All ETDs from UAB

Advisory Committee Chair

Brian F Geiger

Advisory Committee Members

Kathleen C Brown

Phillip B Hammonds

Nataliya Ivankova

Connie Kohler

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Education


During the next decade, it is estimated that 7,918 Americans will turn 60 years old every day. This increase is expected to impact future health care costs. The aging population must be knowledgeable about health care needs to self-manage chronic conditions requiring multiple medications. Nearly half of all American adults have limited literacy skills. Adults at the lowest literacy levels may misunderstand instructions from a health care professional. Confusion about health care instructions can put patients at risk for adverse drug events. The purpose of this two-phase, explanatory mixed methods study was to explore how community dwelling adults ages 60 to 74 self-manage five or more daily prescription medications. Multiple levels of support and influences were examined within the community to determine how each impacted individual health literacy. Adverse drug events from the past 12 months, barriers, and facilitators to medication self-administration were also explored using the Social Ecological Model as the framework for the study. Using the maximal variation strategy for purposive sample selection, quantitative data were used to compose three distinct cases stratified by health literacy scores. Nine English-speaking community dwelling adults ages 60 to 74 participated in the follow-up, in-depth, qualitative phase. Three themes emerged during the analysis of each case; accuracy of self-administration of five or more daily prescribed medications, issues related to prescription medication adherence, and resources for assistance with medication administration. Further, 13 sub-themes emerged; the most prominent sub-themes were community support, patient-provider communication, pharmacy support, confusion related to generic substitutions, medication side effects, self-efficacy and family and friends. Analysis revealed regardless of health literacy level or the number of daily prescribed medications, participants demonstrated high accuracy of self-management for their medications. A likely explanation for these findings may be attributed to a community resource program which provides multiple levels of support for the senior within the community of interest. In 2007, limited health literacy was documented to add up to $238 billion of unnecessary costs to an already overburdened health care system. Future research and interventions should examine factors that influence relationships between health literacy and positive health outcomes.

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