Date of Paper/Work

12-2010

Type of Paper/Work

Systems Change Project

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Roberta Hunt

Abstract

Homeless women with children living in transitional housing programs are at risk for inadequate and inappropriate navigation of the health care system, both medical and mental health services. Effective intervention programs to enhance navigational skills are needed to improve health outcomes and to decrease health care costs. This research study had two objectives: to identify whether the residents had a regular source of health care and to provide an intervention model to impact their navigational skills. Twenty-two women living in a Midwest urban transitional housing program participated. The quantitative study compared participants’ reported health care usage over two points in time: admission and after six months residency in Transitional Housing Program, as well as pre- and post-intervention. Paasche-Orlow and Wolf’s theoretical framework, Causal Pathway between Limited Health Literacy and Health Outcomes, describes the cognitive and psychosocial health literacy skills which are necessary for successful health care navigation. Harvard University’s Health Literacy Study Circles provided evidence-based curriculum for the intervention’s design which focused on three health literacy skills: problem-solving; patient- provider communication; and self-care capacity. Descriptive analysis revealed a change in the women’s navigation skills toward more positive health behaviors. There was an increase in participants’ use of regular health care provider after six months in agency program. There was no change in the reported access or utilization of mental health services The pre-post intervention survey responses also shifted toward improved self-perception of personal health and satisfaction with health care provider. Study limitations include small sample size. Replication of the research in similar programs is needed to establish the merit of this intervention model. This study also reveals the urgent need for effective programs to improve navigational skills related to utilization of mental health services.

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