Reading skills and family planning knowledge and practices in a low-income managed-care population

doi:10.1016/S0029-7844(98)00431-1

Obstetrics & Gynecology

Volume 93, Issue 2, February 1999, Pages 239-244

https://doi.org/10.1016/S0029-7844(98)00431-1 Get rights and content

Abstract

Objective: To examine the relationship between reading ability and family planning knowledge and practices among Medicaid managed care enrollees.

Methods: A total of 406 women age 19–45 years enrolled in TennCare and members of Prudential HealthCare Community Plan in Memphis, Tennessee were interviewed to determine their methods of contraception, desire for additional information about contraceptives, and knowledge about the time in menstrual cycle they are at highest risk for pregnancy. Patient reading ability was assessed by an abbreviated version of the Test of Functional Health Literacy of Adults. The independent associations between reading ability, desire for additional contraceptive information, and knowledge about the highest risk time for pregnancy were assessed with logistic regression.

Results: Almost 10% of the respondents had low reading skills. Women who had used an intrauterine device, douching, rhythm, or levonorgestrel implants as methods of birth control had higher rates of low reading skills than women who used other methods of birth control. Compared with women with good reading skills, women with low reading skills were 2.2 times (95% confidence interval [CI] 1.1, 4.4) more likely to want to know more about birth control methods and 4.4 times (95% CI 2.2, 9.0) more likely to have incorrect knowledge about when they were most likely to get pregnant. These relationships were significant even after controlling for age, race, and marital status.

Conclusion: Health providers and organizations that serve historically underserved populations must understand that some individuals have a low level of reading ability that limits family planning education.

Section snippets

Materials and methods

Women from 13 through 45 years of age enrolled in Prudential HealthCare Community Plan as of March 1, 1996, were eligible to participate in the study. From the list of 2197 age-eligible women, we randomly selected individuals until we completed 500 surveys. Extensive efforts were made to locate women with missing phone numbers. If a phone number was missing or incorrect from the enrollment records, the project coordinator and interviewers used several other sources to obtain a telephone number:

Results

Overall, 9.6% of the respondents were classified as having low reading skills (less than 80% correct) (Table 1). The majority of TennCare enrolled women who completed the in-person interview were at least 25 years of age, black, single, high school educated, employed (full or part-time), and poor (Table 2). Only education was related to reading skill level with 15.4% of women with a high school education or less having low reading skills compared with 3.5% of women with more than a high school

Discussion

Almost 10% of the respondents in this study had low reading skills, which is about what we would expect in a low-income population for this age group.1 The rate of contraceptive use in this population was low, and women who had ever used an intrauterine device, douching, rhythm, or levonorgestrel had higher rates of low reading skills than did women who used other methods of birth control. Compared with women with good reading skills, women with low reading skills were more likely to want to

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Limited Ability of Three Health Literacy Screening Items to Identify Adult English- and Spanish-Speaking Emergency Department Patients With Lower Health Literacy
2020, Annals of Emergency Medicine
Citation Excerpt :
As an alternative to using health literacy screening instruments, asking patients how many years of formal education they have completed would seem to be a potentially straightforward means of rapidly assessing health literacy. Fewer years of formal education are generally, yet imperfectly, associated with lower health literacy.8-14 However, short-TOFHLA (S-TOFHLA) scores have demonstrated only a moderate relationship with educational attainment (Spearman’s r 0.56).6
Brief, easily administered, and valid health literacy assessment tools are needed to optimize health care delivery in the emergency medicine setting. Three health literacy screening items have been proposed to assess health literacy in outpatient settings. We investigated their ability to identify English- and Spanish-speaking adult emergency department (ED) patients with lower health literacy.
Participants were Spanish- or English-speaking adult patients randomly selected from 4 geographically spread, US, urban, safety-net EDs. Participants completed the 3 health literacy screening items, as well as the Short Assessment of Health Literacy–Spanish and English (SAHL-S&E). Test performance characteristics, including receiver operating characteristics area under the curve, of the 3 health literacy screening items were estimated, as compared with the SAHL-S&E.
According to the SAHL-S&E, 36% of the 1,165 English speakers and 35% of the 1,605 Spanish speakers had lower health literacy. Areas under the curve for each health literacy screening item individually were: needing others to help read materials (English 0.59, 95% confidence interval [CI] 0.56 to 0.62; Spanish 0.58, 95% CI 0.56 to 0.61), problems learning because of difficulty reading (English 0.63, 95% CI 0.60 to 0.66; Spanish 0.59, 95% CI 0.56 to 0.62), and confidence with completing forms (English 0.62, 95% CI 0.59 to 0.65; Spanish 0.60, 95% CI 0.57 to 0.63). Areas under the curve for the 3 screening items combined were: English 0.66 (95% CI 0.63 to 0.70) and Spanish 0.62 (95% CI 0.59 to 0.64).
The 3 health literacy screening items performed poorly in identifying adult ED patients with lower health literacy. Higher-validity screening measures are needed to better serve the health care needs of this vulnerable population in the ED setting.
An exploratory study of inactive health information seekers
2015, International Journal of Medical Informatics
Citation Excerpt :
Many studies have investigated the effect of health literacy and health-related outcomes. For instance, a low health literacy is associated with limited knowledge of healthcare services [38–42], a high risk of hospitalization [43,44], high mortality [45–49], decreased probability of screening and prevention [50,51], limited understanding of medical instructions [52–58], and less desirable health behaviors and treatment adherence [59–64]. In addition, studies using health literacy as an intervening factor addressed the effects of interventions designed to explain the effects of low health literacy.
This study aims to identify people who do not actively seek out health information and the demographic characteristics of Inactive Seekers. The possible determinants of inactive seeking behaviors are also explored.
A total of 14,420 survey respondents were drawn from the 2009 Annenberg National Health Communication Survey (ANHCS) data. K-means clustering was used to discriminate Inactive Seekers from Active Seekers. The inactive information seeker group was formed based on their experience with health information seeking. The potential determinants that were tested to predict inactive seeking included the following: health condition, health service use, health media exposure, and computer/Internet activities.
Within this national survey data, the respondents were more likely to be included in the Inactive Seekers (N = 8312, 58.5%) compared to Active Seekers (N = 5908, 41.5%). The demographic characteristics indicated that the Inactive Seekers were identified as younger, male, highly educated, White, and high household income people. The binary logistic regression results from the study model indicated that healthier people were less likely to seek out health information than their counterparts. In addition, those who were exposed to various media were almost 1.6 times more likely to seek out health information than those who were not exposed to such media. Within this study data, the statistically significant determinants identified were health condition and health media exposure while computer/Internet activities did not show strong indications in predicting inactive seeking behavior.
The development of more generalizable measures for health literacy or behavioral patterns will bolster advanced study on inactive seeking relating to knowledge of technology and health context. Further study should be directed at estimating the negative aspects of information seeking such as information ignorance or information avoidance.
Socio-economic correlates of functional health literacy among patients of primary health care in Kosovo
2014, Public Health
Citation Excerpt :
Previous reports have not pointed to a significant relationship between health literacy and marital status,32,33 similar to the findings of this study. As a matter of fact, different studies have introduced marital status as an independent variable in various predictive models and have mainly adjusted/controlled for its potential confounding effect, regardless of its lack of statistically significant relationship with health literacy.32–35 This study has several limitations due to its cross-sectional design, such as selection bias and information bias.
Functional health literacy (FHL) has been related to individual characteristics, ill-health and disease knowledge. However, the information about FHL in Kosovo is very limited and thus the aim of this study was to assess the demographic and socio-economic correlates of FHL among users of primary health care in Kosovo, a postconflict country in the Western Balkans.
Cross-sectional study.
A cross-sectional study was conducted in Kosovo between November 2012–February 2013, including a representative sample of 1035 consecutive primary care users aged ≥18 years (60% females; overall mean age: 44.3 ± 16.9 years; overall response rate: 86%). Test of Functional Health Literacy in Adults (TOFHLA) was used to assess FHL. General linear model and logistic regression were used to assess the association of TOFHLA score with demographic and socio-economic characteristics.
Overall, four out of five participants exhibited inadequate or marginal FHL in this Kosovo sample. FHL score was independently and inversely related to age, but positively associated with educational attainment and being in a situation other than unemployed.
Limited or marginal FHL was very common among primary care users in Kosovo and considerably higher than in the neighbouring Serbia. The low health literacy levels in Kosovo may provide an additional barrier towards achievement of health care goals. There is a need to design and implement suitable and effective educational and health system interventions in the Kosovo context.
Randomized controlled trial of a computer-based module to improve contraceptive method choice
2012, Contraception
Citation Excerpt :
A recently completed Institute of Medicine report on federally funded family planning services cited the lack of evidence of proven efficacy of contraceptive counseling methods or interventions [9]. Despite documented socioeconomic disparities in unintended pregnancy [4,6] and the established link between socioeconomic status and literacy skill level [10], few interventions [11–14] have been specifically designed to reach populations with low educational attainment or with low functional health literacy skills [10,15–18]. Many studies of interventions to improve contraceptive choice or use have lacked internal validity [19], while others have been statistically underpowered [14,20].
Unintended pregnancy is common in the United States, and interventions are needed to improve contraceptive use among women at higher risk of unintended pregnancy, including Latinas and women with low educational attainment.
A three-arm randomized controlled trial was conducted at two family planning sites serving low-income, predominantly Latina populations. The trial tested the efficacy of a computer-based contraceptive assessment module in increasing the proportion of patients choosing an effective method of contraception (<10 pregnancies/100 women per year, typical use). Participants were randomized to complete the module and receive tailored health materials, to complete the module and receive generic health materials, or to a control condition.
In intent-to-treat analyses adjusted for recruitment site (n=2231), family planning patients who used the module were significantly more likely to choose an effective contraceptive method: 75% among those who received tailored materials [odds ratio (OR)=1.56; 95% confidence interval (CI): 1.23–1.98] and 78% among those who received generic materials (OR=1.74; 95% CI: 1.35–2.25), compared to 65% among control arm participants.
The findings support prior research suggesting that patient-centered interventions can positively influence contraceptive method choice.
Oral health literacy and knowledge among patients who are pregnant for the first time
2012, Journal of the American Dental Association
The authors conducted an observational cohort study to determine the levels of and examine the associations of oral health literacy (OHL) and oral health knowledge in low-income patients who were pregnant for the first time.
An analytic sample of 119 low-income patients who were pregnant for the first time completed a structured 30-minute, in-person interview conducted by two trained interviewers in seven counties in North Carolina. The authors measured OHL by means of a dental word recognition test and assessed oral health knowledge by administering a six-item knowledge survey.
The authors found that OHL scores were distributed normally (mean [standard deviation], 16.4 [5.0]). The percentage of correct responses for each oral health knowledge item ranged from 45 to 98 percent. The results of bivariate analyses showed that there was a positive correlation between OHL and oral health knowledge (P < .01). Higher OHL levels were associated with correct responses to two of the knowledge items (P < .01).
OHL was low in the study sample. There was a significant association between OHL and oral health knowledge.
Low OHL levels and, thereby, low levels of oral health knowledge, might affect health outcomes for both the mother and child. Tailoring messages to appropriate OHL levels might improve knowledge.
Assessing health literacy in heart failure patients
2011, Journal of Cardiac Failure
Health literacy has important implications for health interventions and clinical outcomes. The Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7-minute limit and with no time limit (NTL).
We enrolled 612 rural-dwelling adults with HF (mean age 66.0 ± 13.0 years, 58.8% male). Characteristics affecting health literacy were identified by multiple regression. Percentage of correct scores improved from 71% to 86% (mean percent change 15.1 ± 18.1%) between the 7-minute and NTL scores. Twenty-seven percent of patients improved ≥1 literacy level with NTL scores (P < .001). Demographic variables explained 24.2% and 11.1% of the variance in % correct scores in the 7-minute and the NTL scores, respectively. Female gender, younger age, higher education, and higher income were related to higher scores.
Patients with HF may be inaccurately categorized as having low or marginal health literacy when the S-TOFHLA time limits are enforced. New ways to assess health literacy in older adults are needed.

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Original ArticlesReading skills and family planning knowledge and practices in a low-income managed-care population

Abstract

Section snippets

Materials and methods

Results

Discussion

Adult literacy in AmericaA first look at the results of the national adult literacy survey

The relationship of patient reading ability to self-reported health and use of health services

Am J Public Health

The health care experience of patients with low literacy

Arch Fam Med

The gap between patient reading comprehension and the readability of patient education materials

J Fam Pract

Literacy and contraceptionExploring the link

Obstet Gynecol

Level of reading difficulty in the American College of Obstetricians and Gynecologists patient education pamphlets

Obstet Gynecol

Can clients understand our instructions?

Image J Nurs Sch

Patient literacy and the readability of smoking education literature

Am J Public Health

The readability of health-care literature

Dev Med Child Neurol

Reading grade levels and health behaviors of parents at child clinics

Kans Med

The Cloze procedure and readability of patient-oriented drug information

J Drug Educ

Original Articles
Reading skills and family planning knowledge and practices in a low-income managed-care population