Health Literacy Tests for Iraqi Adults Ali Azeez Al-Jumaili (MS)1; Mohammed Dakhil Al-Rekabi ( PhD)2 ; Bernard Sorofman (PhD)3 1 &3: The University of Iowa College of , Iowa City, IA, USA; 2: The University of College of Pharmacy, ,

Introduction Results & Discussion Limitations Health literacy is the ability of a person to read, compute, and Ninety seven adults participated in this study, 42 females and 55 males. The average The selection of participants was a convenient sample rather than understand health-related information, and low health literacy are age of the participants was 27.2 (±9.67) years with range (14-60) year-old. The highest randomized sample. associated with poor health-related outcomes. Iraqi medication labels, percentage of the participants (46.39%) lies within the youngest group (14-24 years). Since Iraqis are not used to read product labels, eight out of 97 appointment slips and drug leaflets are written in both Arabic and More than half of the participants (53.68 %) had completed some college degrees (two- participants refused to answer NVS (Ice-cream label) test. English. year college, bachelor or master). Since participation was voluntary and without compensation, there Although many health literacy studies were conducted in the U.S. and was difficulty to enroll participants and around 20 subjects refused to Western Countries, no such study has been conducted in Iraq. According to SILS test, 76.04% of participants had limited reading ability (chose take the tests after saying they had no time. The study used three common health literacy tests: The Single Item sometimes, often or always). The NVS test indicated that 63.64% of the participants had Literacy Screener (SILS) test, the New Vital Sign (NVS) test (reading an limited health literacy (17.05% probably inadequate (0-1 correct answer) and 46.59% Conclusions ice cream label), and the Short version of Test of Functional Literacy in possibly inadequate (2-3 correct answers) literacy). According to S-TOFHLA, 84.21% of adults (S-TOFHLA) (numeracy and reading). the participants had adequate health literacy level. The participants were mostly young adults with college/university degree. Objectives Eighty nine participants had NVS score average 2.94 (±1.76) out of six. The There were no significant differences ( P > 0.05) between the results The aims of the study presented here were to measure for the first participants answered the TOFHLA passage ( 81.65 %) more correctly than numeracy of three tests according to age, education and gender. time the health literacy level of Iraqis, to explore the use of standardized (75.05%) questions . X-Ray passage had better responses (85.63%) than Medicaid-related SILS is subjective test and could not reflect the accurate level of health literacy tests for Iraqi customers who use one of five community passage. Doctor appointment slip-question had the lowest response rate (64.42%) while literacy because it has only one subjective, possibly culturally biased and to investigate whether there is a relationship between the the blood sugar-question had the highest responses rate (84.74%) among the four question participant characteristics and the health literacy level. numeracy TOFHLA questions. TOFHLA was most comprehensive test because it measures both reading and calculation abilities besides it is considered a standard and Methods The NVS Arabic version needed longer time comparing to English, Spanish and Turkish most commonly used test. version because people in Iraq are unfamiliar with reading of food table of contents in The study involved a cross-sectional descriptive investigation. A their daily life. Instruments convenience sample of 97 Iraqi adults was studied in five community There was no significant difference in TOFHLA scores according to education level. SIlS includes single question “How often do you ask someone for help to pharmacies. Five pharmacists in the participating five independent read the instructions and leaflets from a doctor or pharmacy?” The answer pharmacies administered the three health literacy tests (S-TOFHLA, NVS either never, rarely, sometimes, often or always (Morris et al ,2006). and SILS) to the participants inside the pharmacies after the participant SILS results according to Age categories NVS test has six knowledge questions using an ice-cream label(Weiss et consent. Health literacy tests were translated and printed in the formal Results of NVS for each al,2005). S-TOFHLA contains two portions, numeracy section includes four Arabic language (the native language in Iraq). The translation was Reading ability participants group numeracy questions and reading portion has two prose passages with 35 cloze items. (Baker et al ,1999). performed by two bilingual researchers. Basic demographic information Limited (age, gender, and educational level) was collected. The proposal was Age(Years) Adequate Health literacy (Sometimes, Often , Age The association between TOFHLA scores N=96 IRB exempt in USA and ‘IRB’ approved in Iraq. (Never, Rarely) category N ( %) and educational level Always) 1-Probably 2-Possibly N (%) (years) 3-Adequate Inclusion criteria: The study participants were pharmacy customers. The N (%) inadequate inadequate Total Source DF Sum of Mean F- Pr > F participants should be able to read since all the tests are in written form. (4-6) 14-24 35 (36.46%) 10 (10.42%) (0-1) (2-3) Squares Square value 14-24 8 (9.09) 19 (21.59) 16 (18.18) 43 (48.86) Model 3 2070.18 690.06 2.56 0.0603 Exclusion criteria included subjects under 14 years old, subjects who 30-45 29 (30.21%) 6 (6.25%) have mental illness, health care professionals such physicians & 46-60 9 (9.38%) 7 (7.29%) 25-35 2 (2.27) 17 (19.32) 10 (11.36) 29 (32.95) Error 89 24032.529 270.028 Corrected 92 26102.706 pharmacists, subjects with vision impairment, and anyone who refused to Total 73(76.04%) 23 (23.96%) 36-60 5 (5.68) 5 (5.68) 6 (6.82) 16 (18.18) Total participate. Total 15 (17.05) 41 (46.59) 32 (36.36) 88 (100.0) Results of S-TOFHLA according to participant All analyses were performed using SAS. Two sided t-test, Chi square gender Average Time needed to complete each test by Acknowledgments and exact Fisher test in addition to one –way ANOVA and Tukey-Kramer Health literacy level participants tests were performed to test if there is a significant difference in the English Spanish The authors would like to thank the pharmacists Gender Inadequate Marginal Adequate Arabic form literacy test results / scores (TOFHLA, NVS and SILS) according to age form form Turkish form who helped us to conduct the literacy tests in the Test (Minutes ± SD) groups, gender and education level for each test. N=95 (scores 0-53) (scores 54-66) (scores 67-100) (Minutes (Minutes ± (Minutes ± SD) five Iraqi pharmacies: Zaid Ali, Abdelfadhel J, Ali Logistic regression was fit to measure the association between SILS N ( %) N ( %) N ( %) ± SD) SD) Shlah, Karrar M, and Ali Mohammed; the level and gender. Multiple regression analysis was run to measure the NVS 3 ± 1.2 3.4 ± 1.2 6.28 ±1.27 8 ± 6.73 assistance of the Biostatistics department in the Female 4 (4.21 %) 4 (4.21%) 34 (35.79%) S- 11.12 ± 8.67 association between age, gender and educational degree with TOFHLA 12 University of Iowa, Jacob Simmering in the data Male 4 (4.21 %) 3 (3.16 %) 46 (48.42%) TOFHLA analysis and the Iraqi Higher Committee for score. Less than 1 Total 8 (8.42 %) 7 (7.37) 80 (84.21) SILS Educational Development (HCED).