Behavioral & Community Health Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/2802
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Item The Health Literacy Process Older Adult Long-Term Smokers Use to Make an Informed Decision about Lung Cancer Screening: A Grounded Theory Study(2019) Platter, Heather N; Feldman, Robert; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Lung cancer is the leading cause of cancer-related death in the United States with 160,000 annual deaths. Recent advances in screening technologies have proven effective in reducing mortality and increasing early stage detection of lung cancer, yet only 3.9% of the 6.8 million eligible Americans were screened in 2015. Potential barriers to lung cancer screening have been examined; however, there is limited research available on the impact of health literacy and the process of informed decision-making about lung cancer screening. To fill this gap, this study explored how health literacy relates to intentions and behaviors to screening for lung cancer among long-term smokers between 55 to 80 years old who have a 30-pack year smoking history, health insurance, and a provider seen in the past two years. The study was guided by the following research question: “How does health literacy relate to intentions and behaviors to screen for lung cancer?” Twelve participants (N=12) were enrolled in the study. Participants were 58.3% female, 83.3% black, 83.3% had screened for any cancer besides lung cancer, and 75% were current smokers with a 41.8 mean pack-year history. The majority of the sample (91.7%) had adequate health literacy based on the Short Test of Functional Health Literacy in Adults. Data were transcribed verbatim and analyzed using constructivist grounded theory methods, proceeding through four stages of coding (open, focused, axial, and theoretical). Analysis produced a Health Literacy Theoretical Model of Informed Decision-Making about Lung Cancer Screening. The theoretical model is underpinned by a core category: Making an Informed Decision about Lung Cancer Screening. This core category is supported by eight categories characterizing how health literacy relates to lung cancer screening among older adult long-term smokers, including Health Information Seeking Behaviors, Trusted Sources, Knowledge, Trusted Provider, Advocacy, Perceived Risk, Patient-Provider Communication, and Shared Decision-Making. This is one of the only known studies that describes the health literacy process of informed decision-making about lung cancer screening. The results of this grounded theory study have several implications for public health practice, research, and policy and have the ability to increase lung cancer early detection and survival.Item The relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans(2016) Tagai, Erin Kelly; Holt, Cheryl L; Garza, Mary A; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.