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Improving health literacy is a national public health priority. Given the context of the COVID-19 pandemic, it is even more critical for health and medical information to be clear and understandable for patients and their families. Clinic-based programs to improve health literacy need to be pragmatic, feasible, and helpful for the implementing clinic and patients. This paper describes the development, implementation, and evaluation of a pragmatic, clinic-based health literacy intervention in a safety-net clinic that serves uninsured and indigent patients. Study methods are guided by a previous pilot study and components recommended for pragmatic interventions. An electronic readiness assessment was distributed to out-patient clinics affiliated with a statewide hospital association. The AskMe3 tool was used for the intervention as it is evidence informed and relatively easy to implement. Implementation included ongoing dialogue between the clinic and the academic research team. Within the implementing clinic, data collected from patients via verbally administered questionnaires was analyzed using descriptive statistics and chi-squares. Interview data collected from the clinic director was analyzed qualitatively for themes. The implementing clinic had some of the lowest average scores of the 34 clinics who participated in the initial readiness assessment. Despite this, they were able to successfully implement the health literacy intervention during a global pandemic. Eighty-eight participants completed patient questionnaires at this clinic. Most patients (96%) agreed the AskMe3 questions helped them talk with the doctor or nurse at their current appointment. Most (99%) also perceived the AskMe3 tool to be very helpful when used in a clinical setting. The clinic director offered that the staff initially thought the intervention would be difficult to implement. However, implementation by clinic volunteers with encouragement and prioritization of health literacy by the clinic director contributed to success. When considering interventions for clinical settings, a pragmatic approach can help with selection and implementation of a program that fits with the realities on the ground. Further, frequent technical assistance can help resolve implementation barriers. Interventions utilizing tools such as AskMe3, because of their simplicity, allow creative solutions to capacity issues for clinics who see a need for health literacy improvements.

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Limited health literacy is associated with poor patient health outcomes and increased hospitalization rates. Patient-provider communication plays an important role in patient health literacy and the understanding of medical terminology. This study demonstrates how a collaboration between clinical, academic, and community partners was instrumental in the design and implementation of a clinic readiness assessment and a clinic-based pilot intervention to encourage patient-provider communication and improve patient health literacy. A state hospital association, academic research team, and community adult literacy center director collaborated to develop a 60-item clinic readiness assessment and an evidence-informed pilot intervention. The clinic readiness assessment captured clinics' motivation and capacity for pilot implementation and providers' current communication strategies. The intervention centered around AskMe3™ educational materials and involved 2 patient visits (initial and follow-up visits). Data collection instruments for the intervention were administered verbally and included questions about patient demographics and communication needs, and a single-item health literacy measure. Descriptive statistics (frequencies/percentages) were used to analyze results from the clinic readiness assessment and pilot intervention. Establishment of the partnership, and collaborative, iterative development of the clinic readiness assessment and pilot intervention are described. This pilot project resulted in important lessons learned which led to critical modifications that will inform future expansion of the intervention. Collaboration between healthcare leaders, researchers, and community partners is recommended for developing clinic-based health literacy initiatives.

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Introducción. La motivación conduce a las personas a ejecutar acciones en pro de alcanzar una meta u objetivo. Este estudio buscó examinar la correlación entre la motivación autodeterminada para la actividad física y la composición corporal, en una cohorte de sujetos adultos con sobrepeso. Métodos. Se utilizó la herramienta BREQ 2 de autoinforme y para la antropometría fue medida por un técnico ISAK 1 y la composición corporal con báscula Tanita BC 420. Resultados. 46% (n = 18) de los participantes eran mujeres y 54% (n = 21) hombres. Edad promedio 31 ± 11 años, IMC: 25 ± 3 kg/m2, masa muscular 49 ± 9%, masa grasa 27 ± 16%, circunferencia de cintura (CC) 80 ± 7cm, cadera 98 ± 6cm, ICC 0,8 ± 0,05 cm. Conclusión. Se observó una correlación negativa entre variables antropométricas como IMC e ICC con el índice de autodeterminación en mujeres (r = -1 p < 0,05). La evaluación de la motivación autodeterminada debe ser la base para la programación de actividad física en población con sobrepeso.

Introduction: Motivation leads people to carry out actions in order to achieve a goal or objective. This study tried to examine the correlation between self-determined motivation for physical activity and physical composition, in a cohort of overweight adults. Method: We used the tool BREW 2 of self-report and anthopometry was measured with an ISAK 1 techinician. Body composition was measured with a Tanita BC 420 scale. Results: 46% (n=18) of patients were women and 54% (n=21) were men. The average age was 31 ±, MMI: 25 ± 3 kg/m2, muscular mass 49 ± 9%, fat, 27 ± 16%, waist circumference 80 ± 7cm, hip 98 ± 6cm, CCI 0.8 ± 0.05 cm. Conclusions: we observed a negative correlation among anthropometric variables, such as MMI and CCI with the rate of self-determination in women. Evaluating the self-determined motivation must be the base to program any physical activity in an overweight population.

Introdução: a motivação leva as pessoas a agirem em prol de atingir uma meta. Nesse sentido, este estudo tem o objetivo de analisar a correlação entre a motivacão autodeterminada para a atividade física e a composição corporal, em um grupo de sujeitos adultos com obesidade. Métodos: foi utilizada a ferramenta BREQ 2 de autorrelato; a antropometria foi medida por um técnico ISAK 1, e a composição corporal, com báscula Tanita BC 420. Resultados: 46% (n = 18) dos participantes eram mulheres e 54% (n = 21), homens. A idade média foi de 31 ± 11 anos, IMC: 25 ± 3 kg/m2; massa muscular 49 ± 9%; massa gorda 27 ± 16%; circunferencia de cintura (CC) 80 ± 7cm; quadril 98 ± 6cm, ICC 0,8 ± 0,05 cm. Conclusões: foi observada correlação negativa entre variáveis antropométricas como IMC e ICC com o índice de autodeterminação em mulheres (r = -1 p < 0,05). A avaliação da motivacão autodeterminada deve ser a base para programar atividades físicas em população com obesidade.

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Introducción. La motivación conduce a las personas a ejecutar acciones en pro de alcanzar una meta u objetivo. Este estudio buscó examinar la correlación entre la motivación autodeterminada para la actividad física y la composición corporal, en una cohorte de sujetos adultos con sobrepeso. Métodos. Se utilizó la herramienta BREQ 2 de autoinforme y para la antropometría fue medida por un técnico ISAK 1 y la composición corporal con báscula Tanita BC 420. Resultados. 46 % (n = 18) de los participantes eran mujeres y 54 % (n = 21) hombres. Edad promedio 31 ± 11 años, IMC: 25 ± 3 kg/m2, masa muscular 49 ± 9 %, masa grasa 27 ± 16%, circunferencia de cintura (CC) 80 ± 7cm, cadera 98 ± 6cm, ICC 0,8 ± 0,05 cm. Conclusión. Se observó una correlación negativa entre variables antropométricas como IMC e ICC con el índice de autodeterminación en mujeres (r = -1 p < 0,05). La evaluación de la motivación autodeterminada debe ser la base para la programación de actividad física en población con sobrepeso.

Introduction. Motivation drives people to perform actions in pursuit of a goal or objective. This study sought to examine the correlation between self-determined motivation for physical activity and body composition in a cohort of overweight adult subjects. Methods. The BREQ 2 self-report tool was used and for anthropometry was measured by an ISAK 1 technician and body composition with Tanita BC 420 scale.Results. 46 % (n = 18) of the participants were female and 54 % (n = 21) were male. Mean age 31 ± 11 years, BMI: 25 ± 3 kg/m2, muscle mass 49 ± 9 %, fat mass 27 ± 16%, waist circumference (WC) 80 ± 7cm, hip 98 ± 6cm, ICC 0.8 ± 0.05 cm. Conclusion. A negative correlation was observed between anthropometric variables such as BMI and WC with the self-determination index in women (r = -1 p < 0.05). The evaluation of self-determined motivation should be the basis for physical activity programming in overweight population.

Introdução. A motivação leva os indivíduos a realizar acções em busca de uma meta ou objetivo. Este estudo procurou examinar a correlação entre a motivação autodeterminada para a atividade física e a composição corporal numa coorte de adultos com excesso de peso. Métodos. Foi utilizado o instrumento de auto-relato BREQ 2 e a antropometria foi medida por um técnico do ISAK 1 e a composição corporal pela balança Tanita BC 420. Resultados. 46 % (n = 18) dos participantes eram do sexo feminino e 54 % (n = 21) do sexo masculino. Idade média 31 ± 11 anos, IMC: 25 ± 3 kg/m2, massa muscular 49 ± 9 %, massa gorda 27 ± 16 %, perímetro da cintura (PC) 80 ± 7cm, anca 98 ± 6cm, CC 0,8 ± 0,05 cm. Conclusões. Houve uma correlação negativa entre variáveis antropométricas como IMC e CC com o índice de autodeterminação em mulheres (r = -1 p < 0,05). A avaliação da motivação autodeterminada deve ser a base para a programação da atividade física na população com excesso de peso.

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