The Case for Development of a New Test of Health Literacy

Abstract

If nurses know their patients' reading levels, they can plan more effectively for teaching self-care and discussing decision making. Outcomes related to health and satisfaction may improve if poor readers are given materials they can understand.

Health Literacy Measurement: A Proposed Research Agenda

“…Combined with the risk of harm in labeling individuals as ''low health literate'' in a clinical setting, this argues that resources in clinical settings would be better directed toward lowering barriers to access for all rather than identifying and labeling individuals (Agre et al, 2006;Baker, 2006;Zarcadoolas et al, 2006). A new comprehensive approach to measuring health literacy should address public health contexts and applications rather than simply create another assessment tool for clinical settings.…”

“…However, current measures of health literacy test only a narrow range of reading and, occasionally, numeracy skills, and the vast majority of measures focuses on the competency of the individual rather than the provider or system (Agre, Steiglitz, & Milstein, 2006;Nielsen-Bohlman, Panzer, & Kindig, 2004;Rogers, Ratzan, & Payne, 2001;Schillinger & Davis, 2005;Schwartzberg, VanGeest, & Wang, 2005;Simonds, 1974;Zarcadoolas, Pleasant, & Greer, 2005, 2006. The lack of a comprehensive approach to measurement severely limits the ability to comparatively evaluate the growing number of health literacy initiatives in any depth beyond the superficial aspects of what happened (e.g., how many documents were rewritten or physicians trained).…”

“…In contrast, a comprehensive approach to measurement focuses on causal processes to understand why change did or did not occur at the individual, community, or health care system level. Existing health literacy measures include various versions of both the Rapid Estimate of Adult Literacy in Medicine (REALM) (Davis et al, 1991;Davis et al, 2006;Davis et al, 1993) and the Test of Functional Health Literacy in Adults (TOFHLA) (Gong et al, 2007;Parker, Baker, Williams, & Nurss, 1995), as well as the Health Activities Literacy Scale (HALS) (Rudd, Kirsch, & Yamamoto, 2004), the Newest Vital Sign (NVS) (Weiss et al, 2005), Wide Range Achievement Test Fourth Edition (Dell, Harrold, & Dell, 2008), Stieglitz Informal Reading Assessment of Cancer Text (SIRACT) (Agre et al, 2006), Medical Achievement Reading Test (MART) (Hanson-Divers, 1997), National Adult Reading Test (NART) (Uttl, 2002), Literacy Assessment for Diabetes (LAD) (Nath, Sylvester, Yasek, & Gunel, 2001), Nutrition Literacy Scale (NLS) (Diamond, 2007), the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA) (Lee, Bender, Ruiz, & Cho, 2006), an instrument targeting Canadian adolescents, a ''talking touchscreen'' approach, and the Demographic Assessment of Health Literacy (DAHL) (Hanchate, Ash, Gazmararian, Wolf, & Paasche-Orlow, 2008).…”

“…A number of specific criticisms of existing health literacy measures are found in the academic literature (Agre et al, 2006;Aguirre, Ebrahim, & Shea, 2005;Baker, 2006;Buchbinder, Hall, & Youd, 2006;Friedman & Hoffman-Goetz, 2006;Johnston, Diab, Kim, & Kirshblum, 2005;Kalichman & Rompa, 2000;Morrow et al, 2006;Weiss et al, 2005;Zarcadoolas et al, 2005;Zun, Sadoun, & Downey, 2006). These include observations that existing measures of health literacy:…”

Cognitive Science in Telemedicine: From Psychology to Artificial Intelligence

“…• General education. Agre et al [ 1 ] compared the educational videotape on its own, video combined with a discussion with a physician and a discussion alone. The videotape interventions both provided comprehensive information on the recommended therapy and its associated risks and benefi ts.…”