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. 2017 May 1;46(3):493-499.
doi: 10.1093/ageing/afw229.

A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability

Sean A P Clouston  1 , Jennifer A Manganello  2 , Marcus Richards  3
Affiliations

A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability

Sean A P Clouston et al. Age Ageing. .

Abstract

Objective: social inequalities in health are believed to arise in part because individuals make use of social and economic resources in order to improve survival. In recent years, health literacy has received increased attention as a factor that can help explain differences in health outcomes. However, examination of life course predictors of health literacy has been limited.

Methods: life course data from the Wisconsin Longitudinal Study 1957-2011 were used to examine predictors of health literacy in old age (N = 2,122), using the Newest Vital Sign. Generalised structural equation modelling was used to model pathways to health literacy.

Results: predictors of health literacy included educational attainment, and adolescent cognitive and non-cognitive skills, and, in men, rate of cognitive decline from middle to later life.

Discussion: numerous studies have documented health literacy issues among older adults, and recommendations have been made for ways to improve health literacy for this population. This study reports on risk factors across the life course that are associated with health literacy later in life, identifying possible intervention _targets to reduce risk of poor health as people age. Our results suggest that a range of life course factors, beginning in early life, predict health literacy. Further research studying health literacy over the life course is warranted.

Keywords: cognitive epidemiology; health literacy; life course epidemiology; older people; psychology; social inequalities in health.

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Figures

Figure 1.
Figure 1.
Hypothesised linkages between socioeconomic inequalities, cognitive performance and late-life health literacy alongside legend showing timing of measurement in the WLS 1957–2011.
Figure 2.
Figure 2.
Beta coefficients estimated using GSEM linking life course socioeconomic and cognitive predictors to health literacy. Only significant (α = 0.05) relationships with paths to health literacy are shown, WLS 1957–2011. (A) Males (Pseudo-R2 = 0.153, P < 0.001, ΔPseudo-R2 = 0.01, P = 0.135). (B) Females (Pseudo-R2 = 0.129, P < 0.001, ΔPseudo-R2 = 0.005, P = 0.608)
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