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The Influence of Community and Individual Health Literacy on Self-Reported Health Status

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ABSTRACT

BACKGROUND

Individual health literacy is an established predictor of individual health outcomes. Community-level health literacy may also impact individual health, yet limited research has simultaneously considered the influence of individual and community health literacy on individual health.

OBJECTIVE

The study goal was to determine if community health literacy had an independent relationship with individual self-reported health beyond individual health literacy.

DESIGN

We used data from the 2008 and 2010 Hawai‘i Health Survey, a representative statewide telephone survey. Multilevel models predicted individual self-reported health by both individual and community health literacy, controlling for relevant individual-level (education, race/ethnicity, gender, poverty, insurance status, age, and marital status) and community-level variables (community poverty and community education).

PARTICIPANTS

The sample included 11,779 individuals within 37 communities.

MAIN MEASURES

Individual health literacy was defined by validated self-reported measurement. Communities were defined by zip code combinations. Community health literacy was defined as the percentage of individuals within a community reporting low health literacy. Census data by ZIP Code Tabulation Areas provided community-level variables.

KEY RESULTS

In descriptive results, 18.2 % self-reported low health literacy, and 14.7 % reported self-reported poor health. Community-level low health literacy ranged from 5.37 % to 35.99 %. In final, multilevel models, both individual (OR: 2.00; 95 % CI: 1.63–2.44) and community low health literacy (OR: 1.02; 95 % CI: 1.00–1.03) were significantly positively associated with self-reported poor health status. Each percentage increase of average low health literacy within a community was associated with an approximately 2 % increase in poor self-reported health for individuals in that community. Also associated with poorer health were lower educational attainment, older age, poverty, and non-White race.

CONCLUSIONS

Both individual and community health literacy are significant, distinct correlates of individual general health status. Primary care providers and facilities should consider and address health literacy at both community and individual levels.

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Acknowledgements

This study was supported by grants from the National Cancer Institute 1R03CA158419 and U54CA153459. Biostatistical support was also partially supported by grants from the National Institute on Minority Health and Health Disparities U54MD007584 and G12MD007601 from the National Institutes of Health.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East–West Road, Biomed D104-G, Honolulu, HI, 96821, USA

    Tetine Sentell PhD & Kathryn L. Braun DrPH

  2. Department of Sociology, University of Hawai‘i at Manoa, Honolulu, HI, USA

    Wei Zhang PhD

  3. Biostatistics Core, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI, USA

    James Davis PhD

  4. Hawai’i Department of Health, Office of Health Status Monitoring, Honolulu, HI, USA

    Kathleen Kromer Baker PhD

  5. ‘Imi Hale Native Hawaiian Cancer Network, Honolulu, HI, USA

    Kathryn L. Braun DrPH

Authors
  1. Tetine Sentell PhD
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  2. Wei Zhang PhD
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  3. James Davis PhD
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  4. Kathleen Kromer Baker PhD
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  5. Kathryn L. Braun DrPH
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Correspondence to Tetine Sentell PhD.

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Sentell, T., Zhang, W., Davis, J. et al. The Influence of Community and Individual Health Literacy on Self-Reported Health Status. J GEN INTERN MED 29, 298–304 (2014). https://doi.org/10.1007/s11606-013-2638-3

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  • DOI: https://doi.org/10.1007/s11606-013-2638-3

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