The Meaning and the Measure of Health Literacy
TL;DR: Computer-assisted testing, which selects items from a bank of possible items according to a baseline-predicted reading ability and responses to previous questions, should allow more accurate measurement of indiidual capacity without increasing the time required to complete testing.
Abstract: Health literacy is a complicated construct that depends on individual capacity to communicate and the demands posed by society and the health care system. More comprehensive tests are needed to understand the gap between capacities and current demands to help guide efforts to educate children and adults about health issues and to develop health-related information that more of the general public can understand. For research, new instruments are needed that will measure individuals reading fluency more precisely without posing an undue response burden. Computer-assisted testing, which selects items from a bank of possible items according to a baseline-predicted reading ability and responses to previous questions, should allow more accurate measurement of indiidual capacity without increasing the time required to complete testing. It remains unclear whether it is possible to develop an accurate, practical “screening” test to identify individuals with limited health literacy. Even if this goal is achieved, it remains unclear whether it is better to screen patients or to adopt “universal precautions” to avoid miscommunication by using plain language in all oral and written communication and confirming understanding with all patients by having them repeat back their understanding of their diagnosis and treatment plan. George Bernard Shaw said, “The main problem with communication is the assumption that it has occurred.” This is a universal truth that transcends reading ability.
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TL;DR: Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer able to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates.
Abstract: Health literacy has been associated with health-related knowledge and patient comprehension. This systematic review updates a 2004 review and found 96 eligible studies that suggest that low health ...
3,457 citations
Cites background from "The Meaning and the Measure of Heal..."
...These skills include the ability to read and understand text and to locate and interpret information in documents (print literacy); use quantitative information for tasks, such as interpreting food labels, measuring blood glucose levels, and adhering to medication regimens (numeracy); and speak and listen effectively (oral literacy) (2, 3)....
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...HIV severity and symptoms Cohort Cross-sectional 3 (0) 1 (1) 4 (3) Inconsistent No difference in 4 studies Low...
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...Pap tests Cross-sectional 1 (1) 3 (3) Decrease Decrease Low Prostate cancer control Cross-sectional 1 (1) 1 (1) No difference Decrease Low...
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...Use of health care services Cross-sectional 2 (2) Inconsistent Insufficient Disparities Cross-sectional 3 (3) Numeracy partially mediates relationship between race and 2 outcomes and between sex and 1 outcome Low...
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...Hypertension control Cross-sectional 1 (1) 2 (2) No difference Inconsistent Insufficient Immunization Influenza Cohort Cross-sectional 0 1 (1) 1 (1) 3 (3) Decrease Decrease Moderate...
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TL;DR: An integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively.
Abstract: Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.
3,290 citations
Cites background from "The Meaning and the Measure of Heal..."
...Baker DW: The meaning and the measure of health literacy....
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...Baker [49] divides health literacy into health related print literacy and health related oral literacy, while Paashe-Orlow and Wolf [40] distinguish between listening, verbal fluency, memory span and navigation....
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...6 Baker (2006) [49] - Health-related print literacy - Health-related oral literacy....
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...While originating from the study of the reading and numerical skills that are necessary to function adequately in the healthcare environment, the concept of health literacy has expanded in meaning to include information-seeking, decision-making, problem-solving, critical thinking, and communication, along with a multitude of social, personal, and cognitive skills that are imperative to function in the health-system [49,52,59]....
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...It has now diffused into the realm of culture, context, and language [49,52,59]....
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TL;DR: The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness.
2,082 citations
TL;DR: An overview of the meaning and measurement of financial literacy is presented to highlight current limitations and assist researchers in establishing standardized, commonly accepted financial literacy instruments as mentioned in this paper, which is essential to understand educational impact as well as barriers to effective financial choice.
Abstract: Financial literacy (or financial knowledge) is typically an input to model the need for financial education and explain variation in financial outcomes. Defining and appropriately measuring financial literacy is essential to understand educational impact as well as barriers to effective financial choice. This article summarizes the broad range of financial literacy measures used in research over the last decade. An overview of the meaning and measurement of financial literacy is presented to highlight current limitations and assist researchers in establishing standardized, commonly accepted financial literacy instruments.
1,164 citations
Cites background from "The Meaning and the Measure of Heal..."
...This idea of literacy has been expanded to the study of particular skill sets, for example computer literacy (Wecker, Kohnle, and Fischer 2007), statistical literacy (Callingham and Watson 2005) and health literacy (Baker 2006)....
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TL;DR: A single question may be useful for detecting patients with inadequate health literacy in a VA population and AUROCs were lower for detecting “inadequate or marginal” health literacy than for detecting inadequate health Literacy for each of the 3 questions.
Abstract: Previous studies have shown that a single question may identify individuals with inadequate health literacy. We evaluated and compared the performance of 3 health literacy screening questions for detecting patients with inadequate or marginal health literacy in a large VA population. We conducted in-person interviews among a random sample of patients from 4 VA medical centers that included 3 health literacy screening questions and 2 validated health literacy measures. Patients were classified as having inadequate, marginal, or adequate health literacy based on the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM). We evaluated the ability of each of 3 questions to detect: 1) inadequate and the combination of “inadequate or marginal” health literacy based on the S-TOFHLA and 2) inadequate and the combination of “inadequate or marginal” health literacy based on the REALM. Of 4,384 patients, 1,796 (41%) completed interviews. The prevalences of inadequate health literacy were 6.8% and 4.2%, based on the S-TOHFLA and REALM, respectively. Comparable prevalences for marginal health literacy were 7.4% and 17%, respectively. For detecting inadequate health literacy, “How confident are you filling out medical forms by yourself?” had the largest area under the Receiver Operating Characteristic Curve (AUROC) of 0.74 (95% CI: 0.69–0.79) and 0.84 (95% CI: 0.79–0.89) based on the S-TOFHLA and REALM, respectively. AUROCs were lower for detecting “inadequate or marginal” health literacy than for detecting inadequate health literacy for each of the 3 questions. A single question may be useful for detecting patients with inadequate health literacy in a VA population.
1,116 citations
References
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TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
76,181 citations
01 Jan 2002
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Abstract: EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several “clinical tests of the sensorium”.2*3 The available batteries are lengthy. For example, WITHERS and HINTON’S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is “mini” because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment “pseudodementia”5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects.
70,887 citations
01 Jan 2004
TL;DR: 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.
Abstract: 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.
4,107 citations
TL;DR: NVS, the Newest Vital Sign, is suitable for use as a quick screening test for limited literacy in primary health care settings and correlates with the Test of Functional Health Literacy in Adults.
Abstract: 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.
1,941 citations
TL;DR: The Test of Functional Health Literacy in Adults (TOFHLA) as mentioned in this paper was developed using actual hospital materials and consists of a 50-item reading comprehension and 17-item numerical ability test.
Abstract: 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.
1,932 citations