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PubMedDate not supplied

Development of a Smiling Touchscreen multimedia program for HRQoL assessment in subjects with varying levels of literacy.

OBJECTIVE: As low literacy affects the assessment of health-related quality of life (HRQoL) in several ways (e.g., subject eligibility and cost of administration), better approaches to HRQoL assessment in subjects with varying literacy levels are needed. METHODS: We developed a multimedia touchscreen program (the Smiling Touchscreen, ST) to administer HRQoL instruments to subjects with varying levels of Chinese language and computer literacy, using an iterative process where patients' input on design, clarity of instructions, and user-friendliness were repeatedly gathered and incorporated in development. The ST thus has several user-friendly features for low-literacy subjects (e.g., presentation of individual items using visual and auditory stimuli, voice-text synchronization, and visual analog scale with a touch and drag function), which we evaluated using qualitative and quantitative methods. RESULTS: The ST was well accepted by subjects (n = 66, 76% female, median [interquartile] age: 49.0 [40.0, 56.0]) with high (n = 43) or low (n = 23) literacy, 98% of whom found it easy or very easy to use, and 85% found the voice-text synchronization feature useful. In low-literacy subjects without computer experience (30%), none reported any difficulties using the ST. The median (interquartile) time spent to complete the ST (four Instruction and Practice screens, 24 questions, one visual analog scale) for high- and low-literacy groups was 13.9 (9.6, 23.9) and 23.2 (15.8, 26.5) minutes, respectively. Among subjects expressing a preference (n = 47), 21 (47%) favored the ST over interviewer- or self-administration. CONCLUSION: The ST is well accepted by subjects with varying literacy levels, including those without computer experience. It is thus a promising new approach for HRQoL assessment among subjects with varying literacy levels.

Acoustic Stimulation↗
PubMed2005

The prevalence of limited health literacy.

OBJECTIVE: To systematically review U.S. studies examining the prevalence of limited health literacy and to synthesize these findings by evaluating demographic associations in pooled analyses. DESIGN: We searched the literature for the period 1963 through January 2004 and identified 2,132 references related to a set of specified search terms. Of the 134 articles and published abstracts retrieved, 85 met inclusion criteria, which were 1) conducted in the United States with > or =25 adults, 2) addressed a hypothesis related to health care, 3) identified a measurement instrument, and 4) presented primary data. The authors extracted data to compare studies by population, methods, and results. MAIN RESULTS: The 85 studies reviewed include data on 31,129 subjects, and report a prevalence of low health literacy between 0% and 68%. Pooled analyses of these data reveal that the weighted prevalence of low health literacy was 26% (95% confidence interval [CI], 22% to 29%) and of marginal health literacy was 20% (95% CI, 16% to 23%). Most studies used either the Rapid Estimate of Adult Literacy in Medicine (REALM) or versions of the Test of Functional Health Literacy in Adults (TOFHLA). The prevalence of low health literacy was not associated with gender (P=.38) or measurement instrument (P=.23) but was associated with level of education (P=.02), ethnicity (P=.0003), and age (P=.004). CONCLUSIONS: A pooled analysis of published reports on health literacy cannot provide a nationally representative prevalence estimate. This systematic review exhibits that limited health literacy, as depicted in the medical literature, is prevalent and is consistently associated with education, ethnicity, and age. It is essential to simplify health services and improve health education. Such changes have the potential to improve the health of Americans and address the health disparities that exist today.

Educational Status↗
PubMed2006

Health literacy and anticoagulation-related outcomes among patients taking warfarin.

BACKGROUND: Little is known about whether health literacy affects anticoagulation-related outcomes. OBJECTIVE: To assess how health literacy is associated with warfarin knowledge, adherence, and warfarin control (measured by the international normalized ratio [INR]). DESIGN: Survey. PARTICIPANTS: Patients taking warfarin through an anticoagulation clinic. MEASUREMENTS: Health literacy was measured using the short-form Test of Functional Health Literacy in Adults (s-TOFHLA), dichotomized as "limited" (score 0 to 22) and "adequate" (score 23 to 36). We asked patients to answer questions relating to their warfarin therapy and used multivariable logistic regression to assess whether health literacy was associated with incorrect answers. We also assessed whether health literacy was associated with nonadherence to warfarin as well as time in therapeutic INR range. RESULTS: Bilingual research assistants administered the survey and s-TOFHLA to 179 anticoagulated English- or Spanish-speaking patients. Limited health literacy was associated with incorrect answers to questions on warfarin's mechanism (adjusted odds ratio [OR] 4.8 [1.3 to 17.6]), side-effects (OR 6.4 [2.3 to 18.0]), medication interactions (OR 2.5 [1.1 to 5.5]), and frequency of monitoring (OR 2.7 [1.1 to 6.7]), after adjusting for age, sex, race/ethnicity, education, cognitive impairment, and years on warfarin. However, limited health literacy was not significantly associated with missing warfarin doses in 3 months (OR 0.9 [0.4 to 2.0]) nor with the proportion of person-time in therapeutic INR range (OR 1.0 [0.7 to 1.4]). CONCLUSIONS: Limited health literacy is associated with deficits in warfarin-related knowledge but not with self-reported adherence to warfarin or INR control. Efforts should concentrate on investigating alternative means of educating patients on the management and potential risks of anticoagulation.

Aged↗
PubMed2006

Factors associated with medication refill adherence in cardiovascular-related diseases: a focus on health literacy.

BACKGROUND: The factors influencing medication adherence have not been fully elucidated. Inadequate health literacy skills may impair comprehension of medical care instructions, and thereby reduce medication adherence. OBJECTIVES: To examine the relationship between health literacy and medication refill adherence among Medicare managed care enrollees with cardiovascular-related conditions. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: New Medicare enrollees from 4 managed care plans who completed an in-person survey and were identified through administrative data as having coronary heart disease, hypertension, diabetes mellitus, and/or hyperlipidemia (n=1,549). MEASURES: Health literacy was determined using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). Prospective administrative data were used to calculate the cumulative medication gap (CMG), a valid measure of medication refill adherence, over a 1-year period. Low adherence was defined as CMG> or =20%. RESULTS: Overall, 40% of the enrollees had low refill adherence. Bivariate analyses indicated that health literacy, race/ethnicity, education, and regimen complexity were each related to medication refill adherence (P<.05). In unadjusted analysis, those with inadequate health literacy skills had increased odds (odds ratio [OR]=1.37, 95% confidence interval [CI]: 1.08 to 1.74) of low refill adherence compared with those with adequate health literacy skills. However, the OR for inadequate health literacy and low refill adherence was not statistically significant in multivariate analyses (OR=1.23, 95% CI: 0.92 to 1.64). CONCLUSIONS: The present study suggests, but did not conclusively demonstrate, that low health literacy predicts poor refill adherence. Given the prevalence of both conditions, future research should continue to examine this important potential association.

Aged↗
PubMed2004

Promoting health literacy.

This report reviews some of the extensive literature in health literacy, much of it focused on the intersection of low literacy and the understanding of basic health care information. Several articles describe methods for assessing health literacy as well as methods for assessing the readability of texts, although generally these latter have not been developed with health materials in mind. Other studies have looked more closely at the mismatch between patients' literacy levels and the readability of materials intended for use by those patients. A number of studies have investigated the phenomenon of literacy from the perspective of patients' interactions in the health care setting, the disenfranchisement of some patients because of their low literacy skills, the difficulty some patients have in navigating the health care system, the quality of the communication between doctors and their patients including the cultural overlay of such exchanges, and ultimately the effect of low literacy on health outcomes. Finally, the impact of new information technologies has been studied by a number of investigators. There remain many opportunities for conducting further research to gain a better understanding of the complex interactions between general literacy, health literacy, information technologies, and the existing health care infrastructure.

Adult↗
PubMed1998

Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer.

PURPOSE: Diagnosis of advanced prostate cancer is a major health problem, especially among low-income men. Opportunities vary for early detection of prostate cancer for low-income black and white men because of financial, cultural, and social factors. In this study, we evaluated the association of poor literacy skills with higher rates of presentation of advanced stages of prostate cancer among low-income black and white men who received care in equal-access medical systems. PATIENTS AND METHODS: Literacy and stage at diagnosis of prostate cancer were evaluated in 212 low-income men who received medical care in Shreveport, LA, and Chicago, IL. The patients' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine (REALM), an individually administered reading screening test designed specifically for use in the medical setting. Logistic regression models were used to evaluate predictors of metastatic disease at presentation as a function of patient age, race, literacy, and city. RESULTS: Whereas black men were almost twice as likely to present with stage D prostate cancer (49.5% v 35.9%; P < .05), they were significantly more likely to have literacy levels less than sixth grade (52.3% v 8.7%; P < .001). However, after adjustment for differences in literacy, age, and city, race was not a significant predictor of advanced-stage prostate cancer. CONCLUSION: Low literacy may be an overlooked but significant barrier to the diagnosis of early-stage prostate cancer among low-income white and black men. The development of culturally sensitive, low-literacy educational materials may improve patient awareness of prostate cancer and improve the frequency of diagnosis of early-stage cancer.

Adult↗
PubMed2001

Maternal depressive symptoms and low literacy as potential barriers to employment in a sample of families receiving welfare: are there two-generational implications?

This study examines the role of maternal depressive symptoms and low maternal literacy in predicting outcomes in two generations in families receiving welfare: mothers' employment and children's development. The sample consists of 351 African-American families, each with a preschool-age child, in which the mother had applied for or was receiving welfare. Close to the start of the study, 52.6 percent of the mothers in the sample had scores indicating lower literacy, 39.5 percent reported moderate to high levels of depressive symptoms, and 24.6 percent had a co-occurrence of these. Using continuous scores, in multivariate analyses of variance, neither level of literacy, extent of depressive symptoms, nor the interaction of these, were found to predict two measures of subsequent employment (any employment across the two year follow-up period, and current employment at the time of the follow-up). However, when cut points were used (low literacy; moderate to high depressive symptoms), mothers with low literacy were found less often to be employed approximately two years later. Multivariate analyses of variance examining the set of child outcomes (cognitive school readiness and behavior problems) in light of mothers' depressive symptoms and literacy level found a statistically significant interaction of literacy level and extent of depressive symptoms: children of mothers with more depressive symptoms had less favorable developmental outcomes only in the presence of low maternal literacy. Structural equation models provide evidence that parenting behavior mediates the relationship between the predictor variables and child outcomes, and that the pathways from depressive symptoms through parenting to child outcomes are stronger when maternal depressive symptoms co-occur with low maternal literacy.

Adult↗
PubMed2006

Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy?

OBJECTIVE: Although prior research demonstrated that improving diabetes self-efficacy can improve self-management behavior, little is known about the applicability of this research across race/ethnicity and health literacy levels. We examined the relationship between diabetes self-efficacy and self-management behavior in an urban, diverse, low-income population with a high prevalence of limited health literacy. RESEARCH DESIGN AND METHODS: We administered an oral questionnaire in Spanish and English to patients with type 2 diabetes at two primary care clinics at a public hospital. We measured self-efficacy, health literacy, and self-management behaviors using established instruments. We performed multivariate regressions to explore the associations between self-efficacy and self-management, adjusting for clinical and demographic factors. We tested for interactions between self-efficacy, race/ethnicity, and health literacy on self-management. RESULTS: The study participants were ethnically diverse (18% Asian/Pacific Islander, 25% African American, 42% Latino/a, and 15% white), and 52% had limited health literacy (short version of the Test of Functional Health Literacy in Adults score <23). Diabetes self-efficacy was associated with four of the five self-management domains (P < 0.01). After adjustment, with each 10% increase in self-efficacy score, patients were more likely to report optimal diet (0.14 day more per week), exercise (0.09 day more per week), self-monitoring of blood glucose (odds ratio 1.16), and foot care (1.22), but not medication adherence (1.10, P = 0.40). The associations between self-efficacy and self-management were consistent across race/ethnicity and health literacy levels. CONCLUSIONS: Self-efficacy was associated with self-management behaviors in this vulnerable population, across both race/ethnicity and health literacy levels. However, the magnitude of the associations suggests that, among diverse populations, further study of the determinants of and barriers to self-management is warranted. Policy efforts should be focused on expanding the reach of self-management interventions to include ethnically diverse populations across the spectrum of health literacy.

Diabetes Mellitus, Type 2↗
PubMed2004

Health literacy: implications for family medicine.

As many as 90 million Americans have difficulty understanding and acting on health information. This health literacy epidemic is increasingly recognized as a problem that influences health care quality and cost. Yet many physicians do not recognize the problem or lack the skills and confidence to approach the subject with patients. In this issue of Family Medicine, several articles address health literacy in family medicine. Wallace and Lennon examined the readability of American Academy of Family Physicians patient education materials available via the Internet. They found that three of four handouts were written above the average reading level of American adults. Rosenthal and colleagues surveyed residents and found they lacked the confidence to screen and counsel adults about literacy. They used a Reach Out and Read program with accompanying resident education sessions to provide a practical and effective means for incorporating literacy assessment and counseling into primary care. Chew and colleagues presented an alternative to existing health literacy screening tests by asking three questions to detect inadequate health literacy. Likewise, Shea and colleagues reviewed the prospect of shortening the Rapid Estimate of Adult Literacy in Medicine (REALM), a commonly used health literacy screening tool. Both the Chew and Shea articles highlight the need for improved methods for recognizing literacy problems in the clinical setting. Further research is required to identify effective interventions that will strengthen the skills and coping strategies of both patients and providers and also prevent and limit poor reading and numeracy ability in the next generation.

Adult↗
PubMed2005

[Peculiarities of the health literacy education system].

Health education encompasses opportunities for learning designed to improve health literacy, including increased knowledge and the development of life skills that lead to the improvement of individual and community health. Health literacy represents the cognitive and social skills, which determine the motivation and ability of individuals to gain access, to understand and use information in ways, which promote and maintain good health. There are three types of health literacy: basic, functional and critical. Basic health literacy implies a fundamental understanding of health problem and the ability to comply with prescribed actions to remedy the problem. Functional health literacy involves more advanced knowledge and skills to function in everyday society and the ability to seek out information in order to respond to changing needs. The most advanced level of health literacy is critical health literacy. It implies a significant level of knowledge, personal skills and confidence to manage one's health, and the ability to take action to change the determinants of health in the environment. Although these levels of health literacy are widely examined but systematic point of view is missing. The goal of this article is to report the peculiarities of the health literacy education system.

Health Education↗
PubMed2006

eHealth Literacy: Essential Skills for Consumer Health in a Networked World.

Electronic health tools provide little value if the intended users lack the skills to effectively engage them. With nearly half the adult population in the United States and Canada having literacy levels below what is needed to fully engage in an information-rich society, the implications for using information technology to promote health and aid in health care, or for eHealth, are considerable. Engaging with eHealth requires a skill set, or literacy, of its own. The concept of eHealth literacy is introduced and defined as the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. In this paper, a model of eHealth literacy is introduced, comprised of multiple literacy types, including an outline of a set of fundamental skills consumers require to derive direct benefits from eHealth. A profile of each literacy type with examples of the problems patient-clients might present is provided along with a resource list to aid health practitioners in supporting literacy improvement with their patient-clients across each domain. Facets of the model are illustrated through a set of clinical cases to demonstrate how health practitioners can address eHealth literacy issues in clinical or public health practice. Potential future applications of the model are discussed.

Computer Communication Networks↗
PubMed2005

Health literacy and functional health status among older adults.

BACKGROUND: Individuals with limited health literacy have less health knowledge, worse self-management skills, lower use of preventive services, and higher hospitalization rates. We evaluated the association between health literacy, self-reported physical and mental health functioning, and health-related activity limitations among new Medicare managed care enrollees. METHODS: A cross-sectional survey of 2923 enrollees was conducted in Cleveland, Ohio; Houston, Tex; Tampa, Fla; and Fort Lauderdale-Miami, Fla. Health literacy was measured using the short form of the Test of Functional Health Literacy in Adults. We used outcome measures that included scores on the physical and mental health functioning subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey, difficulties with instrumental activities of daily living and activities of daily living, and limitations because of physical health and pain. RESULTS: After adjusting for the prevalence of chronic conditions, health risk behaviors, and sociodemographic characteristics, individuals with inadequate health literacy had worse physical function (67.7 vs 78.0, P<.001) and mental health (76.2 vs 84.0, P<.001) than individuals with adequate health literacy. Individuals with inadequate health literacy were more likely to report difficulties with instrumental activities of daily living (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.74-2.92) and activities of daily living (OR, 2.83; 95% CI, 1.62-4.96), limitations in activity because of physical health (OR, 1.79; 95% CI, 1.39-2.32), fewer accomplishments because of physical health (OR, 1.90; 95% CI, 1.48-2.45), and pain that interferes with normal work activities (OR, 2.01; 95% CI, 1.46-2.77). CONCLUSION: Among community-dwelling older adults, inadequate health literacy was independently associated with poorer physical and mental health.

Activities of Daily Living↗
PubMed2003

Adults with self-reported learning disabilities in Slovenia: findings from the international adult literacy survey on the incidence and correlates of learning disabilities in Slovenia.

This study of adults with self-reported learning disabilities (SRLD) in Slovenia is part of a larger secondary analysis of the data from the International Literacy Survey project (IALS). The purpose of the study was to examine the characteristics of 79 (2.68%) individuals who reported experiencing learning disabilities and compare them to the general population on a variety of indicators of educational background, employment status, and reading and writing activities at work and at home. The proficiency scores of the SRLD individuals were lower in all three literacy domains (prose, document and quantitative literacy). In prose literacy 77.9% of SRLD adults performed at Level 1 and only 7.8% reached the level necessary for a modern technological society. Experiencing learning disabilities was not related to gender or age, however, results showed significant differences between the levels achieved by older and younger people with SRLD. In SRLD groups aged 40 years and above, no one achieved more than the second level of literacy in any domain. Learning disabilities were reported more frequently in rural areas. SRLD groups achieve significantly lower educational attainment, and lower employment status, with a preference for manual labour or craft. These findings are of critical importance. SRLD people report that poorer literacy skills are an obstacle to their progression in employment. In the Slovene sample, the SRLD group stands out for low scores in quantitative literacy. Results show that they are less active, pick up information only auditorily or in short written form. They need more frequent help from relatives in literacy activities. Interpretation of the IALS data on SRLD presents many problems. These include amongst others, problems in terminology, different background factors, and the validity of self-report measures. However, the study also raises many interesting challenges for future research and policy. Increasing the availability of support, assistance and counselling for adolescents and adults with learning disabilities remains a very important goal for dyslexia and LD policies in Slovenia.

Adolescent↗
PubMed2006

Patient understanding of food labels: the role of literacy and numeracy.

BACKGROUND: Comprehension of food labels can be important for patients, including those with chronic illness, to help follow dietary recommendations. Patient comprehension of food labels was examined, along with the relationship of comprehension to their underlying literacy and numeracy skills. METHODS: From June 2004 to April 2005, a cross-sectional study of 200 primary care patients was performed. A 24-item measure of food label comprehension was administered. Literacy was measured with the Rapid Estimate of Adult Literacy in Medicine (REALM), and numeracy with the Wide Range Achievement Test, third edition (WRAT-3). RESULTS: Most patients (89%) reported using food labels. While 75% of patients reported at least a high school education and 77% had 9th-grade literacy skills, only 37% had 9th-grade math skills. On average, patients answered 69% (standard deviation, 21%) of the food-label questions correctly. Common reasons for incorrect responses included misapplication of the serving size, confusion due to extraneous material on the food label, and incorrect calculations. For example, only 37% of patients could calculate the number of carbohydrates consumed from a 20-ounce bottle of soda that contained 2.5 servings. Higher comprehension of food labels was significantly correlated (all p values were less than 0.001) with higher income (rho=0.39), education (rho=0.49), literacy (rho=0.52), and numeracy (rho=0.67). CONCLUSIONS: Patients demonstrated deficits in understanding nutrition labels. Poor label comprehension was highly correlated with low-level literacy and numeracy skills, but even patients with higher literacy could have difficulties interpreting labels. Providers need to consider patients' literacy and numeracy when providing dietary recommendations. Opportunities may exist for the U.S. Food and Drug Administration to promote changes to make food labels more comprehensible.

Adult↗
PubMed2006

Health literacy and health risk behaviors among older adults.

BACKGROUND: Limited health literacy is associated with poorer physical and mental health, although the causal pathways are not entirely clear. In this study, the association between health literacy and the prevalence of health risk behaviors was examined among older adults. METHODS: A cross-sectional survey of 2923 new Medicare, managed-care enrollees was conducted in four U.S. metropolitan areas (Cleveland OH; Houston TX; Tampa FL; Fort Lauderdale-Miami FL). Health literacy was measured using the short form of the Test of Functional Health Literacy in Adults. Behaviors investigated included self-reported cigarette smoking, alcohol consumption, physical activity, body mass index, and seat belt use. RESULTS: Individuals with inadequate health literacy were more likely to have never smoked (46.7% vs. 38.6, p =0.01); to completely abstain from alcohol (75.6% vs. 57.9, p <0.001); and to report a sedentary lifestyle (38.2% vs. 21.6%, p <0.001) compared to those with adequate health literacy. No significant differences were noted by mean body mass index or seat belt use. In multinomial logistic regression models that adjusted for relevant covariates, inadequate health literacy was not found to be significantly associated with any of the health risk behaviors investigated. CONCLUSIONS: Among community-dwelling elderly, limited health literacy was not independently associated with health risk behaviors after controlling for relevant covariates.

Aged↗
PubMed2005

The impact of low health literacy on the medical costs of Medicare managed care enrollees.

PURPOSE: To examine the impact of low health literacy on medical care use and costs. METHODS: The study sample consisted of 3260 noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, Ohio; Houston, Texas; South Florida; and Tampa, Florida. Health literacy--the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions--was measured using the Short Test of Functional Health Literacy in Adults. We used a 2-part regression model to examine the association between health literacy and medical costs, adjusting for age, sex, race/ethnicity, education, income, alcohol and tobacco consumption, and comorbid conditions. Results are presented as mean differences (with 95% confidence intervals [CI]) between the inadequate and adequate groups and, separately, the marginal and adequate groups. RESULTS: When compared to those with adequate health literacy, emergency room costs were significantly higher ($108; 95% CI: $62 to $154; P <0.0001) among those with inadequate health literacy, while differences in total ($1551; 95% CI: -$166 to $3267; P = 0.08) and inpatient ($1543; 95% CI: -$89 to $3175; P = 0.06) costs were marginally significant. Total costs were higher in the marginal health literacy group, but the difference was not significant ($596; 95% CI: -$1437 to $2630; P = 0.57). CONCLUSIONS: Persons with inadequate health literacy incur higher medical costs and use an inefficient mix of services.

Aged↗
PubMed2006

Literacy, self-efficacy, and HIV medication adherence.

OBJECTIVE: We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship. METHODS: Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while the Patient Medication Adherence Questionnaire (PMAQ) was used to assess medication self-efficacy and adherence to antiretroviral regimens in the past 4 days. RESULTS: Approximately one-third of patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal to low literacy skills. In multivariate analyses, low literate patients were 3.3 times more likely to be non-adherent to their antiretroviral regimen (p < 0.001). Patients' self-efficacy, but not knowledge, mediated the impact of low literacy on medication adherence (AOR 7.4, 95% CI 2.7-12.5). CONCLUSION: While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship. PRACTICE IMPLICATIONS: Comprehensive intervention strategies that go beyond knowledge transfer may be needed to address self-efficacy among patients across all literacy levels to be successful in the management of difficult medication schedules.

Adult↗
PubMed2003

Health literacy and knowledge of chronic disease.

We sought to examine the relationship between health literacy and knowledge of disease among patients with a chronic disease. A total of 653 new Medicare enrollees aged 65 years or older who had at least one chronic disease (115 asthma, 266 diabetes, 166 congestive heart failure, 214 hypertension), completed both the in-person and telephone survey. Health literacy measured by the short test of functional health literacy in adults (S-TOFHLA) and demographic information were collected during the in-person survey. Knowledge of disease was assessed by questions based on key elements in educational materials during a telephone survey. Overall, 24% of patients had inadequate and 12% had marginal health literacy skills. Respondents with inadequate health literacy knew significantly less about their disease than those with adequate literacy. Multivariate analysis indicated that health literacy was independently related to disease knowledge. There are many opportunities to improve patients' knowledge of their chronic disease(s), and efforts need to consider their health literacy skills.

Aged↗