Refining Conceptual Models for the Role of Health Literacy in Health Outcomes

Background: Uncovering the causal pathways linking limited health literacy to health outcomes is an essential task to transform observational research into actionable opportunities for improving healthcare and health outcomes. The lead investigators (Paasche-Orlow & Wolf) have previously proposed a conceptual framework for health literacy. While it has been frequently cited in the literature, there have been limited opportunities to test and refine the underlying premises. With increased availability of data, it is possible to examine in-depth the many proposed associations that could determine the manner in which low health literacy affects health outcomes. In addition, the literature in health literacy includes a small, very important collection of studies that have begun to describe health literacy as mediator for various health disparities. This is an interesting and exciting finding, as it means that health literacy interventions may help eliminate health disparities. This too can now be effectively investigated. Design: Secondary data analyses. Hypotheses: Associations between low health literacy and worse outcomes will be mostly explained by inadequate knowledge, services use, and self-care. Low health literacy, numeracy, problem-solving, and knowledge with health behaviors will represent a significant mediator of the relationship between race/ethnicity and worse clinical outcomes. Population Studied: Seven unique and diverse datasets in which health literacy and a rich array of additional key variables was measured. Methods: Structural equation modeling and other meditational analysis techniques to determine causal pathways linking health-related literacy, numeracy, problem-solving, and knowledge with health behaviors, outcomes, and disparities. Outcome Measures: Hypertension, Diabetes control, Asthma control, hospitalization, cognitive decline, and mortality. Expected Results: Improved understanding of the causal pathways linking health literacy to health outcomes and the role of health literacy in explaining health disparities. This will be the most extensive investigation of its kind, and will significantly contribute to our understanding of health literacy and how best to respond to the problem.