Wolf Michael S, Gazmararian Julie A, Baker David W
Institute for Healthcare Studies and Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 200, Chicago, IL 60611, USA.
Arch Intern Med. 2005 Sep 26;165(17):1946-52. doi: 10.1001/archinte.165.17.1946.
Individuals with limited health literacy have less health knowledge, worse self-management skills, lower use of preventive services, and higher hospitalization rates. We evaluated the association between health literacy, self-reported physical and mental health functioning, and health-related activity limitations among new Medicare managed care enrollees.
A cross-sectional survey of 2923 enrollees was conducted in Cleveland, Ohio; Houston, Tex; Tampa, Fla; and Fort Lauderdale-Miami, Fla. Health literacy was measured using the short form of the Test of Functional Health Literacy in Adults. We used outcome measures that included scores on the physical and mental health functioning subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey, difficulties with instrumental activities of daily living and activities of daily living, and limitations because of physical health and pain.
After adjusting for the prevalence of chronic conditions, health risk behaviors, and sociodemographic characteristics, individuals with inadequate health literacy had worse physical function (67.7 vs 78.0, P<.001) and mental health (76.2 vs 84.0, P<.001) than individuals with adequate health literacy. Individuals with inadequate health literacy were more likely to report difficulties with instrumental activities of daily living (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.74-2.92) and activities of daily living (OR, 2.83; 95% CI, 1.62-4.96), limitations in activity because of physical health (OR, 1.79; 95% CI, 1.39-2.32), fewer accomplishments because of physical health (OR, 1.90; 95% CI, 1.48-2.45), and pain that interferes with normal work activities (OR, 2.01; 95% CI, 1.46-2.77).
Among community-dwelling older adults, inadequate health literacy was independently associated with poorer physical and mental health.
健康素养有限的个体健康知识较少，自我管理技能较差，预防性服务利用率较低，住院率较高。我们评估了新加入医疗保险管理式医疗计划的参保者的健康素养、自我报告的身心健康状况以及与健康相关的活动受限之间的关联。
在俄亥俄州克利夫兰、得克萨斯州休斯敦、佛罗里达州坦帕以及佛罗里达州劳德代尔堡 - 迈阿密对2923名参保者进行了横断面调查。使用成人功能性健康素养测试简表来测量健康素养。我们采用的结果指标包括医学结局研究36项简短健康调查的身心健康状况分量表得分、日常生活工具性活动和日常生活活动方面的困难，以及因身体健康和疼痛导致的活动受限。
在对慢性病患病率、健康风险行为和社会人口学特征进行调整后，健康素养不足的个体与健康素养充足的个体相比，身体功能更差（67.7对78.0，P<.001），心理健康状况也更差（76.2对84.0，P<.001）。健康素养不足的个体更有可能报告在日常生活工具性活动方面存在困难（比值比[OR]，2.25；95%置信区间[CI]，1.74 - 2.92）以及日常生活活动方面存在困难（OR，2.83；95% CI，1.62 - 4.96），因身体健康导致的活动受限（OR，1.79；95% CI，1.39 - 2.32），因身体健康而取得的成就较少（OR，1.90；95% CI，1.48 - 2.45），以及疼痛干扰正常工作活动（OR，2.01；95% CI，1.46 - 2.77）。
在社区居住的老年人中，健康素养不足与较差的身心健康独立相关。
