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Health Literacy and Preventive Health Care Use Among Medicare Enrollees in a Managed Care Organization

Scott, Tracy L. PhD*; Gazmararian, Julie A. MPH, PhD*; Williams, Mark V. MD; Baker, David W. MD, MPH

Original Articles

Background.  Many older adults in Medicare managed care programs have low health literacy, and this may affect use of preventive services.

Objectives.  To determine whether older adults with inadequate health literacy were less likely to report receiving influenza and pneumococcal vaccinations, mammograms, and Papanicolaou smears than individuals with adequate health literacy after adjusting for other covariates.

Research Design.  Cross-sectional survey; home interviews with community dwelling enrollees.

Subjects.  Medicare managed care enrollees 65 to 79 years old in four US cities (n = 2722).

Measures.  Short Test of Functional Health Literacy in Adults and self-reported preventive service use.

Results.  In bivariate analyses, self-reported lack of preventive services was higher among individuals with inadequate health literacy than those with adequate health literacy: never had an influenza vaccination: 29% versus 19% (P = 0.000); never had a pneumococcal vaccination: 65% versus 54% (P = 0.000); no mammogram in the last 2 years: 24% versus 17% (P = 0.017); never had a Papanicolaou smear: 10% versus 5% (P = 0.002). After adjusting for demographics, years of school completed, income, number of physician visits, and health status, people with inadequate health literacy were more likely to report they had never received the influenza (OR, 1.4; 95% CI, 1.1–1.9) or pneumococcal vaccination (OR, 1.3; 95% CI, 1.1–1.7), and women were less likely to have received a mammogram (OR, 1.5; 95% CI, 1.0–2.2) or Papanicolaou smear (OR, 1.7; 95% CI, 1.0–3.1).

Conclusions.  Among Medicare managed care enrollees, inadequate health literacy is independently associated with lower use of preventive health services.

*From the Emory Center on Health Outcomes and Quality, Atlanta, Georgia.

†From the Emory University School of Medicine, Atlanta, Georgia.

‡From the Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.

Supported partially by a grant from The Robert Wood Johnson Foundation. This work was also funded in part by the Prudential Center for Health Care Research, Atlanta, GA. Since this study was conducted, Prudential HealthCare has become a member company of Aetna, and the Prudential Center for Health Care Research now operates as the Emory Center on Health Outcomes and Quality (formerly the USQA Center for Health Care Research).

Address correspondence and reprint requests to: Dr. Scott, Assistant Professor, Emory Center on Health Outcomes and Quality, Department of Health Policy and Management, Rollins School of Public Health of Emory University, 6th Floor, Atlanta, GA 30322. E-mail:

Received June 27, 2001; initial review August 6, 2001; accepted December 7, 2001.

© 2002 Lippincott Williams & Wilkins, Inc.