Public health nurses’ perceptions of health literacy in adolescent patients

Purpose: To obtain and document public health nurses’ thoughts about health literacy in, and related communication practices with, adolescent patients. Methods: Using a qualitative descriptive approach, we conducted semi-structured interviews with a purposeful sample of public health nurses working with adolescents, either part- or full-time. Emerging themes were identified using content analysis and confirmed by two health literacy researchers and a public health nurse. Results: Nurses ascribed different meanings to the term health literacy, the most common being an understanding of one’s health or health-related information. They provided various types of health information to adolescent patients, used more than one mode of communication, and assessed adolescents’ understanding primarily by asking questions. Tailored approaches employed by nurses to communicate information to adolescents included the use of peer educators in schools; business cards with information on where to seek more information; and text messaging. These approaches, however, were not uniformly adopted and some nurses expressed concerns about the lack of security associated with the use of text messaging. Anxiety/fear in adolescents emerged as a prominent patient-related barrier to effective communication and stemmed, in some cases, from adolescents’ lack of understanding about confidentiality policies. Major provider-related barriers to effective communication included hours and locations of services that were inconvenient for adolescents, and limited time to spend with adolescent patients. Conclusions: Attention is needed to patient- and provider-related barriers that may limit or impeded efforts by public health nurses to promote health literacy in adolescent patients.