The association between health literacy and indicators of cognitive impairment in a diverse sample of primary care patients

Patient Educ Couns. 2013 Nov;93(2):319-26. doi: 10.1016/j.pec.2013.07.006. Epub 2013 Aug 6.


Objectives: To confirm the association of health literacy scores as measured by Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) with cognitive ability and education. To determine whether this association differs by cognitive task.

Methods: Cognitive impairment was measured using the Mini-Cog, which combines a delayed word recall task (WRT) and a clock drawing task (CDT) to yield an overall classification of normal versus cognitively impaired. Participants were recruited from primary care clinics that provide care to underserved patients.

Results: Participants (n=574) were predominantly non-Hispanic black (67%) with a mean age of 46 years, 50% did not have health insurance, 56% had a high school education or less and 21% screened positive for cognitive impairment. Overall cognitive ability and education were significantly associated with health literacy after adjusting for other variables, including race/ethnicity and physical health. We observed a stronger association between the CDT and health literacy than between the WRT and health literacy.

Conclusion: By confirming hypothesized associations, this study provides additional support of the validity of Health LiTT.

Practice implications: Health LiTT is a reliable and valid tool that researchers and clinicians can use to identify individuals who might have difficulty understanding health information.

Keywords: Cognitive function; Cognitive impairment; Health literacy; Validity; Vulnerable populations.

Publication types

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

MeSH terms

  • Cognition Disorders / diagnosis*
  • Cognition Disorders / psychology*
  • Female
  • Health Literacy*
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care*
  • Risk Factors
  • Socioeconomic Factors