Journal of Nursing Education

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Pseudo-Twitter Format: Health Literacy Learning Activity

Yvonne L. Chapman, DNP, FNP-BC, CNE, RN

In a qualitative study, Shieh, Belcher, and Habermann (2013) concluded that nursing students did not identify high-risk health literacy patients and failed to assess patient education materials or provide patient empowerment interventions encouraging active information-seeking or self-care behaviors. The Quality and Safety Education for Nurses (QSEN) initiative identified health literacy as a learning competency in the delivery of patient-centered care (Kennard, 2016). The use of Twitter in the classroom has offered an effective high-tech strategy for student goal achievement (Trueman & Miles, 2011). The goal of this trial learning activity was to determine whether a pseudo-Twitter format, fast paced and concise without the inconvenience of Twitter accounts and logins, would be an effective application of health literacy content for first-semester associate degree nursing students.

Learning Activity

Prior to the in-class activity, assigned reading and a brief didactic health literacy session were provided. A pseudo-Twitter format functioned as the learning platform for student review of knowledge, situational cognition application, and feedback. A handout provided directions, assigned topics, and a 140-character grid for tweet development. Assigned topics included health literacy content and health promotion scenarios. For example, an assigned topic read, “As a nurse, you are in the position to empower your patient and family to be active participants in their health care choices. In the following situation, provide teaching for the elderly patient regarding fall risk prevention.” Student pairs developed multiple tweets on each topic.

Once a student pair developed their tweet, they shared the tweet with a corresponding student pair for immediate feedback. After feedback was exchanged, student pairs used smartphones, tablets, or personal computers to post their tweet to a forum within a college-based learning management system. The posted tweets were visually displayed at the front of the class allowing for additional peer and faculty feedback. The tweets were accessible at a later date for use as study aids.

Student Results

Following the trial, a student self-assessment survey was administered to measure learning objectives. The Table shows cohort demographic characteristics. Overall, 100% of the students indicated high satisfaction or satisfaction measures for the following learning objectives: (a) obtainment of health literacy knowledge; (b) ability to identify at-risk patients; (c) ability to define characteristics for low health literacy; (d) ability to plan, implement, and evaluate patient teaching; and (e) confidence with patient empowerment skills. Overall, 94% (n = 34) of the students indicated high satisfaction or satisfaction with the pseudo-Twitter format as a learning strategy. Anecdotal student comments included “I enjoyed it!” and “Loved this project!” In conclusion, a pseudo-Twitter format bypassed high-tech barriers and offered an effective student-centered learning platform.

Demographic Characteristics (N = 37)


Demographic Characteristics (N = 37)

Yvonne L. Chapman, DNP, FNP-BC,


Kalamazoo Valley Community College


  • Kennard, D.K. (2016). Health literacy concepts in nursing education. Nursing Education Perspectives, 37, 118–119. doi:10.5480/14-1350 [CrossRef]
  • Shieh, C., Belcher, A.E. & Habermann, B. (2013). Experiences of nursing student in caring for patients with behaviors suggestive of low health literacy: A qualitative analysis. Journal of Nursing Education and Practice, 3, 75–85. doi:10.5430/jnep.v3n2p75 [CrossRef]
  • Trueman, M.S. & Miles, D.G. (2011). Twitter in the classroom: Twenty-first century flash cards. Nurse Educator, 36, 183–186. doi:10.1097/NNE.0b013e3182297a07 [CrossRef]

Demographic Characteristics (N = 37)

Age (years)
  20 to 292362
  30 to 39924
  40 to 49514
  Caucasian or White2876
  Black or African American411
  Latino, Asian, and American Indian513

The author as disclosed no potential conflicts of interest, financial or otherwise.


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