Health Literacy in Older Adults With and Without Low Vision
Health Literacy in Older Adults With and Without Low Vision
Health Literacy in Older Adults With and Without Low Vision
Low Vision
MeSH TERMS OBJECTIVE. In this study, we investigated whether older adults with low vision (LV) from age-related
comprehension macular degeneration (AMD) demonstrated lower functional health literacy than older adults without LV.
health literacy METHOD. Fifty adults with AMD were matched with adults without LV on age, gender, education, and
income. We measured visual acuity, contrast sensitivity, and reading speed and administered the Test of
macular degeneration
Functional Health Literacy in Adults (TOFHLA) using two test time conditions, standard and unlimited,
reading
to measure health literacy levels.
vision, low
RESULTS. The group with LV had considerably lower TOFHLA scores for both time conditions (p < .001)
and took notably longer to complete the test (p < .001). Poorer acuity correlated with lower TOFHLA scores
in the group with LV.
CONCLUSION. Older adults with LV may take longer to read and understand health information, which has
important implications for providing health education to support self-management. Modifying components of
the reading task may facilitate reading performance and understanding of health education materials.
Warren, M., DeCarlo, D. K., & Dreer, L. E. (2016). Health literacy in older adults with and without low vision. American
Journal of Occupational Therapy, 70, 7003270010. http://dx.doi.org/10.5014/ajot.2016.017400
in the group with LV. According to Legge (2007), paragraph- including instructions on medications and medical regi-
style formats require more attentional effort from readers with mens as well as appointments, referrals, and other paperwork
LV, which may increase fatigue. Although all participants required to receive services (Harrison, Mackert, & Watkins,
were offered and took rest breaks, it is possible that partici- 2010; Sharts-Hopko, Smeltzer, Ott, Zimmerman, &
pants with LV experienced greater fatigue, causing them to Duffin, 2010; Williams, 2002). Difficulty reading print
commit more errors on the reading comprehension section. can limit the persons ability to participate fully in self-
management of his or her health conditions; some
people with LV believe that it suggests to health care
Study Limitations and Future Research providers a cognitive inability to manage their health,
Studying only people with AMD limited generalization of and thus they are excluded from patientprovider conver-
the findings to the greater population with LV. Future sations (Sharts-Hopko et al., 2010). Of the LV participants
researchers should include other age-related eye diseases to in this study, 70% had been to college and read on a daily
obtain a more representative description of the effect of LV basis, but they still had lower TOFHLA scores than their
on functional health literacy levels. On the basis of the peers without LV. However, when slow reading speed was
study findings, one can also question the efficacy of using accommodated for with unlimited test time, 98% of the
timed tests such as the TOFHLA to measure health lit- participants with LV achieved adequate health literacy on the
eracy in adults with LV; future researchers should explore basis of TOFHLA scores.
test designs that accommodate readers with LV. The American Occupational Therapy Association
(2011) published a societal statement on health literacy,
committing occupational therapy practitioners to ensure
Implications for Occupational that all health-related information and education . . .
Therapy Practice match that persons literacy abilities (p. S78). Resources
A consistent complaint voiced by people with LV is the are readily available to assist occupational therapy prac-
heavy reliance by health care providers on using visually titioners to create accessible print materials for clients
inaccessible print materials to deliver health information, with LV. The American Printing House for the Blind
Table 3. Differences in TOFHLA Completion Time for Standard and Unlimited Time Conditions
TOFHLA Score Low Vision (n 5 50), M (SD) Without Low Vision (n 5 50), M (SD) t p 95% CI
Composite
Standard time 19.1 (2.6) 15.0 (3.4) 6.78a <.001 [2.6, 5.3]
Unlimited time 26.8 (10.4) 15.7 (4.7) 6.89a <.001 [7.9, 14.4]
Reading comprehension
Standard time 11.5 (1.3) 9.2 (4.9) 6.03a <.001 [1.5, 3.0]
Unlimited time 18.5 (7.9) 9.9 (3.6) 7.02a <.001 [6.2, 11.2]
Numeracy
Standard time 7.5 (1.7) 5.7 (1.5) 5.49 <.001 [1.1, 2.4]
Unlimited time 8.3 (3.5) 5.8 (1.5) 4.73a <.001 [1.5, 3.6]
Note. Test of Functional Health Literacy in Adults (TOFHLA) time is reported in minutes. CI 5 confidence interval; M 5 mean; SD 5 standard deviation.
a
Denotes Levenes correction for unequal variances.