Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes

Public Health Reports

Volumn 121, Issue 3, 2006, Pages 245-254

  Schillinger, Dean ^a,d   Barton, Lauren R ^b   Karter, Andrew J ^c   Wang, Frances ^a   Adler, Nancy ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b SRI INTERNATIONAL   (United States)

^c DIVISION OF RESEARCH   (United States)

^d SAN FRANCISCO GENERAL HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEMOGLOBIN A1C;

ADOLESCENT; ADULT; ARTICLE; CHILD; CONTROLLED STUDY; CORRELATION ANALYSIS; DIABETES MELLITUS; EDUCATION; ETHNOLOGY; FUNCTIONAL HEALTH PATTERNS; GLYCEMIC CONTROL; HEALTH CARE POLICY; HEALTH INSURANCE; HEALTH PROMOTION; HUMAN; LOWEST INCOME GROUP; MAJOR CLINICAL STUDY; OUTCOME ASSESSMENT; PATH ANALYSIS; PRIORITY JOURNAL; READING; SENSITIVITY ANALYSIS; SOCIAL STATUS; UNITED STATES; BIOLOGICAL MODEL; BLOOD; CLINICAL TRIAL; EDUCATIONAL STATUS; GLYCEMIC INDEX; HEALTH STATUS; MALE; MIDDLE AGED; MULTICENTER STUDY; POVERTY; QUESTIONNAIRE;

DIABETES MELLITUS; EDUCATIONAL STATUS; GLYCEMIC INDEX; HEALTH STATUS; HUMANS; INSURANCE, HEALTH; MALE; MIDDLE AGED; MODELS, BIOLOGICAL; POVERTY; QUESTIONNAIRES; SAN FRANCISCO;

EID: 33646460778     PISSN: 00333549     EISSN: 00333549     Source Type: Journal    
DOI: 10.1177/003335490612100305     Document Type: Article

References (80)

1. Backlund E, Sorlie PD, Johnson NJ. A comparison of the relationships of education and income with mortality: the National Longitudinal Mortality Study. Soc Sci Med 1999;49:1373-84.
2. Sorlie PD, Backlund E, Keller JB. US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. Am J Public Health 1995;85:949-56.
3. Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health 1992;82:816-20.
4. Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood) 2002;21:60-76.
5. Marmot M. The influence of income on health: views of an epidemiologist. Health Aff (Millwood) 2002;21:31-46.
6. Huisman M, Kunst AE, Bopp M, Borgan JK, Borrell C, Costa G, et al. Educational inequalities in cause-specific mortality in middleaged and older men and women in eight western European populations. Lancet 2005;365:493-500.
7. Ross CE, Wu CL. The links between education and health. American Sociological Review 1996;60:719-45.
8. Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of U.S. adults. JAMA 1998;279:1703-8.
9. Nielson-Bohlman L, Panzer AM, Kindig DA, editors; Committee on Health Literacy. Health literacy: a prescription to end confusion. Washington: Institute of Medicine, Board of Neuroscience and Behavioral Health. National Academies Press; 2004 April 8.
10. Parker R. Health literacy: a challenge for American patients and their health care providers. Health Promot Int 2000;15:277-83.
11. Beach MC, Cooper LA, Robinson KA, Price EG, Gary TL, Jenckes MW, et al., Johns Hopkins University Evidence-Based Practice Center. Strategies for improving minority healthcare quality. Evidence Report/Technology Assessment Number 90. AHQR Pub. No. 04-E008-02. Rockville (MD): Department of Health and Human Services, Agency for Healthcare Research and Quality; 2004.
12. Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. Adult literacy in America: a first look at the results of the National Adult Literacy Survey. Washington: Department of Education (US), Office of Educational Research and Improvement, National Center for Education Statistics; 1993. Also available from: URL: http://nces.ed.gov/pubs93/93275.pdf [cited 2006 Jan 10].
13. Sum A, Kirsch I, Taggart R. The twin challenges of mediocrity and inequality: literacy in the U.S. from an international perspective. Policy Information Report. Princeton (NJ): Educational Testing Service; 2002.
14. Angell M. Privilege and health - what is the connection? N Engl J Med 1993;329(2):126-7.
15. Weiss BD, Hart G, McGee DL, D'Estelle S. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract 1992;5:257-64.
16. Baker DW. Reading between the lines: deciphering the connections between literacy and health. J Gen Intern Med 1999;14:315-7.
17. Department of Health and Human Services (US). Healthy People 2010. Understanding and improving health. 2nd ed. Washington: Government Printing Office (US); 2000. Also available from: URL: http://www.healthypeople.gov/ publications/ [cited 2006 Jan 10].
18. American Medical Association, Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs. Health literacy: report of the Council on Scientific Affairs. JAMA 1999;281:552-7.
19. Ratzan SC, Parker RM. Introduction. In: Selden CR, Zorn M, Ratzan SC, Parker RM, editors. Current bibliographies in medicine: health literacy. Bethesda (MD): Department of Health and Human Services (US), Public Health Service, National Institutes of Health, National Library of Medicine; 2000.
20. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med 1995;10:537-41.
21. Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med 1993;25:391-5.
22. DeWalt DA, Pignone MP. Reading is fundamental: the relationship between literacy and health. Arch Intern Med 2005;165:1943-4.
23. Sum A, Kirsch I, Yamamoto K. A human capital concern: the literacy proficiency of U.S. immigrants. Policy Information Report. Princeton (NJ): Policy Information Center, Educational Testing Service; 2004.
24. Grosse RN, Auffrey C. Literacy and health status in developing countries. Annu Rev Public Health 1989;10:281-97.
25. 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.
26. Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Arch Intern Med. 2005;165:1946-52.
27. Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health 2002;92:1278-83.
28. 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.
29. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease: a study of patients with hypertension and diabetes. Arch Intern Med 1998;158:166-72.
30. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA 2002;288:475-82.
31. Piette JD, Wagner TH, Potter MB, Schillinger D. Health insurance status, cost-related medication underuse, and outcomes among diabetes patients in three systems of care. Med Care 2004;42:102-9.
32. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-53.
33. Schillinger D. Improving chronic disease care for populations with limited health literacy. In: Health literacy: a prescription to end confusion. Washington: Institute of Medicine; National Academies Press; 2004.
34. Goldman DP, Smith JP. Can patient self-management help explain the SES health gradient? Proc Natl Acad Sci USA 2002;99:10929-34.
35. Karter AJ, Ackerson LM, Darbinian JA, D'Agostino RB Jr, Ferrara A, Liu J, et al. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am J Med 2001;111:1-9.
36. Chaturvedi N, Stephenson JM, Fuller JH. The relationship between socioeconomic status and diabetes control and complications in the EURODIAB IDDM Complications Study. Diabetes Care 1996;19:423-30.
37. van der Meer JB, Mackenbach JP. The care and course of diabetes: differences according to level of education. Health Policy 1999;46:127-41.
38. Wilder RP. Education and mortality in type 2 diabetes. Diabetes Care 2003;26(5):1650.
39. Steenland K, Henley J, Thun M. All-cause and cause-specific death rates by educational status for two million people in two American Cancer Society cohorts, 1959-1996. Am J Epidemiol 2002;156:11-21.
40. Cowie CC, Eberhardt MS. Sociodemographic characteristics of persons with diabetes. In: Harris MI, Cowie CC, Reiber G, Boyko E, Stern M, Bennett P, editors. Diabetes in America. 2nd ed. Washington: Government Printing Office (US); 1995. p. 85-116.
41. Cooper R, Cutler J, Desvigne-Nickens P, Fortmann SP, Friedman L, Havlik R, et al. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the National Conference on Cardiovascular Disease Prevention. Circulation 2000;102:3137-47.
42. Schillinger D, Bindman A, Stewart A, Wang F, Piette J. Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns 2004;52:315-23.
43. Hart AC, Hopkins CA, editors. ICD-9-CM expert for physicians, volumes 1 and 2: International Classification of Diseases, 9th rev., clinical modification. Salt Lake City: Ingenix; 2003.
44. Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Perez-Stable EJ. Development of a short acculturation scale for Hispanics. Hisp J Behav Sci 1987;9:183-205.
45. Fitzgerald JT, Davis WK, Connell CM, Hess GE, Funnell MM, Hiss RG. Development and validation of the Diabetes Care Profile. Eval Health Prof 1996;19:208-30.
46. Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. Patient Educ Couns 1999;38:33-42.
47. Taylor WL. "Cloze procedure": a new tool for measuring readability. Journalism Quarterly 1953;30:415-33.
48. Powers RD, Sumner WA, Kearl BE. A recalculation of four adult readability formulas. J Educ Psych 1958;49:99-105.
49. Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin K, Coates WC, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA 1995;274:1677-82.
50. Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC. Effect of improved glycemic control on health care costs and utilization. JAMA 2001;285:182-9.
51. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-86.
52. Bio-Rad Laboratories. DiaSTAT Hemoglobin A1c Analyzer. Hercules (CA): Bio-Rad Laboratories [cited 2005 Oct 21]. Available from: URL: http://www.bio-rad.com
53. Hoyle RH, Smith GT. Formulating clinical research hypotheses as structural equation models: a conceptual overview. J Consult Clin Psych 1994;62:429-40.
54. Scientific Software International. LISREL 8: user's reference guide. Lincolnwood (IL): Scientific Software International Inc.; 1996.
55. Piette JD, Wagner TH, Potter MB, Schillinger D. Health insurance status, cost-related medication underuse, and outcomes among diabetes patients in three systems of care. Med Care 2004;42:102-9.
56. Brown AF, Ettner SL, Piette J, Weinberger M, Gregg E, Shapiro MF, et al. Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev 2004;26:63-77.
57. Steiger JH. Structural model evaluation and modification: an interval estimation approach. Multivariate Behavioral Research 1990;25:173-80.
58. Brown M, Cudeck R. Alternative ways of assessing model fit. In: Bollen K, Long J, editors. Testing structural equation models. London: Sage; 1993.
59. Williams MV, Davis T, Parker RM, Weiss BD. The role of health literacy in patient-physician communication. Fam Med 2002;34:383-9.
60. Schillinger D, Machtinger E, Wang F, Rodriguez M, Bindman AB. Preventing medication errors in ambulatory care: the importance of establishing regimen concordance. In: Henriksen K, Battles J, Lewin DI, Marks E, editors. Advances in patient safety: from research to implementation. Vol. 1, Research findings. Rockville (MD): Agency for Healthcare Research and Quality; 2005, p. 199-210.
61. Roter DL, Stashefsky-Margalit R, Rudd R. Current perspectives on patient education in the US. Patient Educ Couns 2001;44:79-86.
62. Castro C, Wilson C, Wang F, Schillinger D. Babel babble: physicians' use of jargon with diabetes patients. Proceedings of the 27th Annual Society of General Internal Medicine Annual Meeting; 2004 May 12-15; Chicago, IL.
63. Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med 2003;163:83-90.
64. Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med 2002;17:243-52.
65. Piette JD, Schillinger D, Potter MB, Heisler M. Dimensions of patient-provider communication and diabetes self-care in an ethnically diverse population. J Gen Intern Med 2003;18:624-33.
66. Grant RW, Pirraglia PA, Meigs JB, Singer DE. Trends in complexity of diabetes care in the United States from 1991 to 2000. Arch Intern Med 2004;164:1134-9.
67. Schillinger D, Chen AH. Literacy and language. Disentangling measures of access, utilization, and quality. J General Intern Med 2004;19:288-90.
68. Yen IH, Moss N. Unbundling education: a critical discussion of what education confers and how it lowers risk for disease and death. Ann N Y Acad Sci 1999;896:350-1.
69. Singh-Manoux A, Ferrie JE, Chandola T, Marmot M. Socioeconomic trajectories across the life course and health outcomes in midlife: evidence for the accumulation hypothesis? Int J Epidemiol 2004;33:1072-9.
70. Wallerstein N. Powerlessness, empowerment, and health: implications for health promotion programs. Am J Health Promot 1992;6:197-205.
71. Baker DW, Gazmararian JA, Sudano J, Patterson M, Parker RM, Williams MV. Health literacy and performance on the Mini-Mental State Examination. Aging Ment Health 2002;6:22-9.
72. Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K. Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort. Arch Intern Med 2004;164:1327-33.
73. Yaffe K, Kanaya A, Lindquist K, Simonsick EM, Harris T, Shorr RI, et al. The metabolic syndrome, inflammation, and risk of cognitive decline. JAMA 2004;292:2237-42.
74. Piette JD, Weinberger M, McPhee SJ. The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial. Med Care 2000;38:218-30.
75. Lynch J, Kaplan G. Socioeconomic position. In: Berkman LF, Kawachi I, editors. Social epidemiology. New York: Oxford University Press; 2000. p. xxii, 391.
76. Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, et al. Preventable hospitalizations and access to health care. JAMA 1995;274:305-11.
77. St Leger L. Schools, health literacy and public health: possibilities and challenges. Health Promot Int 2001;16:197-205.
78. Rothman RL, DeWalt DA, Malone R, Bryant B, Shintani A, Crigler B, et al. Influence of patient literacy on the effectiveness of a primary care-based diabetes disease management program. JAMA 2004;292:1711-6.
79. DeWalt DA, Pignone M, Malone RM, Bryant B, Felix K, Corr K, et al. Randomized controlled trial of a primary care-based heart failure disease management program for patients with low literacy. J Gen Intern Med 2004;19(s1):203.
80. Parker RM, Ratzan SC, Lurie N. Health literacy: a policy challenge for advancing high-quality health care. Health Aff (Millwood) 2003;22:147-53.