ky rural hlth 0708 blogvers
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Health Literacy:Is there a rural link?
Ann Rathbun, Ph.D.Ann Rathbun, Ph.D.
Morehead State UniversityMorehead State University
Morehead, KentuckyMorehead, Kentucky
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Ann
Rathbun,
Ph.D.
Ann
Rathbun,
Ph.D.
Measuring Literacy in theMeasuring Literacy in the
U.S.U.S. NAALNAAL NNationalational AAssessment ofssessment ofAAdultdult LLiteracy isiteracy is
a nationally representative assessmenta nationally representative assessment
of English literacyof English literacy Sponsored by the US Department ofSponsored by the US Department of
EducationEducation
The 2003 assessment was the first oneThe 2003 assessment was the first onecompleted in the U.S. since 1992completed in the U.S. since 1992
(National Adult Literacy Survey).(National Adult Literacy Survey).
National Center for EducationStatistics, 2007
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Ann
Rathbun,
Ph.D.
Ann
Rathbun,
Ph.D.
Literacy and Health LiteracyLiteracy and Health Literacy The 2003 NAAL was the first-everThe 2003 NAAL was the first-ever
national assessment of adults abilitynational assessment of adults ability
to understand health-related materialsto understand health-related materials
and forms.and forms.
Six states purchased separateSix states purchased separate
samples to obtain detailed informationsamples to obtain detailed informationdescribing the literacy of their adultdescribing the literacy of their adult
populations: Kentucky, Maryland,populations: Kentucky, Maryland,
Massachusetts, Missouri, New York,Massachusetts, Missouri, New York,National Center for EducationStatistics, 2007
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Ann
Rathbun,
Ph.D.
Ann
Rathbun,
Ph.D.
Assessment of Skill LevelAssessment of Skill Level
Upon completion of the assessment,Upon completion of the assessment,
participants were assigned a level.participants were assigned a level.
Each level is explained as a list ofEach level is explained as a list of
sample tasks that individuals at thesample tasks that individuals at the
various levels should be able tovarious levels should be able to
perform.perform.
American Institutes for Research,American Institutes for Research,20062006
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Ann
Rathbun,
Ph.D.
Ann
Rathbun,
Ph.D.
Literacy level & abilitiesLiteracy level & abilities
BasicBasic
- Read a pamphlet and state 2- Read a pamphlet and state 2
reasonsreasonsa person should be tested for aa person should be tested for a
condition even though they do notcondition even though they do not
have symptoms.have symptoms.
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Ann
Rathbun,
Ph.D.
Ann
Rathbun,
Ph.D.
Literacy level & abilitiesLiteracy level & abilities
IntermediateIntermediate
- Determine healthy weight on the- Determine healthy weight on the
BMIBMI
chartchart
- Read and interpret information- Read and interpret information
from afrom a
drug label (interactions, when todrug label (interactions, when to
take intake in
relation to eatinrelation to eatin
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Ann
Rathbun,
Ph.D.
Ann
Rathbun,
Ph.D.
Literacy level & abilitiesLiteracy level & abilities ProficientProficient
- Calculate health insurance costs- Calculate health insurance costs
for afor a
year based on information givenyear based on information given
forfor
employees at a companyemployees at a company
- Search a complex document to find- Search a complex document to find
thethe
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Individuals with low healthIndividuals with low health
literacy skills are much moreliteracy skills are much more
likely to:likely to: Skip prevention services (vaccines,Skip prevention services (vaccines,
mammograms, pap tests,mammograms, pap tests,educational programs, etc).educational programs, etc). ((Weiss,1999)
Therefore are sicker when they doTherefore are sicker when they do
enter the healthcare systementer the healthcare system Have chronic conditions and manageHave chronic conditions and manage
them poorlythem poorly (ex. HIV, diabetes, high blood(ex. HIV, diabetes, high bloodpressure)pressure)
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Health Literacy in the USHealth Literacy in the US
NAAL 2003NAAL 2003 Majority of adultsMajority of adults
(65%) in the US(65%) in the US
had INTERMEDIATEhad INTERMEDIATEor PROFICIENTor PROFICIENT
health literacyhealth literacy
36% of adults had36% of adults had
Basic or BelowBasic or BelowBasic healthBasic health
literacy.literacy.
NCES, 2003
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Health Literacy in the USHealth Literacy in the US
NAAL 2003NAAL 2003 Older adults (65+)Older adults (65+)
40% Intermediate or40% Intermediate or
ProficientProficient
60% Basic or Below60% Basic or BelowBasicBasic
Education LevelEducation Level
77% of those with some77% of those with somehigh school or less thanhigh school or less than
a high school educationa high school education
had Basic or Belowhad Basic or Below
Basic health literacy.Basic health literacy.NCES, 2003
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Eastern Kentucky vs. U.SEastern Kentucky vs. U.S
Educational attainment, 2000Educational attainment, 2000
29.9%22.7%14.5%9%Difference
68.084.985.083.9US Total
38.162.270.574.9E Kentucky
25-34 35-44 45-59 60+
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Data Classes
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Data Classes
0.0-9.0%
11-27.1%
28-46.2%
47.4-67.2%
68-98.1%
Percent of Persons Who Live in Urban Areas: Kentucky byCountySource: U.S. Census Bureau, Census 2000 Summary File 1, MatricesP1, and P2.
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
The Health of Kentucky:The Health of Kentucky:
A County AssessmentA County Assessment Ranked each county in the state (n=120) by
health status.
The higher the rank, the worse the healthstatus of individuals in that county. Factors were grouped into the following
categories:
Behavioral/social factors Demographics Health access, and Health outcomes.
Kentucky IOM, 2007
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
The purposes of this studyThe purposes of this study
were to:were to:Look at Graduation rates by county
Health status rank by county Population by county
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Study purposes, cont.Study purposes, cont.
Discover if correlations exist between: High school graduation rates and
health status Population and health status in
counties in the state
Population and high school graduationrates in the state
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
MethodologyMethodology
Entered each countys health statusEntered each countys health status
ranking (KY IOM)ranking (KY IOM)
Entered each countys rate of thoseEntered each countys rate of thosewho did not complete high schoolwho did not complete high school (did(didnot graduate or obtain a GED)not graduate or obtain a GED)
Entered total county populationEntered total county population (sorted(sortedinto quartiles)into quartiles)
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Mean 363,403
Minimum 33,202
Maximum 693,604 (JeffersonCo.)
Quartile 4
Mean 25,472
Minimum 17,800
Maximum 33,144
Quartile 3
Mean 14,810
Minimum 11,971
Maximum 17,649
Quartile 2
Mean 7016
Minimum 2266 (Robertson Co.)
Maximum 11,766
Quartile 1
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
ResultsResults
There is a difference in highThere is a difference in high
school graduation rates based onschool graduation rates based on
population.population.
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Average percent of those lacking a high school degree in
relationship to population
0
5
10
15
20
25
30
35
40
1 2 3 4
Population Quartiles
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Non-graduates and Population:Non-graduates and Population:
Where were the mainWhere were the main
differences?differences?
-4.4-11.0*-10.0*4
4.4-6.6*-5.53
11.0*6.6*1.02
10.0*5.5-1.01
4321
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
ResultsResults
There is a difference in healthThere is a difference in health
status based on population.status based on population.
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Differences in Health Status based on Population
0
10
20
30
40
50
60
70
80
1 2 3 4
Population Quartiles
AverageHealthRank
l h k d l i
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
Health Rank and PopulationHealth Rank and PopulationWhere were the mainWhere were the main
differences??differences??
33.2*5.92
27.2*-5.91
421
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
ResultsResults
There is a strong positive correlationThere is a strong positive correlation
((rr=.77) between Health Rank and the=.77) between Health Rank and the
percent of county population with nopercent of county population with nohs diploma.hs diploma.
In other words: As the percentage ofIn other words: As the percentage of
those with no HS degree in a countythose with no HS degree in a countyincreased, so did health rankingincreased, so did health ranking
(meaning the health of that county is worse)(meaning the health of that county is worse)..
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
ResultsResults
There is a correlation (There is a correlation (rr=.30)=.30)
between population and health rank.between population and health rank.
This is not a strong correlation.This is not a strong correlation. Counties in the 1Counties in the 1stst and 2and 2ndnd quartilesquartiles
had a higher rank in IOM healthhad a higher rank in IOM health
rankings.rankings.
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
RecommendationsRecommendations
In order to effectively planIn order to effectively plan
interventions sensitive to healthinterventions sensitive to health
barriers and disparities, county-levelbarriers and disparities, county-leveldata on all health and health-relateddata on all health and health-related
issues are necessary.issues are necessary.
2 examples of this were the KY IOM data2 examples of this were the KY IOM dataand the county graduation rates forand the county graduation rates for
Appalachian KentuckyAppalachian Kentucky
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
RecommendationsRecommendations
Assess materials currently in stockAssess materials currently in stock
printed materials for reading level.printed materials for reading level. Revise materials based on findings.Revise materials based on findings.
All printed and electronic writtenAll printed and electronic written
materials should be written at a 4materials should be written at a 4thth--
66thth grade level.grade level.
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
RecommendationsRecommendations
Pre-test materials with audiences.Pre-test materials with audiences.This is to avoid mistakes in orderingThis is to avoid mistakes in ordering
materials that are costly that do notmaterials that are costly that do notmeet the needs of the target population.meet the needs of the target population.
If materials dont work; dont orderIf materials dont work; dont order
them!! (seethem!! (see The Pink Book.The Pink Book.))
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AnnR
athbun,
Ph.D.
AnnR
athbun,
Ph.D.
RecommendationsRecommendations
Develop consumer empowermentDevelop consumer empowerment
workshops on How to be a Betterworkshops on How to be a Better
Patient.Patient.This begins to bridge the gap inThis begins to bridge the gap in
provider-patient communicationprovider-patient communication
http://www.cfah.org/hbns/PreparedPatiehttp://www.cfah.org/hbns/PreparedPatie
http://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfmhttp://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfmhttp://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfmhttp://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfmhttp://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfmhttp://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfmhttp://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfmhttp://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfmhttp://www.cfah.org/hbns/PreparedPatient/Prepared-Patient-Vol1-Issue3.cfm -
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