Defense Date


Graduation Date

Summer 8-8-2015


One-year Embargo

Submission Type


Degree Name





School of Nursing

Committee Chair

Linda Goodfellow

Committee Member

Alison Colbert

Committee Member

Michael Quinn


Care Model, Community Health Center, Decision support, Health literacy, Health Literacy interventions


Community health centers (CHCs) serve the largest portion of the medically underserved patients in the United States. Little health literacy research has been conducted in the community health center setting. The Care Model, more specifically the elements of the health care organization, decision support, and productive interactions, guided this study. The purpose of the study was to examine how the characteristics of the CHC (location, size, provider mix and providers reporting of patient language) along with health literacy decision support strategies (formal training and programs) are related to productive interactions between the health care provider (HCP) and the patient when low health literacy intervention are used. Methods. Data from a study that examined HCP perceptions of health literacy in CHCs were used to conduct a secondary analysis. This secondary analysis used a descriptive correlational design. Results. Results indicated that rural HCPs were significantly more likely to assess their patients for low health literacy (p = 0.04). HCPs from urban CHCs were significantly more likely to have a social worker (p = 0.04). HCPs from urban CHCs used low health literacy education materials (p = 0.04) for non-English speaking patients. Results of the multiple regression found the set of predictors were significant (p = 0.000) and were able to explain 60% of the variance. One variable made a significant contribution; individual intense patient education (p = 001). If the CHC had intensive, individualized patient education sessions the health care providers were significantly more likely to use low health literacy interventions (p = 0.001). Discussion. The Care Model can provide support to the CHC organization in developing health literacy decision support strategies. The implementation of health literacy interventions such as individualize patient education can assist the HCP in being prepared and proactive in the care they provide and can help promote the CHC patients to be involved and activated. These decision support strategies could assist in improving the patients’ health outcomes.