Healthcare is becoming more complicated and demanding each year. Futuristic technologies, genetic engineering, highly specific drugs, complex insurance plans, and confusing and often conflicting messages from the media all add to the problem. Knowing how to access, understand, and use information about healthcare (i.e., health literacy) is becoming more of a challenge for everyone. According to the Surgeon General's Report on Oral Health in America, profound and consequential oral health disparities exist in the United States today. Epidemiological assessments reveal that low-income and minority populations have the highest incidence and prevalence of oral diseases and disorders. Given that these groups are also most likely to have limited health literacy skills means that they are especially vulnerable to the complications of the healthcare system and most in need of assistance. In order for effective interventions to be developed and implemented, however, a clearer understanding of the associations between limited health literacy and oral health need to be gained. At the heart of that understanding is knowing the ways that different health literacy skills (e.g., reading comprehension, numeracy, conceptual knowledge) work individually and as a group to support oral healthcare decision making and, ultimately, oral health outcomes. These findings would improve oral health and general well-being, and reduce disparities for millions in the nation. The proposed research project brings an experienced multidisciplinary team together from Baltimore, Los Angeles, Atlanta, and Washington, DC to comprehensively study these associations between health literacy and oral health. A cross-section of dental patients presenting to three dental clinics in Maryland and California will be recruited and a series of assessments will be administered during face-to-face encounters. These data will also be linked to clinical records so that retrospective and prospective use of dental care services, including expenditures and utilization, may be concurrently assessed.
The specific aims of the project include: 1) determining the structural relations between health literacy, oral healthcare decision making, and oral health status;2) determining the extent to which four different measures of health literacy represent unique skills;and 3) determining the extent to which four different measures of health literacy are associated with oral health, independent of selected sociodemographic and healthcare-related covariates. The proposed project is significant because it represents the first to comprehensively study the associations between health literacy and oral health. It is also significant because it will serve as a guide for comprehensive assessments of health literacy and other health outcomes, outside of dentistry. The project is innovative because it combines multiple measures of health literacy, healthcare decision-making, and oral health outcomes into a single investigation. It is also innovative because it incorporates powerful and contemporary statistical analyses that will reveal the relative contribution of each variable to the overall model, while controlling for the aforementioned covariates.

Public Health Relevance

Successful completion of the proposed project will result in a comprehensive understanding of the extent to which health literacy is associated with oral health. Gaining this understanding will lead to interventions aimed at improving oral health and reducing oral health disparities, benefitting millions of low-income and minority Americans. In addition, the proposed project will serve as a model for comprehensive studies of the links between health literacy and other health outcomes, beyond dentistry. This more global approach will greatly expand the field of health literacy and increase the likelihood of successful interventions in medicine.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Research Project (R01)
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Special Emphasis Panel (ZRG1-RPHB-A (50))
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Nowjack-Raymer, Ruth
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University of Maryland Baltimore
Schools of Dentistry
United States
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