We recognize that Health literacy is based on the individual’s skills with health contexts, the health care system, the education system, and social and cultural factors at home, at work and in the community. Despite the acceptance of this definition, which places the patient in the broader health, educational, social and cultural context, most of the research and testing of health literacy treats health literacy as reading, writing, and numeracy. See for example the well-known tests such as TOFHLA and REALM. REALM is basically a word recognition test, while TOFLA uses a modified close method on reading passages as well as numeracy items. Recent meta-synthesis of the health literacy literature (Edwards et al. 2009) calls for an approach that empowers the patient through not only functional literacy but also interactive and critical health literacy. Interactive health literacy involves the social and personal skills that enable patients to derive meaning from different kinds of information and apply it. Critical health literacy involves advanced skills to critically analyze information and use it.
“ We will conclude that while progress is being made, the scope is not broad enough and the pace not fast enough to make the progress that is neessary.”1 -- Parker & Kindig “ In fact, all medical encounters should be thought of as cross-cultural interactions. [...] We can communicate in plain simple terms and take the time to confirm comprehension.”2 -- Richard H. Carmona, US Surgeon General 1. Parker, R. M., & Kindig, D. A. (2006). Beyond the Institute of Medicine Health Literacy report. Journal of General & Internal Medicine , 21, 891-892. 2. Carmona, R. (2006). Health literacy: A national priority. Journal of General & Internal Medicine , 21, 803.
Health literacy is not the sole indicator
As we build the model, we are looking at independent variables separately in relation to adherence and our next step is to change dependent variables and also to chart the interactions and compounding effects of multiple independent variables together. Our psychological construct variables are coded according to a grounded analysis based in linguistic and behavioral theories.
Having high agency in food domain is associated with having a 31% greater chance of being perfectly adherent p-value 0.048 Having high agency in the general diabetes management domain is associated with a 38% greater chance of being perfectly adherent Having score of “Low Comprehension” on PIL test is associated with a 27% greater chance of being perfectly adherent p-value 0.066 Being one year older than the average age is associated with a 2% greater chance of being perfectly adherent p-value 0.041 p-value 0.064
Expressing an additional instance of “insecurity” above the average amount is associated with having a 8.6% lower chance of being perfectly adherent p value 0.048
Expressing an additional instance of “dissatisfaction” above the average amount is associated with having a 3.8% lower chance of being perfectly adherent. P-value 0.023
ICIC recognizes the importance of other current “health literacy” models as well as the study of the differences between functional vs interactional literacy. Taking critical studies into account, we are developing this empirical model to identify the most important and predictive variables of PLAIN Health Indicators. cf .: Levin-Zamir, D. and Peterburg, Y. (2001) Health literacy in health systems: perspectives on patient self-management in Israel. Health Promotion International , 16 , 87-94. Nutbeam, D. (2000) Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International , 15 , 259-267. Von Wagner, C., Steptoe, A., Wolf, M., and Wardle, J. (2008) Health literacy and health actions: A Review and a framework from health psychology. Health Education & Behavior , doi:10.1177/1090198108322819
Percentage of People in different adherence categories English-speakers Never 40% 1-2 times 33% 3-5 times 14% 6-9 times 7% 10 or more 7% Spanish-speakers Never 59% 1-2 Times 27% 3-5 5% 6-9 5% 10 or more 5%