Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1055 — Prevalence and Variation of Health Literacy Skills among Veterans

Author List:
Griffin JM (CCDOR)
Snyder A (CCDOR)
Partin MR (CCDOR)
van Ryn M (University of Minnesota)
Nugent S (CCDOR)
Grill J (CCDOR)
Noorbaloochi S (CCDOR)

Objectives:
Studies show that people with poor health literacy skills have significantly worse health, are less likely to engage in preventative health measures, and have less knowledge about their health. These studies also report that those with the fewest skills are elderly, poor, non-white, and have fewer years of schooling. Little is known about the prevalence and distribution of low health literacy skills among veterans. This study’s objective was to determine the prevalence of health literacy skills among primary care patients at four geographically diverse VAMCs (Minneapolis, Portland, Durham, and West Los Angeles), and to assess variation in skills by age, education, income, race, and marital status.

Methods:
A random sample of veterans with upcoming appointments in primary care clinics at each site was selected. Eligible and willing patients completed a face-to-face survey with trained interviewers. Interviewers collected demographic information and conducted an assessment of health literacy (Short-Test of Functional Health Literacy in Adults, S-TOFHLA). The S-TOFHLA tests reading comprehension and numeracy skills and classifies health literacy by inadequate, marginal and adequate levels of skill.

Results:
Of the 1632 veterans assessed with the S-TOFHLA, the majority (83%) had adequate health literacy skills. Slightly more than 16% had either inadequate (8%) or marginal skills (8%). In bivariate analyses, those with either inadequate or 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.

Implications:
A potentially clinically significant proportion of veterans assessed had inadequate or marginal health literacy skills. Consistent with other studies, veterans with poor health literacy were more likely to be poor, elderly, non-white and have little education.

Impacts:
Vulnerable populations within the VA are more likely to have poor health literacy skills than others. Developing effective strategies to improve outcomes for people with poor health literacy may help reduce disparities among veterans using VA services.