Health Literacy and Awareness of Family Health History in the All of Us Research Program

A 2016 study showed that limited health literacy was associated with lower awareness of family health history. However, this analysis was conducted among adult patients in St. Louis, Missouri, thereby warranting broader replication.

We quantified the association between health literacy and awareness of family health history using a nationwide cross-sectional study of 286,293 All of Us Research Program participants. Modified Poisson regression models estimated PRs (PRs): model 1 (unadjusted), model 2 (demographic factors), model 3 (socioeconomic status), model 4 (health insurance), model 5 (self-rated health status), and model 6 (number of chronic health conditions).

The average age was 53 years (SD = 17), with 4% who self-reported no awareness of family health history and 17% who had limited health literacy. Without controlling for confounders (model 1), participants with limited health literacy were 3.06 (95% confidence interval [CI]: 2.95-3.17) times more likely than those with adequate health literacy to report no awareness of family health history. This significant association persisted but attenuated in models 2 (adjusted PR [aPR]: 2.04, 95% CI: 1.96-2.12) and 3 (aPR: 1.43, 95% CI: 1.37-1.49). The association remained stable in models 4-6 with the sequential addition of health insurance coverage (aPR: 1.42, 95% CI: 1.37-1.48), self-rated health status (aPR: 1.42, 95% CI: 1.36-1.47), and number of chronic health conditions (aPR: 1.42, 95% CI: 1.36-1.48).

These findings indicate that increasing health literacy may increase awareness of family health history, which is vital for delivery of personalized healthcare and active patient participation in precision medicine.