Publication Date

Spring 5-29-2024

Item Type


Executive Summary

Improving Health Literacy on Appropriate Use of Medical Services

As part of a nursing leadership project, a team of nursing students at Seattle Pacific University (SPU) collaborated with a Washington State affordable independent living facility for seniors; they focused on providing information on the appropriate use of emergency care, urgent care, and primary care services for various health concerns. This project began with a team member recognizing a pattern within the older adult population entering the Emergency Department (ED). This observation showed that a noticeable portion of the older adult population could benefit from clarification about when to seek out emergency services appropriately. This project aims to provide information to the facility's residents on the use of various levels of medical services while adhering to their health literacy level.


Emergencies such as natural disasters, falls, and medical crises are more likely to affect the elderly (Priastana et al., 2023). Older adults are also more likely to have many physical and cognitive ailments, such as vision loss, decreased strength, and Alzheimer's disease, which create further difficulties in recognizing and handling emergencies (Priastana et al., 2023). Additionally, older adults can be confused about when to visit the emergency department, when to seek help at urgent care, or when to contact their primary care providers with their concerns. Some of this confusion can be attributed to health literacy deficits. Furthermore, uncertainty when making health decisions contributes to unnecessary trips to the ED as well as hesitation in escalating concerns to the ED during a genuine emergency (Staudenmayer et al., 2013).


Based on these concerns, the SPU nursing students created a template for informational flashcards to provide to the residents of this independent living facility. The provided information contains common reasons and symptoms that warrant using the ED, when to seek urgent care services, and when to reach out to the primary care provider. Also provided within these cards are contact numbers for local EDs and urgent cares and nurse triage hotlines for individual insurance plans.

The template was designed to be customizable so information can be changed to fit varying regions and locations outside of this facility. As the target population consists of elderly individuals, a large, easy-to-read font was utilized in creating these materials. While the typical adult in the United States reads at an eighth-grade level, those aged 65 and older have an average reading level equivalent to the fifth grade. This falls under limited health literacy (LHL), which occurs at or below an eighth-grade reading level (Chodos & Sudore, 2014). Understanding that this population struggles with low health literacy, the team decided to implement only key information formatted in a way that could be easily understood by the target population (Kim & Seieun, 2020). The team avoided using complex medical terminology and abbreviations to preserve simplicity. Additionally, clarifications were included about interpreting the advice on the flashcards.

To ensure the residents in this facility have equal access to the provided information, the team has opted to produce physical materials instead of digital formatting. This decision was made for inclusivity and avoids restricting access only to those with technological access and capability. During the initial assessment of the independent living facility, the team observed that many residents had impaired hearing and eyesight. Evidence-based research shows that older adults better comprehend physical material than digital media (Bogdan et al., 2024). The format of the physical handout also makes it easy to be referred back to while being portable at the same time.


One identified goal for this project was to educate the resident population at the independent living facility about when and how to seek medical attention for various situations. The team produced 100 physical prototypes to be distributed to the residents. Out of these prototypes, a handful were distributed to residents to gauge early feedback and interest before large-scale production was considered. Thus far, the flashcards are trending to be well-received as residents have provided positive feedback on the contents. Based on the feedback, the management team at the site has determined that it would be beneficial to continue producing these materials for current and future residents across all of their established sites.

Some barriers that the team faced while manufacturing this product included strict budgetary limitations and time constraints. This resulted in only being able to complete 100 prototypes, as opposed to servicing the entire 300-resident facility. While the distribution of this project limited the team’s ability to provide access to all residents, this barrier was resolved by management expressing interest in funding further production to increase accessibility to all.


This project was successfully disseminated to the population at a senior affordable housing facility. Having received positive feedback on the materials from residents and management, materials provided from this project are anticipated to be produced for continued use at multiple facilities. While this project was based on one independent living facility, the team hopes these materials can continue expanding and reaching far beyond its current boundaries.


Bogdan, E., Krueger. R., Wright, J., Woods. K., & Cottar, S. (2024). Disaster awareness and preparedness among older adults in Canada regarding floods, wildfires, and earthquakes. International Journal of Disaster Risk Science, 15(1), 198-212.

Chodos A.H. & Sudore R.L. (2014). Helping older adults with low health literacy. Current Diagnosis & treatment:Geriatrics (2nd Edition). McGraw-Hill Education.§ionid=533756

Kim, M. Y. & Seieun, O. (2020). Nurses’ perspectives on health education and health literacy of older patients. International Journal of Environmental Research and Public Health. 17(18). 6455-6466.

Priastana, I. K. A., Artawan., I. K. A., & Fadlilah, S. (2023). Emergency situations and the elderly: a discussion paper. Babali Emergency and Disaster Research, 1(1), 39-53.

Staudenmayer, K. L., Hsia, R. Y., Mann, N. C., Spain, D. A., & Newgard, C. D. (2013). Triage of elderly trauma patients: a population-based perspective. Journal of the American College of Surgeons, 217(4) 569-576.

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