Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Lori Winchell


Doctor of Nursing Practice


This quality improvement project was initiated to address health literacy appropriateness of educational materials used by primarily Native American Elders at a low-income senior housing complex while engaging with healthcare volunteers; and to develop culturally sensitive educational material for indigenous residents. Health education materials were evaluated using the Patient Education Material Assessment Tool (PEMAT) and the Gunning Fog test. Prior to modification of the health educational materials, residents completed the Stanford survey on self-efficacy and confidence in managing their chronic diseases. The Stanford survey was readministered twelve weeks after using the revised health education materials; resident comments on self-care were also captured. The self-efficacy and confidence survey was analyzed using excel t-test. The two-tailed t-test paired two sample for means p-value was 0.003. The null hypothesis was rejected indicating a statically significant finding on resident self-efficacy and confidence levels after engaging with healthcare volunteers using modified educational materials and culturally sensitive communication practices. This finding is not generalizable due to the small number of participants. The health education materials were evaluated by five different health care providers using the PEMAT. There were inconsistences with the interrater reliability as raters interpreted the instructions differently. The Gunning fog test was done on the modified health education materials and demonstrated readability ranging from second grade to eleventh grade level. Findings suggest readability appropriateness of the modified materials exists for most of the participants in this residential community. This quality improvement project demonstrated that consistent in-person healthcare volunteer connections, using modified health literacy level educational materials, delivered improvement in the confidence and self-efficacy levels for self-care health knowledge in the aggregate of participating elders. Groundwork was established to develop an effective pathway to evaluate health education materials to be used by healthcare volunteers within a culturally diverse senior-living community.

Available for download on Tuesday, July 23, 2024