Examining Associations between Health Information Seeking Behavior and Adult Education Status in the U.S.: An Analysis of the 2012 PIAAC Data

Iris Feinberg, Jan Frijters, Vicki Johnson-Lawrence, Daphne Greenberg, Elena Nightingale, Chelsea Moodie, Hajo Zeeb
2016 PLoS ONE  
This paper presents data from the Program for the International Assessment of Adult Competencies with a focus on the interrelationships among health information seeking behavior (HISB), and health status or use of preventive health measures for U.S. adults both with and without a high school diploma. Key results of ordinal and binary logistic regression analyses indicated that, after controlling for demographic factors, (1) adults with a high school diploma use more text-based health
more » ... sources while adults without a high school diploma use more oral sources, (2) using the Internet as a source of health information is more strongly related to reporting excellent/very good health status than having a high school diploma, (3) those without a high school diploma who use the Internet report the largest increase in health status over any other health information source, and (4) for those with learning disability or vision problem, a high facility in reading English is an important predictor of whether the Internet is used as a health information source. The Internet appears to play a key role in both enhancing health status and enabling use of preventive measures for those with and without a high school diploma; although, individuals without a high school diploma who use the Internet for health information derive substantial benefit in health status. management [1] . In order to participate in their care, patients must have adequate health literacy, which includes the ability to read, listen, ask questions, and draw conclusions from healthrelated information [2, 3] . Health Literacy is a concept that is complex and dynamic, and takes into account how people access, understand and use health information and health care in everyday life and in medical situations. There are a number of individual factors (age, socioeconomic status, race) and societal factors (health disparities, community norms, culture) that can affect health literacy, however, adults with low literacy and low education status are less likely to have the basic literacy skills that correspond to adequate health literacy, and therefore are more likely to have low PCC and poor health outcomes in both primary prevention and chronic disease [3] [4] [5] [6] . Adults at many education levels struggle to understand medical statistics, medication dosage requirements, and basic health concepts such as daily nutritional values [4, 6, 7] . Education levels are often used as a proxy for literacy skills, however, over 80% of adults with low-level literacy, numeracy, and problem solving skills do have a high school diploma (OECD). We also know that seeking health information is not only related to literacy and education levels, but also has many other predisposing characteristics including gender, age, education level, general and health literacy levels, pre-existing health conditions, and race [7, 8, 9] . However, people who do have a high school diploma, regardless of their literacy levels and other socio-demographic factors, are more likely to seek and use health information. Education levels and literacy levels are both strongly linked to health outcomes [10, 11] . Health information seeking behavior (HISB) can be enacted through print, visual, or oral media; health information can also be accrued either actively or passively. Although there are many studies that consider HISB for specific diseases and health conditions, very few have addressed the role and influence of HISB in a population with diverse characteristics who may have no specific diagnosis or disease [3, 6, 9] . We are interested in knowing from which sources those with and without a high school diploma seek health information, and if there is any further association with health status and use of preventive measures. The purpose of this study is to gain an understanding about HISB and its determinants with adults of different education levels in the United States through analysis of the Program for International Assessment of Adult Competencies (PIAAC) data. The PIAAC is an international household survey conducted under the auspices of the Organization for Economic Cooperation and Development (OECD), in 26 countries. Each country was allowed to add five minutes of questions; the United States added questions relating to health information seeking and health behaviors as part of the country data. Our focus is therefore on the US data since no other country in the PIAAC study asked questions about HISB. The data provide us with a unique opportunity to understand how adults seek health information while controlling for demographic and socioeconomic factors [10] . We address this question by asking the following research questions: 1. Is there a difference between HISB for individuals with and without a high school diploma? 2. Is there an association between HISB, health status or use of preventive measures for individuals with and without a high school diploma? Education and Health Educational attainment matters for health-past studies have shown that education levels are linked with health through health knowledge and behaviors, literacy levels, employment status, insurance status, and a variety of other social and psychological factors [11] [12] [13] [14] [15] . People with more education report having lower morbidity from common acute and chronic diseases; Health Information Seeking Behavior and Adult Education Status PLOS ONE |
doi:10.1371/journal.pone.0148751 pmid:26882339 pmcid:PMC4755661 fatcat:ue5vlx3iebeapaw6ivvsok3j6u