The Health Literacy of Americas Adults

1
The Health Literacy of Americas Adults

• Summary of Results from the 2003 NAAL

• NIFL/LINCS Region II
• Health Literacy Summit
• March 5, 2008

2
Who I am, Why Im Here

• Sabrina Kurtz-Rossi, M.Ed.
• Health and literacy educator
• Not a statistician
• Objectives
• Summarize key health literacy results from 2003
  NAAL
• Describe how these results have informed my work

3
Background

• 1992 National Adult Literacy Survey (NALS)
• First assessment of adult literacy in the U.S
• Surveyed 26,000 adults gt 16 year
• Measured functional literacy
• Prose, document, and quantitative literacy
• Competency-based scale
• Raised serious concerns about ability of nearly
  half adult population in U.S. to access health
  information and services.

Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
4
Background

• 2003 National Assessment of Adult Literacy (NAAL)
• Reassessment of adult literacy in the U.S., first
  since the 1992 study
• Surveyed 19,000 adults gt 16 years
• Measured functional literacy
• Prose, document, and quantitative literacy
• Competency-based scale
• Included 28 items specifically designed to assess
  health literacy skills

Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
5
Definition

• NAAL definition of health literacy
• The ability to use printed and written
  information associated with a broad range of
  health-related tasks to accomplish ones goals at
  home, in the workplace, and in the community
  (including health care settings).

Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
6
Questions

• Developed in collaboration with DHHS
• Three types of health literacy tasks clinical,
  preventive, and navigational.
• Sample Tasks
• Circle the date of a medical appointment on a
  hospital appointment slip.
• Give 2 reasons a person with no symptoms should
  be tested for a disease based on information in a
  clearly written pamphlet.

Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
7
Questions

• Sample Tasks
• Determine health weight range for a person of a
  specific height, based on a graph that relates
  height and weight to body mass index (BMI).
• Find information required to define a medical
  term by searching through a complex document.

Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
8
Results

• Below Basic no more than the most simple and
  concrete health literacy tasks
• Basic can perform simple and everyday health
  literacy tasks
• Intermediate can perform moderately challenging
  health literacy tasks
• Proficient can perform complex and challenging
  health literacy activities

Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
9
Key Results

• Over 75 million adults had Basic and Below Basic
  health literacy
• Fifty-three percent of adults had intermediate
  health literacy

Number and Percentage of Adults in Each Health
Literacy Level
Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
10
Key Results

• A higher percentage of adults who had not
  completed high school had Below Basic health
  literacy

Percentage of Adults in Each Health Literacy
Level by Highest Educational Attainment
Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
11
Key Results

• Adults in the oldest age group age 65 and older
  had lower health literacy than adults in the
  younger age groups

Percentage of Adults in Each Health Literacy
Level by Age
Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
12
Key Results
Source U.S. Department of Education, Institute
of Education Science, National Center for
Education Statistics, The Health Literacy of
Americas Adults Results from the 2003 National
Assessment of Adult Literacy. http//nces.ed.gov/n
aal/health_results.asp
13
Who Is at Risk?

• People with limited education
• Older adults
• Minority populations
• Persons with limited English proficiency (LEP)
• Those who are poor

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What is the Risk?

• Low health literacy is a barrier to quality care
  and is linked to
• Increased medical error
• Poor knowledge of health condition
• Underutilization of preventive health care
• Increased hospitalization
• Increased health care costs
• Poor health outcomes

Source AHRQ ReportLiteracy and Health Outcomes
(2004) http//www.ahrq.gov/clinic/epcsums/litsum.
htm
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Tobacco and Literacy Education Project

• Adults with less than a high school education,
  with higher rates tobacco use, and less knowledge
  about its health effects
• Developed and piloted health literacy lessons for
  GED/pre-GED classes that integrated tobacco
  information with math, language arts, technology
  instruction
• Health and literacy partners New Hampshire DOE
  Bureau of Adult Education, GED programs, DPH
  Tobacco Control Program, Legacy Foundation

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ESOL Health Literacy Curriculum Project
What is medicine?

• ESOL students many of whom are Hispanic, with
  varying levels of English language proficiency,
  and varying level of familiarity with the U.S.
  health care system.
• Develop and pilot highly illustrated student book
  (3rd 4th grade reading level) and teachers
  manual for ESOL instruction.
• Florida Literacy Coalition, ESOL programs,
  Florida Department of Education

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Health Information Literacy Research Project

• Develop and pilot training to increase awareness
  and use of online consumer health information
  resources by health care providers and their
  patients.
• Promote the role of librarians as providers of
  health information literacy resources and
  services.
• Medical Library Association, National Library of
  Medicine, Hospital-based libraries

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Discussion

• How have the health literacy results of the NAAL
  influenced your work?
• Sabrina Kurtz-Rossi, M.Ed.
• sabrina_kurtz-rossi_at_comcast.net
• Project Coordinator, Health Information Literacy
  Research Project, Medical Library Association
  Adjunct Clinical Instructor, Tufts University
  School of Medicine Health Literacy Curriculum
  and Professional Development Consultant