Demographic and health status data have consistently shown older blacks to be at a disadvantage relative to older whites. Investigations into nonphysiological factors have implicated education as a major cause of these disparities. Optimum health care is contingent upon the ability to comprehend written and oral instructions, yet most investigators have limited the analysis of educational influences to terms of highest grade level completed. Thus, the independent effects of variations in literacy skills have not been adequately addressed in health-related research. Low levels of literacy may lead to insufficient knowledge of available services, noncompliance with recommended treatment protocols, and failure to seek care when needed, all of which may adversely affect health status. Proposed is a cross-sectional study to examine the associations between reading ability and health services utilization in blacks aged 65 years and older living in a defined area. We seek to enroll 224 participants in the study. The primary hypotheses to be tested are: 1) there is no difference in health services utilization between illiterate and literate individuals. 2) There is no relationship between reading ability and physical health status. 3) Level of formal education is a reliable indicator of reading ability. Subjects will be identified from a Federal Medicaid/Medicare data tape for the county of interest. Personal interviews will be conducted and data collected on demographic, socioeconomic, health status, utilization, health beliefs, and locus of control variables. Medical records will be reviewed to supplement existing data and to obtain additional information regarding health status and patterns of utilization. The word recognition subtest from the Wide Range Achievement Tests-Revised (WRAT-R) will be used to measure reading levels. To obtain an assessment of comprehension skills, all participants will be asked to listen to two passages taken in context from health education material prepared by the National Heart, Lung, and Blood Institute. A series of three short questions will follow each passage. One of the most common myths about illiterates is that they are also unintelligent. By virtue of the same argument used to assert that levels of formal education should not be equated with reading ability, one must be cautious in assuming that illiteracy coincides with low intelligence. Thus, distinguishing between reading ability and I.Q. is crucial to this research. To accomplish this objective, matrices from the nonverbal Kaufman Brief Intelligence Test (K-BIT) will be administered and standard scores used in the analytical procedures. The high prevalence of many chronic diseases in older blacks evidences the need for extensive research of this type within this population. Taking into consideration the strong intergenerational patterns accompanying educational attainment, results of this study should facilitate efforts to improve the overall quality of health for all African Americans.
