Limited Health Literacy is Common in Former Prison Inmates

1. Limited Health Literacy is Common in Former Prison Inmates Mim Ari, MD1, Joel M. Hirsh, MD2, Brenda Beaty, MSPH3, Ingrid A. Binswanger, MD, MPH1,2 1Division of General Internal Medicine, University of Colorado Denver, 2Denver Health Medical Center, 3Colorado Health Outcomes Program, University of Colorado Denver RESULTS INTRODUCTION HEALTH LITERACY INSTRUMENTS -Former inmates are a medically vulnerable population with a unique set of challenges -At the same time, they have increased opportunity to engage in high-risk health behaviors -Health literacy: the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions -Understanding the role of health literacy is important in designing interventions to improve health outcomes in this population -Goals of this study: 1) Describe health literacy in former prison inmates 2) Assess the association between health literacy and demographic variables, self-reported health status, access and barriers to care, and high-risk behaviors METHODS • -Participants: 68 individuals recruited from the Denver Community Re-entry Center and from the Denver case management offices at Treatment Accountability for Safer Communities within 6 months of release from Colorado or federal Prison • -Eligibility: >18 years of age, ability to understand study procedures in English • -Instruments: • Survey comprised of questions that assessed access to care, barriers to access to care, criminal justice history, risk behaviors, past and anticipated health care and presence of chronic medical complications of drug use • Two health literacy instruments: • Single item literacy screener (SILS) which asked participants “How confident are you filling out medical forms by yourself?” on a 5 point Likert-type scale • Medical Term Recognition Test (METER): participants were asked to identify real medical terms amidst a list containing both real (emergency, menopause) and “real-sounding” medical words (i.e. cerpes, potient) • -Analysis: The relationships between health literacy and categorical variables were compared using Fisher's Exact, Chi-Square and Mantel-Haenzel Chi-Square tests as appropriate. Continuous variables were analyzed using t-tests or Wilcoxon rank-sum tests as appropriate. DISCUSSION -Limited health literacy is common in recently released inmates: 15% had low health literacy and 57% had marginal health literacy -Our study was limited by small sample size, which makes understanding the contribution that health literacy plays in health outcomes more challenging. However, based on the effect it plays in other vulnerable populations, we believe continued study is valuable. -Health literacy should be considered in designing interventions to improve health outcomes and increase access to care in individuals recently released from prison. -Along with health literacy, other complex social factors may drive decisions related to accessing health care and participating in high-risk health behaviors FUNDING Primary Care Internal Medicine Residency Program of the University of Colorado General Internal Medicine small grants program of the University of Colorado Robert Wood Johnson Foundation