Presenting Author:

Marina Arvanitis, M.D.

Principal Investigator:

Michael Wolf, Ph.D.

Department:

Medicine

Keywords:

health literacy, patient activation, cognition, health outcomes

Location:

Third Floor, Feinberg Pavilion, Northwestern Memorial Hospital

PH28 - Public Health & Social Sciences

Effects of Health Literacy, Activation, and Cognition on Adult Health

Limited adult health literacy (HL) has been repeatedly linked to poor health, yet interventions to address HL-associated disparities have been variable or ineffective. To address this, some propose expanding HL to include factors such as patient activation. We aimed to assess the degree to which patient activation and cognition may explain the associations between HL and intermediate health outcomes in older adults. We analyzed baseline data from Health Literacy and Cognition in Older Adults (LitCog): a prospective study of 900 adults, ages 55–74 years from participating health centers in Chicago. During structured, in-person interviews, participants completed assessments of HL (Test of Functional HL in Adults (TOFHLA), Newest Vital Sign (NVS), and Rapid Estimate of Adult Literacy (REALM)), patient activation (Patient Activation Measure (PAM)), and cognition (fluid cognitive abilities). We assessed participants’ diabetes (DM) control by Hemoglobin A1c (HbA1c), blood pressure (BP) control by average systolic and diastolic pressures, and renal function by estimated glomerular filtration rate (eGFR) measurements from the medical record. We used bivariate statistics to describe participants’ characteristics, HL, activation, and cognition, and assess the relationships between these factors and health outcomes. We used a series of logistic regression models to examine the effects of patient activation and cognition, both individually and together, on the relationship between HL and each health outcome. Nine hundred participants with a mean age of 63 completed baseline interviews, of whom 63% were female, and 71% were high school or college graduates. HL was limited in 32% by TOFHLA, 54% by NVS, and 28% by REALM. Most (84%) were highly activated by PAM, which did not vary by HL. Of participants with DM (n=166), 35% had poor DM control (HbA1c >7%), and of all participants, 46% had poor BP control (>140/>90), and 27% renal dysfunction (eGFR <60). Limited HL by NVS and TOFHLA was significantly associated with all poor health outcomes, and nearly all by REALM. Using the TOFHLA, we found that the associations between limited HL, poor DM control, poor BP control, and renal dysfunction, were largely explained by cognition, which attenuated the odds of poor DM control by 53% (OR 2.8 (95% CI 1.4,5.5) to 1.3 (0.3,3.3)), poor BP control by 24%, and poor renal function by 19%. The inclusion of patient activation did not affect the associations between HL and health outcomes, nor the attenuation of these associations by cognition. We completed the same analyses for HL by NVS and REALM, with similar findings. Despite its growing links to health outcomes, patient activation does not seem to influence the associations between limited HL and poor health outcomes in older adults, which are largely explained by cognition. Interventions to reduce HL-associated disparities should focus on reducing the cognitive burden placed on patients by the health care system.