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Limited Health Literacy is Common in Former
Prison Inmates Mim Ari, MD1, Joel M. Hirsh, MD2,
Brenda Beaty, MSPH3, Ingrid A. Binswanger, MD,
MPH1,2 1Division of General Internal Medicine,
University of Colorado Denver, 2Denver Health
Medical Center, 3Colorado Health Outcomes
Program, University of Colorado Denver
RESULTS
INTRODUCTION
HEALTH LITERACY INSTRUMENTS
-Former inmates are a medically vulnerable
population with a unique set of challenges -At
the same time, they have increased opportunity to
engage in high-risk health behaviors -Health
literacy the degree to which individuals have
the capacity to obtain, process and understand
basic health information and services needed to
make appropriate health decisions -Understanding
the role of health literacy is important in
designing interventions to improve health
outcomes in this population -Goals of this
study 1) Describe health literacy in former
prison inmates 2) Assess the association between
health literacy and demographic variables,
self-reported health status, access and barriers
to care, and high-risk behaviors
METHODS

• -Participants 68 individuals recruited from the
  Denver Community Re-entry Center and from the
  Denver case management offices at Treatment
  Accountability for Safer Communities within 6
  months of release from Colorado or federal Prison
• -Eligibility gt18 years of age, ability to
  understand study procedures in English
• -Instruments
• Survey comprised of questions that assessed
  access to care, barriers to access to care,
  criminal justice history, risk behaviors, past
  and anticipated health care and presence of
  chronic medical complications of drug use
• Two health literacy instruments
• Single item literacy screener (SILS) which asked
  participants How confident are you filling out
  medical forms by yourself? on a 5 point
  Likert-type scale
• Medical Term Recognition Test (METER)
  participants were asked to identify real medical
  terms amidst a list containing both real
  (emergency, menopause) and real-sounding
  medical words (i.e. cerpes, potient)
• -Analysis The relationships between health
  literacy and categorical variables were compared
  using Fisher's Exact, Chi-Square and
  Mantel-Haenzel Chi-Square tests as appropriate.
  Continuous variables were analyzed using t-tests
  or Wilcoxon rank-sum tests as appropriate.

DISCUSSION
-Limited health literacy is common in recently
released inmates 15 had low health literacy and
57 had marginal health literacy -Our study was
limited by small sample size, which makes
understanding the contribution that health
literacy plays in health outcomes more
challenging. However, based on the effect it
plays in other vulnerable populations, we believe
continued study is valuable. -Health literacy
should be considered in designing interventions
to improve health outcomes and increase access to
care in individuals recently released from
prison. -Along with health literacy, other
complex social factors may drive decisions
related to accessing health care and
participating in high-risk health behaviors
FUNDING
Primary Care Internal Medicine Residency Program
of the University of Colorado General Internal
Medicine small grants program of the University
of Colorado Robert Wood Johnson Foundation