Health literacy in adolescents with Sickle Cell Disease



Journal Title

Journal ISSN

Volume Title



Health literacy is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (Ratzan & Parker, 2000). Little literature exists on adolescent health literacy; and, none exists on health literacy in patients with Sickle Cell Disease (SCD) (Perry, 2014). The purpose of this study was to a) describe factors influencing facilitators and barriers of health literacy levels in adolescents with SCD and b) gather reliability and validity evidence for the Newest Vital Sign (NVS) for use in adolescents. This cross-sectional, descriptive correlational study included administration of a demographics form and the REALM-Teen and NVS health literacy instruments to 75 Black, non-Hispanic adolescent SCD patients at Children's Medical Center of Dallas. There were 37 male and 38 female participants. The mean age of participants was 14.7 years (SD=2.2). The mean grade level of participants was 8.7 (SD=2.2). The mean REALM-Teen score was 53.7 (SD=12.8). The mean NVS score was 2.37 (SD=1.33). Current grade level and health literacy scores showed the highest significant positive correlation (r =.52, p < .01). Health literacy scores were also significantly positively correlated with age (r =.49, p < .01) and income (r =.37, p < .01). Multiple regression analysis showed that current grade level and annual household income explain a significant amount of the variance in health literacy scores (F (2. 49)= 15.92, p=.000, R² =.394, R² [subscript adjusted]=.369). The model also showed that current grade level significantly contributed to the model (β= 3.09, SE (β)=.698, Standardized β = .521, p=.000); however, income did not contribute further (β= 1.60, SE(β)=.858, Standardized β =.219, p=.069). Thus, with every unit increase in current grade level, a three-point increase in health literacy scores occurs, with all other variables being held constant. Results of criterion validity analysis showed that the correlation between NVS scores and REALM-Teen scores was a significant moderate, positive correlation (r=.383, p<.01). The internal consistency for the NVS in this population was poor (Cronbach's α=.627) due at least in part to low correlations between items requiring numeracy and reading skills. Therefore, this study gave great insight into health literacy levels in adolescents with SCD, laying a solid foundation for future nursing, policy, and research initiatives.