Co-Principal Investigator: Kristin Duppong-Hurley

Purpose: The purpose of this project is to develop, modify, and evaluate the promise of a supplementary web-based intervention, Health Literacy Transition Curriculum, designed to improve the health literacy skills and health-related transition outcomes of secondary students with high-incidence disabilities. Successful transitions for youth with high-incidence disabilities from high school to independent living continue to be a struggle for educators, researchers, families, and youth. Traditional transition planning has centered on important life domains such as life-skills training, vocational education, employment, and post-secondary education. While each of these areas plays an important role in the transition of youth, one significant set of skills that has often been overlooked is a youth's ability to obtain, process, and understand basic health needs and information. When young adults' health needs are not well met, their success in all other areas is significantly and negatively affected. This project is designed to improve youth health-related transition outcomes through the development, revision, and preliminary evaluation of the supplementary web-based Health Literacy Transition Curriculum.

Project Activities: The project will begin development of the web-based health literacy related curriculum using data obtained from focus groups with youth and educators and structured interviews with experts in the fields of health education, health administration, and secondary special education transition. The researchers will conduct a series of iterative studies to test the implementation feasibility and social validity of the web-based curriculum for further content and implementation modification. Finally, the team will conduct a small randomized controlled trial to assess the promise of the efficacy of the web-based Health Literacy Transition Curriculum on the health-related transition preparedness, knowledge, and skills of secondary students with high-incidence disabilities.

Products: The products of this project will include the fully developed web-based Health Literacy Transition Curriculum designed to improve the health-related transition preparedness, knowledge, and skills of secondary students with high-incidence disabilities and evidence of promise of its efficacy. In addition, products will include peer-reviewed publications and presentations.

Structured Abstract

Setting: This study will be conducted in high schools in Nebraska, including both rural and urban locations.

Sample: Approximately 20 youth in Grade 10 with active Individualized Education Programs (IEPs) for high-incidence disabilities will participate in the development, feasibility, and pilot studies. In addition, approximately 12 students that have graduated will be included in the initial phases of development as will approximately 17 educators working with these youth. Approximately 70 youth in Grade 10 enrolled in general resource room classes for students with disabilities will participate in the pilot study.

Intervention: The Health Literacy Transition Curriculum will be developed as a supplementary curriculum delivered online to teach adolescents important health-related skills that are typically not learned in the home, community, or school setting. Units will cover a range of health topics such as the importance of health, health-related decision making, self-advocacy, health transitions into adulthood, communicating with medical professionals, insurance, medication management, sexual health, staying safe, medical emergencies, accessing medical resources and services in the community, health-related transition IEPs, and personal health journals. The online curriculum will be delivered individually to students during the school day, in transition-specific classes or time within their regular schedules.

Research Design and Methods: To address the primary project aims, four studies will be conducted and expert consultants across the country will review plans, curriculum and materials, and focus group results to inform initial development. Study 1 will involve three focus groups; one with school personnel and two with youth to identify curriculum content, modifications, and support needs and to inform the transformation of materials into a web-based format. Study 2 will use an iterative process to modify the web-based curriculum and to evaluate the implementation feasibility and social validity of the curriculum, assess the tools developed to obtain baseline and outcome data, and inform additional curriculum modifications for further testing in Study 3. Both Studies 2 and 3 will also include educator and student focus groups and the use of the online curriculum to gather pre- and post-test data. Finally, Study 4 will involve a small randomized controlled trial with students assigned to treatment or control conditions to evaluate the promise of the effects of the web-based Health Literacy Transition Curriculum on health-related outcomes of youth with high-incidence disabilities.

Control Condition: Adolescents in the control condition will receive the business-as-usual health education and transition programming provided to all Grade 10 students with high-incidence disabilities.

Key Measures: Outcome measures will include tests of youth health literacy knowledge and skills, health-related transition preparedness, content usage, and social validity. Measures will be developed by the research team based on existing instruments.

Data Analytic Strategy: For the focus group data from the iterative content development study (Study 1) as well as from Studies 2 and 3, qualitative coding methods will be used. For Studies 2 and 3, descriptive statistics and generalized linear models (GLMs) will be used to evaluate change between pretest and posttest measures within a single-group design. For the small randomized controlled trial (Study 4), GLMs will be used to evaluate the potential efficacy of the health literacy intervention. Demographic data will be included as covariates in the models.