Edwin S. Rogers

Objective: To examine whether theories and/or models are used in interventions geared towards improving health-related outcomes for individuals with limited literacy skills. Methods: Intervention studies (n=52) published between 1980 and 2009 that met inclusion criteria were reviewed to assess the topic addressed, type of theory and/or model used, and the extent of theory use. Results: Twenty-one (40.4%) interventions were based on a theory or model. Most of those 21 interventions were either “informed by” (n=15, 71.4%) or “applied” (n=4, 19.1%) theory whereas 2 (9.5%) “tested” theory. Conclusions: Most low-literacy intervention research is not based on any educational, behavioral, or social science theory or model.

Recent research suggests that ethnic subgroup designation plays an important role in health-related disparities among Hispanics. Our objective was to examine the influence of Hispanics' self-reported ethnic subgroup designation on perceptions of their health care providers' communication behaviors.

The purpose of this study was to examine the relationship between health literacy and health-related quality of life (HRQOL) in a sample of English-speaking Tennesseans attending a university-based family medicine residency clinic. We measured the health literacy skills of patients (n = 249) using the Rapid Estimate of Adult Literacy in Medicine (REALM), dividing patients' scores into limited (< or = 8th-grade level) and adequate (> or = 9th-grade) literacy skill levels. We measured HRQOL using four items developed and validated by the Centers for Disease Control and Prevention (CDC). Scores on the REALM indicated that 28.5 percent of patients had limited and 71.5 percent had adequate health literacy skills. There was a significant correlation between patients' health literacy skills and self-reported general health (rho = 0.249, P < 0.01). Patients with limited health literacy skills had a higher median number of physically unhealthy days (P = 0.05) and activity limitation days (P = 0.05) compared with patients with adequate health literacy skills. Based on this study, patients' health literacy skills are associated with several components of HRQOL.

Background: Patients with limited literacy skills often have difficulty understanding medical information, are less likely to undergo cancer screening, and present with cancer at later stages than patients with better literacy skills. Since primary care physicians are responsible for performing or initiating the majority of cancer screening in the United States, they need to be able to not only identify patients who might not understand medical information but also communicate effectively with them about cancer prevention and screening. Methods: To determine whether family medicine residents could identify patients who might have difficulty understanding medical information because of limited literacy, we measured the literacy skills of patients in a university-based family medicine clinic using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). After the patients completed their office visits with a physician, we asked family medicine residents to rate the patients’ ability to understand medical information. Results: Among 140 patients who met with 18 family medicine resident physicians, 24% had limited literacy skills based on testing with the S-TOFHLA. Residents identified only about half of these patients as having poor or below average understanding of medical information. Conclusions: In many cases, family medicine residents are unable to identify patients who, based on assessment of their literacy skills, are likely to have difficulty understanding medical information. When working with residents, medical educators should promote the habit of taking poor literacy into account when communicating with patients.

Based on the most recent information, Tennessee is facing an enormous problem with literacy and health outcomes. As a result, the healthcare industry is vulnerable because of patients' inability to understand and follow a plan of treatment. This in part has resulted in poor healthcare and increased costs in providing care. By implementing strategies such as those outlined in Table 1, strides can be made in improving the healthcare provided to Tennesseans and reducing costs associated.