Risks associated with low functional health literacy in an Australian population

Abstract

Objective: To measure the level of functional health literacy (FHL) in an Australian population, and to explore the level of risk associated with level of FHL. Design, setting and participants: Cross‐sectional, random population survey administered to 2824 South Australians aged ≥ 15 years, September – October 2008. Main outcome measures: Newest Vital Sign as a measure of FHL, self‐reported general health status, and use of health services. Results: 24% of respondents were at risk of limited FHL, and 21% had a high likelihood of inadequate FHL; this increased with age (≥ 65 years, 50% v 25–44 years, 11%). In multiple logistic regression models, a high likelihood of inadequate FHL was significantly more common among those with lower education (left school ≤ 15 years of age, odds ratio [OR], 8.1; 95% CI, 4.8–13.6); with lower annual income (< $20 000, OR, 4.1; 95% CI, 2.3–7.4); who were born in countries other than Australia, New Zealand, the United Kingdom and Ireland; and with poorer health status (OR, 1.6; 95% CI, 1.2–2.2). Inadequate FHL was significantly less common among females (OR, 0.6; 95% CI, 0.5–0.8). People with inadequate or at‐risk FHL were significantly more likely to report having diabetes, cardiac disease or stroke, and significantly less likely to have recently attended a doctor. Respondents aged ≥ 65 years with inadequate FHL were more likely to have been admitted to hospital (OR, 2.2; 95% CI, 1.1–4.5). Conclusion: Many Australians are likely to have limited health literacy, and this is a risk to effective health care delivery and health improvement across the community.

Health Literacy and Weight Change in a Digital Health Intervention for Women: A Randomized Controlled Trial in Primary Care Practice

“…These findings are particularly concerning given the lack of efficacious weight management treatment options for black females (Osei-Assibey, Kyrou, Adi, Kumar, & Matyka, 2010), a demographic who has the highest prevalence of overweight or obesity (82%) among any racial/ethnic group in the U.S. (Ogden et al, 2014). However, in contrast to previous findings (Adams et al, 2009; Barber, et al, 2009; Schillinger et al, 2002), we did not find an association between health literacy and age, employment status, or health insurance status, likely due to ceiling effects. We also did not find a link between health literacy and BMI, cardiometabolic indicators, or presence of medical conditions, unlike some prior work (Adams et al, 2009; Barber et al, 2009; Huizinga et al, 2008), but consistent with other past findings (Cha et al, 2014; Rothman et al, 2006; Shah et al, 2010).…”

“…We observed lower health literacy levels relative to other studies that used this measure (Adams et al, 2009; Darlow et al, 2012; Weiss et al, 2005), likely due to the characteristics of our sample. Lower rates of health literacy have been observed among racial/ethnic minority groups, including blacks (Cha et al, 2014; Darlow et al, 2012; Huizinga et al, 2008; Rothman et al, 2006), and those of low socioeconomic position (Adams et al, 2009; Barber et al, 2009; Cha et al, 2014; Huizinga et al, 2008; Rothman et al, 2006; Shah, West, Bremmeyr, & Savoy-Moore, 2010). These findings are particularly concerning given the lack of efficacious weight management treatment options for black females (Osei-Assibey, Kyrou, Adi, Kumar, & Matyka, 2010), a demographic who has the highest prevalence of overweight or obesity (82%) among any racial/ethnic group in the U.S. (Ogden et al, 2014).…”

“…Low health literacy challenges 90 million U.S. adults (USDHHS, 2010). Individuals most at risk include those from low socioeconomic status groups, those of older age, and some racial/ethnic minority groups (Adams et al, 2009; Huizinga, Beech, Cavanaugh, Elasy, & Rothman, 2008; Kutner, Greenburg, Jin, & Paulsen, 2006). However, unlike the link between education and general literacy skills (Kutner et al, 2006), even individuals with high educational attainment may have low health literacy (Kutner et al 2006; Shigaki, Kruse, Mehr, & Ge, 2012).…”

“…However, unlike the link between education and general literacy skills (Kutner et al, 2006), even individuals with high educational attainment may have low health literacy (Kutner et al 2006; Shigaki, Kruse, Mehr, & Ge, 2012). In two recent studies, among individuals with at least some college education, 32%-53% lacked adequate health literacy (Adams et al, 2009; Shigaki et al, 2012). …”

Role of Health Literacy in Self-Reported Musculoskeletal Disorders

“…Limited FHL is associated with adverse health outcomes, less frequent preventive health behaviors, less active self-management of chronic conditions, premature mortality, and higher healthcare costs [3, 4]. Population studies from developed countries, including the USA and Australia, have demonstrated that approximately 50% of adults have limited FHL skills, achieving a score below that needed to use health related materials found in everyday life with accuracy and consistency [5–7]. …”