title: Health literacy association with health behaviors and health care utilization in multiple sclerosis: a cross-sectional study.
abstract: BACKGROUND
  Low health literacy is generally associated with poor health outcomes; however, health literacy has received little attention in multiple sclerosis (MS).
  
  
  OBJECTIVE
  The aim of this study was to investigate the health literacy of persons with MS using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry.
  
  
  METHODS
  In 2012, we conducted a cross-sectional study of health literacy among NARCOMS participants. Respondents completed the Medical Term Recognition Test (METER) which assesses the ability to distinguish medical and nonmedical words, and the Newest Vital Sign (NVS) instrument which evaluates reading, interpretation, and numeracy skills. Respondents reported their sociodemographic characteristics, health behaviors, comorbidities, visits to the emergency room (ER), and hospitalizations in the last 6 months. We used logistic regression to evaluate the characteristics associated with functional literacy, and the association between functional literacy and health care utilization.
  
  
  RESULTS
  Of 13,020 eligible participants, 8934 (68.6%) completed the questionnaire and were US residents. Most of them performed well on the instruments with 81.04% (7066/8719) having functional literacy on the METER and 74.62% (6666/8933) having adequate literacy on the NVS. Low literacy on the METER or the NVS was associated with smoking, being overweight or obese (all P<.001). After adjustment, low literacy on the METER was associated with ER visits (OR 1.28, 95% CI 1.10-1.48) and hospitalizations (OR 1.19, 95% CI 0.98-1.44). Findings were similar for the NVS.
  
  
  CONCLUSIONS
  In the NARCOMS cohort, functional health literacy is high. However, lower levels of health literacy are associated with adverse health behaviors and greater health care utilization.
authors: University of Manitoba, Departments of Internal Medicine and Community Health Sciences, Winnipeg, MB, Canada. rmarrie@hsc.mb.ca.
authors: Ruth Ann
authors: RA
authors: Marrie
authors: Amber
authors: A
authors: Salter
authors: Tuula
authors: T
authors: Tyry
authors: Robert J
authors: RJ
authors: Fox
authors: Gary R
authors: GR
authors: Cutter
keywords: comorbidity; health behaviors; health care utilization; health literacy; multiple sclerosis