Pre-injury Predictors of Health Literacy Following Moderate-to-severe Traumatic Brain Injury

Research Objectives: To investigate the contribution of pre-injury mental health treatment and problem substance use to health literacy in individuals with traumatic brain injury (TBI).

Design: Secondary analysis of the cross-sectional TBI Model Systems (TBIMS) collaborative module study (5 participating centers). Participants at follow-up (>1 year post-injury) were randomly assigned to complete an online health literacy survey, with stratification by education and race/ethnicity.

Setting: Community.

Participants: 164 adult participants (75% White, 76% >high school education, 70% adequate health literacy) who received inpatient rehabilitation for TBI.

Interventions: N/A.

Main Outcome Measures: Health Literacy Assessment With Talking Touchscreen Technology (HealthLiTT), with participants categorized into marginal/inadequate (T-score < 55) and adequate (T-score=55+) health literacy groups.

Results: Logistic regression assessing the impact of pre-injury mental health treatment and pre-injury problem substance use on health literacy an average of 8 years post-injury, after controlling for education and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic) revealed no significant difference in odds of adequate health literacy for those with mental health treatment or a history of problem substance use. Non-Hispanic Black (OR = 0.34, 95% CI [0.11, 0.99]) and Hispanic (OR = 0.16, 95% CI [0.05, 0.52]) participants were less likely to have adequate health literacy than Non-Hispanic Whites. Above high school education increased the likelihood of adequate health literacy (OR = 8.71, 95% CI [2.95, 27.35]) compared to below high school education or a high school diploma.

Conclusions: Neither history of pre-injury mental health treatment nor problem substance use significantly contributed to the adequacy of health literacy long-term post-injury. However, both education and race/ethnicity had significant contributions. Findings indicate that sociodemographic factors may be more important than pre-injury health in determining health literacy for individuals with TBI. It is worth noting that health literacy was assessed an average of 8 years post-injury, and it is possible that the evolution of injury-related impairments and environmental characteristics may have greater impact on health literacy at these long-term periods. Future research should explore the contribution of pre-injury mental health and problem substance use to health literacy early after injury, including in the first year, when psychoeducation is typically taking place in rehabilitation. Addressing sociodemographic disparities and promoting education is crucial post-injury for informed decision-making and improved health outcomes.

Author(s) Disclosures: The authors report research funding from the National Institute on Disability, Independent Living, and Rehabilitation Research, Grant numbers 90DPTB0025 [PIs: Sander, Juengst], 90DPTB0016 [PIs: Sherer, Sander].