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Fixing Low Health Literacy: Meet Walden Alumna Dr. Shiloh Williams

This hospital research director works to improve population health.

Dr. Shiloh WilliamsWhen she was a nurse in the ER, Shiloh Williams would see many of the same patients cycle in and out of the emergency department. These “frequent fliers,” as they’re sometimes affectionately known, often returned because they’d stopped taking medication for chronic conditions.

“My background had kind of led me to think that there are just noncompliant patients out there—patients who aren’t going to do what we tell them to do. And I still believe maybe there are some out there. However, we did this qualitative study about five years ago where we tracked an individual for an entire year, and we looked at every visit they came in for ... And what we saw was that patients were doing their darndest to try to be healthy and to try to follow what we were telling them, but they just couldn’t get there,” she says.

“And that’s really when I started looking at, OK, so if they’re really trying, what are some other factors? And that’s where health literacy kind of came forward as, this really could be the link for patients. If we can teach them exactly what’s going on with them in a way that is meaningful to them, and at their level, then would they be more responsive?”

Now, Dr. Williams, who received her PhD in Nursing from Walden University in 2020, is digging deeper into that question. She’s received a $50,000 grant to study health literacy among residents of southern California’s Imperial Valley. The research is supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health.

“We don’t do a good job detecting that,” says Dr. Williams, who is the director of research at El Centro Regional Medical Center and nursing community liaison and nursing program lecturer at San Diego State University–Imperial Valley. “We tend to overestimate our patients’ ability.”

We caught up with Dr. Williams recently to learn more about her health literacy project and the educational path that helped lead her there.

WALDEN: Congratulations on receiving this purposeful grant. Can you talk a little about health literacy and its importance?

DR. WILLIAMS: Sure. Health literacy is the ability of a patient to locate, receive, process, and understand health information and be able to use it in a meaningful way to make decisions regarding their health and healthcare. It is imperative for a patient to have adequate health literacy to be able to participate as an active member of their own healthcare team.

WALDEN: Can you share an example of how health literacy touches a patient’s life?

DR. WILLIAMS: When you look at the American Heart Association or the American Diabetes Association, for example, their materials are typically written at the national average, which is about a sixth- to eighth-grade reading level. Well, when I look at my participants here in the Imperial Valley, having taken care of them for many, many years now, typically they’re at a second- to third-grade reading level. So, when we hand them those materials … they’re not meeting their need because they aren’t written at the level that they need them to be at. And so, our nurses and our educators have had to do a lot of work to really get them to understand what’s going on with them, even though we’ve got these materials.

So, you know, I think that the middle approach of what we’re trying to do in terms of this project is to figure out, OK, what is that average health literacy level here. Maybe it’s different for different populations. Maybe it’s different for the elderly population versus the middle-aged versus the young adult population. And so, if we can get kind of a general idea, then we can move toward interventions that might work better.

WALDEN: We understand this project is a continuation of work you did for your doctoral dissertation. Can you tell us about that?

DR. WILLIAMS: Absolutely. So, one of the fun things about my Walden dissertation is that it actually launched into my intended program of research. With my dissertation, I focused very specifically on the medical surgical environment. And now we are trying to figure out if we can generalize what we found in my dissertation to a larger population, which is hospital-wide. So, we went from just med-surg to now looking at the health literacy level of the entire hospital, which we believe will kind of characterize based on the number of patients the hospital sees and their areas of service. We think those will be more generalizable findings in terms of their health literacy level.

WALDEN: What happens after you’ve finished data collection?

DR. WILLIAMS: That will hopefully launch us into that next phase of research. Now that we’ve got this data, what do we do with it? You know, what are some solutions to either raise a patient’s health literacy level or bring our materials and our education down to meet their true needs. Hopefully this study will attract federal funding to find solutions to address low health literacy in a rural-border region inhabited by a racially and ethnically diverse community.

WALDEN: How can health literacy help improve outcomes for patients?

DR. WILLIAMS: We think that we’re going to find that if we can better educate patients, we would increase compliance and really engage that participant as a member of their care team. And that I think is the critical part, because if we’re having that conversation with the patient and the patient is understanding the things we’re telling them, then they can give us feedback. If they can come back and say, look, no, this treatment plan doesn’t work because of X, Y, and Z, then we can remedy that and we can find a treatment plan that really works for them. And that’s where you get into true patient-centered care.

WALDEN: And how about benefits for healthcare systems?

DR. WILLIAMS: If you can get into that precision medicine, where you’re really looking at what works for an individual patient, then we do reduce the cost to the hospital. We do reduce the burden associated with our individuals who overutilize the healthcare system. Instead of coming in and being admitted for the 12th time this year, maybe they’re identifying when they’re getting in trouble earlier on and can reach out and go, “OK, something’s wrong. My blood sugars are no longer in control; they’re starting to spike.” Whereas before, perhaps they were coming in when they were already in a critical hyperglycemic state. So, I think it can have significant impact if we can just work better with our patient, understand where they’re at, and then give them materials and give them knowledge that they can actually use for their healthcare.

WALDEN: You are clearly using your Walden education to effect positive social change. What advice would you offer a nurse who is considering earning a doctoral degree and who wants to do just that?

DR. WILLIAMS: It’s the same advice that was actually given to me: It’s a marathon and not a sprint. And it’s not about intelligence, it’s more about determination. … You can do it if you’re just determined. You know, sometimes my determination comes off more like a bull in a china shop. But I’m going to get it done. And that was the tenacity I had to have with this PhD in Nursing program because it is challenging, and it is difficult. I think [learning] statistics made me cry a couple of times.

WALDEN: You finished your online PhD program during the first phase of the COVID-19 pandemic. What kept you going when things got tough?

DR. WILLIAMS: I knew that the next door to my career would not open without this. And I knew that the only way that I could really do something good for my community—that only I could do—was to start showcasing the data, particularly in terms of health literacy. And so, I needed to have the doctoral degree behind me. I needed to have the training behind me.

WALDEN: You earned both your Master of Science in Nursing (MSN) and PhD in Nursing from Walden University. Why did you choose Walden?

DR. WILLIAMS: I got my MSN in 2015 and I had chosen Walden at that point because a friend of mine was going there and she said, it’s really good and it’s easy to do in terms of the scheduling. (We were both working full time.) And so, I did, and I really enjoyed it. I was majoring in nursing education and it gave me a really great foundation to start my career as a faculty member with San Diego State University. When I finished up my master’s in 2015, I thought, OK, I’m going to put in some years in administration and I’ll go back way later. But then it was just kind of one of those things that was left undone. … So, I came back to Walden.

And one of the things that I absolutely love about Walden is just that commitment to social change and seeing it play out. And it just fit exactly who I am and what I want to do in terms of my career: making sure that my community is taken care of and doing anything that I can do to help.

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