The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

Abstract

PURPOSE Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults. METHODSWe undertook a cross-sectional study of a nationally representative sample of 2,668 US adults aged 65 years and older from the 2003 National Assessment of Adult Literacy. Multiple regression analysis was used to assess for evidence of mediation. RESULTSOf older adults in the United States, 29% reported fair or poor health status, and 27% to 39% reported not utilizing 3 recommended preventive health care services in the year preceding the assessment (infl uenza vaccination 27%, mammography 34%, dental checkup 39%). Health literacy and the 4 health outcomes (self-rated health status and utilization of the 3 preventive health care services) varied by race/ethnicity and educational attainment. Regression analyses indicated that, after controlling for potential confounders, health literacy significantly mediated both racial/ethnic and education-related disparities in self-rated health status and receipt of infl uenza vaccination, but only education-related disparities in receipt of mammography and dental care.CONCLUSIONS Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities.

Correlates of influenza vaccine uptake among community-dwelling older adults in Brazil

“…Previous studies have reported similar associations with education 4,11 and race. 4,30,31 Since vaccine delivery is provided free of charge by the Brazilian National Immunization Program, socioeconomic inequalities in access to the vaccine cannot be attributed to the lack of money to afford it. They rather reflect the lower level of health literacy that affects lower socioeconomic and minority strata.…”

“…They rather reflect the lower level of health literacy that affects lower socioeconomic and minority strata. 32 Accordingly, Bennet et al 30 found that health literacy significantly mediates racial/ethnic and education-related disparities in receiving influenza vaccination. Another explanation for the abovementioned association is the so-called Inverse Care Law, which states that good medical care tends to vary inversely with the need of the population served, 33 as richer people often benefit more from public spending on health.…”

Do Patient Preferences for Health Information Vary by Health Literacy or Numeracy? A Qualitative Assessment

“…Having sufficient and comprehensible information is necessary for patients to make health-related choices that best suit their needs and conditions. Information that is not designed for low health literacy/numeracy users can potentially exacerbate health disparities (Bennett, Chen, Soroui, & White, 2009). The purposes of this article are (a) to describe where a diverse sample of primary care patients who are at risk for cardiovascular disease and have varying health literacy and health numeracy abilities obtain their health information and (b) to describe their preferences for methods of receiving health information using a qualitative approach.…”

Promoting Health Literacy Research to Reduce Health Disparities

“…The consequences of early failures in education have more recently been linked to problems in healthcare. Research has begun to emerge showing how a health literacy skill set is linked to a range of health outcomes, and evidence has also emerged demonstrating how deficits in these skills possibly explain certain disparities (Bennett, 2009;Osborn, Cavanaugh, Wallston, White, & Rothman, 2009;Osborn, Paasche-Orlow, Davis, & Wolf, 2007;Sentell, 2006;Waldrop-Valverde, 2010;Wolf, 2006).…”