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Promoting Health Literacy and Self-Care Management with
Inmates
D. Young, C. Weinert, G. Kouame, J. Keery & I. Frye
College of Nursing, Gallatin County Detention Center & National Network of Libraries of
Medicine
Bozeman, Montana
Gallatin County Detention Center
Definition of Health Literacy
“The degree to which individuals have the capacity to obtain, communicate, process, and understand basic health information and services needed to make appropriate health decisions.”
- Affordable Care Act (ACA)
What is the Greatest Predictor of Health Outcomes?
• Age• Race• Income• Education• Employment• Health literacy
Why Promote Health Literacy?
• Nearly 9 out of 10 adults have difficulty using everyday health information
• Health literacy is the #1 predictor of health outcomes
• Inmates have high incidence of chronic health conditions (80-90% vs 50% for all US)
• Chronic health conditions account for 75% of all health care expenditures and 70% of all deaths
Poor Health Literacy Leads to:• Lower use of preventive care services• Greater use of emergency care• Frequent hospitalizations• Poor self-care management• Unhealthy behaviors• Poor health outcomes & premature deaths• Higher health care costs (loss of $238
billion/yr)
Why Inmates & Health Literacy?
• Poor health literacy = poor health outcomes• Low literacy levels• High incidence of chronic health conditions• Poor self-care management• 9 out of 10 have no health insurance• Frequent users of high cost emergency
services upon release
Why Inmates & Health Literacy?
Inmates Have High Incidence of Chronic Health Conditions
• Asthma• Hypertension• Tuberculosis• Diabetes• Hepatitis• HIV/AIDS• Substance Abuse & Mental Health Issues
Inmates Have High Mortality Rates After Release
• Drug overdose• Cardiovascular disease• Homicide• Suicide• Cancer• Liver disease• HIV
Goal of the Project
To improve the health literacy, self-care management skills and personal health care decision-making of inmates incarcerated in the county jail
Objectives of the Project
• To enhance the capacity of inmates in their understanding of locating, evaluating and using basic health information
• To motivate inmates to take more responsibility for their own health care
• To increase the inmate’s understanding of the importance in seeking assistance from local librarians after release
Experimental Design• Target Population – adult men scheduled to be
housed in the jail more than 21 days• Timetable – 10 weekly sessions, seven inmates
per session, involving a total of 70 inmates • Class Format – – Six handouts provided on day one– Instructed classes 2.5 hrs/day – M, W, F– Self study classes 2 hrs/day – T & Th
What was the Biggest Challenge?
Constructing a Health Information Internet-in-a-Box Offline System• MedlinePlus• Understanding Medical Words: A Tutorial
from the National Library of Medicine• USDA SuperTracker• Plain Language Medical Dictionary• 12 Power Point Presentation• 42 videos
Internet-in-a-Box Offline System
12 PPT Presentations on the CD
• Computer Basics• What is Health Literacy?• My Health Companion © & Other Resources• Advocacy and Self-Care• Prevention and Screening• Sexually Transmitted & Infectious Diseases
12 PPT Presentations (con’t)
• Tobacco Epidemic• Mental Illness• The Science of Addiction• Nutrition• Oral Health• Library Resources
Experimental Design
• Project announced to inmates• Participating inmates selected• Informed Consent forms signed• Pre-Survey Questionnaires filled out
Experimental Design (con’t)
• Six Handouts:–My Health Companion ©– Staying Healthy Student Resource Book– Coping with Stress Student Book – Talking with Your Doctor– Seeking Drug Abuse Treatment: Know What to
Ask– the List – Community Resources for Gallatin
County
General Population Pod
Inmate Meeting Room
Results• 55 participants recruited• 39 completed all class session and pre-and
post-surveys• Age range – 19-69 (mean of 35.4 years)• Marital status– 13 % married– 41 % divorced– 39 % never married– 7 % other (2 % widowed; 5 % common law)
Results (con’t)
• Likelihood to use handout materials: – “the List” – 49 %– Seeking Drug Abuse Treatment - 44 %– Coping with Stress – 44 %– Talking with your Doctor – 36 %– Staying Healthy – 33 % – My Health Companion © – 29 %
• Strengths and Weaknesses• Other Comments
Results (con’t)
• Unfortunately with the small number of 39, we cannot say anything definite about the outcomes
• There was a noted increase in confidence in seeking health care and understanding the health care system
• There was a noted increase in knowledge of using My Health Companion © & Staying Healthy
Local Key Collaborators
• Gallatin County Detention Center (County Jail)• Montana State University (Extension, College
of Nursing, & Library)• Gallatin City-County Health Department• Gallatin Mental Health Center• Bozeman Public Library• Healthy Roads Media
National Key Contributors• National Network of Libraries of Medicine,
Pacific Northwest Region, Uof WA• National Library of Medicine, NIH, DHHS–MedlinePlus– Understanding Medical Words
• United States Department of Agriculture– SuperTracker
• Taubman Health Sciences Library, University of Michigan– Plain Language Medical Dictionary
The Future of ACA and Inmates
Who’s Eligible for ACA Health Insurance Marketplaces?
• The only requirements to get insurance through the Marketplace are:– You must live in the U.S.– You must be a U.S. citizen or national (or lawfully
present)– You can’t be currently incarcerated
http://www.healthcare.gov/marketplace/about/eligibility/
ACA Ten Essential Health Benefits• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services• Prescription drugs• Rehabilitative and habilitative services and devices• Laboratory services• Preventive and wellness services and chronic disease
management• Pediatric services, including oral and vision care
Q & A Time
Contact Information
• David Young• Extension/College of Nursing• P.O. Box 172230• Bozeman, MT 59717-2230• E-mail: [email protected]• Phone: (406) 994-5552
