Author ORCID Identifier

https://orcid.org/0000-0001-7535-8099

Date of Award

8-31-2026

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Gerontology

First Advisor

Edward Alan Miller

Second Advisor

Jeffrey Burr

Third Advisor

Jane Tavares

Abstract

Many older adults and their families lack awareness of home and community-based services (HCBS) and express a desire to receive guidance about available service options. Health literacy may play a key role in promoting access to HCBS. Older adults with low health literacy likely face barriers to accessing needed HCBS, and may rely on family or friends to facilitate access to such care. Research is needed to better understand how health literacy among older adults and their social networks relates to the use of formal HCBS.

This mixed-method study examined the relationship between a range of health literacy skills and HCBS use among older adults and their close social ties. In the quantitative phase, multi-wave, national-level data were analyzed to examine the relationship between older adults’ basic health literacy and the likelihood of their using formal HCBS. The mediating effect of self-efficacy and the moderating effect of social support were tested. In the qualitative phase, focus groups were conducted with older adults’ social ties to understand how social support systems use advanced health literacy skills to find HCBS information.

Findings from the quantitative phase partially support a significant, positive association between health literacy and formal HCBS. No mediating or moderating effects were detected, yet noteworthy main effects emerged. Namely, older adults with higher levels of health literacy exhibited greater self-efficacy; those with greater levels of perceived social support had a lower likelihood of using formal HCBS. Although quantitative findings suggested that social support may temporarily replace the need for formal HCBS, the qualitative phase illustrated the value of social support in promoting access to formal HCBS.

This research has implications for home care practice and policy. Understanding the impact of health literacy on HCBS utilization can help home care providers modify their marketing and communication strategies to target a wider range of consumers. Physicians, hospital social workers, and case managers can use findings from the study to improve referral processes. As continued efforts are made to rebalance state and federal spending away from institutional care and toward HCBS, increasing access to home care services is likely a priority among policymakers.

Comments

Free and open access to this work is made available to the UMass Boston community by ScholarWorks at UMass Boston. Those not on campus and those without a UMass Boston campus username and password may gain access to this work through Interlibrary Loan. If you have a UMass Boston campus username and password and would like to download this work from off-campus, click on the “Off-Campus Users” button.

Download
Off-Campus UMass Boston Users

Share

COinS