Date of Award

August 2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Criminal Justice

First Advisor

Meghan Mitchell

Abstract

Health literacy, defined as the ability to access, understand, evaluate, and apply health information, is a critical determinant of health and health equity. Although national public health initiatives emphasize improving health literacy, incarcerated populations remain largely overlooked in health literacy research despite experiencing disproportionately high rates of chronic illness, infectious disease, mental health conditions, and substance use disorders. Using data from the 2014 U.S. Program for the International Assessment of Adult Competencies (PIAAC) Prison Study, this dissertation examined health literacy among incarcerated adults through three sequential analyses. First, literacy, numeracy, and problem-solving measures were evaluated as proxy indicators of health literacy by assessing their conceptual alignment with the multidimensional domains of the Health Literacy Questionnaire (HLQ). Findings indicated that these cognitive measures provided a useful, though incomplete, proxy for functional and cognitive dimensions of health literacy. Second, latent class analysis identified three distinct health literacy profiles, Limited, Emerging, and Broad Health Literacy Profiles, demonstrating meaningful heterogeneity in health literacy among incarcerated adults. Educational attainment emerged as the strongest predictor of profile membership, while age, gender, and race/ethnicity were also associated with differences across profiles. Although the statistical analyses estimated independent demographic associations, interpretation of these findings was informed by an intersectional perspective recognizing that health literacy develops within overlapping social and structural contexts. Third, health literacy profile membership was examined in relation to self-rated health. Individuals classified in the Limited Health Literacy Profile reported significantly poorer self-rated health than those in the Broad Health Literacy Profile, even after adjusting for demographic characteristics. While the cross-sectional design precludes causal inference, the findings demonstrate a meaningful association between multidimensional health literacy profiles and health among incarcerated adults. This study contributes to the limited literature on health literacy in correctional settings by demonstrating the utility of repurposing nationally representative literacy assessments to approximate multidimensional health literacy and by identifying distinct health literacy profiles with implications for correctional healthcare, prison education, reentry planning, and public health efforts to reduce health inequities among justice-involved populations.

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