Health Literacy Within a Diverse Community-Based Cohort: The Multi-Ethnic Study of Atherosclerosis
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ORIGINAL PAPER
Health Literacy Within a Diverse Community-Based Cohort: The MultiEthnic Study of Atherosclerosis Madison D. Anderson1 · Sharon Stein Merkin2 · Susan Everson Rose3 · Rachel Widome1 · Teresa Seeman4 · Jared W. Magnani5 · Carlos J. Rodriguez6 · Pamela L. Lutsey1 Accepted: 11 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Health literacy has yet to be described in a non-clinical, racially diverse, community-based cohort. Methods Four questions assessing health literacy were asked during annual phone encounters with Multi-Ethnic Study of Atherosclerosis (MESA) participants between 2016 and 2018 (n = 3629). We used prevalence ratios (PRs) with 95% confidence intervals (CIs) to characterize how demographic and acculturation factors related to limited health literacy. Models adjusted for age, sex, and race/ethnicity, and race/ethnicity-stratified models were also examined. Results Limited health literacy was prevalent in 15.4% of the sample. Participants who were older, female, lower-income, or less acculturated were at greater risk for having limited health literacy. Chinese, Hispanic, and Black participants were more likely than White participants to have limited health literacy. Patterns were similar when stratified by race/ethnicity. Discussion Within MESA limited health literacy was common, particularly among Chinese and Hispanic participants, with some of the variance explained by differences in acculturation. Keywords Health literacy · Acculturation · Risk factors
Introduction Health literacy has been defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” [1]. Limited health literacy can impact a person’s health and quality of care in numerous * Madison D. Anderson [email protected] 1
Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN 55455, USA
2
Division of Geriatrics, University of California, Los Angeles, Los Angeles, CA, USA
3
Department of Medicine, University of Minnesota, Minneapolis, MN, USA
4
Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA
5
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
6
Department of Cardiovascular Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
ways [2, 3]. For instance, limited health literacy can make navigating the complex health care systems intimidating [2, 4]. Individuals with limited health literacy may have difficulty filling out forms, locating providers and services, and managing health insurance [4, 5]. It may also be more difficult for these individuals to share personal information with providers, such as health history, or to engage in self-care and chronic-disease management [6, 7]. Related, numeracy skills are important to health literacy, as they are necessary for tasks such as calculating cholesterol
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