Person:

Rudd, Rima

Attention to the effect of a patient's literacy skills on health care interactions is relatively new. So too are studies of either structural or personal factors that inhibit or support a patient's ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural environment, of interpersonal dynamics, and of a variety of psychological and sociological factors in the relationship between patients and providers have long been under study. Less frequently examined is the advocacy role expected of patients. However, the complex nature of health care in the U.S. increasingly requires a proactive stance.

This study examined whether four literacy skills (reading, numeracy, speaking, and listening) were associated with patient self-advocacy, a component of health literacy itself, when faced with a hypothetical barrier to scheduling a medical appointment. While all literacy skills were significantly associated with advocacy when examined in isolation, greater speaking and listening skills remained significantly associated with better patient advocacy when all four skills were examined simultaneously. These findings suggest that speaking and listening skills and support for such skills may be important factors to consider when developing patient activation and advocacy skills.

Background

Research has demonstrated associations between smoking and reading skills, but other literacy skills such as speaking, listening and numeracy are less studied despite our dependence on the use of numbers and the oral exchange to deliver information on the risks of smoking.

Methods

We used multivariable logistic regression to examine the effects of reading, numeracy, speaking and listening skills on 1) becoming a regular smoker and 2) smoking cessation. Further, multivariable linear regression was used to examine the relation between literacy skills and amount smoked among current smokers. Models controlled for education, gender, age, race/ethnicity, income, and, when relevant, age they became a regular smoker.

Results

For each grade equivalent increase in reading skills, the odds of quitting smoking increased by about 8% (OR=1.08, 95%CI: 1.01–1.15). For every point increase in numeracy skills, the odds of quitting increased by about 24% (OR=1.24, 95%CI: 1.06 – 1.46). No literacy skills were associated with becoming a regular smoker or current amount smoked.

Conclusion

The ability to locate, understand and use information related to the risks of smoking may impact one’s decision to quit. Messaging should be designed with the goal of being easily understood by all individuals regardless of literacy level.