Functional health literacy is one path through which the educational system, health system, culture and society intersect to influence health outcomes and their associated costs. Inadequate functional health literacy can impair oral and written communication and subsequently the ability to understand the prevention and self-management of disease. Despite these concerns, the national prevalence of inadequate, marginal and adequate functional health literacy and their association with health status, health care utilization and subsequent health care outcomes remain largely unknown. For those tasked with the responsibility of managing population health, there is a void of tools and techniques that can be used to efficiently identify those at greatest risk of inadequate functional health literacy. Using standard regression modeling and diagnostic techniques, this study was the first to develop and validate a model to estimate functional health literacy and to confirm its direct relationship with preventive health services utilization in a nationally representative sample of elderly >= 65 years of age. The national prevalence of inadequate and marginal functional health literacy was estimated to be 39%. Preventive health care utilization varied by functional health literacy category. Individuals with inadequate or marginal functional health literacy had odds of not receiving a flu shot within the past 12 months that was 1.26 times that of individuals with adequate functional health literacy (OR = 1.26, 95% CI (1.11 - 1.43)) after controlling for income, insurance coverage, having a usual source of care, and self-reported general health status. Women with inadequate or marginal functional health literacy had odds of not ever having a mammogram that was 2.21 times that of women with adequate functional health literacy (OR = 2.21, 95% CI (1.85 - 2.65)) in multivariate analysis. This research confirms the national public health relevance of functional health literacy in preventive health care utilization in the elderly. Race, education and age-related disparities in preventive health care utilization may, in part, be mediated through functional health literacy. As we move to equalize health care access, utilization and quality for all, functional health literacy must be considered part of the solution if we are to empower those in greatest need.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12022004-001521 |
| Date | 03 December 2004 |
| Creators | Miller, Michael Joseph |
| Contributors | Edmund M. Ricci, PhD, Chyongchiou Jeng Lin, PhD, Susan M. Sereika, PhD, Howard B. Degenholtz, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12022004-001521/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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