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8/14/2019 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.


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.


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.


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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