All ETDs from UAB

Advisory Committee Chair

Laura Forbes

Advisory Committee Members

John E Crews

Dawn Decarlo

Laura Dreer

Scott Snyder

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Education


Functional health literacy is the ability to understand and apply health information from printed documents and is dependent on reading. Few studies have examined functional health literacy levels in visual impaired older adults despite the fact low vision is common among older adults and impairs reading performance. This study investigated whether community dwelling older adults with moderate visual impairment from age-related macular degeneration had lower health literacy levels compared to older adults without low vision. The Test of Functional Health Literacy for Adults (TOFHLA) was administered to 50 adults aged 65- 94 years with AMD and 50 normally sighted adults matched on age, gender and education. Inclusion criteria included a minimum of high school education and annual income of $20,000; English speaking, and minimal risk for depression or dementia. The participant also had to report reading at least 20 minutes daily. TOFHLA scores were recorded for two timing conditions: the standard test time limit and unlimited time that permitted participants to take as much time as needed to complete the test. Low vision participants scored significantly lower than controls on both time conditions but significantly improved scores on unlimited time. Given extra time to complete the test, 98% of the low vision participants were classified as having adequate health literacy levels compared to 60% on the standard time condition. Significant associations were found among TOFHLA scores and acuity, reading speed and critical print size in the low vision group on the standard time condition. A partial correlation showed that reading speed and acuity contributed to TOFHLA scores on the standard time condition. Only acuity significantly correlated with TOFHLA scores in the unlimited time condition. Significant associations were also found among TOFHLA scores and reading frequency and activity level in the entire sample. The study findings suggest that slower reading speed associated with AMD significantly influenced test performance on the standard time condition, but did not account for all of the difference in scores between the groups. Reduced acuity also may have contributed to lower TOFHLA scores by affecting reading accuracy.

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