Health Care
Doctoral Research
Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign
Under the supervision of Professor Daniel Morrow from the Department of Educational Psychology, I've led a series of studies to investigate the impact of health literacy (and cognition more broadly) on older adults’ comprehension of information needed for self-management of chronic illness, as well as how to leverage information technology to support patient/provider communication and self-care among older adults.
Health literacy is defined at the ability to access, understand, and use information to make effective health care decisions, and is often measured by the ability to read lists or health-related words or to understand brief health-related texts such as medication instructions. Many earlier studies have shown that older adults with lower health literacy skills tend to have poorer self-care and health outcomes, but we don’t know why. We are investigating how low health literacy undermines health outcomes. The first step is to better understand what abilities are involved in health literacy is and how they influence comprehension of health information. There are three specific goals: to understand the components of health literacy, to investigate the effects of these components on processing health texts, and to examine how to design the health texts for people with lower health literacy.
Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana Champaign
Under the supervision of Professor Daniel Morrow from the Department of Educational Psychology, I've led a series of studies to investigate the impact of health literacy (and cognition more broadly) on older adults’ comprehension of information needed for self-management of chronic illness, as well as how to leverage information technology to support patient/provider communication and self-care among older adults.
Health literacy is defined at the ability to access, understand, and use information to make effective health care decisions, and is often measured by the ability to read lists or health-related words or to understand brief health-related texts such as medication instructions. Many earlier studies have shown that older adults with lower health literacy skills tend to have poorer self-care and health outcomes, but we don’t know why. We are investigating how low health literacy undermines health outcomes. The first step is to better understand what abilities are involved in health literacy is and how they influence comprehension of health information. There are three specific goals: to understand the components of health literacy, to investigate the effects of these components on processing health texts, and to examine how to design the health texts for people with lower health literacy.
I. The Process-Knowledge Model of Health Literacy
We investigated the effects of domain-general processing capacity (fluid ability such as working memory), domain-general knowledge (crystallized ability such as vocabulary), and domain-specific health knowledge for two of the most commonly used measures of health literacy (STOFHLA and REALM). One hundred and forty six community-dwelling older adults participated (103 diagnosed with hypertension). The results showed that older adults who had higher levels of processing capacity or knowledge (domain-general or health) performed better on both health literacy measures. Processing capacity interacted with knowledge: Processing capacity had a lower level of association with health literacy for participants with more knowledge than for those with lower levels of knowledge, suggesting that knowledge may offset the effects of processing capacity limitations on health literacy. Furthermore, performance on the two health literacy measures appeared to reflect a different weighting for the three types of abilities. STOFHLA performance reflected processing capacity as well as general knowledge, while performance on the REALM depended more on general and health knowledge than on processing capacity. The findings support a process-knowledge model of health literacy among older adults, and have implications for selecting health literacy measures in different health care contexts.
II. Memory and Comprehension for Health Information among Older Adults: Distinguishing the Effects of Domain-General and Domain-Specific Knowledge
While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallized ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n=107, aged 60 to 88 yrs) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modeling of word-by-word reading times suggested that domain-general crystallized ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallized ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed.
We investigated the effects of domain-general processing capacity (fluid ability such as working memory), domain-general knowledge (crystallized ability such as vocabulary), and domain-specific health knowledge for two of the most commonly used measures of health literacy (STOFHLA and REALM). One hundred and forty six community-dwelling older adults participated (103 diagnosed with hypertension). The results showed that older adults who had higher levels of processing capacity or knowledge (domain-general or health) performed better on both health literacy measures. Processing capacity interacted with knowledge: Processing capacity had a lower level of association with health literacy for participants with more knowledge than for those with lower levels of knowledge, suggesting that knowledge may offset the effects of processing capacity limitations on health literacy. Furthermore, performance on the two health literacy measures appeared to reflect a different weighting for the three types of abilities. STOFHLA performance reflected processing capacity as well as general knowledge, while performance on the REALM depended more on general and health knowledge than on processing capacity. The findings support a process-knowledge model of health literacy among older adults, and have implications for selecting health literacy measures in different health care contexts.
II. Memory and Comprehension for Health Information among Older Adults: Distinguishing the Effects of Domain-General and Domain-Specific Knowledge
While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallized ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n=107, aged 60 to 88 yrs) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modeling of word-by-word reading times suggested that domain-general crystallized ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallized ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed.
III. Effects of Reengineering Health Texts on Comprehension of Self-Care Information among Older Patients
There are two lines of studies to investigate the effects of reengineering patient education materials on comprehension. One is to use multimedia information to assist patients to understand health information, and the other is to focus on the organizational aids and linguistics-related strategies to reduce the processing demands of health texts for patients with inadequate health literacy.
Selected Publications:
Chin, J., Johnson, J., Moeller, D., Duwe, E., Graumlich, J. F., Murray, M. D., Stine-Morrow, E. A. L. & Morrow, D. G. (2015). Promoting comprehension of health information among older adults. In D. C. Noelle, R. Dale, A. S. Warlaumont, J. Yoshimi, T. Matlock, C. D. Jennings, & P. P. Maglio (Eds.), Proceedings of the 37th Annual Conference of the Cognitive Science Society (pp. 375-380). Austin, TX: Cognitive Science Society.
Chin, J., Madison, A., Gao, X., Graumlich, J. F., Conner-Garcia, T., Murray, M. D., Stine-Morrow, E. A. L. & Morrow, D. G. (2015). Cognition and health literacy in older adults’ recall of self-care information. The Gerontologist. DOI:10.1093/geront/gnv091
Chin, J., Payne, B., Gao, X., Conner-Garcia, T., Graumlich, J. F., Murray, M. D.. Morrow, D. & Stine-Morrow, E.A. L. (2014). Distinguishing the effects of domain-general and domain-specific knowledge. Memory. DOI: 10.1080/09658211.2014.912331
Chin, J., Morrow, D. G., Stine-Morrow, E. A. L., Conner- Garcia, T., Graumlich, J. F., & Murray, M. D. (2011). The process-knowledge model of health literacy: Evidence from a componential analysis of two commonly used measures. Journal of Health Communication, 16 (Suppl3), 222-241.
Chin, J., D’Andrea, L., Morrow, D. G., Stine-Morrow, E. A. L., Conner-Garcia, T., Murray, M. D., & Graumlich, J. F. (2009). Cognition and illness experience are associated with illness knowledge among older adults with hypertension. Proceedings of the 53rd Annual Meeting of the Human Factors and Ergonomics Society 2009 (pp. 116-120). San Antonio, TX: Human Factors and Ergonomics Society.
There are two lines of studies to investigate the effects of reengineering patient education materials on comprehension. One is to use multimedia information to assist patients to understand health information, and the other is to focus on the organizational aids and linguistics-related strategies to reduce the processing demands of health texts for patients with inadequate health literacy.
Selected Publications:
Chin, J., Johnson, J., Moeller, D., Duwe, E., Graumlich, J. F., Murray, M. D., Stine-Morrow, E. A. L. & Morrow, D. G. (2015). Promoting comprehension of health information among older adults. In D. C. Noelle, R. Dale, A. S. Warlaumont, J. Yoshimi, T. Matlock, C. D. Jennings, & P. P. Maglio (Eds.), Proceedings of the 37th Annual Conference of the Cognitive Science Society (pp. 375-380). Austin, TX: Cognitive Science Society.
Chin, J., Madison, A., Gao, X., Graumlich, J. F., Conner-Garcia, T., Murray, M. D., Stine-Morrow, E. A. L. & Morrow, D. G. (2015). Cognition and health literacy in older adults’ recall of self-care information. The Gerontologist. DOI:10.1093/geront/gnv091
Chin, J., Payne, B., Gao, X., Conner-Garcia, T., Graumlich, J. F., Murray, M. D.. Morrow, D. & Stine-Morrow, E.A. L. (2014). Distinguishing the effects of domain-general and domain-specific knowledge. Memory. DOI: 10.1080/09658211.2014.912331
Chin, J., Morrow, D. G., Stine-Morrow, E. A. L., Conner- Garcia, T., Graumlich, J. F., & Murray, M. D. (2011). The process-knowledge model of health literacy: Evidence from a componential analysis of two commonly used measures. Journal of Health Communication, 16 (Suppl3), 222-241.
Chin, J., D’Andrea, L., Morrow, D. G., Stine-Morrow, E. A. L., Conner-Garcia, T., Murray, M. D., & Graumlich, J. F. (2009). Cognition and illness experience are associated with illness knowledge among older adults with hypertension. Proceedings of the 53rd Annual Meeting of the Human Factors and Ergonomics Society 2009 (pp. 116-120). San Antonio, TX: Human Factors and Ergonomics Society.
Postdoctoral Research
Advanced Interface Design Lab, Systems Design Engineering, University of Waterloo
Supervisor: Prof. Catherine Burns
Collaborator: TELUS Health
For many Canadians, the local pharmacist serves as first point of contact with the healthcare system as they fill prescriptions and ask health related questions. However, current information systems, Pharmacy Management Systems (PMS), for pharmacists are largely focused on inventory management and have no clinical information of patients. Hence, pharmacists and physicians have difficulty collaborating because they do not share the same clinical information and do not use the same information systems. The asymmetry of information happens on both sides. The aim of the proposed research is to fill this gap by investigating the current state of Electronic Medical Records systems (EMR) and PMS, developing the ideal model of the interaction between healthcare professionals and health information systems, as well as proposing theory-driven solutions to optimize the information contents, structures and flow of the systems to support physician-pharmacist collaboration.
Advanced Interface Design Lab, Systems Design Engineering, University of Waterloo
Supervisor: Prof. Catherine Burns
Collaborator: TELUS Health
For many Canadians, the local pharmacist serves as first point of contact with the healthcare system as they fill prescriptions and ask health related questions. However, current information systems, Pharmacy Management Systems (PMS), for pharmacists are largely focused on inventory management and have no clinical information of patients. Hence, pharmacists and physicians have difficulty collaborating because they do not share the same clinical information and do not use the same information systems. The asymmetry of information happens on both sides. The aim of the proposed research is to fill this gap by investigating the current state of Electronic Medical Records systems (EMR) and PMS, developing the ideal model of the interaction between healthcare professionals and health information systems, as well as proposing theory-driven solutions to optimize the information contents, structures and flow of the systems to support physician-pharmacist collaboration.