Journal of Community Health

, Volume 39, Issue 2, pp 394–399 | Cite as

The Role of Health Literacy and Numeracy in Contraceptive Decision-Making for Urban Chicago Women

Original Paper

Abstract

Low functional health literacy and numeracy have known associations with poor health outcomes, yet little work has investigated these markers of health disparity in a family planning population. We used an in-depth qualitative process and 2 literacy and numeracy assessment tools, the REALM-7 and the Schwartz numeracy scale, to assess the role of literacy and numeracy in contraceptive decision-making in an urban Chicago population. Brief surveys and semi-structured interviews were conducted with 30 postpartum women who had received Medicaid-funded care at an obstetrics clinic in an academic medical center. In-person one-on-one interviews were then reviewed for themes using an iterative process. Qualitative analysis techniques identifying emergent themes were applied to interview data. Literacy and numeracy were assessed using REALM-7 and a validated 3-question numeracy scale. In this cohort of African American (63 %) and Hispanic (37 %) women (median age 26), 73 % had unplanned pregnancies. Although health literacy rates on the REALM-7 were adequate, numeracy scores were low. Low literacy and numeracy scores were associated with interview reports of poor contraceptive knowledge and difficulty with contraceptive use. Low health literacy and numeracy may play an important role in contraception decision-making in this low-income, minority population of women. We recommend further study of literacy and numeracy in a family planning population. Comprehensive contraception education and communication around the contraceptive decision-making process should take place at literacy and numeracy levels appropriate to each individual.

Keywords

Health literacy Health numeracy Family planning Contraceptive decision-making Health disparities Postpartum 

References

  1. 1.
    Jones, R. K., et al. (2008). Abortion in the United States: Incidence and access to services, 2005. Perspectives on Sexual and Reproductive Health, 40(1), 6–16.PubMedCrossRefGoogle Scholar
  2. 2.
    Finer, L. B., & Henshaw, S. K. (2006). Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health, 38(2), 90–96.PubMedCrossRefGoogle Scholar
  3. 3.
    Henshaw, S. (1998). Unintended pregnancy in the United States. Family Planning Perspectives 30, 24–29, 46.Google Scholar
  4. 4.
    Finer, L. B., & Zolna, M. R. S. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84, 478–485.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Frost, J. J., Darroch, J. E., & Remez, L. (2008). Improving contraceptive use in the United States. Issues Brief (Alan Guttmacher Institute), 1, 1–8.Google Scholar
  6. 6.
    Frost, J. J., Singh, S., & Finer, L. B. (2007). Factors associated with contraceptive use and nonuse, United States, 2004. Perspectives on Sexual and Reproductive Health, 39(2), 90–99.PubMedCrossRefGoogle Scholar
  7. 7.
    Peipert, J. F., et al. (2012). Preventing unintended pregnancies by providing no-cost contraception. Obstetrics and Gynecology, 120(6), 1291-1297.Google Scholar
  8. 8.
    DeWalt, D. A., et al. (2004). Literacy and health outcomes: A systematic review of the literature. Journal of General Internal Medicine, 19, 1228–1239.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Osborn, C. Y., et al. (2011). Health literacy explains racial disparities in diabetes medication adherence. Journal of Health Communication: International Perspectives, 16(supp 3), 268–278.CrossRefGoogle Scholar
  10. 10.
    Nielsen-Bohlman, L., et al. (2004). Health literacy: A prescription to end confusion. Washington, DC: The National Academies Press.Google Scholar
  11. 11.
    Berkman, N. D., et al. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155, 97–107.PubMedCrossRefGoogle Scholar
  12. 12.
    Kutner, M. et al. (2006) The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006483). Washington, DC: US Department of Education.Google Scholar
  13. 13.
    Baker, D., et al. (1998). Health literacy and the risk of hospital admission. Journal of General Internal Medicine, 13(12), 791–798.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Mancuso, C., & Rincon, M. (2006). Impact of health literacy on longitudinal asthma outcomes. Journal of General Internal Medicine, 21, 813–817.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Schillinger, D., et al. (2002). Association of health literacy with diabetes outcomes. Journal of the American Medical Association, 288, 475–482.PubMedCrossRefGoogle Scholar
  16. 16.
    Wolf, M., et al. (2006). Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer. Urology, 68, 89–93.PubMedCrossRefGoogle Scholar
  17. 17.
    Lindau, S. T., Basu, A., & Leitsch, S. A. (2006). Health literacy as a predictor of follow-up after an abnormal Pap smear: A prospective study. Journal of General Internal Medicine, 21, 829–834.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Scott, T., et al. (2002). Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Medical Care, 49(5), 395–404.CrossRefGoogle Scholar
  19. 19.
    Dolan, N., et al. (2004). Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: Does literacy make a difference? Journal of Clinical Oncology, 22, 2617–2622.PubMedCrossRefGoogle Scholar
  20. 20.
    Ancker, J. S., & Kaufman, D. (2007). Rethinking health numeracy: A multidisciplinary literature review. Journal of the American Medical Informatics Association, 14(6), 713–721.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Golbeck, A. L., et al. (2005). A definition and operational framework for health numeracy. American Journal of Preventive Medicine, 29(4), 375–376.PubMedCrossRefGoogle Scholar
  22. 22.
    Peters, E., et al. (2007). Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Affairs, 26(3), 741–748.PubMedCrossRefGoogle Scholar
  23. 23.
    Lipkus, I. M., Samsa, G., & Rimer, B. K. (2001). General performance on a numeracy scale among highly educated samples. Medical Decision Making, 21, 37–44.PubMedCrossRefGoogle Scholar
  24. 24.
    Estrada, C. A., et al. (2004). Literacy and numeracy skills and anticoagulation control. The American Journal of Medical Sciences, 328(2), 88–93.CrossRefGoogle Scholar
  25. 25.
    Rothman, R. L., et al. (2006). Patient understanding of food labels: The role of literacy and numeracy. American Journal of Preventive Medicine, 31(5), 391–398.PubMedCrossRefGoogle Scholar
  26. 26.
    Gazmararian, J. A., Parker, R. M., & Baker, D. W. (1999). Reading skills and family planning knowledge and practices in a low-income managed-care population. Obstetrics and Gynecology, 93(2), 239–244.PubMedCrossRefGoogle Scholar
  27. 27.
    El-Ibiary, S., & Youmans, S. (2007). Health literacy and contraception: A readability evaluation of contraceptive instructions for condoms, spermicides, and emergency contraception in the USA. European Journal of Contraception and Reproductive Health Care, 12(1), 58–62.PubMedCrossRefGoogle Scholar
  28. 28.
    Parker, R. M., et al. (1996). Literacy and contraception: Exploring the link. Obstetrics and Gynecology, 88, 72S–77S.PubMedCrossRefGoogle Scholar
  29. 29.
    Ulin, P., Robinson, E., & Tolley, E. (2005). Qualitative methods in public health: A field guide for applied research. San Francisco, CA: Jossey-Bass.Google Scholar
  30. 30.
    Wolf, M. S., et al. (2004). Identifying persons with poor health literacy in 7-seconds: An important adjunct to improving cancer screening and treatment. Journal of Clinical Oncology, 22(14), 6007. 2004 ASCO Annual Meeting Proceedings.Google Scholar
  31. 31.
    Schwartz, L. M., et al. (1997). The role of numeracy in understanding the benefit of screening mammography. Annals of Internal Medicine, 127(11), 966–972.PubMedCrossRefGoogle Scholar
  32. 32.
    Makoul, G., & Clayman, M. (2006). An integrative model of shared decision making in medical encounters. Patient Education and Counseling, 60, 301–312.PubMedCrossRefGoogle Scholar
  33. 33.
    Rowlands, G. (2012). Health literacy and public health: A framework for developing skills and empowering citizens. Perspectives in Public Health, 132(1), 23–24.PubMedCrossRefGoogle Scholar
  34. 34.
    Osborn, C. Y., et al. (2007). Measuring adult literacy in health care: Performance of the newest vital sign. American Journal of Health Behavior, 31(supp 3), S36–S46.PubMedCrossRefGoogle Scholar
  35. 35.
    Vangeest, J. B., Welch, V. L., & Weiner, S. J. (2010). Patients’ perceptions of screening for health literacy: Reactions to the newest vital sign. Journal of Health Communication, 15, 402–412.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Maternal-Fetal Medicine, Department of Obstetrics and GynecologyNorthwestern University, Feinberg School of MedicineChicagoUSA
  2. 2.Departments of Obstetrics and Gynecology, Preventive Medicine and Medical Social SciencesNorthwestern University, Feinberg School of MedicineChicagoUSA

Personalised recommendations