The Health Literacy of America’s Adults

1. The Health Literacy of America’s Adults Summary of Results from the 2003 NAAL NIFL/LINCS Region II Health Literacy Summit March 5, 2008

2. Who I am, Why I’m Here • Sabrina Kurtz-Rossi, M.Ed. • Health and literacy educator • Not a statistician • Objectives • Summarize key health literacy results from 2003 NAAL • Describe how these results have informed my work

3. Background • 1992 National Adult Literacy Survey (NALS) • First assessment of adult literacy in the U.S • Surveyed 26,000 adults; > 16 year • Measured functional literacy • Prose, document, and quantitative literacy • Competency-based scale • Raised serious concerns about ability of nearly half adult population in U.S. to access health information and services. Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

4. Background • 2003 National Assessment of Adult Literacy (NAAL) • Reassessment of adult literacy in the U.S., first since the 1992 study • Surveyed 19,000 adults; > 16 years • Measured functional literacy • Prose, document, and quantitative literacy • Competency-based scale • Included 28 items specifically designed to assess health literacy skills Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

5. Definition • NAAL definition of health literacy • The ability to use printed and written information associated with a broad range of health-related tasks to accomplish one’s goals at home, in the workplace, and in the community (including health care settings). Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

6. Questions • Developed in collaboration with DHHS • Three types of health literacy tasks – clinical, preventive, and navigational. • Sample Tasks • Circle the date of a medical appointment on a hospital appointment slip. • Give 2 reasons a person with no symptoms should be tested for a disease based on information in a clearly written pamphlet. Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

7. Questions • Sample Tasks • Determine health weight range for a person of a specific height, based on a graph that relates height and weight to body mass index (BMI). • Find information required to define a medical term by searching through a complex document. Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

8. Results • Below Basic: no more than the most simple and concrete health literacy tasks • Basic: can perform simple and everyday health literacy tasks • Intermediate: can perform moderately challenging health literacy tasks • Proficient: can perform complex and challenging health literacy activities Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

9. Key Results • Over 75 million adults had Basic and Below Basic health literacy • Fifty-three percent of adults had intermediate health literacy Number and Percentage of Adults in Each Health Literacy Level Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

10. Key Results • A higher percentage of adults who had not completed high school had Below Basic health literacy Percentage of Adults in Each Health Literacy Level by Highest Educational Attainment Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

11. Key Results • Adults in the oldest age group – age 65 and older – had lower health literacy than adults in the younger age groups Percentage of Adults in Each Health Literacy Level by Age Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

12. Key Results Source: U.S. Department of Education, Institute of Education Science, National Center for Education Statistics, The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. http://nces.ed.gov/naal/health_results.asp

13. Who Is at Risk? • People with limited education • Older adults • Minority populations • Persons with limited English proficiency (LEP) • Those who are poor 13

14. What is the Risk? Low health literacy is a barrier to quality care and is linked to: • Increased medical error • Poor knowledge of health condition • Underutilization of preventive health care • Increased hospitalization • Increased health care costs • Poor health outcomes Source: AHRQ Report—Literacy and Health Outcomes (2004): http://www.ahrq.gov/clinic/epcsums/litsum.htm 14

15. Tobacco and Literacy Education Project • Adults with less than a high school education, with higher rates tobacco use, and less knowledge about its health effects • Developed and piloted health literacy lessons for GED/pre-GED classes that integrated tobacco information with math, language arts, technology instruction • Health and literacy partners New Hampshire DOE Bureau of Adult Education, GED programs, DPH Tobacco Control Program, Legacy Foundation

16. What is medicine? ESOL Health Literacy Curriculum Project • ESOL students many of whom are Hispanic, with varying levels of English language proficiency, and varying level of familiarity with the U.S. health care system. • Develop and pilot highly illustrated student book (3rd – 4th grade reading level) and teachers manual for ESOL instruction. • Florida Literacy Coalition, ESOL programs, Florida Department of Education

17. Health Information Literacy Research Project • Develop and pilot training to increase awareness and use of online consumer health information resources by health care providers and their patients. • Promote the role of librarians as providers of health information literacy resources and services. • Medical Library Association, National Library of Medicine, Hospital-based libraries

18. Discussion • How have the health literacy results of the NAAL influenced your work? Sabrina Kurtz-Rossi, M.Ed. sabrina_kurtz-rossi@comcast.net Project Coordinator, Health Information Literacy Research Project, Medical Library Association; Adjunct Clinical Instructor, Tufts University School of Medicine; Health Literacy Curriculum and Professional Development Consultant