Health Literacy and Womens Reproductive Health Outcomes Are They Related

1
Health Literacy and Womens Reproductive Health
Outcomes Are They Related?
Tonya N. Walker, BA Elizabeth Moye, BA Alex
Quistberg, BA Katrina Armstrong, MD,
MSCE Division of General Internal Medicine and
the Leonard Davis Institute of Health Economics,
University of Pennsylvania Philadelphia, PA and
the Doris Duke Charitable Foundation (TW)
Background

• Institute of Medicine Report -- Health Literacy
  a Prescription to End Confusion states
• Approximately half of U.S. adults (47) have
  difficulty understanding and acting upon health
  information
• This increases risk for poor health outcomes,
  increased hospitalizations, and lack of awareness
  and/or use of preventive health services such as
  annual GYN exams and contraception.
• Healthy People 2010 defines Health Literacy (HL)
  as
• the degree to which individuals have the
  capacity to obtain, process, and understand basic
  health information and services needed to make
  appropriate decisions.
• Major Goal reduce health disparities
  including those related to womens reproductive
  health. Example decrease unintended pregnancies
  from 49 in 1999 to 30 in 2010.
• Inadequate Health Literacy potential
• explanation for reproductive health
• disparities
• Average U.S. Adult Reading Level 8th
• grade

• N 149
• Participants in the low HL group were more
  likely to
• -- Be Black/African-American
• -- Report having a high school diploma/GED
• -- Lie in the lt10K income bracket
• -- Be married and have health care insurance
• Participants in the high HL group were more
  likely to
• -- Be white or bi/multiracial
• -- Have a college education
• -- Earn more than 10,000 annually
• -- Be employed for wages but more likely to be
  out of work for gt1year.
• Not statistically significant or shown on
  Table 1

Table 2 Reproductive Health Outcomes
Next Steps

• Multivariate Analysis
• Must insure that results are correct
• Re-code REALM using shortened REALM 8-item list.
  No reproductive health words included.

Table 1 Demographic Characteristics
Select References
Center for Disease Control. Unintended Pregnancy
PRAMS?CDC Reproductive Health. www.cdc.gov/repro
ductivehealth/prams_factsheet.htm National Center
for Education Statistics. National Adult Literacy
Survey. www.nces.ed.gov/pubsearch/pubsinfo.asp?pu
bid93275. U.S. Department of Health and Human
Services. Healthy People 2010. 2nd ed. With
Understanding and Improving Health and
Objectives for Improving Health. 2 vols.
Washington, DC U.S. Government Printing Office,
2000 Endres LK, Sharp LK, Haney E, Dooley SL.
Health Literacy and Pregnancy Preparedness in
Pregestational Diabetes. Diabetes Care. 2004
Feb 27(2) 331-34 Fortenberry JD, McFarlane MM,
Hennessy M, Bull SS, Grimley DM, St. Lawrence J,
Stoner BP, VanDevanter N. Relation of Health
Literacy to Gonorrhea Related Care. Sex Transm
Infect. 2001 Jun 77(3)306-11 Gazmarrarian JA,
Parker RM, Baker DW. Reading Skills and Family
Planning Knowledge in Low-Income Managed-Care
Population. Obstet Gynecol. 1999 Feb 93(2)
239-44 Kirsch I, Jungeblut A, Jenkins L, Kolstad
A. Adult Literacy in America a first look at the
results for the National Adult Literacy Survey.
Washington, DC National center for Education
Statistics, US Department of Education,
1993 Nielsen-Bohlman LT, Panzer AM, Hamlin B,
Kindig DA, eds. Institute of Medicine. Health
Literacy a Prescription to end confusion.
Committee on Health Literacy, Board on
Neuroscience and Behavioral Health. Washington,
DC National Academies Press. April 2004. Wallace
LS, Lennon ES. American Academy of Family
Physicians Patient Education Materials Can
Patients Read Them? Fam Med 200436(8)571-4
Objectives

• To investigate the relationship between health
  literacy and
• Sexually Transmitted Infections (STIs)
• Unintended Pregnancies
• The correct/incorrect use of contraception

• Participants in the low HL group were more
  likely to
• -- Have either between 1-3 or more than 7
  lifetime sexual partners
• -- Report always having unprotected
  intercourse
• -- Use birth control properly
• -- Suffer from at least 5 STIs
• -- Gave birth at younger ages (15-21 years
  old)
• Participants in the high HL group were more
  likely to
• -- Have between 4-6 lifetime sexual partners
• -- Ever have a STI and received appropriate
  treatment
• -- Have had at least one unplanned pregnancy
• -- Report the incorrect use of birth control
• Not statistically significant
• Results not shown on Table 2

REALM Handouts
Average REALM Score 57 Low HL group mean score
4912 High HL group mean score 641