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Construct Overview of Health Literacy

Please note that this section is an archive and is no longer being updated.

Background

Health literacy has been defined in numerous ways. One definition, from the Institute of Medicine (IOM), is "the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions."¹ This definition of health literacy transcends reading and writing (although those skills are certainly central) to include numerical skills and the ability to speak, listen, obtain adequate background information and advocate for oneself in the health care system.²

Although the exact nature of the relationship between low health literacy and physiological health outcomes is not yet known, it is known that approximately 90 million American adults have difficulty obtaining and using health information, and that low health literacy may be responsible many patient injuries and for billions of dollars annually in avoidable health care costs.³ Additionally, studies have found that patients with low health literacy have difficulties with reading medicine labels, appointment slips, informed consent forms, and even the educational materials developed presumably to enhance their use of health information.⁴

VA Relevance

While findings specific to veterans are scant to date, indications are that patients' difficulties due to low health literacy are prevalent across all health care settings, and surprisingly prevalent even among generally literate, well-educated persons.^1,3,5 Due to these and other recent findings, health literacy has become a "hot topic," garnering the attention of major medical and health services organizations such as the IOM, the American Medical Association (AMA) and the National Library of Medicine as well as a wide variety of local public and private institutions across the nation. Attention increased yet again with this summer's release by the National Institutes of Health (NIH) of a series of program announcements on "understanding and promoting health literacy."

Measurement

Health literacy is assessed by patient self-report. Commonly used instruments for measuring health literacy focus on the ability to read, and sometimes on the ability to use numbers.⁶ Given the myriad of health literacy definitions, it is difficult to make comparisons among studies evaluating health literacy because they use varied instruments and cut-off scores.⁶ In considering the measurement of health literacy, it is also important to consider the role that literacy may have in influencing the self-report of health outcomes; therefore, future research should focus on this area. A person's ability to obtain, process, and understand health information may impact the way that they understand and respond to outcomes instruments.

Most Frequently Cited Instruments

1. Test of Functional Health Literacy in Adults (TOFHLA)
   [200 citations]
2. The Wide Range Achievement Test-Revised (WRAT-R)
   [111 citations]
3. Rapid Estimate of Adult Literacy in Medicine (REALM)
   [82 citations]

1. Institute of Medicine. Document from the Committee on Health Literacy. Accessed August 2004. Available URL: http://www.iom.edu/project.cfm?id=3827
2. Institute of Medicine. Health Literacy: A Presicription to End Confusion. Accessed August 2004. Available URL: http://www.iom.edu/Object.File/Master/19/726/0.pdf
3. Greenberg D. A critical look at health literacy. Adult Basic Education 2001:11(2);67-79.
4. American Medical Association. Health Literacy Problems Are Common and Affect People From All Backgrounds. Press Release Dated May 7, 2003.
5. The National Academies. 90 Million Americans are Burdened with Inadequate Health Literacy. Press Release Dated April 8, 2004. Accessed August 2004. Available URL: http://www4.nationalacademies.org/news.nsf/isbn/0309091179?OpenDocument
6. Berkman ND, DeWalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and Health Outcomes. Summary, Evidence Report/Technology Assessment No. 87 (Prepared by RTI International-University of North Carolina Evidence-based Practice Center under Contract No. 290-02-0016). AHRQ Publication No. 04-E007-1. Rockville, MD: Agency for Healthcare Research and Quality.January 2004.
7. ISI Web of Knowledge, Accessed June 2005. Available URL: http://isi01.isiknowledge.com/portal.cgi/wos/