The Relationship of Health Literacy to Health Outcomes among Individuals with Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study

Monique R. Pappadis, Angelle M. Sander, Shannon B. Juengst, Luis Leon-Novelo, Esther Ngan, Kathleen R. Bell, John D. Corrigan, Simon Driver, Laura E. Dreer, Anthony H. Lequerica

Research output: Contribution to journalArticlepeer-review


Objective: To examine the associations between health literacy and health outcomes among individuals with traumatic brain injury (TBI) at least a year post-injury. Setting: Community following discharge from inpatient rehabilitation. Participants: A total of 205 individuals with complicated mild to severe TBI who completed a TBI Model Systems National Database follow-up interview and a web-based health literacy measure. Design: A multicenter, cross-sectional, observational study. Main Measures: The Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT), number of comorbid conditions (Medical and Mental Health Comorbidities Interview [MMHCI]), perceived physical and mental health (PROMIS Global Physical and Mental Health subscales), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Results: After controlling for sociodemographic, injury, cognition, and time post-injury, adequate health literacy was associated with higher odds of greater perceived physical health compared with participants with marginal/inadequate health literacy (odds ratio = 4.10; CI = 1.52-11.70]. Participants with inadequate/marginal health literacy had 3.50 times greater odds of depression (PHQ-9 ≥ 10) compared with those with adequate health literacy. Participants 45 years and older reported a greater number of MMHCI physical health conditions, but fewer MMHCI mental health conditions and GAD-7 anxiety symptoms compared with those who were younger. Non-Hispanic White participants and those with mild/moderate TBI were more likely to report a greater number of MMHCI mental health conditions compared with non-Hispanic Black participants or those with severe TBI. Greater time post-injury was associated with greater number of chronic physical and mental health conditions, and less odds of good-to-excellent perceived global mental health. Conclusions: Inadequate health literacy is associated with worse perceived physical health and greater depressive symptoms among adults with TBI. Greater efforts are needed to explore the mechanisms by which health literacy influences chronic disease management and mental health after TBI to improve postinjury health status and outcomes, particularly among those with limited health literacy skills.

Original languageEnglish (US)
Pages (from-to)103-114
Number of pages12
JournalJournal of Head Trauma Rehabilitation
Issue number2
StatePublished - Mar 1 2024


  • chronic disease
  • health literacy
  • mental health
  • quality of life
  • social determinants of health
  • traumatic brain injuries

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology


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