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

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

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.

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.

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.

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.

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.

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.

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.

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.

Key Results  Adults in the oldest age group – age 65 and older – had lower health literacy than adults in the younger age groups 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. Percentage of Adults in Each Health Literacy Level by Age

Key Results Percentage of Whites in Each Health Literacy Level Percentage of Blacks in Each Health Literacy Level Percentage of Hispanics Each Health Literacy Level Below basic: 9% Basic: 19% Intermediate: 58% Proficient: 14% Below basic: 24% Basic: 34% Intermediate: 41% Proficient: 2% Below basic: 41% Basic: 25% Intermediate: 31% Proficient: 4% 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.

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

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 14 Source: AHRQ Report—Literacy and Health Outcomes (2004):

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

ESOL Health Literacy Curriculum Project What is medicine?  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 (3 rd – 4 th grade reading level) and teachers manual for ESOL instruction.  Florida Literacy Coalition, ESOL programs, Florida Department of Education

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

Discussion  How have the health literacy results of the NAAL influenced your work? Sabrina Kurtz-Rossi, M.Ed. 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