Skip to main content
Top
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Health literacy in an urban elderly East-German population – results from the population-based CARLA study

Authors: Daniel Tiller, Beatrice Herzog, Alexander Kluttig, Johannes Haerting

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Health literacy (HL) has gained increasing attention in public health research. However, until now research was mainly focused on clinical settings rather than on the general population. Due its relation to social determinants and health outcomes, HL is of special interest in epidemiological studies. The aim of the present study was therefore to describe HL among an elderly general high-risk population, to analyze the potential contributing factors of HL, and to analyze the impact of HL on health-related outcomes.

Methods

We used data from the CARLA Study, which is a prospective population-based cohort study of the elderly general population of the city of Halle (Saale) in Eastern Germany. The short version of the HLS-EU Questionnaire (HLS-EU-Q16) was administered with 1,107 subjects aged between 55 and 91 year old. A HL score ranging from 0 to 50 points was computed and classified according to the recommendation of the HLS-EU project. Socio-economic as well as health-related variables were determined during the standardized interview and clinical examination. We calculated linear as well as logistic regression models in order to analyze the association between HL and health-related outcomes as well as potential influencing factors of HL.

Results

Overall, the HL score was 36.9 (SD 6.9). Among all subjects, 4 % showed inadequate HL, 23 % problematic HL, 50 % sufficient HL, and 23 % excellent HL. HL was positively associated with educational level, net household income, and self-perceived social position. Further, we found an increase of HL with age (β = 0.10; 95 % CL 0.05; 0.15) and a lower HL score among women compared with men (Diff = -1.4; 95 % CL −2.2; −0.6). An inverse association was observed between HL and diabetes among both sexes (OR 0.93; 95 % CL 0.93; 0.98), between HL and myocardial infarction among women, and between HL and stroke among men.

Conclusions

In this elderly general Eastern German population, we found higher HL score values compared with previous studies using the same questionnaire. HL was associated with socio-economic status. Furthermore, this cross-sectional study could show associations between HL and different health-related outcomes even after adjustment for educational level. However, further research is needed in order to evaluate the impact of HL on health-related outcomes using longitudinal data derived from the general population.
Literature
1.
go back to reference Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67.CrossRef Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67.CrossRef
2.
go back to reference Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Słońska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12(1):80. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Słońska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12(1):80.
3.
go back to reference Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.CrossRefPubMed Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.CrossRefPubMed
5.
go back to reference Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med. 1995;10(10):537–41.CrossRefPubMed Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med. 1995;10(10):537–41.CrossRefPubMed
6.
go back to reference Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3(6):514–22.CrossRefPubMedPubMedCentral Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3(6):514–22.CrossRefPubMedPubMedCentral
7.
go back to reference Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25(6):391–5.PubMed Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25(6):391–5.PubMed
8.
go back to reference HLS EU Consortium. The European Health Literacy Project (HLS-EU). 27-4-2012. HLS EU Consortium. The European Health Literacy Project (HLS-EU). 27-4-2012.
9.
go back to reference Nutbeam D, Kickbusch I. Advancing health literacy: a global challenge for the 21st century. Health Promot Int. 2000;15(3):183–4.CrossRef Nutbeam D, Kickbusch I. Advancing health literacy: a global challenge for the 21st century. Health Promot Int. 2000;15(3):183–4.CrossRef
11.
go back to reference Lee S-YD, Tsai T-I, Tsai Y-W, Kuo KN. Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Publ Health. 2010;10:614.CrossRef Lee S-YD, Tsai T-I, Tsai Y-W, Kuo KN. Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Publ Health. 2010;10:614.CrossRef
12.
go back to reference Schipf S, Werner A, Tamayo T, Holle R, Schunk M, Maier W, et al. Regional differences in the prevalence of known Type 2 diabetes mellitus in 45–74 years old individuals: results from six population-based studies in Germany (DIAB-CORE Consortium). Diabet Med. 2012;29(7):e88–95.CrossRefPubMed Schipf S, Werner A, Tamayo T, Holle R, Schunk M, Maier W, et al. Regional differences in the prevalence of known Type 2 diabetes mellitus in 45–74 years old individuals: results from six population-based studies in Germany (DIAB-CORE Consortium). Diabet Med. 2012;29(7):e88–95.CrossRefPubMed
13.
go back to reference Stang A, Döring A, Völzke H, Moebus S, Greiser KH, Werdan K, et al. Regional differences in body fat distributions among people with comparable body mass index: a comparison across six German population-based surveys. Eur J Cardiovasc Prev Rehabil. 2011;18(1):106–14.PubMed Stang A, Döring A, Völzke H, Moebus S, Greiser KH, Werdan K, et al. Regional differences in body fat distributions among people with comparable body mass index: a comparison across six German population-based surveys. Eur J Cardiovasc Prev Rehabil. 2011;18(1):106–14.PubMed
14.
go back to reference Greiser KH, Kluttig A, Schumann B, Kors JA, Swenne CA, Kuss O, et al. Cardiovascular disease, risk factors and heart rate variability in the elderly general population: design and objectives of the CARdiovascular disease, Living and Ageing in Halle (CARLA) Study. BMC Cardiovasc Disord. 2005;5:33.CrossRefPubMedPubMedCentral Greiser KH, Kluttig A, Schumann B, Kors JA, Swenne CA, Kuss O, et al. Cardiovascular disease, risk factors and heart rate variability in the elderly general population: design and objectives of the CARdiovascular disease, Living and Ageing in Halle (CARLA) Study. BMC Cardiovasc Disord. 2005;5:33.CrossRefPubMedPubMedCentral
15.
go back to reference Greiser KH, Kluttig A, Schumann B, Swenne CA, Kors JA, Kuss O, et al. Cardiovascular diseases, risk factors and short-term heart rate variability in an elderly general population: the CARLA study 2002–2006. Eur J Epidemiol. 2009;24(3):123–42.CrossRefPubMed Greiser KH, Kluttig A, Schumann B, Swenne CA, Kors JA, Kuss O, et al. Cardiovascular diseases, risk factors and short-term heart rate variability in an elderly general population: the CARLA study 2002–2006. Eur J Epidemiol. 2009;24(3):123–42.CrossRefPubMed
16.
go back to reference Pelikan JM, Röthlin F, Canahl K. Introduction to HL measurement procedures of the HLS-EU study, 2nd European HL Conference, Aarhus, 10.4.2014. 2014. Pelikan JM, Röthlin F, Canahl K. Introduction to HL measurement procedures of the HLS-EU study, 2nd European HL Conference, Aarhus, 10.4.2014. 2014.
18.
go back to reference Ware Jr JE, Kosinski M, Keller SD. A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.CrossRefPubMed Ware Jr JE, Kosinski M, Keller SD. A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.CrossRefPubMed
19.
go back to reference Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.CrossRef Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.CrossRef
20.
go back to reference Unterschiede bei der Gesundheitskompetenz Ergebnisse einer bundesweiten Repräsentativ-Umfrage unter gesetzlich Versicherten. WIdO-monitor 11(2), 1–12. 2014. Unterschiede bei der Gesundheitskompetenz Ergebnisse einer bundesweiten Repräsentativ-Umfrage unter gesetzlich Versicherten. WIdO-monitor 11(2), 1–12. 2014.
21.
go back to reference Nakayama K, Osaka W, Togari T, Ishikawa H, Yonekura Y, Sekido A, et al. Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy. BMC Public Health. 2015;15:505.CrossRefPubMedPubMedCentral Nakayama K, Osaka W, Togari T, Ishikawa H, Yonekura Y, Sekido A, et al. Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy. BMC Public Health. 2015;15:505.CrossRefPubMedPubMedCentral
22.
go back to reference van der Heide I, Rademakers J, Schipper M, Droomers M, Sørensen K, Uiters E. Health literacy of Dutch adults: a cross sectional survey. BMC Public Health. 2013;13:179.CrossRefPubMedPubMedCentral van der Heide I, Rademakers J, Schipper M, Droomers M, Sørensen K, Uiters E. Health literacy of Dutch adults: a cross sectional survey. BMC Public Health. 2013;13:179.CrossRefPubMedPubMedCentral
23.
go back to reference Gazmararian JA, Baker DW, Williams MV, Parker RM, Scott TL, Green DC, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999;281(6):545–51.CrossRefPubMed Gazmararian JA, Baker DW, Williams MV, Parker RM, Scott TL, Green DC, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999;281(6):545–51.CrossRefPubMed
24.
go back to reference Rothman RL, Housam R, Weiss H, Davis D, Gregory R, Gebretsadik T, et al. Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med. 2006;31(5):391–8.CrossRefPubMed Rothman RL, Housam R, Weiss H, Davis D, Gregory R, Gebretsadik T, et al. Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med. 2006;31(5):391–8.CrossRefPubMed
25.
go back to reference Barber MN, Staples M, Osborne RH, Clerehan R, Elder C, Buchbinder R. Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey. Health Promot Int. 2009;24(3):252–61.CrossRefPubMed Barber MN, Staples M, Osborne RH, Clerehan R, Elder C, Buchbinder R. Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey. Health Promot Int. 2009;24(3):252–61.CrossRefPubMed
27.
go back to reference Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20(2):175–84.CrossRefPubMedPubMedCentral Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20(2):175–84.CrossRefPubMedPubMedCentral
28.
go back to reference Toçi E, Burazeri G, Sørensen K, Kamberi H, Brand H. Concurrent validation of two key health literacy instruments in a South Eastern European population. Eur J Public Health. 2015;25(3):482–6.CrossRefPubMed Toçi E, Burazeri G, Sørensen K, Kamberi H, Brand H. Concurrent validation of two key health literacy instruments in a South Eastern European population. Eur J Public Health. 2015;25(3):482–6.CrossRefPubMed
29.
go back to reference Ricardo AC, Yang W, Lora CM, Gordon EJ, Diamantidis CJ, Ford V, et al. Limited health literacy is associated with low glomerular filtration in the Chronic Renal Insufficiency Cohort (CRIC) study. Clin Nephrol. 2014;81(1):30–7.CrossRefPubMed Ricardo AC, Yang W, Lora CM, Gordon EJ, Diamantidis CJ, Ford V, et al. Limited health literacy is associated with low glomerular filtration in the Chronic Renal Insufficiency Cohort (CRIC) study. Clin Nephrol. 2014;81(1):30–7.CrossRefPubMed
30.
go back to reference Cunha M, Gaspar R, Fonseca S, Almeida D, Silva M, Nunes L. Implications of literacy for health for body mass index. Aten Primaria. 2014;46 Suppl 5:180–6.CrossRefPubMed Cunha M, Gaspar R, Fonseca S, Almeida D, Silva M, Nunes L. Implications of literacy for health for body mass index. Aten Primaria. 2014;46 Suppl 5:180–6.CrossRefPubMed
31.
go back to reference Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475–82.CrossRefPubMed Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475–82.CrossRefPubMed
32.
go back to reference Cajita MI, Cajita TR, Han HR. Health literacy and heart failure: a systematic review. J Cardiovasc Nurs. 2015; Epub ahead of print. Cajita MI, Cajita TR, Han HR. Health literacy and heart failure: a systematic review. J Cardiovasc Nurs. 2015; Epub ahead of print.
Metadata
Title
Health literacy in an urban elderly East-German population – results from the population-based CARLA study
Authors
Daniel Tiller
Beatrice Herzog
Alexander Kluttig
Johannes Haerting
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2210-7

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue