Health Literacy Among Young Adults Formerly in Foster Care

Background and Purpose: Each year more than 20,000 youth age out of the US foster care system because they were unable to return to their families of origin or exit care through what is termed permanency (i.e., adoption). In addition to educational deficiencies, employment challenges, and a lack of familial support, the American Academy of Pediatrics has declared that one area of particular concern among aged out foster youth is their health. Fortunately, the Patient Protection and Affordable Care Act (ACA) provides these young adults with comprehensive health care; however, access to care is only a first step, not a final solution. Young adults who have aged out of foster care must be able to navigate the health system, communicate appropriately with health professionals, understand care plans, and independently apply the information they are provided. Unfortunately, research has not paid attention to the health literacy of former foster youth or how they utilize health care insurance they are entitled to through ACA. The aim of this paper is to assess the health literacy of young adults who had aged out of foster care.

Methods: To obtain a sample of emancipated foster youth, study participants were recruited through convenience sampling by staff at a local non-profit organization. Those who expressed interest in participating were scheduled for a time to complete a health survey and take the Newest Vital Sign health literacy assessment. The final sample consisted of 57 participants between the ages of 18 and 26 (M = 20) who had aged out of foster care. The participants were predominately female (54%) and racially and ethnically diverse (56% Hispanic/Latino and 14% African American/Black).

Results: Univariate analysis revealed that only 30% of participants had adequate health literacy according to the Newest Vital Sign assessment. When compared to other studies, the health literacy scores of our young adult participants were considerably lower than those of adults sampled from the general population, and surprisingly, even lower than those of youth who were sampled while placed in a large residential foster care treatment facility. Racial and ethnic disparities were also found, with adequate health literacy reported for 70% (7/10) of Whites/Caucasians, 25% (8/32) of Latinos/Hispanics, and 0% (0/8) of Blacks/African Americans, a statistically significant difference.

Conclusions and Implications: Aligned with extant research suggesting that young adults with foster care histories might struggle to manage their personal health needs, our data showed that less than one-third of those sampled had adequate health literacy. To address this, general information about how to navigate the US health system should be taught to foster youth before they turn 18 years old. After aging out, community health professionals or physicians could be designated to reach out to emancipated youth on a regular basis (e.g., quarterly) and serve as health mentors or guides. Regardless of the approach, a coordinated effort by policymakers, foster care providers, and community health workers is essential to address the low health literacy of former foster youth.