title: Relationship between health literacy, health status, and healthy behaviors among older adults in Isfahan, Iran.
abstract: BACKGROUND
  Health literacy is a measure of an individual's ability to read, comprehend, and act on medical instructions. Limited health literacy can reduce the adults' ability to comprehend and use basic health-related materials, such as prescription, food labels, health education pamphlets, articles, appointment slips, and health insurance plans, which can affect their ability to take appropriate and timely health care action. Nowadays, low health literacy is considered a worldwide health threat. So, the purpose of this study was to assess health literacy level in older adults and to investigate the relationships between health literacy and health status, health care utilization, and health preventive behaviors.
  
  
  METHODS
  A cross-sectional survey of 354 older adults was conducted in Isfahan. The method of sampling was clustering. Health literacy was measured using the Test of Functional Health Literacy in Adults (TOFHLA). Data were collected using home interviewing. Health status was measured based on self-rated general health. Health care utilization was measured based on self-reported outpatient clinic visits, emergency room visits, and hospitalizations, and health preventive behaviors were measured based on self-reported preventive health services use.
  
  
  RESULTS
  Approximately 79.6% of adults were found to have inadequate health literacy. They tended to be older, had fewer years of schooling, lower household income, and were females. Inadequate health literacy was associated with poorer general health (P < 0.001). Health literacy level was negatively associated with outpatient visits (P = 0.003) and hospitalization (P = 0.01). No significant association was found between health literacy level and emergency room utilization. Self-reported lack of PSA (Prostate-Specific Antigen) test (P < 0.001) and fecal occult blood test (FOBT; P = 0.003) was higher among individuals with inadequate health literacy than those with adequate health literacy. No significant association was found between health literacy level and mammogram in the last 2 years.
  
  
  CONCLUSIONS
  Low health literacy is more prevalent in older adults. It indicates the importance of health literacy issue in health promotion. So, with simple educational materials and effective interventions for low health literacy group, we can improve health promotion in the society and mitigate the adverse health effects of low health literacy.
authors.affiliation: Department of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Seyed Homamodin
authors.initials: SH
authors.lastname: Javadzade
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Sharifirad
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Radjati
authors.forename: Firoozeh
authors.initials: F
authors.lastname: Mostafavi
authors.forename: Mahnoosh
authors.initials: M
authors.lastname: Reisi
authors.forename: Akbar
authors.initials: A
authors.lastname: Hasanzade
keywords: Health care utilization; health literacy; health preventive behaviors; health status; older adults
references.citation: Am J Prev Med. 2000 May;18(4):325-31
references.pmid: 10788736
references.citation: Am J Health Behav. 2008 May-Jun;32(3):227-42
references.pmid: 18067463
references.citation: Pediatrics. 1996 Jun;97(6 Pt 1):804-10
references.pmid: 8657518
references.citation: Am J Public Health. 1989 Nov;79(11):1554-6
references.pmid: 2817172
references.citation: Patient Educ Couns. 1996 Jan;27(1):33-9
references.pmid: 8788747
references.citation: J Health Commun. 2007 Dec;12(8):721-32
references.pmid: 18030638
references.citation: Obstet Gynecol. 1989 Dec;74(6):955-60
references.pmid: 2586962
references.citation: Med Care. 2002 May;40(5):395-404
references.pmid: 11961474
references.citation: J Am Geriatr Soc. 2004 Jan;52(1):123-7
references.pmid: 14687326
references.citation: Am J Prev Med. 2007 Jan;32(1):19-24
references.pmid: 17184964
references.citation: J Gen Intern Med. 2006 Feb;21(2):140-5
references.pmid: 16336616
references.citation: J Gen Intern Med. 2006 Aug;21(8):857-61
references.pmid: 16881947
references.citation: Patient Educ Couns. 2009 Jun;75(3):411-7
references.pmid: 19403259
references.citation: J Epidemiol Community Health. 2007 Dec;61(12):1086-90
references.pmid: 18000132
references.citation: J Rheumatol. 1997 Dec;24(12):2335-9
references.pmid: 9415638
references.citation: Pediatrics. 1994 Mar;93(3):460-8
references.pmid: 8115206
references.citation: JAMA. 1999 Feb 10;281(6):545-51
references.pmid: 10022111
references.citation: Am J Public Health. 1997 Jun;87(6):1027-30
references.pmid: 9224190
references.citation: Arch Intern Med. 2005 Sep 26;165(17):1946-52
references.pmid: 16186463
references.citation: Arch Intern Med. 1998 Jan 26;158(2):166-72
references.pmid: 9448555
references.citation: J Public Health (Oxf). 2009 Dec;31(4):490-5
references.pmid: 19454605
references.citation: Arch Intern Med. 2007 Jul 23;167(14):1503-9
references.pmid: 17646604
references.citation: J Acquir Immune Defic Syndr. 2000 Dec 1;25(4):337-44
references.pmid: 11114834
references.citation: Soc Sci Med. 2008 Apr;66(8):1809-16
references.pmid: 18295949
references.citation: Lancet. 2008 Nov 8;372(9650):1661-9
references.pmid: 18994664
references.citation: J Gen Intern Med. 2005 Feb;20(2):175-84
references.pmid: 15836552
references.citation: Am J Public Health. 2002 Aug;92(8):1278-83
references.pmid: 12144984
references.citation: JAMA. 2002 Jul 24-31;288(4):475-82
references.pmid: 12132978
references.citation: BMC Public Health. 2010 Oct 16;10:614
references.pmid: 20950479