Patient Illiteracy Affects Compliance With Health Care Instructions

Determining patient illiteracy in managed care plans

From 1997 to 1998, investigators at the Prudential Center for Health Care Research assessed the functional health literacy of 3,260 older Americans at four Prudential HealthCare sites in Cleveland, Ohio; Houston, Texas; Tampa, Fla.; and south Florida.

Investigators collected data through interviews with new Medicare managed-care enrollees, and by administering a shortened version of the Test of Functional Health Literacy in Adults (TOFHLA), which was developed under earlier RWJF grants to researchers at Emory University School of Medicine.

Key Findings

The investigators reported the following findings in the February 10, 1999 issue of the Journal of the American Medical Association (JAMA):

  • 23.5 percent of English-speaking respondents and 34.2 percent of Spanish-speaking respondents had inadequate functional health literacy, which means they may have difficulty understanding directions on prescription bottles, appointment cards or hospital informed consent forms.
  • For English speakers, rates of inadequate functional health literacy were highest in Cleveland (34.1 percent) and lowest in Tampa (16.6 percent).
  • For Spanish speakers, inadequate literacy rates were highest in Tampa (60 percent) and lowest in Houston (21.2 percent).
  • Rates of inadequate functional health literacy increased with increasing age — from 15.6 percent for individuals 65 to 69 years old to 58 percent for those 85 and over.
  • Individuals who rated their health as fair or poor were twice as likely to have inadequate functional health literacy compared with those who rated their health as good or excellent.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $100,000.

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