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PubMed2007

Caregiver health literacy and the use of child health services.

OBJECTIVES: Eighty million US adults have low health literacy, a risk factor for increased health care use among adults. The purpose of this work was to assess the association between caregiver health literacy and the use and cost of child health services. METHODS: We conducted a cross-sectional study of caregiver-child dyads from a sample of children aged 12 months to 12 years presenting to the pediatric emergency department of an urban, public hospital. Caregiver health literacy was measured by the Short Test of Functional Health Literacy in their preferred language (English or Spanish). Child health care use was measured by a 12-month retrospective review of the public hospital system's electronic database and of state Medicaid billing records for 4 types of visits: preventive care, urgent care, emergency care, and hospital care. Cost of child health care use was provided by Medicaid billing records. Multivariate analysis included caregiver education, age, and language proficiency, as well as child age, special health care needs, ethnicity, and health-insurance coverage. RESULTS: A total of 290 dyads were enrolled in the study. Twenty-two percent of caregivers had low (inadequate or marginal) health literacy. Caregivers with low health literacy were more likely to have less than a high school education, to have limited English proficiency, and to have been born outside the United States. There were no differences in health care use or cost between children of caregivers with low health literacy and children of caregivers with adequate health literacy. Three caregiver characteristics were associated with increased use of child health care services: born outside the United States, age at child's birth <24 years, and limited English proficiency. CONCLUSIONS: One in 5 caregivers of young children has low health literacy. Caregiver health literacy, however, was not associated with disparities in the use of child health services in this inner-city, ethnic minority population.

Caregivers↗

PubMed2001

Health literacy: an important issue for communicating health information to patients.

"Health literacy" refers to an individual's ability to read, understand, and use the information necessary to obtain adequate health care. Because so much health-related information is provided to patients in written form, some degree of health literacy is essential. A review of the international medical and education literature was conducted to identify research on health literacy. Limited health literacy is a widespread problem in both non-industrialized and industrialized nations, and it is mostly related to deficient reading skills. Deficient reading skills are most prevalent among those with a limited educational background, but considerable research shows that limited reading skills exist even among those who have completed a formal education. Risk factors for limited literacy include poverty, membership in an ethnic minority group, advanced age, and other sociodemographic characteristics. Limited health literacy highly associated with poor health status, and literacy skills more accurately predict health status than education level, income, ethnic background, or any other sociodemographic variable. Individuals with limited literacy have higher rates of illness and more hospitalizations than individuals with more well-developed reading skills. Considerable effort has been directed at creating special health education materials for communicating with patients who have limited reading skills, but there is minimal evidence that these interventions have any effect on the health status of these individuals. In conclusion, poor health literacy is a common problem with important implications for health status. Limited data are available about how to best address the needs of patients with limited literacy skills.

Educational Status↗

PubMedDate not supplied

Building knowledge in literacy and health.

Health and literacy share an interesting relationship. The complexities of the relationship between literacy and health need to be recognized by policy-makers and practitioners to dispel myths, reduce stigma attached to low literacy, and empower disadvantaged groups. As we engage in building knowledge in the field, there is a need for multi-sectoral collaboration, both quantitative and qualitative information, and more effective ways to communicate with and educate people with low literacy. At the Second Canadian Conference on Literacy and Health, research reported indicates that in terms of what we know, the field has focussed on: linking literacy and health; examining intervention programs; exploring e-health and rural health; evaluating programs; and empowering people. In exploring what we need to know, researchers at the conference identified the need to understand: the extent of literacy sensitivity among health care providers in diverse settings; the impact of using plain language and readability formulas; the effectiveness of approaches to instructing literacy; and the incorporation of health content and health literacy goals into literacy instruction. Further, we need to create accessible ways of sharing knowledge in the field to build and strengthen existing multi-sector partnerships within and between communities.

Canada↗

PubMed1998

Child development and emergent literacy.

Emergent literacy consists of the skills, knowledge, and attitudes that are developmental precursors to reading and writing. This article offers a preliminary typology of children's emergent literacy skills, a review of the evidence that relates emergent literacy to reading, and a review of the evidence for linkage between children's emergent literacy environments and the development of emergent literacy skills. We propose that emergent literacy consists of at least two distinct domains: inside-out skills (e.g., phonological awareness, letter knowledge) and outside-in skills (e.g., language, conceptual knowledge). These different domains are not the product of the same experiences and appear to be influential at different points in time during reading acquisition. Whereas outside-in skills are associated with those aspects of children's literacy environments typically measured, little is known about the origins of inside-out skills. Evidence from interventions to enhance emergent literacy suggests that relatively intensive and multifaceted interventions are needed to improve reading achievement maximally. A number of successful preschool interventions for outside-in skills exist, and computer-based tasks designed to teach children inside-out skills seem promising. Future research directions include more sophisticated multidimensional examination of emergent literacy skills and environments, better integration with reading research, and longer-term evaluation of preschool interventions. Policy implications for emergent literacy intervention and reading education are discussed.

Achievement↗

PubMed2026

Effectiveness of a Web-Based Educational eHealth Platform on Women's Health Literacy About Phthalate Exposure: Randomized Controlled Trial.

BACKGROUND: Phthalates are environmental endocrine-disrupting chemicals widely used in plastics, cosmetics, food packaging, and personal care products. Women may experience frequent exposure through everyday consumer and household products. Improving phthalate-related health literacy may support informed exposure-reduction decisions; however, conventional health education provides limited opportunities for repeated, interactive, and individually tailored learning. OBJECTIVE: This randomized controlled trial evaluated the effectiveness of an eHealth educational intervention (Phthalates Free) in improving women's overall and domain-specific phthalate-related health literacy and examined the association between platform engagement and health literacy outcomes. METHODS: A double-blind randomized controlled trial was conducted in the outpatient department of a regional teaching hospital in Taipei, Taiwan. A total of 114 women were randomly assigned to an intervention group (n=58) receiving a 6-month eHealth platform-based education program and a control group (n=56) receiving conventional paper-based education. Assessments were conducted at baseline (T0), 3 months (T1), and 6 months (T2). The Phthalate Health Literacy Scale (10 items; α=.90, content validity index=0.93) measured overall and domain-specific literacy (health care, disease prevention, and health promotion). Longitudinal outcomes were analyzed using generalized estimating equations based on all available observations according to participants' original randomized assignments, with adjustment for waist circumference and pregnancy history. Analysis of covariance (ANCOVA) was used to compare 6-month outcomes after adjustment for baseline scores. Platform engagement and perceived usability were assessed using back-end analytics and the System Usability Scale (SUS). RESULTS: At 6 months, the intervention group showed a significantly greater increase in total health literacy than the control group (+9.93 points, Wald χ²1=17.74; P<.001). Domain analyses revealed significant improvements in health care (+1.52; P=.001), disease prevention (+1.32; P=.001), and health promotion (+1.12; P=.001) domains. ANCOVA confirmed the between-group difference at T2 after adjusting for baseline scores (F1,109=11.43; P=.001; adjusted mean difference=7.15, 95% CI 2.96-11.34). Engagement analysis showed that high-engagement users (n=10) scored significantly higher in overall health literacy (t55=-3.00; P=.004) and all domains than general users. The SUS results (mean 84.7, SD 5.2; n=46, 79.3%) indicated high perceived usability. CONCLUSIONS: The Phthalates Free eHealth educational intervention significantly improved women's overall and domain-specific health literacy over 6 months. Higher platform engagement was associated with better health literacy outcomes. The intervention may serve as a practical adjunct to nurse-led education in outpatient and community settings by providing accessible, continuous, and evidence-based guidance on reducing phthalate exposure.

Humans↗

PubMed1988

Kiti No. AN VI-121 FP.MEBAM setting forth the organization of the Ministry of Basic Education and Mass Literacy, 21 December 1988.

This legislation sets forth the organization of the Burkina Faso Ministry of Basic Education and Mass Literacy. Among the directorates of the Ministry is the General Directorate of the National Literacy Institute which has as objectives 1) the promotion of literacy throughout the country; 2) the fostering and coordination of literacy activities and the training of young persons and adults; 3) the formulation of a national strategy to eliminate illiteracy; 4) the training of literacy trainers; 5) linguistic research applied to national languages; 6) methodological literacy research; 7) the creation and production of literacy materials; 8) creation and help in the implementation of a national postliteracy strategy; 9) participation in the production and reproduction of literacy materials; 10) the creation of methods and means of planning, overseeing, and evaluating literacy activities; and 11) the orientation, supervision, coordination, and administrative control of directorates that depend on it.

Africa↗

PubMed1999

Health literacy among Medicare enrollees in a managed care organization.

CONTEXT: Elderly patients may have limited ability to read and comprehend medical information pertinent to their health. OBJECTIVE: To determine the prevalence of low functional health literacy among community-dwelling Medicare enrollees in a national managed care organization. DESIGN: Cross-sectional survey. SETTING: Four Prudential HealthCare plans (Cleveland, Ohio; Houston, Tex; south Florida; Tampa, Fla). PARTICIPANTS: A total of 3260 new Medicare enrollees aged 65 years or older were interviewed in person between June and December 1997 (853 in Cleveland, 498 in Houston, 975 in south Florida, 934 in Tampa); 2956 spoke English and 304 spoke Spanish as their native language. MAIN OUTCOME MEASURE; Functional health literacy as measured by the Short Test of Functional Health Literacy in Adults. RESULTS: Overall, 33.9% of English-speaking and 53.9% of Spanish-speaking respondents had inadequate or marginal health literacy. The prevalence of inadequate or marginal functional health literacy among English speakers ranged from 26.8% to 44.0%. In multivariate analysis, study location, race/language, age, years of school completed, occupation, and cognitive impairment were significantly associated with inadequate or marginal literacy. Reading ability declined dramatically with age, even after adjusting for years of school completed and cognitive impairment. The adjusted odds ratio for having inadequate or marginal health literacy was 8.62 (95% confidence interval, 5.55-13.38) for enrollees aged 85 years or older compared with individuals aged 65 to 69 years. CONCLUSIONS: Elderly managed care enrollees may not have the literacy skills necessary to function adequately in the health care environment. Low health literacy may impair elderly patients' understanding of health messages and limit their ability to care for their medical problems.

Aged↗

PubMedDate not supplied

Child labour, adult literacy and employment rates in India.

This study assesses the relationship between literacy and labour rates among the adults and children in 17 Indian states. Among children aged 5-14 years, 53.9% were literate and 3.74% were working for wages; these figures, however varied markedly among the states. Kerala, a state with the best overall adult literacy, also recorded the highest child literacy rate, and the lowest child employment rate. The states with high adult literacy also tended to have high child literacy (Spearman's coefficient of rank correlation, Rho 1 = 0.95, P less than 0.001), and low child labour (Rho = 0.56, P less than 0.02). Child labour rates did not correlate with adult labour rates. However, change in adult literacy and labour rates over a 7-year period correlated significantly both with the change in child literacy and labour rates: The states with a greater increase in adult literacy also observed a greater rise in child literacy, and a greater fall in child labour rates. But the states with a greater increase in adult labour had a greater rise in child labour rates; for each ten additional adults working, two more children also worked for wages, suggesting that increasing job opportunities drew both adults and children into the labour force. The findings, and their implications for pediatric care are discussed.

Adolescent↗

PubMed2006

Health literacy and adherence to glaucoma therapy.

PURPOSE: To describe the health literacy of subjects with open angle glaucoma and to investigate the hypothesis that low health literacy is associated with poor glaucoma medication adherence. DESIGN: Cross-sectional patient survey and concomitant chart review. METHODS: One hundred and ninety-seven subjects with open angle glaucoma participated in a survey which included basic demographic information such as age, gender, ethnicity, and level of education completed, and a test of heath literacy, the Rapid Assessment of Adult Literacy in Medicine. Information was collected regarding visual field tests and prescribed medication. The subjects' pharmacies were contacted to ascertain the number of refills requested over the previous six months. RESULTS: Although 146 subjects (74%) reported completing high school, only 94 subjects (48.0%) read at or above a ninth grade level; 23 (11.7%) read at a level of third grade or below. The mean number of refills requested by a subject in the preceding six months was not predicted by race (P = .27,) gender (P = .31), age (P = .92), mean deviation of the visual field (P = .36), or level of education (P = .58). There was a positive relationship between health literacy and the number of refills obtained (P = .003). CONCLUSIONS: Many patients with open angle glaucoma may have poor health literacy. The subjects in our study with low literacy were less adherent with their glaucoma medications than those with a higher level of literacy. Interventions specifically targeting patients with low literacy may improve medication adherence.

Aged↗

PubMed2000

Health literacy and health-related knowledge among persons living with HIV/AIDS.

BACKGROUND: Functional health literacy is associated with illness-related knowledge, understanding, and treatment perceptions for several chronic illnesses. This study examined health literacy in relation to knowledge and understanding of HIV/AIDS. METHODS: Persons living with HIV/AIDS recruited from AIDS service organizations and HIV clinics completed the Test of Functional Health Literacy for Adults (TOFHLA) reading comprehension scale and measures of health status, knowledge and understanding of health status, perceptions of primary care givers, and perceptions of anti-HIV treatments. RESULTS: Eighteen percent of the sample scored below the cutoff for marginal functional health literacy on the TOFHLA. Controlling for years of education, persons of lower health literacy were significantly less likely to have an undetectable HIV viral load, somewhat less likely to know their CD4 cell count and viral load, and lower health-literacy persons who knew their CD4 count and viral load were less likely to understand their meaning. Lower health literacy was also related to misperceptions that anti-HIV treatments reduce risks for sexually transmitting HIV and beliefs that anti-HIV treatments can relax safer-sex practices. CONCLUSIONS: Poor health literacy creates barriers to fully understanding one's health, illness, and treatments. Misperceptions of treatment in the case of HIV infection creates danger for potentially transmitting treatment-resistant strains of HIV. These results have implications for patient education and treatment programming for people who have poor health-literacy skills and are living with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Use of a parent questionnaire in emergent and early literacy assessment of preschool children.

PURPOSE: The purpose of this project was to evaluate the use of a parent questionnaire in the assessment of emergent and early literacy skills of preschool children with language impairments (LI) and their typically developing (TD) peers to determine the relationship between parent report and more formal measures of early literacy, as well as to compare home literacy practices of these two groups of children. METHOD: Preschool children with LI (n = 17) were referred by area school district speech-language pathologists, and age-matched peers (n = 20) were recruited from local preschools. Examiner-administered measures of early literacy included assessment of rhyme, knowledge of environmental print, knowledge of print conventions, and letter-name and letter-sound knowledge, as well as analyses of narrative abilities. The parent questionnaire included 31 closed questions with responses chosen on a 5-point scale that addressed a number of domains of knowledge: phonological awareness, response to print in the environment, alphabet knowledge, interactions around books, writing, orientation to literacy, and parent practices, in addition to a number of open-ended questions. RESULTS: Results revealed a strong relationship between examiner-administered measures of early literacy and parent report for the children with LI only. Parents of children with LI rated their children more poorly across domains of literacy knowledge than did parents of the comparison group. Finally, a comparison of home literacy practices found differences between the groups in time spent watching television, age parents began reading to the child, and number of books owned by the child. CLINICAL IMPLICATIONS: Findings support the use of parent report as a tool in the assessment of emergent and early literacy knowledge and skills for children with LI.

Case-Control Studies↗

PubMed2003

Reaching for the stars: SLPs shine on literacy teams.

Speech-language pathologists (SLPs) who work with school-age children have the opportunity to contribute to the literacy development of specific students as well as the literacy instruction and intervention programs in their district. These efforts are made in collaboration with other professionals and parents and may be referred to as participation on literacy teams. This article describes successful literacy teams in elementary schools including the variety of possible members as well as common characteristics of successful literacy teams. We describe how SLPs participate by developing collegial relationships with their team, using best practices for literacy, and supporting children as they progress in the general curriculum. Finally, we discuss some strategies for SLPs to take stock of their own literacy team participation, identify new goals, and map out a plan to reach new heights in literacy as integral members of literacy teams.

Adolescent↗

PubMed2003

Literacy and memory decline among ethnically diverse elders.

Literacy may be a more powerful indicator of brain reserve than years of education. Literacy level may be a proxy for native intellectual capacity or life experience that can compensate for brain damage or provide brain reserve. Alternately, the experience of acquiring literacy skills may in itself change the organization of the brain and increase protection against cognitive decline. However, because people with low levels of literacy obtain poor scores on most cognitive measures, only longitudinal studies can elucidate the role of reading ability in reserve. We determined whether literacy skills could predict cognitive change in a sample of 136 English-speaking African American, Caucasian, and Hispanic elders selected from a longitudinal aging study in New York City. According to a physician's independent examination, all participants were nondemented throughout the four longitudinal assessments. Literacy level was assessed using the WRAT-3 reading subtest. After accounting for age at baseline and years of education, GEE analyses showed that elders with low levels of literacy had a steeper decline in both immediate and delayed recall of a word list over time as compared to high literacy elders. Our findings suggest that literacy skills are protective against memory decline among nondemented elders.

Black or African American↗

PubMed2001

Improving medical students' communication with limited-literacy patients: project development and implementation.

BACKGROUND: Physicians may not realize that some of their patients have limited reading abilities. The AMC Cancer Research Center and the Primary Care Curriculum at the University of Colorado collaborated to develop and implement a project to teach medical students to identify and effectively communicate with limited-literacy patients regarding cancer screening. METHOD: The project incorporated two standardized-patient (SP) cases on cancer screening and literacy into the existing curriculum for second-year students. A small-group, interactive problem-based learning (PBL) case on breast cancer screening and literacy introduced the concept of communicating about cancer screening and literacy issues. A clinical practice examination on colorectal cancer screening and literacy was given at the end of the year. RESULTS: The collaborative project proved successful in incorporating literacy and cancer screening into a medical school curriculum. Time spent training SPs to play the role of adults with limited literacy was very important, as was time spent pre-testing the cases. The PBL case effectively promoted group discussion of cancer screening and literacy. CONCLUSION: The project succeeded in making students aware of literacy and cancer screening issues. Outcome results are being analyzed.

Communication↗

PubMed2002

Health literacy and performance on the Mini-Mental State Examination.

The objectives of the study were to determine the relationship between functional health literacy and performance on the Mini-Mental State Examination (MMSE). New Medicare managed-care enrollees aged 65 years and older, living independently in the community in four US cities (Cleveland, Houston, Tampa, and Fort Lauderdale/Miami), were eligible to participate. In-home interviews were conducted to determine demographics and health status, and interviewers then administered the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the MMSE. We then determined the relationship between functional health literacy and the MMSE, including total scores, subscale scores (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction), and individual items. Functional health literacy was linearly related to the total MMSE score across the entire range of S-TOFHLA scores (R(2) = 0.39, p < 0.001). This relationship between health literacy and MMSE was consistent across all MMSE subscales and individual items. Adjustment for chronic conditions and self-reported overall health did not change the relationship between health literacy and MMSE score. Health literacy was related to MMSE performance even for subscales of the MMSE that were not postulated to be directly dependent on reading ability or education (e.g. delayed recall). These results suggest that the lower MMSE scores for patients with low health literacy are only partly due to 'test bias' and also result from true differences in cognitive functioning. 'Adjusting' MMSE scores for an individual's functional health literacy may be inappropriate because it may mask true differences in cognitive functioning.

Aged↗

PubMed2006

Correlates of health literacy in patients with chronic heart failure.

PURPOSE: Many older adults have inadequate health-related literacy, which is associated with poor health outcomes. Thus, it is important to identify determinants of health literacy. We investigated relationships between health literacy and general cognitive and sensory abilities, as well as education, health, and demographic variables, in a community sample of middle-aged and older adults. DESIGN AND METHODS: Participants were 314 community-dwelling adults (67% female, 48% African American) diagnosed with chronic heart failure recruited for a pharmacist-based intervention study to improve adherence to chronic heart failure medications. We adminstered demographic, health, education, cognitive (e.g., processing speed, working memory), and sensory measures, and the Short Test of Functional Health Literacy in Adults (STOFHLA), as part of the baseline condition of this study. RESULTS: STOFHLA scores were lower for participants who were older, less educated, male, African American, had more comorbidities, or scored lower on all cognitive ability measures. Hierarchical linear regression analyses showed that education and cognitive ability were independently associated with the STOFHLA measure and explained age differences in health literacy. IMPLICATIONS: The association of cognitive abilities and literacy has important implications for health literacy models and for interventions to reduce the impact of low health literacy on health outcomes. For example, medication instructions should be designed to reduce comprehension demands on general cognitive abilities as well as literacy skills.

Aged↗

PubMed2005

Predicting literacy at age 7 from preliteracy at age 4.

Early literacy experience and preliteracy knowledge have been shown to predict later literacy outcomes. Using a representative sample of 3,052 same-sex twin pairs (6,104 children) in the United Kingdom, we explored phenotypic and etiological interrelationships among early literacy experience, preliteracy knowledge, and school-based literacy outcomes (reading and writing). Both literacy experience and preliteracy knowledge at age 4 significantly and independently predicted literacy at age 7. Both measures also showed genetic influence that significantly predicted literacy at age 7, although genetic mediation was stronger for preliteracy knowledge than for early literacy experience. However, for both measures, shared environmental factors explained most of the association with literacy at age 7.

Age Factors↗

PubMed2006

Development of an easy-to-use Spanish Health Literacy test.

OBJECTIVE: The study was intended to develop and validate a health literacy test, termed the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA), for the Spanish-speaking population. STUDY DESIGN: The design of SAHLSA was based on the Rapid Estimate of Adult Literacy in Medicine (REALM), known as the most easily administered tool for assessing health literacy in English. In addition to the word recognition test in REALM, SAHLSA incorporates a comprehension test using multiple-choice questions designed by an expert panel. DATA COLLECTION: Validation of SAHLSA involved testing and comparing the tool with other health literacy instruments in a sample of 201 Spanish-speaking and 202 English-speaking subjects recruited from the Ambulatory Care Center at UNC Health Care. PRINCIPAL FINDINGS: With only the word recognition test, REALM could not differentiate the level of health literacy in Spanish. The SAHLSA significantly improved the differentiation. Item response theory analysis was performed to calibrate the SAHLSA and reduce the instrument to 50 items. The resulting instrument, SAHLSA-50, was correlated with the Test of Functional Health Literacy in Adults, another health literacy instrument, at r=0.65. The SAHLSA-50 score was significantly and positively associated with the physical health status of Spanish-speaking subjects (p<.05), holding constant age and years of education. The instrument displayed good internal reliability (Cronbach's alpha=0.92) and test-retest reliability (Pearson's r=0.86). CONCLUSIONS: The new instrument, SAHLSA-50, has good reliability and validity. It could be used in the clinical or community setting to screen for low health literacy among Spanish speakers.

Adolescent↗