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Health Literacy, Preventive Health Screening, and Medication Adherence Behaviors of Older African Americans at a PCMH

Anil N.F. Aranha, PhD, and Pragnesh J. Patel, MD
A health literacy study of older African Americans aimed to establish whether associations exist between health literacy and preventive health screening behaviors, disease control, and medication adherence.
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Objectives: To determine the health literacy (HL) of older African Americans (AAs) and establish whether associations exist between HL and preventive health screening (PHS) behaviors, disease control (DC), and medication adherence (MA).

Study Design: A prospective study using a clustered sampling of older AAs.

Methods: A total of 99 older AAs seeking care at a patient-centered medical home were given the Newest Vital Sign (NVS), Short Test of Functional Health Literacy in Adults (STOFHLA), and Morisky Medication Adherence Scale (MMAS). Sociodemographic and clinical data were obtained.

Results: The group was 75.8% female, with means of 75 years of age, 12.7 years education, and 29.5 kg/m2 body mass index and good control over disease markers: For blood pressure, 62.6% had good control; for blood glucose, 82.8%; and for total lipids/cholesterol, 63.6% (high-density lipoprotein, 81.8%; low-density lipoprotein, 73.7%). Compliance rates for primary PHS behaviors were 61.6% for influenza vaccine and 57.7% for pneumococcal vaccine. For secondary PHS behaviors, compliance rates for mammography were 97.3% among women; for colonoscopy, 84%; and for bone densitometry (BD), 62.8%. Performance differences were observed on HL scales, with 31.3% and 73.7% obtaining an adequate NVS score and STOFHLA score, respectively, but no gender differences were noted. HL scales showed positive association among themselves (= .001), patient education (NVS, P = .001; STOFHLA, P = .004), MMAS (P = .001 and P = .563, respectively), anthropometry measurements, primary PHS procedures, and 1 secondary PHS procedure (mammography), but they exhibited negative association with colonoscopy and BD. DC achieved using a PHS approach to clinical care was not associated with HL.

Conclusions: HL was positively associated with patient education, some PHS behaviors, and MA. Performance on HL scales may not enable positive identification of PHS behaviors, DC, and MA. Thus, HL may have limited efficacy as a tool to assess PHS behaviors and DC among older AAs.

Am J Manag Care. 2018;24(9):428-432
This article has been corrected in
Am J Manag Care. 2019;25(5):256.

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