Is the cloze procedure appropriate to evaluate health literacy in older individuals? Age effects in the test of functional health literacy in adults.

Raymond L Ownby,Amarilis Acevedo,Robin J Jacobs,Drenna Waldrop-Valverde

doi:10.1155/2014/194635

Raymond L Ownby, Amarilis Acevedo + Show 2 more

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https://doi.org/10.1155/2014/194635

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Abstract

Health literacy has received increasing attention because of its importance for older individuals' health, as studies have shown a close relation between older individuals' health literacy and their health. Research also suggests that older individuals have low levels of health literacy, but this finding is variable and may depend on which health literacy test is used. Older individuals assessed with the Test of Functional Health Literacy (TOFHLA) score lower than younger individuals, but a previous study suggested that this may result from age-related differential item functioning (DIF) on the TOFHLA. The study reported here assessed age-related DIF in a sample of community-dwelling volunteers. Twenty-two percent of items were differentially more difficult for older individuals independent of their overall ability, and when these items were eliminated from the total score, age differences were no longer found. Performance on a working memory task predicted older but not younger individuals' performance on the age-related items. At least part of older individuals' apparent deficits in health literacy when assessed by the TOFHLA may be related to DIF on its items. The TOFHLA, and any measure that employs the cloze procedure to evaluate reading comprehension, should be used cautiously in older individuals.

Highlights

Over the past several decades, research on health literacy has become increasingly relevant to gerontologists, as studies have shown that older adults’ health literacy is an important factor in their health status and service utilization [1,2,3,4]
It should be noted that each of group’s scores on the Test of Functional Health Literacy (TOFHLA) Reading is similar, in spite of previous reports of significantly lower performance among older individuals. This fact can be attributed to the overall higher levels of education and basic reading skill in the older group, an issue that we addressed in group comparisons by taking these factors into account in analysis of covariance (ANCOVA) models
When the 11 differential item functioning (DIF)-related items were removed from the total TOFHLA reading score, a significant age group difference was no longer present

Summary

Introduction

Over the past several decades, research on health literacy has become increasingly relevant to gerontologists, as studies have shown that older adults’ health literacy is an important factor in their health status and service utilization [1,2,3,4]. Studies have shown that level of health literacy is related to use of health services and measures of disease control [1, 6]. Several studies have found that individuals 65 years of age and older perform at lower levels on measures of health literacy compared to younger individuals [10, 11]. Studies with other measures, including the widely-used Test of Functional Health Literacy in Adults or TOFHLA [12], have found age-related decrements in performance [13]. Some studies with another widely-used measure of health literacy, the Rapid Estimate of Adult Literacy in Medicine, or REALM [14], have not found age-related differences [9, 15,16,17]. Given the link between health literacy and health, a better understanding of reasons underlying older individuals’ poorer performance on some

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