Relation of health literacy to gonorrhoea related care.

OBJECTIVE To assess the relation between health literacy and receipt of a screening test for gonorrhoea in the past year. METHODS Study design was multisite, cross sectional survey of subjects enrolled from clinics, from community based organisations, and by street intercept. Data were obtained using face to face interview. The dependent variable was self reported receipt of a test for gonorrhoea in the past year. Health literacy was measured by the Rapid Estimate of Adult Literacy in Medicine (REALM), recoded to represent 8th grade or lower reading or 9th grade and higher reading level. Statistical analyses were adjusted to account for selection bias in literacy assessment. RESULTS 54% of the sample reported at least one gonorrhoea test in the previous year. 65% of the sample read at a 9th grade level or higher. REALM score was moderately correlated with the respondent's years of education. After adjustment for missing REALM data, past suspicion of gonorrhoea, self inspection for gonorrhoea, self efficacy for care seeking, REALM score of 9th grade reading level or higher, and younger age were independently associated with gonorrhoea testing in the previous year. For the average respondent, REALM reading grade level of 9th grade or higher is associated with a 10% increase in the probability of having a gonorrhoea test in the past year. CONCLUSIONS Low literacy appears to pose a barrier to care for sexually transmitted infections such as gonorrhoea.

[1]  Christopher Winship,et al.  Models for Sample Selection Bias , 1992 .

[2]  Khan Mk,et al.  Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. , 1999, JAMA.

[3]  D W Baker,et al.  Reading skills and family planning knowledge and practices in a low-income managed-care population. , 1999, Obstetrics and gynecology.

[4]  David Haber,et al.  Guide to clinical preventive services: a challenge to physician resourcefulness , 1993 .

[5]  J. Fortenberry,et al.  Health care seeking behaviors related to sexually transmitted diseases among adolescents. , 1997, American journal of public health.

[6]  K. Nawata.  Estimation of sample selection bias models by the maximum likelihood estimator and Heckman's two-step estimator , 1994 .

[7]  "Race-ethnicity": a dubious scientific concept. , 1990, Public health reports.

[8]  C. Feied,et al.  Functional illiteracy among emergency department patients: a preliminary study. , 1993, Annals of emergency medicine.

[9]  C. Meade,et al.  Improving patient comprehension of literature on smoking. , 1989, American journal of public health.

[10]  J. Root,et al.  Materials and strategies that work in low literacy health communication. , 1994, Public health reports.

[11]  L. G. Doak,et al.  Improving comprehension for cancer patients with low literacy skills: Strategies for clinicians , 1998, CA: a cancer journal for clinicians.

[12]  Nina S. Parikh,et al.  Shame and health literacy: the unspoken connection. , 1996, Patient education and counseling.

[13]  J. Heckman.  Sample selection bias as a specification error , 1979 .

[14]  R. Berk.  An introduction to sample selection bias in sociological data. , 1983 .

[15]  Nina S. Parikh,et al.  The health care experience of patients with low literacy. , 1996, Archives of family medicine.

[16]  Cathy D. Meade,et al.  Readability Formulas: Cautions and Criteria , 1991 .

[17]  J. Wells.  Readability of HIV/AIDS educational materials: the role of the medium of communication, target audience, and producer characteristics. , 1994, Patient education and counseling.

[18]  S. Fortmann,et al.  The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults. , 1997, American journal of public health.

[19]  E. J. Mayeaux,et al.  Rapid estimate of adult literacy in medicine: a shortened screening instrument. , 1993, Family medicine.

[20]  T. Davis,et al.  Literacy in patients with a chronic disease: systemic lupus erythematosus and the reading level of patient education materials. , 1997, The Journal of rheumatology.

[21]  E. J. Mayeaux,et al.  Reading ability in patients in substance misuse treatment centers. , 1993, The International journal of the addictions.

[22]  Nina S. Parikh,et al.  Inadequate functional health literacy among patients at two public hospitals. , 1995, JAMA.

[23]  ATTRIBUTIONS AND THE STIGMA OF ILLITERACY : UNDERSTANDING HELP SEEKING IN LOW LITERATE ADULTS , 1996 .

[24]  D. Ruscavage,et al.  Literacy of women attending family planning clinics in Virginia and reading levels of brochures on HIV prevention. , 1994, Family planning perspectives.

[25]  L. G. Doak,et al.  Teaching Patients With Low Literacy Skills , 1985 .

[26]  Mark V. Williams,et al.  Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. , 1998, Archives of internal medicine.

[27]  A Estey,et al.  Patient's understanding of health information: a multihospital comparison. , 1994, Patient education and counseling.

[28]  B. Weiss,et al.  Communicating with patients who cannot read. , 1997, The New England journal of medicine.

[29]  Mark V. Williams,et al.  Literacy and Contraception: Exploring the Link , 1996, Obstetrics and gynecology.

[30]  Improvement,et al.  Adult literacy in America : a first look at the results of the National Adult Literacy Survey , 1993 .

[31]  P. Kefalides.  Illiteracy: the silent barrier to health care. , 1999, Annals of internal medicine.