Abstract
CONTEXT: Low health literacy disproportionately affects individuals and communities that are socially disadvantaged or have geographical barriers to health care. For injuries such as concussion, preparticipation education is typically mandatory, but it is unclear if the reading level of these educational documents is suitable to meet the health literacy needs of adolescent athletes across urban and rural communities. OBJECTIVE: To assess differences in health literacy among adolescent athletes in urban and rural communities and compare scores with the state-mandated concussion education handout. DESIGN: Cross-sectional study. SETTING: High school athletics. PATIENTS OR OTHER PARTICIPANTS: Participants included 270 adolescent athletes in total who attended urban (n = 157) and rural (n = 110) schools. MAIN OUTCOME MEASURES: The Rapid Estimate of Adolescent Literacy in Medicine-Teen (REALM-Teen) was used to assess a participant's ability to read common medical words and lay terms for body parts and illnesses. The tool consists of 66 words divided into 3 lists, and scores can range from 0 to 66. Scores are tabulated into a health literacy score for each participant, equating to a grade-specific reading level. RESULTS: Urban adolescent athletes had a higher total REALM-Teen score than rural participants (t = 3.868, p < .001). Urban adolescents had higher mean scores than those from rural locations for each individual REALM-Teen list; score differences were statistically significant for lists 2 and 3 (t = 2.888, p = .004; t = 4.012, p < .001, respectively). Only 26% (n = 41) of urban and 12.7% (n = 14) of rural adolescent athletes scored at a reading level that aligns with the health literacy level necessary to read /comprehend the state-provided concussion education handout. CONCLUSIONS: Urban adolescent athletes had better health literacy compared with their rural peers; however, irrespective of rurality, more than half of participants had low health literacy for their appropriate age/grade in high school (≤seventh grade). Ensuring that health information is provided at an appropriate reading level for the target audience is essential to increasing health literacy.