Assessing health professionals’ perception of health literacy in Rhode Island community health centers: a qualitative study

Background: Limited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy. Methods: Using the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes. Results: Eight unique themes centered on health literacy, sources of health information, organizational culture’s impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients’ health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy. Conclusions: Study findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids

Health services research : how economics plays a role in public health for children in Somaliland and inmates in Texas.

Throughout this dissertation, I will assess three studies: (1) a cost-effectiveness analysis for pediatric surgery uptake for children in Somaliland with congenital conditions; (2) a survival analysis for time to suicidality for inmates in Travis county, Texas; and (3) an instrumental variables model for mental health courts and their effect on repeat offending and suicidality. Each chapter aims to highlight the economic impact on public health for each of the studied populations. The chapter on cost-effectiveness utilizes a Markov model to display the disability-adjusted life-years averted, net monetary benefits, and incremental cost-effectiveness ratios for nine congenital conditions for children aged 0 to 3 years old in Somaliland. The chapter on survivability for inmates finds the probability of surviving during various length of stays within the Travis county prison for suicidality (suicide attempt and/or suicide ideation). The chapter on mental health courts focuses on their effect on repeat offending and suicidality through evidence from randomized clinicians within the Travis county prison. Each chapter highlights the importance of health services research, the effects of economics and opportunities, and the need to increase health services research for vulnerable populations, such as children in low-income countries and inmates in prison