Health Literacy, Cognitive Abilities, and Learning in the Context of Health Care

Objective: Over the past two decades, the relationship between health literacy and health outcomes has been well documented. Recently, researchers have begun to question whether this relationship might be explained by individual differences in cognitive abilities. In this study we sought to investigate whether the associations between health literacy and the acquisition of health knowledge could be explained by cognitive abilities.

Methods: In this study, 99 adults ages 55-74 participated in two interviews that assessed health literacy, cognitive function, and the ability to complete health related tasks. Specific cognitive abilities that were investigated included speed of processing, working memory, and abstract reasoning. Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA).

Results: Health literacy was moderately to strongly correlated with the three cognitive abilities (working memory r=0.56, abstract reasoning r=0.42, processing speed r=0.55). Both literacy and cognitive abilities were significantly associated with one's ability to acquire knowledge from a multimedia tool. After adjusting for age, gender, and exposure to asthma and other chronic conditions, health literacy was a significant independent predictor of knowledge (β=0.17, 95% Confidence Interval (CI) 0.11-0.24). However, over 40 percent of this relationship was explained by cognitive abilities.

Conclusion: Cognition, specifically fluid abilities such as speed of processing, working memory and reasoning explain a significant amount of the known relationship between health literacy and the acquisition of health knowledge. Cognitive factors should be considered in the design of health materials and instructional strategies aimed at educating patients on important health concepts.