Trial Information

Determining the Prevalence of Health Literacy Among Veterans

BACKGROUND / RATIONALE:

Studies have shown that people with poor health literacy skills have significantly worse
health status, greater risk for hospitalization, less knowledge about their health
conditions, and are less likely to use preventative services. Little is known about the
prevalence of low health literacy skills among veterans who use the VHA or the effect poor
health literacy skills may have on complex preventative behaviors, such as screening for
colorectal cancer (CRC). Understanding the distribution of health literacy skills among
veterans and their effect on preventive behavior is critical for improving patient
education, reducing health disparities, and promoting patient-centered care.

OBJECTIVE(S):

The primary objectives for this study are to develop an estimate of the prevalence of health
literacy at four geographically diverse VAMCs (Minneapolis, Portland, Durham, and West LA),
and for specific groups based on age, race, education, and geographic location. The
secondary objectives are to link health literacy estimates for those 50 to 75 years old to
CRC screening data, examine variation in guideline concordant screening rates by health
literacy levels, and identify the mechanisms that may mediate or moderate the effect of
health literacy on screening.

METHODS:

This observational study uses a time-sequential randomized design of 1440 veterans,
stratified by age (<50, 50-75, >75), who have upcoming appointments in primary care clinics
at the 4 study sites. Patients who are eligible (i.e., have at least 20/50 vision and are
not demented) are asked to participate in a face-to-face structured survey with a study
interviewer. The survey includes demographic data, functional status, social support,
measures of attitudes and beliefs about health care providers, health insurers, medical care
and the Short-Test of Functional Health Literacy in Adults (S-TOFHLA). For those between
ages 50-75, knowledge of and attitudes towards CRC screening are also measured. Survey data
are then matched to data from the CRC QUERI screening assessment and surveillance data
system (CRS 02-162-1) to evaluate screening adherence.

STATUS:

Project work is ongoing.

IMPACT:

Findings from this study are expected to have a number of broad implications for research
and practice within the VHA. This project will inform organizational changes aimed to
improve the efficacy and efficiency of communication strategies and identify areas where
interventions or system-level changes could be most effective; inform improvements in
informed consent procedures, patient education, discharge summaries and prescription
instructions; inform and improve the effectiveness of interventions and the Quality
Enhancement and Research Initiative (QUERI) translation efforts; provide the basis for
future longitudinal investigations into how health literacy changes over time; and,
contribute to our understanding and amelioration of factors associated with health
disparities.