Levels of Health Literacy in a Community-Dwelling Population of Chinese Older Adults

Health literacy is commonly defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness (1)”. Health literacy has been accepted by researchers, health care professionals, and policy makers as a necessary area of study for reducing health disparities and improving health outcomes. Because of its importance in promoting better health services, health literacy was incorporated into multiple provisions of the Patient Protection and Affordable Care Act (ACA) (2). Additionally, the U.S. Department of Health and Human Services has issued a strategic plan to improve health literacy nationally (3). Although researchers are still exploring how health literacy directly or indirectly impact health outcomes, many empirical studies have identified significant associations between inadequate health literacy and poor health outcomes. For example, low health literacy level is associated with reduced likelihood of understanding diagnoses, treatment (4), and prescription drug label instructions (5). Emergency Department patients with poor health literacy might be subject to increased risk of hospitalization (6). Evidence suggests that people with low health literacy tend to have reduced understanding regarding the necessities and benefits of using preventive care services, including cancer screening tests (7). In addition, the high prevalence of low health literacy has been found to be associated with certain deteriorating cognitive abilities, such as memory and verbal fluency, among the elderly (8). Overall, approximately 14% of Americans have a “below basic” health literacy level, meaning they are only able to locate easily identifiable information and comprehend written instructions in simple documents, such as the date on a hospital appointment slip (9). It has been further suggested that low health literacy is particularly prevalent among certain populations—including people aged 65 and over, racial/ethnic minorities, recently arrived refugees and immigrants, people who did not complete high school, those living at or below the poverty line, and those whose native language is not English (3). Progress has been made in explaining why health literacy disparities exist among these groups, but little is known about health literacy levels in the U.S. Chinese population. The Chinese community constitutes the largest Asian American subgroup population while Asian Americans are the fastest growing ethnic group in the United States (10). Therefore, it is important to develop a better understanding of health literacy level of U.S. Chinese population, especially for Chinese older adults who might be more significantly impacted by low health literacy. To grow our knowledge of Chinese older adults’ Chinese health literacy level, we examined over 3,000 Chinese older adults in the greater Chicago area. Chicago has one of the largest Chinese older adult populations and prior studies indicate that over 90% of Chinese older adults in Chicago do not speak or read English (11). Moreover, similar with Chinese older adults in other metropolitan areas, the majority of Chinese older adults in the greater Chicago area choose to live in ethnic enclaves, namely Chinatown neighborhoods and its surrounding areas where Chinese is used as the main language (12). Because Chinese older adults usually are able to obtain health care services and medical information from their primary care physicians and other health professionals who speak Chinese, Chinese instead of English is the language they usually use to seek care for their health needs. Therefore, our study focuses on Chinese older adults’ health literacy in Chinese. The objectives of this study are to: 1) examine health literacy level among community-dwelling Chinese older adults in the greater Chicago area and 2) examine the sociodemographic, family position, and health-related correlates of health literacy among this population.