Prevalence of Limited Health Literacy During Middle Adulthood and Its Associations with Health Self-Management and Physical Function

Abstract

Background: Although the relationship between health literacy and health self-management has been studied in older adults, it is understudied in middle-aged, primary care patients. Objective: To determine the prevalence of limited health literacy and health self-management among middle-aged adults and associations with self-reported physical function. Design: Cross-sectional analyses from interviews assessing health literacy, self-management capacity, and physical function. Patients: 942 middle-aged, primary care patients in Chicago, IL participating in a longitudinal cognitive aging cohort study (‘MidCog’). Main Measures: We assessed health literacy using the Newest Vital Sign, health self-management skills using the Comprehensive Health Activities Scale Short Form, and self-reported physical function using the Patient Reported Outcomes Measurement Information System Physical Function Scale. Key Results: About one in eight adults (13.2%) presented with low health literacy and 19.3% had marginal abilities. Low health literacy was associated with less education, lower income, unemployment, and identifying as non-Hispanic Black or Hispanic/Latino. Those with low health literacy had more chronic conditions, more prescription medications, and worse performance on a cognitive screener. In multivariable models controlling for age, race, sex, education, income, and number of chronic conditions, compared to those with adequate health literacy, performance on health management tasks was worse among individuals with low (β = -15.5; 95% CI: -19.7 to -11.2; p < 0.001) and marginal health literacy (β = -8.4; 95% CI: -11.6 to -5.0; p < 0.001). Although initially significant, after adjusting for covariates, the relationship between health literacy and physical function was no longer significant for either low (β = -0.3; 95% CI: -2.2 to 1.6; p = 0.75) or marginal groups (β = -1.1; 95% CI: -2.6 to 0.3; p = 0.13). Conclusions: Our results suggest a significant proportion of this middle-aged primary care sample, some already managing multiple chronic conditions, demonstrated limited health literacy and health self-management, potentially leading to greater risk of poorer physical health in later life.