Assessing health literacy and diversity within the All of Us Research Program.

Objective: The objective was to understand the association between people with adequate and inadequate health literacy (HL) in the All of Us cohort.

Materials and methods: Overall, health survey responses to 3 questions from 246 555 people, ages 18-77 years in the controlled tier V7 dataset, were used to assess and compare HL. HL scores ranged from 3 to 15, with scores ≤9 indicating inadequate HL and >9 indicating adequate HL.

Results: Cohort participants' responses indicate 92.4% met criteria for adequate HL. Persons with inadequate HL versus adequate HL were likely to be Gen X, male, Black, report an income less than $25k, and have less than a high school education. Furthermore, the rate of HL may not represent that for the broader US population.

Discussion: All of Us participants had much higher rates of HL than that for the 2003 National Assessment of Adult Literacy, suggesting approximately over 90% of the US population has HL challenges. The All of Us cohort's high rates of HL may reflect response and recruitment bias. Given the emphasis on diversity and inclusion within the cohort, and understanding HL as the ability to find, understand, and use health information, revisiting the recruitment strategies and, potentially, the assessment of HL within the All of Us cohort is recommended.

Conclusion: Factoring HL into diversity and inclusion research recruitment efforts will require review and testing of innovative approaches to community recruitment, engagement, and retention methods. Infusing HL into precision medicine can advance opportunities for individual improvement in health promotion and disease management. Future population level efforts in precision medicine should consider more sensitive measures to critical social determinants of health, such as health literacy, to more carefully characterize diversity and inclusion in these studies.