Health literacy and preventive health care use among Medicare enrollees in a managed care organization

Med Care. 2002 May;40(5):395-404. doi: 10.1097/00005650-200205000-00005.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Attitude to Health
  • Cross-Sectional Studies
  • Educational Status
  • Female
  • Health Care Surveys
  • Health Education / standards*
  • Health Knowledge, Attitudes, Practice
  • Health Status
  • Humans
  • Influenza Vaccines
  • Logistic Models
  • Male
  • Mammography / statistics & numerical data
  • Managed Care Programs*
  • Medicare*
  • Multivariate Analysis
  • Papanicolaou Test
  • Pneumococcal Vaccines
  • Preventive Health Services / statistics & numerical data*
  • Sex Factors
  • Surveys and Questionnaires
  • United States
  • Vaccination / statistics & numerical data
  • Vaginal Smears / statistics & numerical data


  • Influenza Vaccines
  • Pneumococcal Vaccines