Cognition and health literacy in patients with hypertension

J Gen Intern Med. 2008 Aug;23(8):1172-6. doi: 10.1007/s11606-008-0612-2. Epub 2008 May 6.


Background: Approximately half of the US population has marginal or inadequate health literacy, a measure highly associated with health outcomes. This measure is often linked to age and education, but recent evidence from patients with chronic heart failure suggests that much of age-related variability in health literacy can be explained by cognitive abilities (e.g., working memory, processing speed).

Objective: We examined the role of cognitive and sensory abilities as mediators of age and education in determining functional health literacy among patients with hypertension.

Participants: Four hundred ninety two community-dwelling adults diagnosed with hypertension (aged 21 to 92 years) participated. They were primarily female (73%), African-American (68%), and reported taking on average 7.8 prescribed medications.

Measurements: Before participation in a medication adherence intervention study, participants completed a battery of health literacy-related tasks. They completed tests that measured health literacy [Short Test of Functional Health Literacy in Adults (STOFHLA)], cognitive abilities (working memory, processing speed), sensory abilities (visual acuity and hearing), and physical health.

Results: Regression analyses showed that health literacy was related to age, education, and race (accounting for 24.4% of variance in STOFHLA scores). Cognitive ability accounted for an additional 24% of variance and greatly reduced the influence of age, education, and race (by 75%, 40%, and 48%, respectively).

Conclusions: When controlling for cognitive and sensory variables, the association of age and education with STOFHLA scores was dramatically reduced. Thus, future interventions aimed at improving self-care for patients with low health literacy should aim to reduce demands on patients' cognitive abilities.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use*
  • Cognition*
  • Comorbidity
  • Educational Status
  • Female
  • Health Literacy*
  • Health Status Indicators
  • Hearing Tests
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / ethnology
  • Linear Models
  • Male
  • Medication Adherence
  • Middle Aged
  • United States
  • Visual Acuity


  • Antihypertensive Agents