|
BACKGROUND/RATIONALE:
Studies have shown that people with poor health literacy skills have significantly worse health status, greater risk for hospitalization, less knowledge about their health conditions, and are less likely to use preventative services. Little is known about the prevalence of low health literacy skills among veterans who use the VHA or the effect poor health literacy skills may have on complex preventative behaviors, such as screening for colorectal cancer (CRC). Understanding the distribution of health literacy skills among veterans and their effect on preventive behavior is critical for improving patient education, reducing health disparities, and promoting patient-centered care.
OBJECTIVE(S):
The primary objectives for this study are to develop an estimate of the prevalence of health literacy at four geographically diverse VAMCs (Minneapolis, Portland, Durham, and West LA), and for specific groups based on age, race, education, and geographic location. The secondary objectives are to link health literacy estimates for those 50 to 75 years old to CRC screening data, examine variation in guideline concordant screening rates by health literacy levels, and identify the mechanisms that may mediate or moderate the effect of health literacy on screening.
METHODS:
This observational study used a time-sequential randomized design of 4868 veterans, stratified by age (<50, 50-75, >75), who had upcoming appointments in primary care clinics at the 4 study sites. Patients who were eligible (i.e., have at least 20/50 vision and are not demented) were asked to participate in a face-to-face structured survey with a study interviewer. The survey included demographic data, functional status, social support, measures of attitudes and beliefs about health care providers, health insurers, medical care and the Short-Test of Functional Health Literacy in Adults (S-TOFHLA). For those between ages 50-75, knowledge of and attitudes towards CRC screening were also measured. Survey data are now being matched to CRC screening data to evaluate screening adherence.
FINDINGS/RESULTS:
Of the 1796 veterans who were eligible, enrolled in the study, and were assessed with the S-TOFHLA, the majority (84.3%) had adequate health literacy skills. Preliminary results show that slightly less than 16% had either inadequate (8.13%) or marginal skills (7.57%). In bivariate analyses, those with either inadequate and marginal skills were significantly more likely to be over 75, have less than a high school education, an annual household income less than $20,000, and be widowed. In bivariate analyses the S-TOFHLA did not vary significantly by race. In multivariate analyses, age, education, income, and race were significantly associated with inadequate or marginal skills after adjusting for study site. Additional analyses are currently underway to verify these preliminary findings and to examine variation of CRC screening adherenece by health literacy levels.
IMPACT:
Findings from this study are expected to have a number of broad implications for research and practice within the VHA. This project will inform organizational changes aimed to improve the efficacy and efficiency of communication strategies and identify areas where interventions or system-level changes could be most effective; inform improvements in informed consent procedures, patient education, discharge summaries and prescription instructions; inform and improve the effectiveness of interventions and the Quality Enhancement and Research Initiative (QUERI) translation efforts; provide the basis for future longitudinal investigations into how health literacy changes over time; and, contribute to our understanding and amelioration of factors associated with health disparities.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Chronic Diseases, Health Services and Systems
DRE:
none
Keywords:
Behavior (patient), Cancer, Screening
MeSH Terms:
none
|
