Journal of General Internal Medicine

, Volume 27, Issue 10, pp 1300–1307

Literacy, Cognitive Function, and Health: Results of the LitCog Study

  • Michael S. Wolf
  • Laura M. Curtis
  • Elizabeth A. H. Wilson
  • William Revelle
  • Katherine R. Waite
  • Samuel G. Smith
  • Sandra Weintraub
  • Beth Borosh
  • David N. Rapp
  • Denise C. Park
  • Ian C. Deary
  • David W. Baker
Original Research

DOI: 10.1007/s11606-012-2079-4

Cite this article as:
Wolf, M.S., Curtis, L.M., Wilson, E.A.H. et al. J GEN INTERN MED (2012) 27: 1300. doi:10.1007/s11606-012-2079-4

ABSTRACT

BACKGROUND

Emerging evidence suggests the relationship between health literacy and health outcomes could be explained by cognitive abilities.

OBJECTIVE

To investigate to what degree cognitive skills explain associations between health literacy, performance on common health tasks, and functional health status.

DESIGN

Two face-to-face, structured interviews spaced a week apart with three health literacy assessments and a comprehensive cognitive battery measuring ‘fluid’ abilities necessary to learn and apply new information, and ‘crystallized’ abilities such as background knowledge.

SETTING

An academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois.

PATIENTS

Eight hundred and eighty-two English-speaking adults ages 55 to 74.

MEASUREMENTS

Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA), and Newest Vital Sign (NVS). Performance on common health tasks were globally assessed and categorized as 1) comprehending print information, 2) recalling spoken information, 3) recalling multimedia information, 4) dosing and organizing medication, and 5) healthcare problem-solving.

RESULTS

Health literacy measures were strongly correlated with fluid and crystallized cognitive abilities (range: r = 0.57 to 0.77, all p < 0.001). Lower health literacy and weaker fluid and crystallized abilities were associated with poorer performance on healthcare tasks. In multivariable analyses, the association between health literacy and task performance was substantially reduced once fluid and crystallized cognitive abilities were entered into models (without cognitive abilities: β = −28.9, 95 % Confidence Interval (CI) -31.4 to −26.4, p; with cognitive abilities: β = −8.5, 95 % CI −10.9 to −6.0).

LIMITATIONS

Cross-sectional analyses, English-speaking, older adults only.

CONCLUSIONS

The most common measures used in health literacy studies are detecting individual differences in cognitive abilities, which may predict one’s capacity to engage in self-care and achieve desirable health outcomes. Future interventions should respond to all of the cognitive demands patients face in managing health, beyond reading and numeracy.

KEY WORDS

health literacy cognitive abilities health tasks patient-reported outcomes physical health mental health 

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Michael S. Wolf
    • 1
    • 2
  • Laura M. Curtis
    • 1
  • Elizabeth A. H. Wilson
    • 1
  • William Revelle
    • 3
  • Katherine R. Waite
    • 1
    • 2
  • Samuel G. Smith
    • 4
  • Sandra Weintraub
    • 5
  • Beth Borosh
    • 5
  • David N. Rapp
    • 2
    • 3
  • Denise C. Park
    • 6
  • Ian C. Deary
    • 7
  • David W. Baker
    • 1
  1. 1.Health Literacy and Learning Program, Division of General Internal MedicineFeinberg School of Medicine at Northwestern UniversityChicagoUSA
  2. 2.Department of Learning Sciences, School of Education and Social PolicyNorthwestern UniversityEvanstonUSA
  3. 3.Department of PsychologyNorthwestern UniversityEvanstonUSA
  4. 4.Health Behaviour Research Centre, Department of PsychologyUniversity College LondonLondonUnited Kingdom
  5. 5.Department of Psychiatry & Behavioral SciencesFeinberg School of Medicine at Northwestern UniversityChicagoUSA
  6. 6.Center for Vital LongevityUniversity of Texas at DallasDallasUSA
  7. 7.Centre for Cognitive Ageing and Cognitive Epidemiology, Department of PsychologyUniversity of EdinburghEdinburghUnited Kingdom

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