Health Literacy Research and Practice (Jun 2017)

Health and Functional Literacy in Physical Rehabilitation Patients

  • Elizabeth A. Hahn,
  • Susan R. Magasi,
  • Noelle E. Carlozzi,
  • David S. Tulsky,
  • Alex Wong,
  • Sofia F. Garcia,
  • Jin-Shei Lai,
  • Joy Hammel,
  • Ana Miskovic,
  • Sara Jerousek,
  • Arielle Goldsmith,
  • Kristian Nitsch,
  • Allen W. Heinemann

DOI
https://doi.org/10.3928/24748307-20170427-02
Journal volume & issue
Vol. 1, no. 2
pp. e71 – e85

Abstract

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Background: People with disabilities, who face multiple barriers to care, experience health disparities, yet few studies have measured health literacy in this population. Objective: This study evaluated functional literacy, health literacy, fluid cognitive function, and self-reported health in people who live in community dwellings with spinal cord injury, stroke, or traumatic brain injury. Methods: Participants with a traumatic spinal cord injury, stroke, or traumatic brain injury, one-year postinjury, and age 18 to 85 years, completed a battery of instruments at three medical centers in the Midwestern U.S.: functional literacy (word recognition, vocabulary knowledge), health literacy (comprehension of prose, document, and quantitative health information), fluid cognitive function (memory, executive function, and processing speed), and patient-reported outcomes (mobility, fatigue, sadness, anxiety, social function, and overall health). Key Results: There were strong correlations between functional literacy, health literacy, and fluid cognitive function. After adjustment for sociodemographic and clinical characteristics, higher health literacy was associated with better mobility, less anxiety, and better overall health; higher functional literacy was associated with less anxiety and better overall health; and higher fluid cognitive function was associated with better mobility, less sadness, better social function, and better overall health. Conclusions: To effectively address limited health literacy among people with spinal cord injury, stroke, and traumatic brain injury, and ensure that they are able to be informed partners in their health care, intervention is required at the level of patients, providers, and health care delivery systems. A special consideration is to ensure that health information is both well-targeted to people's health literacy levels and accessible for people with a range of physical, cognitive, and sensory limitations. The multimedia self-administered health literacy measure used in this study could be useful to rehabilitation providers and designers of health information and interfaces.

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