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Effects of health literacy on health status and health service utilization amongst the elderly

Author

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  • Cho, Young Ik
  • Lee, Shoou-Yih D.
  • Arozullah, Ahsan M.
  • Crittenden, Kathleen S.

Abstract

Amid increased concerns about the adverse consequences of low health literacy, it remains unclear how health literacy affects health status and health service utilization. With a sample of 489 elderly Medicare patients in a Midwestern city in the USA, we explored the intermediate factors that may link health literacy to health status and utilization of health services such as hospitalization and emergency care. We expected to find that individuals with higher health literacy would have better health status and less frequent use of emergency room and hospital services due to (1) greater disease knowledge, (2) healthier behaviors, (3) greater use of preventive care, and (4) a higher degree of compliance with medication. Using path analysis, we found, however, that health literacy had direct effects on health outcomes and that none of these variables of interest was a significant intermediate factor through which health literacy affected use of hospital services. Our findings suggest that improving health literacy may be an effective strategy to improve health status and to reduce the use of expensive hospital and emergency room services among elderly patients.

Suggested Citation

  • Cho, Young Ik & Lee, Shoou-Yih D. & Arozullah, Ahsan M. & Crittenden, Kathleen S., 2008. "Effects of health literacy on health status and health service utilization amongst the elderly," Social Science & Medicine, Elsevier, vol. 66(8), pages 1809-1816, April.
    • Handle: RePEc:eee:socmed:v:66:y:2008:i:8:p:1809-1816
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    1. Baker, D.W. & Parker, R.M. & Williams, M.V. & Clark, W.S. & Nurss, J., 1997. "The relationship of patient reading ability to self-reported health and use of health services," American Journal of Public Health, American Public Health Association, vol. 87(6), pages 1027-1030.
    2. Lee, Shoou-Yih D. & Arozullah, Ahsan M. & Cho, Young Ik, 2004. "Health literacy, social support, and health: a research agenda," Social Science & Medicine, Elsevier, vol. 58(7), pages 1309-1321, April.
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    Cited by:

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    2. Inmyung Song, 2024. "Relationship between health literacy and health-related quality of life in Korean adults with chronic diseases," PLOS ONE, Public Library of Science, vol. 19(4), pages 1-13, April.
    3. Tianfeng He & Lefan Liu & Jing Huang & Guoxing Li & Xinbiao Guo, 2021. "The Community Health Supporting Environments and Residents’ Health and Well-Being: The Role of Health Literacy," IJERPH, MDPI, vol. 18(15), pages 1-22, July.
    4. Liping Ye & Xinping Zhang, 2021. "The association mechanism between social network types and health‐related behaviours among the elderly in rural Hubei Province, China," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(3), pages 826-846, May.
    5. Ai, Jingyi & Chen, Xi & Feng, Jin & Xie, Yufei, 2025. "Early Effects of Cognitive-Impairment Friendly Community on Health Care Utilization in China: Evidence from Administrative Data," GLO Discussion Paper Series 1666, Global Labor Organization (GLO).
    6. Ziyan Wang & Kaori Fukayama & Bing Niu, 2023. "Does Long-Term Care Literacy Matter in Evaluating Older Care Recipients’ Satisfaction with Care Managers? Empirical Evidence from Japanese Survey Data," IJERPH, MDPI, vol. 20(3), pages 1-20, January.
    7. Lopez, Claude & Kim, Bumyang & Sacks, Katherine, 2022. "Health Literacy in the United States: Enhancing Assessments and Reducing Disparities," MPRA Paper 114019, University Library of Munich, Germany.
    8. Tian, Wei-Hua & Liu, Tsai-Ching & Chen, Chin-Shyan & Liu, Li-Fan & Tien, Joseph J., 2012. "The relationship between depressive symptoms and health service utilization for elderly people in Taiwan," Health Policy, Elsevier, vol. 108(2), pages 256-267.
    9. Chiao Ling Huang & Chia Hsing Chiang & Shu Ching Yang & Fu-Zong Wu, 2022. "The Associations among Gender, Age, eHealth Literacy, Beliefs about Medicines and Medication Adherence among Elementary and Secondary School Teachers," IJERPH, MDPI, vol. 19(11), pages 1-13, June.
    10. Sam S. S. Lau & Eric N. Y. Shum & Jackie O. T. Man & Ethan T. H. Cheung & Padmore Adusei Amoah & Angela Y. M. Leung & Kevin Dadaczynski & Orkan Okan, 2022. "COVID-19-Related Health Literacy of School Leaders in Hong Kong: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(19), pages 1-17, October.
    11. Takuya Aoki & Machiko Inoue, 2017. "Association between health literacy and patient experience of primary care attributes: A cross-sectional study in Japan," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-10, September.
    12. Nutbeam, Don, 2008. "The evolving concept of health literacy," Social Science & Medicine, Elsevier, vol. 67(12), pages 2072-2078, December.
    13. Samuel G Smith & Laura M Curtis & Jane Wardle & Christian von Wagner & Michael S Wolf, 2013. "Skill Set or Mind Set? Associations between Health Literacy, Patient Activation and Health," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-7, September.
    14. Ai, Jingyi & Chen, Xi & Feng, Jin & Xie, Yufei, 2025. "Early effects of cognitive-impairment friendly community on health care utilization in China: Evidence from administrative data in Shanghai," Social Science & Medicine, Elsevier, vol. 385(C).
    15. Ganime Can Gür & Yasemin Altinbaş, 2022. "Covid-19 Literacy Scale: Turkish Validity and Reliability Study," Clinical Nursing Research, , vol. 31(3), pages 404-412, March.
    16. Yiwei Liu & Qiuyue Guo, 2025. "Impact of Adult Children’s Socioeconomic Status on the Health of Older Adults in China," Journal of Family and Economic Issues, Springer, vol. 46(2), pages 427-443, June.
    17. Hongyun Zhou & Jiqing Hong & Su Yang & Yuxuan Huang, 2022. "The Impact of Social Capital on Rural Residents’ Medical Service Utilization in China—An Empirical Study Based on CFPS Data," IJERPH, MDPI, vol. 19(23), pages 1-19, November.
    18. repec:plo:pone00:0208091 is not listed on IDEAS
    19. Sarah Shahed, 2013. "The Impact of Health Information Provision on Breast Cancer-Related Knowledge and Protective Behaviors: An Experiment in Health Education," Lahore Journal of Economics, Department of Economics, The Lahore School of Economics, vol. 18(1), pages 117-133, Jan-June.

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