How Low Literacy and Education Can Impact Patient Health Outcomes

Basic reading, writing, and counting skills are critical in our everyday lives, but many of us take these skills for granted. Around the world, there are still 773 million adults who lack basic literacy skills—and in the U.S, in particular, 21% of adults lack the English literacy skills necessary to make simple inferences, paraphrase, or compare and contrast information.

What are the consequences of low literacy and education, beyond poor reading comprehension? People who are illiterate are less likely to be employed than those who are, more likely to be incarcerated, and earn less on average. What’s more, a lack of literacy skills can result in lower self esteem and feelings of shame, as well as alienation from school and society. People with lower education levels also experience more factors that correlate with depression onset than those with higher education, including daily stressors, a lack of resilience, and low sense of control.

Health impacts of low literacy and education

In addition to the psychosocial impacts, low literacy is linked to low health literacy. The CDC defines health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” Without the skills necessary to read and comprehend information about their own health or health issues in general, patients with low literacy can suffer in the long term.

For example, low-literacy patients can have a hard time reading and following written instructions on medications, in turn lowering the efficacy of these regimens. Another study found that men with low health literacy who were diagnosed with low- to intermediate-risk prostate cancer were 7 times less likely to choose active surveillance over immediate treatment for prostate cancer after receiving a particular type of gene test, even when treatment might not be necessary. This research points to the critical need for counseling and education tools developed with these patients in mind.

The connection between literacy and age

Low literacy is disproportionate among a few demographics, including the elderly. According to the National Center for Educational Statistics, adults ages 65 and older have lower health literacy skills, on average, than those under the age of 65.

Combined with this age group’s increased risk for a number of health conditions—including mild cognitive impairment (MCI), Alzheimer’s disease (AD), and Parkinson’s disease—it’s important that these patients are given extra time and attention by medical professionals. MoCA has taken steps to ensure these patients can receive the care they need when it comes to screening for cognitive decline.

Benefits of MoCA Basic

MoCA Basic is a cognitive assessment test that’s been validated as accurate and effective at screening people with low education and literacy for mild cognitive impairment (MCI) across cultures. It’s offered in a number of languages.

Multiple peer-reviewed studies have validated the effectiveness of MoCA Basic, such as:

• “MoCA-Basic appears to have excellent validity and addresses an unmet need…” In 2015, researchers in Thailand investigated MoCA Basic’s efficacy in screening elderly adults with low education and literacy for MCI. They found that MoCA Basic scores didn’t significantly vary with literacy levels, and had little correlation to age or education, indicating the test’s validity.¹
• “…the MoCA-Basic, despite being an easier task, is likely capable of detecting impairments in various cognitive domains with better sensitivity than the MMSE…” A number of normative studies are currently underway to assess the efficacy of MoCA and MoCA Basic within different cultures. In this 2020 study, researchers studied the validity of MoCA Basic, as well as the standard MoCA, on community-dwelling Saudi Arabians. They found that, while future research is needed to determine cut-offs in the Arabic version, both tests are “useful tools for detecting cognitive impairment” and likely more effective than the MMSE.²
• “The Chinese version of the MoCA-Basic (MoCA-BC), translated with cultural modifications from the original English version, has shown excellent validity and accuracy…” Researchers set out to determine if the MoCA-BC could identify early MCI and mild and moderate AD in Chinese elderly with various levels of education. They found that the test “had high sensitivity” and could successfully discriminate between MCI, mild AD, and moderate-severe AD.³

While literacy rates continue to improve around the globe, remaining sensitive to the constraints those who lack literacy skills may face will be critical. For more information about MoCA Basic, as well as the original MoCA and other versions of the test sensitive to a wide range of patient populations, visit our website.

References:

1 Julayanont, P., Tangwongchai, S., Hemrungrojn, S., Tunvirachaisakul, C., Phanthumchinda, K., Hongsawat, J., …& Nasreddine, Z.S. (2015). The Montreal Cognitive Assessment—Basic: A Screening Tool for Mild Cognitive Impairment in Illiterate and Low-Educated Elderly Adults. Journal of the American Geriatrics Society. doi : 10.1111/jgs.13820

2 Muayqil, T. A., Alamri, N. K., Alqahtani, A. M., Julaidan, S. S., Alsuhaibani, R., Nafisah, I., … & Alanazy, M. H. (2021). Normative and Equated Data of the Original and Basic Versions of the Montreal Cognitive Assessment among Community Dwelling Saudi Arabians. Behavioural Neurology, 2021.

3 Zhang, Y. R., Ding, Y. L., Chen, K. L., Liu, Y., Wei, C., Zhai, T. T., … & Dong, W. L. (2019). The items in the Chinese version of the Montreal cognitive assessment basic discriminate among different severities of Alzheimer’s disease. BMC Neurology, 19(1), 1-7.

‍