Effect of poor health literacy on eye examination behavior

Health literacy affects many aspects of health including poorer health outcomes, less frequent screening, poorer medicine compliance, and poor communication. We examined the effects of health literacy on knowledge, attitudes, and beliefs about eye health, stage of change for dilated fundus examinations (DFEs), and patient-physician communication, in a population of community-dwelling African Americans ages 65 and older. Health literacy was assessed using the REALM-R, a shortened version of the Rapid Estimate of Adult Literacy in Medicine (REALM) word recognition test. Of the 328 study participants, 63% were classified as having poor health literacy. We found statistically significant differences by health literacy score for gender, education, income, and behavioral intention. Males (P=.0002), those with less than a high school education (P<.0001), people with incomes less than $20,000 (P<.0001), and participants who had decided not to have a DFE or were still deciding (P=.03) were more likely to have poor health literacy scores. Those with poor health literacy had lower general eye knowledge scores than those with adequate literacy (P <.001), although no differences were observed for glaucoma or diabetic eye disease knowledge scores. Participants with poor health literacy reported more barriers to getting DFEs compared to those with adequate health literacy (P<.004). We found a statistically significant difference in medical decision-making preference by health literacy status (P=.006); people with poor health literacy were more likely to prefer that the doctor make medical decisions and less likely to prefer making the decisions themselves compared with participants with adequate health literacy.