Skip to main content

Advertisement

Log in

The roles of low literacy and social support in predicting the preventability of hospital admission

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: Prior studies found higher hospitalization rates among patients with low literacy, but did not determine the preventability of these admissions or consider other determinants of hospitalization, such as social support. This study evaluated whether low literacy was a predictor for preventability of hospitalization when considered in the context of social support, sociodemographics, health status, and risk behaviors.

METHODS: A convenience sample of 400 patients, admitted to general medicine wards in a university-affiliated Veterans Affairs hospital between August 1, 2001 and April 1, 2003, completed a face-to-face interview to assess literacy, sociodemographics, social support, health status, and risk behaviors. Two Board-certified Internists independently assessed preventability of hospitalization and determined the primary preventable cause through blinded medical chart reviews.

RESULTS: Neither low literacy (< seventh grade) nor very low literacy (< fourth grade) was significantly associated with preventability of hospitalization. In multivariable analysis, significant predictors of having a preventable cause of hospitalization included binge alcohol drinking (P≤.001), lower social support for medical care (P<.04), ≤3 annual clinic visits (P<.005), and ≥12 people talked to weekly (P<.023) Among nonbinge drinkers with lower social support for medical care, larger social networks were predictive of preventability of hospitalization. Among nonbinge drinkers with higher support for medical care, lower outpatient utilization was predictive of the preventability of hospitalization.

CONCLUSIONS: While low literacy was not predictive of admission preventability, the formal assessment of alcohol binge drinking, social support for medical care, social network size, and prior outpatient utilization may enhance our ability to predict the preventability of hospitalizations and develop targeted interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Nielsen-Bohlman L, Panzer A, Kindig D. Health Literacy: A Prescription to End Confusion. Washington, DC: Institute of Medicine of the National Academies; 2003.

    Google Scholar 

  2. Davis TC, Arnold C, Berkel H, Nandy I, Jackson R, Glass J. Knowledge and attitude on screening mammography among low-literate, low-income women. Cancer. 1996;78:1912–20.

    Article  CAS  PubMed  Google Scholar 

  3. Davis TC, Dolan N, Ferreira MR, et al. The role of inadequate health literacy skills in colorectal cancer screening. Cancer Invest. 2001;19:193–201.

    Article  CAS  PubMed  Google Scholar 

  4. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;114:1008–15.

    Article  CAS  PubMed  Google Scholar 

  5. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. Arch Int Med. 1998;158:166–72.

    Article  CAS  Google Scholar 

  6. Baker DW, Parker RM, Williams MV. Patient reading ability and use of health care services. J Gen Intern Med. 1997;12:50.

    Article  Google Scholar 

  7. Baker DW, Parker RM, Williams MV, Clark WS, Nurss J. The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health. 1997;87:1027–30.

    Article  CAS  PubMed  Google Scholar 

  8. Gazmararian JA, Baker DW, Williams MV, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999;281:545–51.

    Article  CAS  PubMed  Google Scholar 

  9. Baker DW, Gazmararian JA, Williams MV, et al. Functional health literacy and the risk of hospital admission among medicare managed care enrollees. Am J Public Health. 2002;92:1278–83.

    Article  PubMed  Google Scholar 

  10. Baker DW, Parker RM, Williams MV, Clark DS. Health literacy and the risk of hospital admission. J Gen Intern Med. 1998;13:791–8.

    Article  CAS  PubMed  Google Scholar 

  11. Kefalides P. Illiteracy: the silent barrier to health care. Ann Intern Med. 1999;130:333–6.

    CAS  PubMed  Google Scholar 

  12. Lee S, Arozullah A, Cho Y. Health literacy, social support, and health: a research agenda. Soc Sci Med. 2004;58:1309–21.

    Article  PubMed  Google Scholar 

  13. Brez SM, Taylor M. Assessing literacy for patient teaching: perspectives of adults with low literacy skills. J Adv. Nursing. 1997;25:1040–7.

    Article  CAS  Google Scholar 

  14. Davis TC, Long S, Jackson R, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391–5.

    CAS  PubMed  Google Scholar 

  15. Davis TC, Crouch MA, Long SW, et al. Rapid assessment of literacy levels of adult primary care patients. Fam Med. 1991;23:433–5.

    CAS  PubMed  Google Scholar 

  16. Lin N, Ye X, Ensel WM. Social support and depressed mood: a structural analysis. J Health Soc Behav. 1999;40:344–59.

    Article  CAS  PubMed  Google Scholar 

  17. Sherbourne C, Steward A. The medical outcomes study social support survey. Soc Sci Med. 1991;32:705–14.

    Article  CAS  PubMed  Google Scholar 

  18. Ware JJ, Kosinski M, Keller S. A 12-item short form health survey. Medical Care. 1996;34:220–33.

    Article  PubMed  Google Scholar 

  19. Walker S, Sechrist K, Pender N. The health-promoting lifestyle profile: development and psychometric characteristics. Nursing Res. 1987;36:76–81.

    Article  CAS  Google Scholar 

  20. Oddone E, Weinberger M, Horner M, et al. Classifying general medicine readmissions are they preventable? J Gen Intern Med. 1996;11:597–607.

    Article  CAS  PubMed  Google Scholar 

  21. Soltysik R, Yarnold P. Univariable optimal discriminant analysis: one-tailed hypotheses. Educ Psychol Meas. 1994;54:646–53.

    Article  Google Scholar 

  22. Yarnold P, Soltysik R. Theoretical distributions of optima for univariate discrimination of random data. Decision Sci. 1991;22:739–52.

    Article  Google Scholar 

  23. Yarnold P, Soltysik R, Bennett CL. Predicting in-hospital mortality of patients with AIDS-related Pneumocystis carinii pneumonia: an example of hierarchically optimal classification tree analysis. Stat. Med. 1997;16:1451–63.

    Article  CAS  PubMed  Google Scholar 

  24. Yarnold P, Soltysik R. Optimal Data Analysis: Guidebook with Software for Windows. Washington, DC: APA Books; 2005.

    Google Scholar 

  25. Arozullah A, Yarnold P, Weinstein R, et al. A new preadmission staging system for predicting in-patient mortality from HIV-associated Pneumocystis carinii pneumonia in the early-HAART era. Am J Respir Crit Care Med. 2000;161:1081–6.

    CAS  PubMed  Google Scholar 

  26. Arozullah A, Parada J, Bennett C, et al. A rapid staging system for predicting mortality from HIV-associated community-acquired pneumonia. Chest. 2003;123:1151–60.

    Article  PubMed  Google Scholar 

  27. Penning M. Health, social support, and the utilization of health services among older adults. J Gerontol Series B, Psychol Sci Soc Sci. 1995;50:S330–9.

    CAS  Google Scholar 

  28. Chin MH, Goldman L. Correlates of early hospital readmission or death in patients with congestive heart failure. Am J Cardiol. 1997;79:1640–4.

    Article  CAS  PubMed  Google Scholar 

  29. Grant R, Charlebois E, Wachter RM. Risk factors for early hospital readmission in patients with AIDS and pneumonia. J Gen Intern Med. 1999;14:531–6.

    Article  CAS  PubMed  Google Scholar 

  30. Mor-Barak M, Miller L, Syme L. Social networks, life events, and health of poor, frail elderly: a longitudinal study of the buffering versus direct effect. Fam Community Health. 1991;12:1–13.

    Google Scholar 

  31. Mistry R, Rosansky J, McGuire J, McDermott C, Jarvik L. Social isolation predicts re-hospitalization in a group of older American veterans enrolled in the UPBEAT program. Int J Geriatric Psychiatry. 2001;16:950–9.

    Article  CAS  Google Scholar 

  32. Andersen R. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.

    Article  CAS  PubMed  Google Scholar 

  33. Naimi T, Brewer R, Mokdad A, Denny C, Sedula M, Marks J. Binge drinking among US adults. JAMA. 2003;289:70–5.

    Article  PubMed  Google Scholar 

  34. Fleming M, Barry K, Manwell L, Johnson K, London R. Brief physician advice for problem alcohol drinkers: a randomized controlled trial in community-based primary care practices. JAMA. 1997;277:1039–45.

    Article  CAS  PubMed  Google Scholar 

  35. Maisto S, Saitz R. Alcohol use disorders: screening and diagnosis. Am J Addict. 2003;12:S12–25.

    PubMed  Google Scholar 

  36. Healthy People 2010: With Understanding and Improving Health and Objectives for Improving Health. 2nd edn. Washington, DC: U.S. Department of Health and Human Services; 2000.

    Google Scholar 

  37. McCaul M, Petry N. The role of psychosocial treatments in pharmacotherapy for alcoholism. Am J Addict. 2003;12:S41–52.

    Article  PubMed  Google Scholar 

  38. Baker D, Gazmararian J, Williams M, et al. Health literacy and use of outpatient physician services by Medicare managed care enrollees. J Gen Intern Med. 2004;19:215–20.

    Article  PubMed  Google Scholar 

  39. Payne S. Identifying and managing inappropriate hospital utilization: a policy synthesis. Health Services Res. 1987;22:712–69.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ahsan M. Arozullah MD, MPH.

Additional information

The authors of this article have no conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arozullah, A.M., Lee, SY.D., Khan, T. et al. The roles of low literacy and social support in predicting the preventability of hospital admission. J Gen Intern Med 21, 140–145 (2006). https://doi.org/10.1007/s11606-006-0248-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-006-0248-z

Key words

Navigation