eprintid: 9943 rev_number: 4 userid: 6 dir: disk0/00/00/99/43 datestamp: 2011-11-10 20:07:28 lastmod: 2016-11-15 13:52:45 status_changed: 2011-11-10 20:07:28 type: thesis_degree metadata_visibility: show contact_email: michael.miller@drake.edu item_issues_count: 0 eprint_status: archive creators_name: Miller, Michael Joseph creators_email: michael.miller@drake.edu title: THE RELATIONSHIP BETWEEN A SYNTHETIC ESTIMATE OF FUNCTIONAL HEALTH LITERACY AND PREVENTIVE HEALTH CARE USE IN A NATIONAL SAMPLE OF ELDERLY ispublished: unpub divisions: sch_gsph_behavioralcommhealthsci full_text_status: public keywords: flu shot; health literacy; mammogram; elderly; preventive health care abstract: Functional health literacy is one path through which the educational system, health system, culture and society intersect to influence health outcomes and their associated costs. Inadequate functional health literacy can impair oral and written communication and subsequently the ability to understand the prevention and self-management of disease. Despite these concerns, the national prevalence of inadequate, marginal and adequate functional health literacy and their association with health status, health care utilization and subsequent health care outcomes remain largely unknown. For those tasked with the responsibility of managing population health, there is a void of tools and techniques that can be used to efficiently identify those at greatest risk of inadequate functional health literacy. Using standard regression modeling and diagnostic techniques, this study was the first to develop and validate a model to estimate functional health literacy and to confirm its direct relationship with preventive health services utilization in a nationally representative sample of elderly >= 65 years of age. The national prevalence of inadequate and marginal functional health literacy was estimated to be 39%. Preventive health care utilization varied by functional health literacy category. Individuals with inadequate or marginal functional health literacy had odds of not receiving a flu shot within the past 12 months that was 1.26 times that of individuals with adequate functional health literacy (OR = 1.26, 95% CI (1.11 - 1.43)) after controlling for income, insurance coverage, having a usual source of care, and self-reported general health status. Women with inadequate or marginal functional health literacy had odds of not ever having a mammogram that was 2.21 times that of women with adequate functional health literacy (OR = 2.21, 95% CI (1.85 - 2.65)) in multivariate analysis. This research confirms the national public health relevance of functional health literacy in preventive health care utilization in the elderly. Race, education and age-related disparities in preventive health care utilization may, in part, be mediated through functional health literacy. As we move to equalize health care access, utilization and quality for all, functional health literacy must be considered part of the solution if we are to empower those in greatest need. date: 2004-12-03 date_type: completed institution: University of Pittsburgh refereed: TRUE etdcommittee_type: committee_chair etdcommittee_type: committee_member etdcommittee_type: committee_member etdcommittee_type: committee_member etdcommittee_name: Degenholtz, Howard B etdcommittee_name: Lin, Chyongchiou Jeng etdcommittee_name: Ricci, Edmund M etdcommittee_name: Sereika, Susan M etdcommittee_email: degen@pitt.edu etdcommittee_email: cjlin@pitt.edu etdcommittee_email: emricci@pitt.edu etdcommittee_email: ssereika@pitt.edu etdcommittee_id: DEGEN etdcommittee_id: CJLIN etdcommittee_id: EMRICCI etdcommittee_id: SSEREIKA etd_defense_date: 2004-08-09 etd_approval_date: 2004-12-03 etd_submission_date: 2004-12-02 etd_access_restriction: immediate etd_patent_pending: FALSE assigned_doi: doi:10.5195/pitt.etd.2011.9943 thesis_type: dissertation degree: DrPH committee: Howard B. Degenholtz, PhD (degen@pitt.edu) - Committee Chair committee: Chyongchiou Jeng Lin, PhD (cjlin@pitt.edu) - Committee Member committee: Edmund M. Ricci, PhD (emricci@pitt.edu) - Committee Member committee: Susan M. Sereika, PhD (ssereika@pitt.edu) - Committee Member etdurn: etd-12022004-001521 other_id: http://etd.library.pitt.edu/ETD/available/etd-12022004-001521/ other_id: etd-12022004-001521 citation: Miller, Michael Joseph (2004) THE RELATIONSHIP BETWEEN A SYNTHETIC ESTIMATE OF FUNCTIONAL HEALTH LITERACY AND PREVENTIVE HEALTH CARE USE IN A NATIONAL SAMPLE OF ELDERLY. Doctoral Dissertation, University of Pittsburgh. (Unpublished) document_url: http://d-scholarship-dev.library.pitt.edu/9943/1/miller_dissertation_final_pdf.pdf