Risk Estimate of Inadequate Health Literacy (REIHL) for community-dwelling Chinese older adults

Abstract

Background: Older adults are heterogenetic group and their health literacy is known to be lower than younger generations. For those with inadequate health literacy, they are prone to use more health services and less willing to receive vaccinations. Identifying those who have inadequate health literacy is crucial however; using a specific assessment tool may not be possible in some occasions. This study aims to develop a quick tool to estimate the risk of inadequate health literacy for the vulnerable group so that tailor-made health education can be provided. Method: This is a methodology study using a cross-sectional data of 304 community-dwelling subjects. Chinese Health Literacy Scale for Chronic Care (CHLCC) was used to assess their actual health literacy. Demographics and presence of 5 types of chronic illnesses (Osteoporosis, Diabetes, Hypertension, Heart Disease and Stroke) were collected. Using logistic regression model, factors significantly associated with CHLCC score were identified. Risk Estimate of Inadequate Health Literacy (REIHL) was developed using the coefficients of these associated factors. Sensitivity and specificity of the REIHL and ROC were calculated. Results: A total of 185 subjects were shown to have inadequate health literacy (CHLCC score < 36). REIHL was formulated by adding specific scores with reference to education level, age and number of chronic diseases. REIHL ranged from 0 to 23, with 10 as the cut-off. For those whose REIHL score greater than 10 are considered as “inadequate health literacy”. Correlation between CHLCC score and REIHL showed 76.9% accuracy. The sensitivity and specificity of REIHL were 77.8% and 75.6% respectively. In the REIHL, 2, 5 and 11 marks are given to junior secondary education, primary education and no formal education respectively. 4 and 7 marks are given to those who are aged between 65-84 and aged > 84 respectively. Marks were also given according to the number of chronic diseases suffered. Conclusion: The newly developed REIHL was an accurate estimation of inadequate health literacy. Such estimation can be applied to practical settings in which clinicians can identify the at-risk group with poor health literacy using readily available administrative data and develop appropriate health educational to these targeted population addressing their limitations in self-care learning and poor health outcomes.