Environmental health literacy (EHL) is a relatively new framework for conceptualizing how people understand and use information about potentially harmful environmental exposures and their influence on health. As such, information on the characterization and measurement of EHL is limited. This review provides an overview of EHL as presented in peer-reviewed literature and aggregates studies based on whether they represent individual level EHL or community level EHL or both. A range of assessment tools has been used to measure EHL, with many studies relying on pre-/post-assessment; however, a broader suite of assessment tools may be needed to capture community-wide outcomes. This review also suggests that the definition of EHL should explicitly include community change or collective action as an important longer-term outcome and proposes a refinement of previous representations of EHL as a theoretical framework, to include self-efficacy.

Environmental health literacy (EHL) is developing as a framework that can inform educational interventions designed to facilitate individual and collective action to protect health, yet EHL measurement poses several challenges. While some studies have measured environmental health knowledge resulting from interventions, few have incorporated skills and self-efficacy. In this study, a process-focused EHL instrument was developed, using the Newest Vital Sign (NVS) health literacy instrument as a model and tailoring it for the context of private well contamination with toxic metals. Forty-seven (47) participants, including undergraduate students and residents of communities with contaminated well water, piloted a prototype EHL instrument alongside NVS. Results suggested a moderate degree of correlation between NVS and the EHL prototype, and significant differences in scores were observed between students and residents. Responses to a self-efficacy survey, tailored for drinking water contaminated with arsenic, revealed significant differences between students and residents on items related to cost and distance. In response to open-ended questions, participants identified a range of potential environmental contaminants in drinking water and deemed varied information sources as reliable. This study highlights differences in knowledge and self-efficacy among students and residents and raises questions about the adequacy of EHL assessments that mimic formal education approaches.

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