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Michael S. Wolf, PhD, MPH; Julie A. Gazmararian, PhD, MPH; David W. Baker, MD, MPH

Arch Intern Med. 2005;165:1946-1952.

Background  Individuals with limited health literacy have less health knowledge, worse self-management skills, lower use of preventive services, and higher hospitalization rates. We evaluated the association between health literacy, self-reported physical and mental health functioning, and health-related activity limitations among new Medicare managed care enrollees.

Methods  A cross-sectional survey of 2923 enrollees was conducted in Cleveland, Ohio; Houston, Tex; Tampa, Fla; and Fort Lauderdale–Miami, Fla. Health literacy was measured using the short form of the Test of Functional Health Literacy in Adults. We used outcome measures that included scores on the physical and mental health functioning subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey, difficulties with instrumental activities of daily living and activities of daily living, and limitations because of physical health and pain.

Results  After adjusting for the prevalence of chronic conditions, health risk behaviors, and sociodemographic characteristics, individuals with inadequate health literacy had worse physical function (67.7 vs 78.0, P<.001) and mental health (76.2 vs 84.0, P<.001) than individuals with adequate health literacy. Individuals with inadequate health literacy were more likely to report difficulties with instrumental activities of daily living (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.74-2.92) and activities of daily living (OR, 2.83; 95% CI, 1.62-4.96), limitations in activity because of physical health (OR, 1.79; 95% CI, 1.39-2.32), fewer accomplishments because of physical health (OR, 1.90; 95% CI, 1.48-2.45), and pain that interferes with normal work activities (OR, 2.01; 95% CI, 1.46-2.77).

Conclusion  Among community-dwelling older adults, inadequate health literacy was independently associated with poorer physical and mental health.

Author Affiliations: Institute for Healthcare Studies and Division of General Internal Medicine, Feinberg School of Medicine (Drs Wolf and Baker), and Robert H. Lurie Comprehensive Cancer Center (Dr Wolf), Northwestern University, Chicago, Ill; and Emory Center on Health Outcomes and Quality, Emory University, Atlanta, Ga (Dr Gazmararian).

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