Examining health literacy among a low-income adolescent population in California

As U.S. health care reform is implemented in upcoming years, many will have first-time access to a complex health care system. This study developed a multi-dimensional measure of an expanded health-literacy definition that captures competencies needed to effectively navigate the health care system. Self-selected, publicly insured adolescent members (aged 13-17) of a large California health insurance network participated in a self-reported survey on their health care knowledge, attitudes, and experiences. Data from teens receiving health care in the past 12 months (n=1,209) were examined using Factor Analysis to investigate the emergence of underlying health-literacy domains. Domain scores were then used as predictors in Ordinal Logistic regression models to evaluate associations with wellness visits, general health, and emotional health. Factor Analysis results suggest the presence of six health-literacy domains: 1) Patient-Provider Encounter; 2) Interactions with the Health Care System; 3) Rights and Responsibilities; 4) Confidence in Health Information from a Personal Source; 5) Confidence in Health Information from a Media Source; and 6) Health Information-Seeking Competency Using Internet. Results suggest that less-frequent wellness visits are associated with lower health-literacy scores in domains 1 (p<.001), 2 (p=.031), and 4 (p=.047). Poor general health is associated with lower health-literacy scores in domains 1 (p<.001), 2 (p<.001), 4 (p<.001), and 6 (p=.005). Poor emotional health is associated with lower health-literacy scores in domains 1 (p=.001), 2 (p=.003), 4 (p=.001), and 5 (p=.002). Our findings suggest that improving skills in certain health-literacy domains may increase preventive care and health among an adolescent population.