ETSU study examines health literacy in Appalachia

Published 4:56 pm Thursday, January 7, 2021

OHNSON CITY — Dr. Hadii Mamudu, professor in the Department of Health Services Management and Policy in the East Tennessee State University College of Public Health, authored an article that examines the disproportionately burdened central Appalachian region’s health literacy about cardiovascular disease.
The article, which appeared in the October 2020 issue of the Southern Medical Journal, is titled “Cardiovascular Diseases Health Literacy among Patients, Health Professionals, and Community-Based Stakeholders in a Predominantly Medically Underserved Rural Environment.”
ETSU College of Public Health faculty emerita Dr. Mary Ann Littleton and CVD Appalachia project coordinator Amy Poole are co-authors. Additional co-authors include Rob Gregory from Karing Hearts Cardiology Services, Cynthia Blair of Johnson City Schools, Lynn Frierson and Carl Voigt of Mended Hearts – Johnson City Chapter, Dr. Timir Paul of ETSU’s Quillen College of Medicine, and Dr. Liang Wang of Baylor University. 
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
“Health literacy can have a substantial impact on a patient’s ability to access health care systems and seek appropriate management for his or her medical ailments and unhealthy habits,” said Mamudu. “Inadequate health literacy levels in a rural population have been shown to have a more significant impact on health status and outcomes compared with people living in urban areas because the rural population has lesser access to socioeconomic resources such as healthcare facilities and health-related information.”
This study aimed to examine the prevalence and factors of cardiovascular disease health literacy among a sample of patients/caregivers, providers/professionals, and community stakeholders in central Appalachia. In 2018, data were collected from central Appalachian residents in six states: Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia as part of a larger project funded by the Patient-Centered Outcomes Research Institute (PCORI). Health literacy status was determined by assessing correct responses to five interrelated questions about basic knowledge of cardiovascular disease.
The study concluded that cardiovascular disease literacy in rural central Appalachia was low. The researchers found having less than a college degree and being older than 50 years were significantly associated with lower cardiovascular disease literacy levels. Fewer than half of the study participants correctly answered all of the questions. 
“The small sample size suggests that both cross-sectional and longitudinal studies with a larger sample size are warranted to confirm this association,” Mamudu said. “Furthermore, health care providers must take these findings into consideration in the delivery of health services to provide better care and counseling to their patients, including adherence to medication regimens and therapies.”
To learn more about the ETSU College of Public Health, visit

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