Health Literacy among Adolescent Athletes across Rural and Urban Communities and Evaluating Scores aside State-Mandated Concussion Education

ABSTRACT Context: Low health literacy disproportionately affects individuals and communities that are socially disadvantaged or have geographical barriers to healthcare. For injuries like concussion, pre-participation education is typically mandatory, but it is unclear if the reading level of these educational documents are suitable to meet 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 to the state-mandated concussion education handout. Design: Cross-sectional. Setting: High School Athletics. Patients or Other Participants: Participants included 270 adolescent athletes total that attended urban (n=157) and rural schools (n=110). Main Outcome Measure(s): The Rapid Estimate of Adolescent Literacy in Medicine-Teen (REALM-Teen) was used to assesses 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 three lists and scores can range from 0-66. 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) 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 to their rural peers; however, irrespective of rurality, over half of participants had low health literacy for their appropriate age/grade in high school (≤7th 28 grade). Ensuring that health information is provided at an appropriate reading level for the target audience is essential to increasing health literacy.