More about "Traditional" Health Literacy
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One of the major limitations to the research on health literacy is confusion or lack of clarity between the various meanings of health literacy. For example, literacy broadly defined can be used as an indicator for education level, which is in turn treated as a proxy for socioeconomic status (e.g., Nelson 1992 and Keil et al. 1993, cited in Baker et al. 1998). A patient’s education level, or socioeconomic status, may shape their morbidity and mortality in ways quite unrelated to their disease knowledge or adherence to disease management protocols (Gregg et al. 2001). |
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Literacy assessments can also be used to measure a patient’s ability to understand instructions from a health care provider. This more specific understanding of literacy is known as health literacy which may include disease knowledge. Definitions of health literacy are often limited to patient reading skills and material readability (e.g., Davis et al. 1998, Williams, Counselman and Caggiano 1996, Wilson 2000). |
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We argue that health literacy should be understood as distinct from SES or education level. For example, even elderly patients in an affluent retirement center reported low health literacy on the Test of Functional Health Literacy (TOFHL) (Gausman-Benson and Forman 2002). Kalichman, Ramachandran and Catz (1999) report that education and health literacy were significant independent predictors of medication adherence among a community sample of 182 HIV-seropositive participants. Similarly, poor medication knowledge was positively associated with lower adherence and lower literacy (p<.03) among 128 HIV-seropositive patients (Miller et al. 2003) |
References
Baker, D.W., et al.
1998 Health literacy and risk of hospital admission.
Journal of General Internal Medicine 13:791-8.
Davis, T.C., et al.
1998 Practical assessment of adult literacy in health
care. Health Educ Behav 25(5):613-24.
Gausman Benson, J., and W. B. Forman
2002 Comprehension of written health care information
in an affluent geriatric retirement community: Use of the
Test of Functional Health Literacy. Gerontology
48(2):93-7.
Gregg, E.W., et al.
2001 Use of Diabetes Preventive Care and Complications
Risk in Two African-American Communities. American Journal
of Preventative Medicine 21(3):197-202.
Kalichman, S.C., B. Ramachandran, and S. Catz
1999 Adherence to combination antiretroviral therapies
in HIV patients with low health literacy. Journal of
General Internal Medicine 14(5):315-7.
Keil, J.E., et al.
1993 Mortality rates and risk factors for coronary
disease in black as compared with white men and women. New
England Journal of Medicine 329:73-8.
Miller, L.G., et al.
2003 Knowledge of antiretroviral regimen dosing and
adherence: A longitudinal study. Clinical Infectious
Disease 36(4):513-8.
Nelson Jr., M. D.
1992 Socioeconomic status and childhood mortality in
North Carolina. American Journal of Public Health
82:1131-3.
Williams, D.M., F. L. Counselman, and C. D. Caggiano
1996 Emergency department discharge instructions and
patient literacy: A problem of disparity. Am J Emerg Med
14(1):19-22.
Wilson, F. L.
2000 Are patient information materials too difficult to
read? Home Healthcare Nurse 18(2):107-15.
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