Recommendation 2-1 The Department of Health and Human Services and other government and private funders should support research leading to the development of causal models explaining the relationships among health literacy, the education system, the health system, and relevant social and cultural systems.

Recommendation 2-2 The Department of Health and Human Services and public and private funders should support the development, testing, and use of culturally appropriate new measures of health literacy. Such measures should be developed for large ongoing population surveys, such as the National Assessment of Adult Literacy Survey, Medical Expenditure Panel Survey, and Behavioral Risk Factor Surveillance System, and the Medicare Beneficiaries Survey, as well as for institutional accreditation and quality assessment activities such as those carried out by the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance. Initially, the National Institutes of Health should convene a national consensus conference to initiate the development of operational measures of health literacy which would include contextual measures.

Recommendation 3-1 Given the compelling evidence noted above, funding for health literacy research is urgently needed. The Department of Health and Human Services, especially the National Institutes of Health, Agency for Healthcare Research and Quality, Health Resources and Services Administration, the Centers for Disease Control and Prevention, Department of Defense, Veterans Administration, and other public and private funding agencies should support multidisciplinary research on the extent, associations, and consequences of limited health literacy, including studies on health service utilization and expenditures.

Recommendation 4-1 Federal agencies responsible for addressing disparities should support the development of conceptual frameworks on the intersection of culture and health literacy to direct in-depth theoretical explorations and formulate the conceptual underpinnings that can guide interventions.