Doctoral Defense PresentationUniversity of San Francisco

Seanny Min, DNP©, FNP, CNS, MSN

Dean: Dr. Judith Karshmer, PhD, RNAdvisor: Dr. Karen Van LeuvenCommittee: Drs. Judith Labmton and Alice Laurence BatzlaffDr. George Lee, clinic directorLetida Sot Cambodian navigator and research supportHusband Bun Ea and sonsDNP classmates, esp. Dr. Ben GardnerCambodian patients who participated in study

Defining the Relevant problemsReviewing the Evidence and LiteratureTheoretical FrameworkInterventions: Pictorial aids toolEvaluationContinuous Quality Improvement ProcessDissemination PlanLessons Learned

Nearly half of all American adults have difficulty understanding and acting upon on health information.Many patients have a fifth-grade reading level or less 36% by the National Assessment of Adult Literacy (NAAL) and as high as 40%- 60% for some studies.Multi-factors affect medication adherence: health system, conditions, patients, therapy, and socio/economic related factors.Relationship between Health Literacy and Medication Adherence.

90% of Medicare beneficiaries take prescription medicationsNearly half take five or more different medications50% of American Adult and 55% of older fail to adhere medication regimen60% discontinue medications36% unable to read medication labels67% or more do not fully understand information given to them

Medication adherence accounts for:10% of geriatric hospital admission20% of preventable adverse drug effects140 million unfilled prescriptions and worth about $2.8 billion per year$106 billion to $238 billion in health care costs annually125,000 deaths annually

Many patients disregard doctor’s course of treatment:44% of patients ignored treatment27% left prescription unfilled43% believe physicians over treat patients

Humans have a cognitive preference, thePictorial Superiority Effect (PSE)Oldest-old is 90-97 years old demonstrate in retention PSEPictures can be shown dually in one’s memory by visual and verbal codesWords are primarily shown in verbal codesPictures improve Alzheimer disease (AD) and amnestic-type mild cognitive impairment (MCI)

The Roy Adaptation Model:

• Physiological, self-concept, role function and interdependent

• Coping skills to deal with stressors

Knowles:

• Andragogy• Self-Directed Learning

Paivio:• First advanced Dual-Coding Theory• Sensory codes for pictures are richer than

sensory codes for verbal information

Mayer:• Cognitive Theory of Multimedia Learning• Dual Channel: visual and auditory

Implementation of pictorial aids tool

Target Population 35 adult Cambodian patients at Asian Health ServicesAge ranged from 40-80 years old

Method:Pre and post-intervention survey question screeningDistribute of pictorial aids labels and a customized pictorial aids calendarPill counts and refill records

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The effectiveness of the pictorial aids tool was assessed and measured every two weeks for three months.Up to 50% of patient with no education improved in recall, and comprehension after their first visits.Up to 70% improved after their second visits17% with a few years of schooling improved by 90% after their visits.

Do you understand your medication instruction?

How often do you need someone to help you take your medicine?

100% of participants felt the pictorial aids label was helpful100% of participants strongly agreed that AHS should use the pictorial aids label100% of participants requested to continue using the pictorial aids label90% of AHS staff felt strongly that the pictorial aids label could benefit AHS85% of AHS staff had concerns sufficient time

Dissemination plan: DNP role to collaborate and disseminate the findings

Publicize the concept of the pictorial aids tool in scholarly journal, as well as, foreign language journal

Publicize the concept of the pictorial aids tool to Cambodian Diabetes Association, and Khmer Health Advocates.

Continue to provide the pictorial aids tool at AHS

Will be implemented at St Mary’s outpatient clinic in San Francisco in 2010Will be implemented at community-based where several underserved, minority patients are seen for primary careWill continue with the project so as to collect long-term outcomes, including monitoring HbA1c, lipid panel, and blood pressure

Time period is a challenging task

Stay focused on the project

Prepare for unexpected fallout from subjects

Good guidelines and communication lines

Support from family, school and project is crucial