Development and results of an older adult health communication program using the Theory of Planned

BehaviorVirginia Brown, DrPH; Lisa McCoy, MS

The National Assessment of Adult Literacy found that over one-third of American adults do not have the health literacy necessary to manage their health. Health Literacy is defined as, “… The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” (Ratzan and Parker, 2004). Basic health literacy tasks include being able to explain medical symptoms to physicians, read and understand medicine instructions and explain health information to other consumers.

A national survey of adults found that only 12% have high health literacy and over half have below average levels of health literacy. Finally, health literacy is a fluid concept that changes based on the circumstances experienced.

Because of the positive effect health literacy and health communication has on health outcomes, many private and governmental agencies have disseminated publications to enhance communication. What is missing from much of the literature is evidence of providing education to adults about how to use this information to increase their health literacy and enhance their quality of life.

Therefore, the first author and the University of Maryland Extension developed a health communication program for older adults. This population was selected because older adults are more likely to access and use health services than the rest of the population. The Theory of Planned Behavior served as the framework for the program components and evaluation.

What is Health Literacy? Theoretical Framework

The Theory of Planned Behavior was selected. This is because a) research has shown it can be effective with one-time program sessions, b) previous successful use in health behavior change and c) it measures intent to perform a behavior.

Because the theory shows that perceived behavioral control is often the most significant indicator of behavior, particular attention was paid to this. A toolkit highlighting how to prepare for doctor’s visits, complete with forms and sample questions, was developed to assist in gaining greater control.

Testing LocationsSenior Centers, community centers, retirement homes and residential facilities.

Workshops lasted on average 45 minutes.

Participants Approximately 130 people participated in the program and 101 provided pre and post-test data.

Approximately 80% of participants were female and 90% white. This is consistent with the demographics of the communities hosting the program.

Data Collection Pre and posttest data was collected. 4-5 questions were developed to measure each of the three main constructs (subjective norm, attitude and perceived behavioral control). A three month follow-up survey was sent to find out if they used their new knowledge and skills at their most recent doctor’s visit.

Data AnalysisData was analyzed using SPSS. Paired sample t-tests were used to determine if differences from pre to post were different for each question. A factor analysis was run to determine which of the questions predicted the majority of behavioral intent.

METHODS

Discussion and Next Steps

The program was found to increase participant’s attitude, subjective norms and perceived behavioral control to speak openly with their doctor.

Participants experienced a greater change in subjective norms or belief in how others would want them to act and over their perception on how much they can control the behavior. The last finding is significant as the theory shows this usually the construct that can prevent people from performing health behaviors. At follow-up, participants indicated they used the information and toolkit provided in the program at their most recent office visit.

Based on this, the following steps will be taken. First, additional Extension Educators in Maryland will be trained to deliver the program. The program is being made available to additional states for use with their older adult population. Finally, the PI is work with 4H to begin adapting it for families with young children.

Quantitative Results

Program Development

The University of Maryland, College of Agriculture and Natural Resources programs are open to all and will not discriminate against anyone because of race, age, sex, color, sexual orientation, physical or mental disability, religion, ancestry, or national origin,

marital status, genetic information, or political affiliation, or gender identity and expression.

Attitude

Subjective Norm

Perceived Behavioral Control

Intention

Actual Control

Behavior

t=3.204, p=.002

t=4.438, p=.000

t=4.123, p=.000

t=2.789, p=.007“I was glad to have an easy way of recording all I’ve been through

in the past 5 months.”

“Made me realize that I need to change

doctors ”

“All this information will be helpful in the

future when our health problems

increase.”

Participant Feedback

• Discuss benefits of talking with doctor• Discuss people’s attitudes or beliefs and where they

came fromAttitude

• Discuss how they think doctor’s want them to act• Discussion on why others talk with doctorsSubjective Norm

• Case studies of common barriers to brainstorm strategies for overcoming them

• Toolkit distributionPerceived Behavioral Control