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Adult Health Literacy in the Portland/Vancouver Metropolitan Area

1 August 2007


Background: Health literacy as defined by Healthy People 2010, the national health initiative, is " the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." In order for patients to properly take medication, follow treatment instructions, and ask the appropriate questions of their medical providers, adequate health literacy is essential. Many studies have suggested a low level of health literacy corresponds to poor health outcomes, including higher medical costs, higher rates of disease and death, and increased hospitalization rates. The most recent National Assessment of Adult Literacy (NAAL), conducted in 2003 by the National Center for Education Statistics, found that only 12 percent of the adult population had a Proficient level of health literacy. Of the remaining population, 53 percent had Intermediate health literacy, 22 percent had a Basic concept of health literacy and 14 percent were considered Below Basic. Given these statistics, physicians and other medical providers should be striving to know the literacy rates of their patient population and adjust their interactions and patient education materials to meet the needs of their patients' understanding. Hypothesis: The purpose of this study was to assess the health literacy of the general adult population of Northern Oregon/Southern Washington metropolitan areas. It is a continuation of a study on adult health literacy that began last year by a previous Pacific University Physician Assistant Student, Henry Sessions. Last year, Mr. Sessions found the rate of Adequate health literacy levels in a local family practice clinic, at 95 percent, to be much higher than the national average of 62 percent, (if the Proficient and Intermediate levels from NAAL are combined). This year's authors were interested in discovering if the local literacy rate would approximate the national average, given a larger, more diverse sample population from a non-medical setting. They were interested in determining if there was a correlation in socioeconomic status, age, or ethnicity with adult health literacy rates. In addition, they hypothesized that people who see their medical providers frequently are more educated in medical jargon and disease processes, and, therefore, have a higher rate of health literacy. Study Design: Continuation study. Methods: Adult residents of Oregon and Washington were asked to fill out a short demographic survey and then complete a short, standardized medical-literacy test, the Test of Functional Health Literacy in Adults (s-TOFHLA). Multiple non-medical sites were used for participant recruitment, including several area churches, community recreation exercise facilitates, and private homes. As an incentive, participants where entered into a drawing for a $250 Best Buy gift card. Adults with medical conditions were identified and asked the frequency of their medical visits. This population group was then compared with one that reported neither medical conditions nor regular provider visits. Microsoft Excel and Statistix 8.1 software was used to analyze the data and compare variables of interest, such as gender, age and income. Results: This year, 289 s-TOFHLA's were completed by adults, ages 18 years or older, who live in either Oregon or Washington. Last year's sample consisted of 123 completed sTOFHLA's. This year's Adequate literacy rate, at 94.5 percent, was comparable to that found last year. Combining the two sample sets for a total population of 412, the overall Adequate literacy rate was 94.7 percent, with 5.3 percent having a Marginal or Inadequate health literacy rate. The data showed a positive correlation between higher scores and more education (p=< 0.001) as well as increased income (p=0.003). There was also a positive correlation between people that had more medical problems and a higher score (p=0.008). Caucasians scored higher than all other races. It also showed a negative correlation with age and scores. Typically those over age 65 scored lower on the s-TOHFLA (p= 0.002). There was no correlation between score and gender, score and type of provider seen or type of insurance. Conclusion: The researchers this year had similar results as those found by Mr. Sessions last year. Combined and individual study results showed that the Vancouver/Portland areas had a much higher adult health literacy rate as measured by the written s-TOFHLA than the national average. People with higher income and education were more likely to score the highest while people over age 65 were more likely to score lower. People that claimed to have more medical problems scored higher on the s-TOFHLA.


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