title: Factors explaining variability in health literacy outcomes of public health nursing clients.
abstract: OBJECTIVE
  To evaluate variability in health literacy outcomes due to home visiting (HV) program components including PHN, Intervention, and Client.
  
  
  METHODS
  A comparative, correlational study evaluated PHN home visiting program data that included PHNs (N = 16); Interventions (N = 21,634); and Clients (N = 141). Client age ranged from 14 to 46 (median = 21, mean = 22.8, SD = 6.65). Clients were predominately White (75.9%), not married (84.4%), and female (99.3%). PHNS documented care using electronic health records (EHR) and the Omaha System.
  
  
  METHODS
  The outcome of interest was health literacy benchmark attainment (adequate knowledge) operationalized by Omaha System Problem Rating Scale for Outcomes Knowledge scores averaged across problems.
  
  
  METHODS
  Program of individually tailored, evidence-based HV interventions provided by PHNs.
  
  
  RESULTS
  There were 233 different interventions for 22 problems. Knowledge benchmark was attained by 16.3% of clients. Four factors explained variance in reaching the knowledge benchmark: Client (51%), Problem (17%), Intervention (16%), and PHN (16%).
  
  
  CONCLUSIONS
  The PHN and intervention tailoring are actionable components of HV programs that explain variability in health literacy outcomes. Further research should examine effects of training on PHN relationship skills and intervention tailoring to optimize outcomes of evidence-based PHN HV programs, and to evaluate whether improving health literacy may subsequently improve client problems.
authors.affiliation: School of Nursing, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Monsen
authors.forename: Snigdhansu B
authors.initials: SB
authors.lastname: Chatterjee
authors.forename: Jill E
authors.initials: JE
authors.lastname: Timm
authors.forename: J Kay
authors.initials: JK
authors.lastname: Poulsen
authors.forename: Diane B
authors.initials: DB
authors.lastname: McNaughton
mesh_terms: D003152:Community Health Nursing / Q000193:education* / Q000639:trends*; D004511:Education, Nursing, Graduate / Q000639:trends*; D006801:Humans; D024802:Nurse's Role; D011637:Public Health Nursing / Q000193:education* / Q000639:trends*
keywords: Omaha System; health disparities; health literacy; home visiting; informatics; interventions; outcomes; public health nursing