Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Amy Hughes Lansing


Emerging adulthood is a developmental period in the late teens and early twenties that is critical for addressing chronic pain and preventing pain-related morbidity and mortality, especially for emerging adults with rural residency. Emerging adults with chronic pain experience environmental and behavioral vulnerabilities, which disrupt typical developmental trajectories and increase long-term risk for poor chronic pain outcomes (Brown et al., 2021) at a time when they are becoming increasingly responsible for their own pain management and health decisions. In addition to the vulnerabilities associated with emerging adulthood and chronic pain, rural residency has also been linked with higher prevalence rates of chronic pain (Dahlhamer et al., 2018) and increased risk for worsened pain outcomes (Thorn et al., 2011). For rural emerging adults with chronic pain, health literacy may be a key driver of treatment engagement and behavioral health outcomes. By examining health literacy measurement, predictors and outcomes in this unique disease and developmental context, this research provides a framework for new avenues for interventions to mitigate risk factors associated with health literacy challenges in rural emerging adults experiencing chronic pain.

Rural emerging adults with chronic pain (M = 23.7 years; SD = 2.1 years) completed an anonymous, online questionnaire. Participants reported on health literacy, chronic pain variables, healthcare access status, and behavioral health factors. First, we examined the psychometric properties of a health literacy scale to examine reliability and validity of its use among rural emerging adults with chronic pain, establishing a three-factor scale. Next, our findings showed significant associations between health literacy and healthcare access, wherein increased distance to various healthcare professionals was associated with decreased health literacy. Further, our results indicated that increased health literacy was associated with decreased behavioral health outcomes, such as decreased pain interference, pain intensity, and decreased sleep difficulties. These results highlight the need for further research into the importance of health literacy for rural populations, as well as increased public policy efforts to ameliorate structural urbanism in healthcare for persons with chronic pain and other illnesses.



Number of Pages

142 p.

Available for download on Wednesday, December 11, 2024