Research Accomplishment Reports 2011

Health Education Leadership, KY

Vail, A., F.D. Scutchfield, D. Murray
Department of Human Environmental Sciences

 

Non-Technical Summary

Health literacy is the foundation for the development of Extension health education programs. A deeper understanding, evaluation, and development of health literacy concepts are the focus of this project. Health Education Leadership, KY addresses the need for further evaluation of both the concept of health literacy and its role in health outcomes as documented by the Agency for Healthcare Research and Quality.

The current literature focuses patient-centered approaches in the health care system. This project's approach is a family-centered approach in a community system addressing the challenge of improving health literacy through enrolling individuals in a health literacy program. The project will evaluate the efficacy of conducting a face-to-face health literacy intervention to improve the functional health literacy in low socio-economic status rural communities, in low SES urban communities, as compared to high SES communities.

One of the health literacy issues surrounds the impact of vitamin D on chronic diseases and overall well-being of Kentuckians. Research has now well established that Americans are deficient in vitamin D and that the daily intake recommended by several respected nutrition-information sources is inadequate. In analyses of 1988-1994 National Health and Nutrition Examination of 1988-1994 data, researchers determined that the prevalence of mild-to-moderate vitamin D insufficiency ranged from 34.4% among white men to 77.5% for black women. Severe deficiency ran as high as 3.4% in elderly women and 11.2% among black women. A similar analysis found that the prevalence of insufficiency among children age 1-11 was 69%.

A multitude of observational studies and several research studies provide strong evidence that certain levels of vitamin D provide protection against cancer. The evidence is strongest for colon cancer. In the most well-controlled trial to date, researchers estimated that there is a 35% risk reduction for every 25nmol/L 10ng/mL increase in vitamin D level.

In addition to cancer prevention, there is also ample evidence that low vitamin D levels are associated with glycemic control in diabetics, incidence and sequelae of cardiovascular disease, frequency of falls and cognitive impairment in the elderly, development of upper respiratory infections and asthma, symptoms and progression of rheumatoid arthritis and multiple sclerosis, and symptoms of fibromyalgia. In addition, several studies show that achieving adequate vitamin D levels in pregnancy and infancy reduces risk of the child later developing Type I diabetes.

Because blacks in the developed world suffer disproportionately from many of the aforementioned cancers and conditions, and those with darker skin are consistently found to have reduced vitamin D levels, there is much speculation on whether equalizing vitamin D through supplementation could also reduce racial disparities in health status. Increasing public and health provider knowledge and awareness of the benefits of achieving adequate vitamin D levels has the potential to reduce health disparities and the burden of chronic disease.

2011 Project Description

The Health Education Leadership KY Project (HEEL) has been successful engaging the Kentucky Cooperative Extension Service with the University of Kentucky's (U.K.) College of Public Health and the academic health colleges at U.K to address the poor health status of Kentuckians. HEEL's model of building teams and partnerships between the community and campus has been successful in effectively utilizing resources to impact the health of Kentuckians. HEEL has developed many programs that have shown an impact to increase the level of physical activity, improve the diets of Kentuckians, and build the capacity of the community to address complex health issues such as mental health.

Health literacy is the foundation for the development of HEEL health education program. A deeper understanding, evaluation, and development of health literacy concepts are the focus of this proposal. HEEL is providing leadership not only at the University of Kentucky but with other partners in Kentucky in the development of a statewide health literacy coalition.

A HEEL partnership of the University of Kentucky, the Humana Corporation, and UK HealthCare hosted the first Kentucky Health Literacy Summit on February 26th, 2011. This resulted in a new health literacy collaboration, Health Literacy Kentucky. HEEL has been instrumental in providing the infrastructure and support for this organization. The 2nd Health Literacy Summit was held in March of 2011. More than 300 professionals representing universities, health care businesses, hospitals, and for profit organizations participated.

Six focus groups were held with consumers and interviews were conducted with primary care physicians in the developmental phases of the What is Vitamin D health literacy development project.

A health literacy curriculum, What's in a Doctor's Bag, developed to reach preschool, Kindergarten, and primary grade school students, and their parents.

A diabetes health literacy curriculum, Taking Ownership of your Diabetes provides a cost-effective means for individuals to manage their diabetes. Poorly controlled diabetes too often results in complications such as heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system disease, dental disease, and amputations. The twelve module curriculum is evidence based and used the stages of change theory to bring about behavior change. It includes goal setting and problem solving to empower individuals to manage their diabetes. The goal of the curriculum is to improve the quality of life of individuals living with diabetes.

Small Steps to Health and Wealth was adapted for Kentucky use and identified as a featured Extension program.

2011 Impact

More than thirty state partners are represented in the Health Literacy Kentucky collaboration with more than $100,000 in external support generated over two years in support of health literacy programs through partnership with corporations and foundations. More than three hundred professionals in education, adult literacy, health care, and extension received continuing education and medical education credits and training through Health Literacy Kentucky.

Ninety-two consumers and four primary practice health care entities have participated in the developmental phases of the What is Vitamin D health literacy development project. Curriculum is now being developed to be diffused in all 120 counties on Vitamin D with consumers. Continuing education materials are being developed for primary care practices that complement the consumer education materials.

958 people have participated in the Taking Ownership of Your Diabetes pilot, with 276 reporting moving into the action maintenance stage. 491 participants took part in physical activity for 30 minutes or more for 5 or 6 days a week. 421 saw a health care professional one or more times during the year as a means of managing their diabetes, with 417 reporting having the A1C checked. 334 followed a diabetes meal plan, with 378 implementing three or more healthy eating practices to control their diabetes, and 332 set goals for themselves as a result of the program.

1276 Kentuckians participated in the Small Steps to Health and Wealth program with 769 achieving or partially achieving at least one specific wealth-related goal for themselves because of the program; 686 achieved or partially achieved at least one specific health-related goal for themselves because of the program.

35 Extension educators, Area Health Education Center heath educators, librarians, elementary school personnel, Health Occupations Student Association members at Western Kentucky University are piloting the What's in a Doctor's Bag curriculum in 15 rural and urban counties in Kentucky.