Purpose: Studies have established a relationship between health literacy and improved health outcomes including knowledge, improved health indicators, and mortality. The purpose of this study is to evaluate the association of health print and numeric literacy with psychological factors that could mediate the relationship between health literacy and health outcomes.
Method: A cross sectional study was conducted. Participants, aged 40-74, were randomly recruited from patients in one of three primary care internal medicine practices. Print and numeric health literacy were assessed with the Rapid Estimate of Adult Health Literacy (Realm) and the Lipkus numeracy scale (Lipkus), respectively. The following psychological constructs were identified as potential mediators of the relationship between health literacy and the adoption of protective health behaviors ; general self efficacy scale, mastery, optimism ( Life Orientation Test), locus of control (Multidimensional Health Locus of Control with Internal, Powerful Others, Chance, and God subscales), and trust (Trust in People Scale). Correlation and multivariate linear regression analyses were used to evaluate the association of print and numeric health literacy to psychological traits.
Result: There were 359 participants in the study; 70% were white and 27% were black. Twenty-eight percent (28%) had no more than a high school education. The mean Realm score on a scale of 0-67 was 63.3 (SD 5.7). The mean Lipkus score on a scale of 0-11 was 7.7 (SD 2.6). A positive correlation was found between scores on the Realm and Lipkus and the traits of Optimism (cc: 0.22, 0.19) and Trust in People (cc: 0.29,0.30). An inverse correlation was found between scores on the Realm and Lipkus and the Health Locus of Control-God Subscale (cc -0.28, -0.28). In multivariate analyses controlling for age, gender, race, and income, scores on the Realm remained positive associated with the trait of Optimism (p=0.03) and negatively associated with Health Locus of Control-God scale (p=040). Health numeracy was not independently associated with any of the psychological traits evaluated in the multivariate analyses.
Conclusion: The results of this study suggest health literacy is associated with psychological traits that could influence health behavior and health outcomes. Psychological traits should be considered as potential mediators of the relationship between health literacy and improved health outcomes.
Candidate for the Lee B. Lusted Student Prize Competition