Health and Functional Literacy in Physical Rehabilitation Patients

Abstract

Background: People with disabilities, who face multiple barriers to care, experience health disparities, yet few studies have measured health literacy in this population. Objective: This study evaluated functional literacy, health literacy, fluid cognitive function, and self-reported health in people who live in community dwellings with spinal cord injury, stroke, or traumatic brain injury. Methods: Participants with a traumatic spinal cord injury, stroke, or traumatic brain injury, one-year postinjury, and age 18 to 85 years, completed a battery of instruments at three medical centers in the Midwestern U.S.: functional literacy (word recognition, vocabulary knowledge), health literacy (comprehension of prose, document, and quantitative health information), fluid cognitive function (memory, executive function, and processing speed), and patient-reported outcomes (mobility, fatigue, sadness, anxiety, social function, and overall health). Key Results: There were strong correlations between functional literacy, health literacy, and fluid cognitive function. After adjustment for sociodemographic and clinical characteristics, higher health literacy was associated with better mobility, less anxiety, and better overall health; higher functional literacy was associated with less anxiety and better overall health; and higher fluid cognitive function was associated with better mobility, less sadness, better social function, and better overall health. Conclusions: To effectively address limited health literacy among people with spinal cord injury, stroke, and traumatic brain injury, and ensure that they are able to be informed partners in their health care, intervention is required at the level of patients, providers, and health care delivery systems. A special consideration is to ensure that health information is both well-targeted to people's health literacy levels and accessible for people with a range of physical, cognitive, and sensory limitations. The multimedia self-administered health literacy measure used in this study could be useful to rehabilitation providers and designers of health information and interfaces. [ Health Literacy Research and Practice. 2017;1(2):e71–e85.] Plain Language Summary: Health literacy represents people's abilities to obtain, understand, and use health information to make informed decisions about their health and health care. People with disabilities face physical, attitudinal, economic, and structural barriers to care. Consideration of health literacy in rehabilitation practice can enhance the effectiveness of the patient-clinician relationship and help address the needs of this population.

Health literacy and recovery following a non-catastrophic road traffic injury

“…Further, low HL was associated with poor understanding of injuries and treatment provided, leading to decreased adherence with discharge instructions and longer recovery time [ 7 ]. Hahn et al [ 8 ] showed that among people with spinal cord injury, stroke, or traumatic brain injury; higher HL was significantly associated with better overall health. Additionally, a single study of individuals with spinal cord injuries indicated that lower HL was associated with poorer physical mobility [ 9 ].…”

Social Insurance Literacy of Dutch Workers Receiving Disability Benefits and its Associations with Socio-Economic Characteristics

“…Additionally, these studies should unravel the influence of SIL on different social insurance related outcomes, such as received work disability benefits and perceived system justice. This is important because we know limited HL has a negative impact on multiple outcomes, such as active participation in the treatment [ 28 ] and mobility during rehabilitation from physical injuries [ 29 , 30 ]. Additionally, it is important to learn more about the role of professionals in their contact with people with limited SIL, for example if they are able to tailor their communication, and to develop and test interventions targeting clients and professionals in social insurance systems to optimize support of people with limited SIL.…”

Health literacy, health outcomes, and the caregiver role in traumatic brain injury.

“…In terms of HRQOL, two systematic reviews identified only four studies that measured both HRQOL and health literacy, with some reporting associations between health literacy and HRQOL, and others not finding such associations (Berkman et al, 2004(Berkman et al, , 2011. As the field of health literacy has advanced, more studies in diverse populations are emerging to investigate the associations between health literacy and HRQOL; these results have also been mixed (Hahn et al, 2015(Hahn et al, , 2017; This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.…”

“…In terms of HRQOL, two systematic reviews identified only four studies that measured both HRQOL and health literacy, with some reporting associations between health literacy and HRQOL, and others not finding such associations (Berkman et al, 2004, 2011). As the field of health literacy has advanced, more studies in diverse populations are emerging to investigate the associations between health literacy and HRQOL; these results have also been mixed (Hahn et al, 2015, 2017; Montbleau, King, Henault, & Magnani, 2017; Stellefson et al, 2019; Wang, Kane, Xu, & Meng, 2015; Zhang, Li, Fong, & Thumboo, 2009). Because HRQOL is a multidimensional concept, with dozens of disease-specific and generic domains, more research is needed to identify patterns of associations between health literacy and various HRQOL domains.…”