The Health Literacy of America's Adults - Part 1: Key Findings

This is the first article, in a 4-part series on health literacy. We begin by a discussion of the major finding from the National Center for Education Statistics of the U.S. Department of Education.

We are concerned about health literacy in the adult population because of the assumed connection between literacy and health outcomes. Low health literacy is correlated to poor communication between patient and provider and with poor health outcomes, increased rate of hospitalization, lower frequency of appropriate health screenings and higher disease morbidity and mortality. The results of this study are instructive for integrated health care organizations and insurers who are motivated to design educational offerings to patients/subscribers to prevent disease, improve health and improve treatment outcomes.

"The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy," was published in September 2006. The report was prepared by Mark Kutner, Elizabeth Greenberg, Ying Jin and Christine Paulsen of the American Institutes for Research. Detailed information on the report and questions can be found by directing inquiries to The National Center for Education Statistics, Institute of Educational Sciences of the U.S. Department of Education in Washington D.C..

The study is a sound statistical representation of the U.S. adult population. Over 19,000 adults were administered the test(an interesting side note is that 1,200 incarcerated adults received the demographically representative survey). It is quite an achievement when you consider that the test itself is conducted one assessment at a time, face to face with the surveyor and with pre-test screening used to assure accuracy of the test administration. All participants were rated based on their observed completion of specific tasks related to literacy assessment. Based on the study, health literacy is defined as:

"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 layman's terms, the study assessed the ability of adults to do a task that they are likely to experience in their daily lives along the following dimensions:
A. Clinical - including provider-patient interactions, clinical encounters, medication, diagnosis and treatment.
B. Prevention - including maintaining and improving health, disease prevention, early intervention for emerging health issues.
C. Navigation of the health system - including understanding how the health system works and the rights and responsibilities of the individual.

Survey Respondents were categorized into 4 literacy levels:

1. Below Basic - and may represent abilities such as: circle the date of a medical appointment on a hospital slip;

2. Basic - and may represent abilities such as: give two reasons a person with no symptoms of a specific disease should be tested for the disease, based on information in a clearly written pamphlet;

3. Intermediate - and may represent abilities such as: determine a health weight range for a person of a specified height, based on a graph that relates height and weight to body mass index (BMI);

4. Proficient - and may represent abilities such as: find the information required to define a medical term by searching through a complex document


Key Results:

Although a majority of U.S. Adults (53%) had intermediate literacy, it is noteworthy that 22 percent had basic and 14 percent had below basic literacy.

Women, on average, tend to score higher than men.

White and Asian/Pacific Islanders score higher than all other ethnic groups.

Adults who spoke English prior to starting school scored higher, on average.

Older adults (over the age of 65) had lower health literacy than younger adults.

Adults with increasing formal education, scored higher in direct relation to additional years of education.

Poor adults (e.g. living below the poverty line) had lower average health literacy.

Healthier adults (self-reported measure) tended to have higher health literacy.

Adults who either purchased their health insurance or received it as an employment benefit, scored higher than adults receiving insurance from Medicare or Medicaid.