowledge and Experience Survey to collect data from the participants, who were 190 registered nurses working in Tehran, Iran.

          Key Results:

          Findings identify gaps in participants' knowledge and experience with health literacy practices. Knowledge deficits are most noticeable in standards to create written materials, screening tools to identify limited health literacy, and the Teach-Back strategies to determine people's understanding. Limited experience is prominent in using health literacy screening tools, evaluating written health information, and applying technologies to provide health information. Our multivariate analysis suggests participants who reported more interaction with health care professionals for personal reasons scored higher in knowledge of health literacy practices.

          Conclusions:

          This study indicated that registered nurses in Iran do not have adequate knowledge and experience regarding health literacy practices. Addressing this issue is fundamental to promoting health equity. Future investigations should identify both barriers and facilitators for nurses to apply health literacy practices. [ HLRP: Health Literacy Research and Practice. 2019;3(4):e268–e279.]

          Plain Language Summary:

          Health literacy practices enable health care professionals to offer understandable health information to all people and contribute to health equity. We surveyed 190 registered nurses in Iran to assess their knowledge of and experience with health literacy practices. The findings will be a guide to create interventions to improve registered nurses' knowledge of these practices and to use them to communicate clearly with clients.

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          Most cited references21

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          The Causal Pathways Linking Health Literacy to Health Outcomes

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            Tailored education may reduce health literacy disparities in asthma self-management.

            Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown. In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique. At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique. Seventy-three patients were enrolled. Inadequate health literacy was identified in 16 (22%) participants. Before instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2/10 vs. 7.2/10, p < 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p = 0.03). However, inadequate health literacy was not associated with difficulty learning (p = 0.33) or retaining (p = 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p = 0.26) or retaining (p = 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators. These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills.
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              Health literacy, health inequality and a just healthcare system.

              Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy from within the ethical perspective of the least well-off and argue that poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy.
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                Author and article information

                Journal
                Health Lit Res Pract
                Health Lit Res Pract
                HLRP
                HLRP: Health Literacy Research and Practice
                SLACK Incorporated (Thorofare, NJ )
                2475-6024
                2474-8307
                October 2019
                05 December 2019
                : 3
                : 4
                : e268-e279
                Author notes

                Maryam Nesari, PhD, RN, is a Postdoctoral Fellow, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy. Joanne K. Olson, PhD, RN, FAAN, is a Professor, Faculty of Nursing, University of Alberta. Alireza Nikbakht Nasrabadi, PhD, RN, is the Dean and a Professor, School of Nursing and Midwifery, Tehran University of Medical Science. Colleen Norris, PhD, RN, FAHA, is a Professor, Faculty of Nursing, University of Alberta.

                Address correspondence to Maryam Nesari, PhD, RN, Faculty of Medicine and Dentistry, University of Alberta, 4-284, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, Canada, T6G 1C9; email: nesari@ 123456ualberta.ca .

                Grant: This work was supported by a research award from the Sigma Theta Tau International Honor Society of Nursing, Mu Sigma Chapter.

                Disclosure: The authors have no relevant financial relationships to disclose.

                Article
                10.3928_24748307-20191021-01
                10.3928/24748307-20191021-01
                6901361
                31893259
                7651da16-e7a1-41dd-afaa-4b990e8540a0
                ©2019 Nesari, Olson, Nasrabadi, et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International ( https://creativecommons.org/licenses/by-nc/4.0). This license allows users to copy and distribute, to remix, transform, and build upon the article non-commercially, provided the author is attributed and the new work is non-commercial.

                History
                : 12 November 2018
                : 07 March 2019
                Categories
                Original Research

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