The Association of Health Literacy with Self-care Agency in Older Adults in Jamaica

Older adults are the fastest growing segment of the population in Jamaica. With an increase from 10% (252,225) of the total Jamaican population in 1995 to 11% (279,051) in 2005, the rate is expected to rise to 25% by 2025. Thus, it will be critically important to understand factors that may contribute to health maintenance, disease prevention, and wellness promotion. Two such factors -- not studied extensively in this country -- are health literacy and self-care. The purposes of this study were to (a) generate health literacy profile data with the newly-developed Health Literacy Questionnaire for community-dwelling older adults in Jamaica and (b) determine whether relationships exist among aspects of health literacy and self-care practices while controlling for potential socio-demographic influences. The research design was cross-sectional and correlational; multistage sampling and a survey were used. The Health Literacy Questionnaire measures nine aspects of health literacy (e.g., gathering, reading, and understanding health information, social support, and healthcare provider and system engagement). Self-care was measured with an established scale, Appraisal of Self-care Agency Scale. A sample of 200 community-dwelling elders 60 years and older completed the survey. Because the Health Literacy Questionnaire is new, there are no published normative data. There was variation is scores across the nine aspects of health literacy, and among the highest scores were those for social support and active engagement with healthcare providers. Scores for self-care were relatively high, with 84% of the sample scoring in the high perceived capacity range (based on an established cut off score). As predicted, there was a strong positive correlation between health literacy and self-care. Regression analysis revealed three of the health literacy scales -- critical appraisal, social support and ability to engage the healthcare provider -- to be statistically significant predictors for self-care after controlling for education, region, health status, age, and sex. It seems reasonable to conclude that gains in health literacy can facilitate improvements in older adults' self-care ability. Nurses can play pivotal roles in this by assessing health literacy, providing education and information, and, particularly, fostering genuine understanding.;Key words: older adult, community dwelling, health literacy, self-care, self-care agency.