Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey

Abstract

The objective of this paper is to measure health literacy in a representative sample of the Australian general population using three health literacy tools; to consider the congruency of results; and to determine whether these assessments were associated with socio-demographic characteristics. Face-to-face interviews were conducted in a stratified random sample of the adult Victorian population identified from the 2004 Australian Government Electoral Roll. Participants were invited to participate by mail and follow-up telephone call. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA) and Newest Vital Sign (NVS). Of 1680 people invited to participate, 89 (5.3%) were ineligible, 750 (44.6%) were not contactable by phone, 531 (32%) refused and 310 (response rate 310/1591, 19.5%) agreed to participate. Compared with the general population, participants were slightly older, better educated and had a higher annual income. The proportion of participants with less than adequate health literacy levels varied: 26.0% (80/308) for the NVS, 10.6% (51 33/310) for the REALM and 6.8% (21/309) for the TOFHLA. A varying but significant proportion of the general population was found to have limited health literacy. The health literacy measures we used, while moderately correlated, appear to measure different but related constructs and use different cut offs to indicate poor health literacy.

Measuring health literacy in emergency departments

“…Surveys across various countries such as the National Assessment of Adult Literacy (NAAL) [7] have revealed unexpected figures, with one third of Americans being found to have limited health literacy [8] while approximately 20% of the British population are illiterate [9] . In Canada, 65% of the population lack basic health literacy [10] , and more than 60% of Australians are reported as having inadequate health literacy skills [11] .…”

“…Surveys across various countries such as the National Assessment of Adult Literacy (NAAL) [7] have revealed unexpected figures, with one third of Americans being found to have limited health literacy [8] while approximately 20% of the British population are illiterate [9] . In Canada, 65% of the population lack basic health literacy [10] , and more than 60% of Australians are reported as having inadequate health literacy skills [11] . According to an international report, Australian teenagers skills in reading, writing and arithmetic were found to be much worse now than they were 10 years ago [12] indirectly influencing the health literacy level of the general population.…”

Challenging a Statistic: Why should we accept that 60 percent of adult Australians have low health literacy?

“…Necessarily, any measurement tool which determines a cut-off point indicating those who do or do not have a particular level of skills for effective functioning in society is likely to be problematic, and the case of health literacy is no exception (see Barber et al 2009). But the argument in this paper is that the level 3 criterion represents a particularly misleading example.…”

Socioeconomic factors and total joint replacement: Comment on the article by Mnatzaganian et al

“…Smokers are more likely to be from lower socioeconomic groups (10), which is also a population that has a lower level of health literacy (11). It may be that those who smoke are less willing to undergo TJR and are affected more strongly by sociodemographic factors, health beliefs, lack of community and family support, lack of resources, and clinician characteristics, as highlighted by Hawker (12).…”