Category 9
Health Literacy, Health Communication, Health Education

Background: Control of diabetes—the seventh leading cause of death in the U.S. in 2019—requires that individuals engage in a variety of disease management behaviors. Health literacy may lead to better engagement in care; however, few studies have examined detailed measures of health literacy in relation to diabetes self-management, and most have used small and non-generalizable samples.

Goal: We investigated associations between health literacy and self-management of type II diabetes among 4,816 diabetic adults from the 2016 Behavioral Risk Factor Surveillance System and also tested for effect modification by sex, informed by prior research on sex differences in healthcare utilization.

Objectives: We hypothesized that health literacy proficiency will be associated with higher odds of self-management behaviors and that sex will act as an effect modifier within this association with the relationship being stronger in females than males.

Approach/Methods: The study outcome, self-management behaviors included checking blood glucose, checking feet for sores, going to see a healthcare provider about diabetes, going to a healthcare provider to check A1C levels, ever taking a class on managing diabetes, and retinopathy screening. The outcome was treated as a nominal variable based on the number of behaviors (0-2, 3-4, 5-6).

Results: In bivariate multinomial logistic regressions all three self-reported measures of health literacy were associated with increased odds of more self-management behaviors (i.e., proficiency in finding health information, OR: 2.514, 95% CI: 1.455, 4.345; understanding oral health information, OR: 1.941, 95% CI: 1.215, 3.103; and, understanding written health information, OR: 1.604, 95% CI: 1.021, 2.521). Analyses adjusted for demographics and health conditions showed that proficiency in finding health information was associated with self-management among females but not males (OR: 2.398, 95% CI: 1.114, 5.165). This association was attenuated after controlling for healthcare access.

Importance to Public Health: These results provide evidence that proficiency in finding health information may be important for self-management of diabetes, especially in females, and that health care access is important to consider for both health literacy and self-management behaviors.

Background: Padres Preparados Jóvenes Saludables (Padres) is a federally funded, behavioral prevention intervention, aimed to strengthen Latino healthy parenting practices, promote energy-balance related behaviors, and ultimately prevent obesity.

Padres initiated in the US following Community-Based Participatory Research principles. During COVID-19, a community partner requested to implement the program in rural Honduras in collaboration with health clinic personnel.

Goal: The purpose is to collaboratively adapt the Padres program for rural communities in Honduras and increase cultural relevance, usability and reach a larger audience.

Objectives: We aim to increase awareness and promotion of healthy behaviors in order to strengthen health outcomes. The prevention strategies presented are widely accepted but rarely supported or studied in developing countries.

This presentation will focus on the collaborative process between a research team at UMD and a health clinic in Honduras. The process includes decision making, recognizing as equals the local knowledge and priorities, and the evidence-based science accumulated by our research team.

Approach/Methods: The collaboration process included the Padres research team and OCHO to determine the community strengths and gaps for prevention programs. Communication was done via Google platforms and Zoom for regular biweekly meetings. Our team described the Padres curriculum, its content, implementation practices and evidence to OCHO. In Honduras, the local team assessed the resident’s interests and opportunities. Certain program content seemed relevant and preferred, and other new ones were created. Team members went back and forth examining the changes with the larger team, translating and updating components as needed to be more culturally appropriate and relevant to the population in Honduras.

Results: The process occured between September 2020 to March 2021 and included 10 meetings to work on intervention adaptations and logistic details of program implementation on a pilot basis that will begin in April 2021. The topics include: positive parenting practices, adolescent development, sexual and reproductive health, and more. A train-the-trainer module is being created and discussion about program evaluation and sustainability is occurring.

Importance to Public Health: Making public health information more accessible to international communities allows for individuals across different populations to make educated decisions about their health and decrease their risk of disease and other chronic risk factors.

Background: Oral health literacy is essential to improving oral health outcomes. The use of effective communication techniques is necessary to increase oral health literacy, but research indicates that oral health providers do not always use effective communication techniques such as plain language.

Goal: The purpose of this pilot study is to improve communication between dental providers and their patients.

Objectives: The objective of this pilot study is to determine if a glossary of plain language dental terms would help improve communication between dental providers and their patients.

Approach/Methods: We developed a survey through a Google format to measure prospective dental patients’ understanding of ten dental terms. The survey included fifteen multiple-choice questions: five collected demographic data, and ten provided a plain language definition for a dental term with the following choice options: the correct term, a distractor, and “not sure”. A convenience sample from a community in Calvert County Maryland-. received the multiple-choice question survey via text and email. Respondents were given eight days to complete the survey. Descriptive statistics were used to describe the study sample and respondents’ understanding of the dental terms. The UMB Institutional Review Board determined our study to be Non-Human Subjects Research.

Results: More than fifty percent of respondents (n=68) incorrectly identified three commonly used dental terms: calculus, restoration, and xerostomia by selecting the distractor or the not sure option response. Although our sample size was small, these results demonstrate a disconnect between the respondents’ oral health literacy and terms commonly used by dental providers. These results also indicate a need for oral health providers to use dental plain language to effectively communicate with their patients and that a dental terminology glossary may help disseminate evidence-based oral health recommendations to patients to promote improved oral health outcomes. Further research with a larger and more diverse study sample is necessary to adequately measure understanding of commonly used dental terms.

Importance to Public Health: Oral health literacy allows patients to make informed healthcare choices, improves communication between medical providers and the patient, and is vital to improving public health.

Background: Around the world, well-produced television programming can engage vulnerable, hard-to-reach audiences by offering a source of informal education and enrichment. Akili and Me is a children’s program available in Tanzania that provides literacy, numeracy, socio-emotional, and health education. The producers (Ubongo) created a second season of this show in 2018, changing how the content was presented.

Goal: This prospective study aimed to measure the association between the exposures of new Akili and Me content viewing and receptivity and the outcomes of socio-emotional and health knowledge among children (mean age 5.32 years, SD=0.82) in Arusha, Tanzania.

Objectives: The objective was to determine whether new Akili and Me content would significantly increase socio-emotional and health knowledge schools among Tanzanian preschool children.

Approach/Methods: The intervention (Akili and Me) was provided to the participants after school over the course of twelve weeks, with different content screened on different days. The exposure was measured by attendance during these viewing sessions as well as receptivity measured by character identification. Researchers conducted one-on-one baseline and post-intervention surveys with each participant. Socio-emotional outcomes were measured by presenting six different scenarios and asking the children about the emotions represented and about possible problem-solving strategies. Health outcomes were by asking the children about health behaviors (such as handwashing) as well as asking the children to identify local food or beverages as “healthy” or “unhealthy.” Socio-emotional and health scores were calculated based on the number of correct answers. Data from a total of 411 participants from 10 public schools were analyzed using hierarchical linear models, clustered by school and controlling for sex, age, baseline scores, and general media receptivity (identification of non-Akili and Me characters).

Results: This study shows overwhelmingly that children who watched and remembered characters from Akili and Me performed better on assessments of socio-emotional and health skills than children with lower receptivity and attendance. Children with higher Akili and Me receptivity did significantly better on the post-intervention assessments for socio-emotional and health measures. Attendance on the relevant days resulted in significantly higher scores for naming emotions and overall health content.

Importance to Public Health: The education of children in healthy behaviors is a widely acknowledged public health goal. Akili and Me is therefore a valuable public health resource for Tanzanian children.

Background: Though statistically improbable, early-onset breast cancer still accounts for about 11% of breast cancer cases annually and tends to be more aggressive, diagnosed at later stages, and leads to greater mortality than breast cancer among screening-age women. African American women below the screening age are disproportionately impacted by early-onset breast cancer compared to women of other races, experiencing three times greater mortality relative to their White peers.

Goal: Given these disparities and because young African American women are often not represented in breast cancer educational messaging, this study's purpose was to reduce the breast cancer disparities young African American women face through better understanding how to hone breast cancer education for them.

Objectives: This study aimed to identify recommendations for age-appropriate breast cancer educational approaches and messages for African American women below mammogram eligibility.

Approach/Methods: We conducted 30 key informant interviews with young African American breast cancer survivors (diagnosed between 18-45), family members, community organization leaders, and healthcare providers. The study used McGuire’s Persuasion Communication Model for data analysis and reporting.

Results: Across the four themes involving Source, Message, Channel, and Audience Factors, we identified a number of recommendations relevant for young African American women. Participants recommended the educator source should be a young African American breast cancer survivor, social media influencer, or celebrity. Participants indicated an elevated need for messages on family cancer history, self-advocacy in healthcare encounters, and concerns about loss of womanhood, financial costs, and opportunity costs of investing in preventive healthcare. Finally, participants recommended communication channels emphasizing social media and brief videos.

Importance to Public Health: Findings will inform future age-appropriate educational messaging aimed at eliminating disparities associated with early-onset breast cancer, which disproportionately impacts young African American women. Messages should address the unique combination of early life stage, culture, and race-based experiences relevant to this group of women.

Background: Foundations of Public Health (SPHL100) partnered with the Undergraduate Teaching and Education Assistants and Mentors (UTEAM) to implement several interventions to increase student engagement in an online environment. The current online learning environment is less conducive for deep discussions that encourage reflective thinking and reasoning, therefore informing the use of Undergraduate Teaching Assistants (UTAs) to support peer interactions and learning.

Goal: The goal of this initiative was to incorporate a peer-led approach to address the teaching challenges that occur in a large (classes of 100 or more students) classroom setting by transcending the natural barriers inherent to an online learning environment through the use of UTAs.

Objectives: This proposal had three main objectives in relation to the student experience with the UTA-led events. (1) Implement effective opportunities for students to gather and discuss course content. (2) Implement effective opportunities for UTA-led review sessions. (3) Implement Expert Panels moderated by UTAs to increase awareness in careers in public health. (4) The utilization of UTAs in this course also served to advance the teachings of health equity and social justice, topics that students in the course historically struggled to grasp. UTAs sought to promote the tenets of social justice and health equity —the fabric of public health— through health communication, literacy, and education.

Approach/Methods: Adding a structured course component, led by UTAs, provided more opportunities to develop community and collaborate amongst the students and the instructional team. The structured component consists of several UTA-led virtual events including the following: Expert Panels – Students will have a chance to meet and engage with public health experts in online panel meetings. Coffee & Chats - Non-mandatory online meetings hosted by the teaching staff to provide a space for deeper discussions on course materials as well as create opportunities for socialization and networking. In addition, these meetings benefit those students who naturally learn using this format. Review Sessions – UTA-led review sessions on Zoom with Piazza for Q&A.

Results: Findings from an end, of course, show that of the 119 student responses 78 students attended at least one UTA-led session. Of those students, 76 students knew how to contact UTAs, 70 students found UTA-led review sessions to be valuable, and 63 knew how to contact UTAs. These findings suggest that the UTA-led sessions provide effective opportunities for students to gather and discuss course content. The interventions provided more opportunities for students to connect with other students and discuss and review public health theory and real-world applications.

Importance to Public Health: The creation of UTA-led events allowed for student exposure to the continued application of public health knowledge to take into future careers as public health professionals. The intersectionality of the UTAs and SPHL100 curriculum overall provided students the opportunity to learn inside the structure, think outside the structure, and act to improve existing structures.

Background: Weight centered definitions of health are associated with weight stigma, body dissatisfaction, and unhealthy weight management strategies. Young Black women, particularly college students, athletes, and those affected by chronic health conditions, are already at risk for developing unhealthy attitudes and are frequently exposed to weight-centered health messaging through university health initiatives, healthcare providers, and public health campaigns.

Goal: The goal of this study was to better understand how young Black women personally define health.

Objectives: Using a qualitative approach, this study sought to examine how young Black women define good and poor health, and the degree to which their definitions reflect an internalization of weight-centered health discourse.

Approach/Methods: 40 semi structed interviews were conducted with young Black women aged 18-24 from Los Angeles, California. Participants were recruited via respondent driven sampling as part of a larger, mixed methods study examining sexual health communication amongst young Black women. The interviews were audio recorded, transcribed verbatim, and co-coded for emergent themes.

Results: Thematic analysis revealed that overall, young Black women resist the idea that health is solely defined by weight and instead offer a more nuanced definition of health that includes function, behaviors, and overall wellbeing. The three main emerging themes include: (1) being free from sickness and able to carry out daily tasks are functional indicators of health; (2) behaviors are more important than size in determining health; and (3) overall health is a reflection of physical, emotional, and spiritual wellbeing.

Importance to Public Health: The findings from this study suggest that for young Black women, behaviors are a more salient indicator of physical health than weight. In continuing to reconsider dominant conceptualizations of health, future research should examine the characteristics associated with the dietary and exercise habits of this population, particularly as they may pertain to dietary restriction and compensatory exercise.