ments. Effective recommendations depend on clear, accurate assessments. But much work remains to be done on the specific and targeted issue of health literacy assessment in educational settings.

Educational assessments generally include formative and summative components. Formative assessments are constructed so that test results can directly inform and shape ongoing instruction. They should provide feedback to teachers and to school systems regarding how well the instruction meets the learning needs of their students. The major effort of assessment should be devoted to informed formative assessment.

Summative assessments are a part of instructional contexts, and serve primarily to rate, or grade, the student on how well they learned what was taught. Within the health literacy context, summative assessments can be used to make judgments about individual persons regarding their “level” of health literacy.

Health literacy programs in schools and colleges can be designed to accomplish four distinct, but overlapping and interdependent, types of goals (Kolbe, 2002). First, such programs can be designed to improve health literacy; that is, improve important health knowledge, attitudes, and skills. The Council of Chief State School Officers (which represents the nation’s state school superintendents) established a State Collaborative on Assessment and Student Standards (SCASS) to assess student achievement in several context areas. To assess health literacy, SCASS created an Assessment Framework Matrix (Council of Chief State School Officers and State Collaborative on Assessment and Student Standards, 1998) that was used to develop test items within nine content areas3 and six core concepts and skills4 that reflect the NHES for elementary, middle, and high school students (Joint Committee on National Health Education Standards, 1995). The major purpose of the SCASS Health Education Assessment Project is to improve health literacy by guiding improvements in school health education planning and delivery (Pateman, 2003).

Examples of Current Approaches

Several state organizations have developed programs to address health literacy education in kindergarten through high school. Many examples of programs are detailed in the State Official’s Guide to Health Literacy


These nine content areas are: alcohol and other drugs, injury prevention, nutrition, physical activity, sexual health, tobacco, mental health, personal and consumer health, and community and environmental health.


These six core concepts and skills are: accessing information, self-management, internal and external influences, interpersonal communication, decision-making/goal-setting, and advocacy.

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