To maintain their own health and the health of their families and communities, consumers rely heavily on the health information that is available to them. This information is at the core of the partnerships that patients and their families forge with today?s complex modern health systems. This information may be provided in a variety of forms ? ranging from a discussion between a patient and a health care provider to a health promotion advertisement, a consent form, or one of many other forms of health communication common in our society. Yet millions of Americans cannot understand or act upon this information. To address this problem, the field of health literacy brings together research and practice from diverse fields including education, health services, and social and cultural sciences, and the many organizations whose actions can improve or impede health literacy. Health Literacy: Prescription to End Confusion examines the body of knowledge that applies to the field of health literacy, and recommends actions to promote a health literate society. By examining the extent of limited health literacy and the ways to improve it, we can improve the health of individuals and populations.

Health literacy : a prescription to end confusion

PURPOSE Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in Eng- lish and Spanish. METHODS We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach's and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores 0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish ver- sions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy. CONCLUSION NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.

https://www.annfammed.org/content/annalsfm/3/6/514.full.pdf

Quick assessment of literacy in primary care: the newest vital sign.

OBJECTIVE: To develop a valid, reliable instrument to measure the functional health literacy of patients. DESIGN: The Test of Functional Health Literacy in Adults (TOFHLA) was developed using actual hospital materials. The TOFHLA consists of a 50-item reading comprehension and 17-item numerical ability test, taking up to 22 minutes to administer. The TOFHLA, the Wide Range Achievement Test-Revised (WRAT-R), and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered for comparison. A Spanish version was also developed (TOFHLA-S). SETTING: Outpatient settings in two public teaching hospitals. PATIENTS: 256 English- and 249 Spanish-speaking patients were approached. 78% of the English- and 82% of the Spanish-speaking patients gave informed consent, completed a demographic survey, and took the TOFHLA or TOFHLA-S. RESULTS: The TOFHLA showed good correlation with the WRAT-R and the REALM (correlation coefficients 0.74 and 0.84, respectively). Only 52% of the English speakers completed more than 80% of the questions correctly. 15% of the patients could not read and interpret a prescription bottle with instructions to take one pill by mouth four times daily, 37% did not understand instructions to take a medication on an empty stomach, and 48% could not determine whether they were eligible for free care. CONCLUSIONS: The TOFHLA is a valid, reliable indicator of patient ability to read health-related materials. Data suggest that a high proportion of patients cannot perform basic reading tasks. Additional work is needed to determine the prevalence of functional health illiteracy and its effect on the health care experience.

The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills.

OBJECTIVE: To review the relationship between literacy and health outcomes DATA SOURCES: We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resources Information Center (ERIC), Public Affairs Information Service (PAIS), Industrial and Labor Relations Review (ILLR), PsychInfo, and Ageline from 1980 to 2003 STUDY SELECTION: We included observational studies that reported original data, measured literacy with any valid instrument, and measured one or more health outcomes Two abstractors reviewed each study for inclusion and resolved disagreements by discussion DATA EXTRACTION: One reviewer abstracted data from each article into an evidence table; the second reviewer checked each entry The whole study team reconciled disagreements about information in evidence tables Both data extractors independently completed an 11-item quality scale for each article; scores were averaged to give a final measure of article quality DATA SYNTHESIS: We reviewed 3,015 titles and abstracts and pulled 684 articles for full review; 73 articles met inclusion criteria and, of those, 44 addressed the questions of this report Patients with low literacy had poorer health outcomes, including knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources Patients with low literacy were generally 15 to 3 times more likely to experience a given poor outcome The average quality of the articles was fair to good Most studies were cross-sectional in design; many failed to address adequately confounding and the use of multiple comparisons CONCLUSIONS: Low literacy is associated with several adverse health outcomes Future research, using more rigorous methods, will better define these relationships and guide developers of new interventions

/pdf/literacy-and-health-outcomes-4pmopsjgz6.pdf

Literacy and health outcomes

National Asthma Education and Prevention Program.

It is estimated that 1 out of 5 American adults lacks the literacy skills needed to function effectively in todays society and as patients they present a challenge to health instruction This book provides teaching strategies to aid in making self-help and self-management a reality for the patient with low literacy skills The magnitude of the problem is explored and myths about illiteracy are exemplified Two chapters deal with comprehension of written materials from theory to practical proven testing techniques including the cloze technique and the word-recognition test Another chapter offers 2 formulas for testing the readability of written materials: the SMOG formula and the Fry index Once a problem is identified a 4-step teaching strategy gives tips on teaching the low-literacy patient For those pamphlets and booklets commonly given to patients suggestions for writing and rewriting to simplify the text are given along with examples of comprehension level The use of audiotapes for teaching is explored in depth for those who learn better by listening A chapter on the use of visuals stresses simplification to reduce the amount of text reading to emphasize instruction and to motivate and appropriate examples are given Where written material audiotapes and visuals are drafted and produced according to the guidelines in the book the last chapter is devoted to pretesting to determine whether intended concepts are coming through It defines the components of pretesting describes procedures discusses possible stages for production and provides examples of results Although the book is aimed at providing teaching methods for the low-literate patient the suggestions also apply to the learning disabled

Teaching Patients With Low Literacy Skills

The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence

This paper provides strategies to improve communication between clinicians and patients, particularly patients who are among the 44 million adult Americans with low literacy skills. Included are insights into the nature of the literacy problem and how it affects patient comprehension of information across the continuum of cancer care. Practical strategies address how to help patients understand medical advice, reduce literacy levels of cancer information, and help patients remember the advice given. A summary of the strategies is included in the Appendix for convenient reference.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.48.3.151

Improving comprehension for cancer patients with low literacy skills: Strategies for clinicians

Patient comprehension profiles: recent findings and strategies.

Erratum to “The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence” [Patient Education Counseling 61 (2006) 173–190]

Leonard G. Doak

Papers

Teaching Patients With Low Literacy Skills

The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence

Improving comprehension for cancer patients with low literacy skills: Strategies for clinicians

Patient comprehension profiles: recent findings and strategies.

Erratum to “The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence” [Patient Education Counseling 61 (2006) 173–190]