A Life Course Approach to Health Literacy: the Role of Gender, Educational Attainment and Lifetime Cognitive Capability

Overview

Journal Age Ageing

Publisher Oxford University Press

Specialty Geriatrics

Date 2016 Dec 13

PMID 27940567

Citations 79

Authors

Sean A P Clouston

Jennifer A Manganello

Marcus Richards

Affiliations

Soon will be listed here.

Abstract

Objective: social inequalities in health are believed to arise in part because individuals make use of social and economic resources in order to improve survival. In recent years, health literacy has received increased attention as a factor that can help explain differences in health outcomes. However, examination of life course predictors of health literacy has been limited.

Methods: life course data from the Wisconsin Longitudinal Study 1957-2011 were used to examine predictors of health literacy in old age (N = 2,122), using the Newest Vital Sign. Generalised structural equation modelling was used to model pathways to health literacy.

Results: predictors of health literacy included educational attainment, and adolescent cognitive and non-cognitive skills, and, in men, rate of cognitive decline from middle to later life.

Discussion: numerous studies have documented health literacy issues among older adults, and recommendations have been made for ways to improve health literacy for this population. This study reports on risk factors across the life course that are associated with health literacy later in life, identifying possible intervention targets to reduce risk of poor health as people age. Our results suggest that a range of life course factors, beginning in early life, predict health literacy. Further research studying health literacy over the life course is warranted.

Citing Articles

Rural-urban disparities of Alzheimer's disease and related dementias: A scoping review.

Kramer M, Cutty M, Knox S, Alekseyenko A, Mollalo A Alzheimers Dement (N Y). 2025; 11(1):e70047.

PMID: 39935615 PMC: 11811960. DOI: 10.1002/trc2.70047.

Health literacy disparities in Thai university students: exploring differences between health science and non-health science disciplines.

Manochaiwuthikul T, Chaichutchouwakul A, Yunan N, Winothai N, Kanta P, Sapbamrer R BMC Public Health. 2025; 25(1):557.

PMID: 39934783 PMC: 11817181. DOI: 10.1186/s12889-025-21761-0.

Knowledge regarding human monkeypox among a sample of undergraduate and post-graduate students from selected tertiary institutions in Bangladesh: An online-based cross-sectional study.

Banna M, Seidu A, Mallick T, Rahman N, Sultana M, Mouly H PLoS One. 2024; 19(12):e0315677.

PMID: 39739877 PMC: 11687903. DOI: 10.1371/journal.pone.0315677.

Exposure to violence and other determinants of health literacy among Palestinian adolescents: a cross-sectional study.

Sarhan M, Fujiya R, Jimba M, Giacaman R, Kiriya J, Shibanuma A BMC Public Health. 2024; 24(1):3460.

PMID: 39696167 PMC: 11658375. DOI: 10.1186/s12889-024-20942-7.

Community voices in health literacy: a qualitative exploration into perceptions of a health literacy mediator.

Spencer M, Cruickshank V, Kemp N, Nash R Health Promot Int. 2024; 39(5).

PMID: 39397747 PMC: 11471997. DOI: 10.1093/heapro/daae130.

References

Goodman M, Gaskin D, Si X, Stafford J, Lachance C, Kaphingst K . Self-reported segregation experience throughout the life course and its association with adequate health literacy. Health Place. 2012; 18(5):1115-21. PMC: 3418469. DOI: 10.1016/j.healthplace.2012.04.010. View

Rhodes E, Devlin K, Steinberg L, Giovannetti T . Grit in adolescence is protective of late-life cognition: non-cognitive factors and cognitive reserve. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2016; 24(3):321-332. PMC: 5785334. DOI: 10.1080/13825585.2016.1210079. View

Carpenter C . A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Commun. 2010; 25(8):661-9. DOI: 10.1080/10410236.2010.521906. View

Serper M, Patzer R, Curtis L, Smith S, OConor R, Baker D . Health literacy, cognitive ability, and functional health status among older adults. Health Serv Res. 2014; 49(4):1249-67. PMC: 4111764. DOI: 10.1111/1475-6773.12154. View

Weiss B, Mays M, Martz W, Castro K, DeWalt D, Pignone M . Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005; 3(6):514-22. PMC: 1466931. DOI: 10.1370/afm.405. View

Herd P, Carr D, Roan C . Cohort profile: Wisconsin longitudinal study (WLS). Int J Epidemiol. 2014; 43(1):34-41. PMC: 3937969. DOI: 10.1093/ije/dys194. View

Wister A, Malloy-Weir L, Rootman I, Desjardins R . Lifelong educational practices and resources in enabling health literacy among older adults. J Aging Health. 2010; 22(6):827-54. DOI: 10.1177/0898264310373502. View

Zamora H, Clingerman E . Health literacy among older adults: a systematic literature review. J Gerontol Nurs. 2011; 37(10):41-51. DOI: 10.3928/00989134-20110503-02. View

Kripalani S, Bengtzen R, Henderson L, Jacobson T . Clinical research in low-literacy populations: using teach-back to assess comprehension of informed consent and privacy information. IRB. 2008; 30(2):13-9. View

10.

Pearson T, Bazzarre T, Daniels S, Fair J, Fortmann S, Franklin B . American Heart Association guide for improving cardiovascular health at the community level: a statement for public health practitioners, healthcare providers, and health policy makers from the American Heart Association Expert Panel on Population.... Circulation. 2003; 107(4):645-51. DOI: 10.1161/01.cir.0000054482.38437.13. View

11.

Mottus R, Johnson W, Murray C, Wolf M, Starr J, Deary I . Towards understanding the links between health literacy and physical health. Health Psychol. 2013; 33(2):164-73. DOI: 10.1037/a0031439. View

12.

Richards M, Power C, Sacker A . Paths to literacy and numeracy problems: evidence from two British birth cohorts. J Epidemiol Community Health. 2008; 63(3):239-44. PMC: 3495306. DOI: 10.1136/jech.2007.064923. View

13.

Gardner W, Mulvey E, SHAW E . Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychol Bull. 1995; 118(3):392-404. DOI: 10.1037/0033-2909.118.3.392. View

14.

Kaphingst K, Goodman M, MacMillan W, Carpenter C, Griffey R . Effect of cognitive dysfunction on the relationship between age and health literacy. Patient Educ Couns. 2014; 95(2):218-25. PMC: 4172373. DOI: 10.1016/j.pec.2014.02.005. View

15.

Parker R, Ratzan S, Lurie N . Health literacy: a policy challenge for advancing high-quality health care. Health Aff (Millwood). 2003; 22(4):147-53. DOI: 10.1377/hlthaff.22.4.147. View

16.

Shah L, West P, Bremmeyr K, Savoy-Moore R . Health literacy instrument in family medicine: the "newest vital sign" ease of use and correlates. J Am Board Fam Med. 2010; 23(2):195-203. DOI: 10.3122/jabfm.2010.02.070278. View

17.

Clouston S, Kuh D, Herd P, Elliott J, Richards M, Hofer S . Benefits of educational attainment on adult fluid cognition: international evidence from three birth cohorts. Int J Epidemiol. 2012; 41(6):1729-36. PMC: 3535750. DOI: 10.1093/ije/dys148. View

18.

Kobayashi L, Smith S, OConor R, Curtis L, Park D, Von Wagner C . The role of cognitive function in the relationship between age and health literacy: a cross-sectional analysis of older adults in Chicago, USA. BMJ Open. 2015; 5(4):e007222. PMC: 4410118. DOI: 10.1136/bmjopen-2014-007222. View

19.

Marteau T, Hollands G, Fletcher P . Changing human behavior to prevent disease: the importance of targeting automatic processes. Science. 2012; 337(6101):1492-5. DOI: 10.1126/science.1226918. View

20.

Abel T, Frohlich K . Capitals and capabilities: linking structure and agency to reduce health inequalities. Soc Sci Med. 2011; 74(2):236-44. DOI: 10.1016/j.socscimed.2011.10.028. View