Last December, project directors of the 16 Traumatic Brain Injury Model Systems funded by the National Institute on Disability, Independent Living, and Rehabilitation Research attended the program’s national meeting in Washington, D.C., to present proposals for module projects and select a handful to be implemented. Among those chosen is a multisite project that will characterize health literacy in a representative sample of persons with traumatic brain injury (TBI) and determine the contribution of health literacy to health outcomes.

Angelle SanderLed by principal investigator Angelle Sander, PhD, the study will help guide rehabilitation specialists and other health care providers in tailoring education to persons with traumatic brain injury. “TBI is a long-term health problem,” says Dr. Sander, who directs TIRR Memorial Hermann’s Brain Injury Research Center and is an Associate Professor of Physical Medicine and Rehabilitation at Baylor College of Medicine. “Even though cognitive abilities may improve over time, the brain injury can impact lifespan developmental issues. The normal effects of aging can be exacerbated by a brain injury. Like everyone else, people with TBI may develop chronic health issues, and the brain injury may make it harder for them to manage health conditions and age in healthy ways. They may have more difficulty digesting information from physicians about disease conditions, leading to trouble with medical decision-making. We’re hoping that by understanding how brain injury affects health literacy we’ll be able to share the information with people with TBI, their caregivers and their health care providers to improve health management across the lifespan.”

According to the Institute of Medicine, health literacy is “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” The existing literature linking low health literacy to poor health behaviors and poor health outcomes in the general population, particularly in older persons, indicates that low health literacy is an important obstacle to management of chronic health problems.

“Knowledge of how TBI impacts health literacy is crucial for promoting recovery of persons with TBI,” Dr. Sander says. “As TBI is a chronic health condition, adequate health literacy is important for managing TBI-related symptoms across the lifespan. A substantial number of persons in the general population have low health literacy, with literacy being lower for older persons, minorities and those with less education. These groups are disproportionately represented among persons with TBI. Low health literacy has been associated with poorer knowledge of hypertension and diabetes, lower self-rated health status, worse health status in the elderly, a greater number of chronic health conditions and higher mortality, among other things.”

Data will be collected from 242 participants divided equally among TIRR Memorial Hermann and four (4) other TBI Model Systems supporting the project: the University of Alabama at Birmingham, Ohio State University in Columbus, Baylor Institute for Rehabilitation in Dallas and Kessler Rehabilitation Institute in New Jersey.

“Health literacy is a major public goal,” Dr. Sander says. “Understanding its role in health outcomes after TBI can lead to development of specific interventions to improve health literacy, empowering people to maintain physical and mental health.”

For more information about the study, contact Dr. Sander at

Summer 2018 Edition