Clinical Assessment of Health Literacy

Abstract

Limited health literacy has been associated with adverse health outcomes in the older adult population. Minimizing the negative impact of limited health literacy in the rehabilitative setting is essential to achieve optimal outcomes. Clinical assessment of health literacy identifi es those patients who experience limited health literacy, thus allowing for customization of the practitioner-patient interaction to address the patient's limited health literacy. To use current assessment instruments, practitioners must understand the purpose and limitations of each instrument. The purposes of this article were to ( a ) provide a brief background on clinical assessment of health literacy, ( b ) describe health literacy assessment instruments commonly used, ( c ) discuss the value of conducting clinical measurement of health literacy, and ( d ) discuss research examining the use of health literacy assessment in the clinical environment. Key words: health literacy , health literacy assessment , health literacy instruments , older adult , rehabilitation in the area of health literacy uses measurement instruments to assess literacy levels. These assessment instruments use word recognition, comprehension, numeracy, or a combination of comprehension and numeracy when assessing health literacy levels. Assessment instruments vary in the type of assessment, the time that is taken for administration, and the fi nal health literacy category. The more comprehensive health literacy measurement instruments will yield a reading grade level whereas shorter screening tools may simply indicate adequate or inadequate health literacy levels. Instruments to assess oral literacy skills have yet to be validated.The purposes of this article were to ( a ) provide a brief background on clinical assessment of health literacy, ( b ) describe health literacy assessment instruments commonly used, ( c ) discuss the value of conducting clinical measurement of health literacy, and ( d ) discuss research examining the use of health literacy assessments in the clinical environment. BACKGROUND ON CLINICAL ASSESSMENT OF HEALTH LITERACYHealth care providers commonly use word recognition or reading comprehension instruments to evaluate the health literacy skills of individuals in a clinical setting. The Rapid Estimate of Adult Literacy in Medicine (REALM) 10 and the Test of Functional Health Literacy (TOFHLA) 11 are considered to be the "gold standard" assessment instruments most widely used in health literacy research. The REALM assesses a patient's ability to read and correctly pronounce medical terms 10 whereas the TOFHLA 11 assesses both reading comprehension and numerical ability. These instruments have been used in evaluating a wide variety of patient populations. Both instruments provide an estimate of the patient's health literacy skills through direct versus self-report measurement and provide a detailed estimate for research purposes. However, these assessment instruments are time consuming and may not be ideal in the dayto-day busy clinical setti...

Capturing health literacy assessment in the electronic health record through evidence-based concept creation: A review of the literature and recommendations for action

“…By performing HL assessment during a clinical encounter, providers could better identify patients with limited HL, address HL deficits and tailor communication to the needs of patients. 36 Consequently, HL assessment will likely be stored in the electronic health record (EHR). Although storing the HL assessment in the EHR has many benefits, the ability to capture, store, retrieve and synthesize HL instruments into usable information via the EHR is limited.…”

Implementation of a Routine Health Literacy Assessment at an Academic Medical Center

“…Limited health literacy is associated with numerous poor health outcomes including hospital readmissions, increased emergency department visits, and excess morbidity and mortality. 9,12–16 There is an abundance of literature on well-validated screening tools for health literacy, 17,18 and studies of interventions aimed at improving health outcomes for those with limited health literacy are beginning to show promise. 19,20 The Institute of Medicine recommended in 2004 that health literacy assessment be incorporated into health care information systems.…”