National Academies Press: OpenBook

Measures of Health Literacy: Workshop Summary (2009)

Chapter: 1 Introduction

« Previous: Front Matter
Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
×

1
Introduction

Health literacy, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Ratzan and Parker, 2000) is being increasingly recognized as important to health and health outcomes (Berkman et al., 2004). Although research on health literacy has grown tremendously in the past decade, both in terms of assessing the level of health literacy of individuals and examining the relationship of health literacy to various health outcomes, a concern is that there is no widely agreed-on framework for health literacy as a determinant of health outcomes. Furthermore, existing measures do not adequately capture the data that are necessary to understand how health literacy works to affect outcomes (Pleasant, 2009) and what can be done to improve health literacy.

The only national health literacy assessment tool is the National Assessment of Adult Literacy (NAAL) supplement conducted by the Department of Education in 2003. The NAAL identifies four levels of health literacy: below basic, basic, intermediate, and proficient.

Several other instruments are used for assessing the health literacy of individuals, including the frequently used Rapid Estimate of Adult Literacy in Medicine (REALM) and the Test of Functional Health Literacy in Adults (TOFHLA). One problem with these instruments, however, is that they largely measure reading ability or print literacy. This makes it difficult to differentiate between health literacy and basic literacy. Another difficulty is assessing health literacy of those with limited English pro-

Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
×

ficiency. Several of the health literacy assessment tools discussed in the following report attempt to address this difficulty.

Population-based assessments of health literacy focus on the health literacy of populations rather than individuals. Two of these approaches, the Demographic Assessment of Health Literacy (DAHL) and a geomapping approach, are discussed in Chapter 4. The DAHL imputes limited health literacy from sociodemographic indicators and estimates the association of imputed limited health literacy with indicators of health status. The geomapping approach uses Census data and the NAAL data to map mean health literacy by Public Use Microdata Area.

However, most currently available instruments focus on assessing an individual’s health literacy, yet health literacy is broader than an individual’s skills and abilities. Health literacy occurs in the context of the health care system, and it is increasingly recognized that measures of health literacy must assess not only patients’ skills and abilities, but also the demands and complexities of the health care systems with which patients interact. For example, measures are needed to determine how well the system has been organized so that it can be navigated by individuals with different levels of health literacy and how well health organizations are doing at making health information understandable and actionable.

The Institute of Medicine Roundtable on Health Literacy serves to educate the public, press, and policy makers regarding issues of health literacy. To examine what is known about measures of health literacy, the Roundtable convened a planning committee (see Appendix A) to develop a workshop agenda that would address the following issues:

  • The current status of measures of health literacy, including those used in the health care setting;

  • Possible surrogate measures that might be used to assess health literacy; and

  • Ways in which health literacy measures can be used to assess patient-centered approaches to care.

The following pages summarize the workshop presentations and discussions. Chapter 2 presents an overview of the field of health literacy measurement, describing current measurement tools and their strengths and weaknesses, measurement needs, and proposed principles for developing health literacy measures. In Chapter 3 several new approaches to assessing health literacy are presented, including new measures of written and oral health literacy, a bilingual assessment of health literacy, self-report measures of health literacy, a functional approach to assessing health literacy, and an approach to measuring whether people understand

Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
×

what they hear. Chapter 4 explores two population-based approaches to assessing health literacy—the DAHL and geographic coding of health literacy. Chapter 5 explores health system responses to health literacy, including development of two new health literacy supplements to the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Chapter 6 summarizes the presentation and discussion, which focused on reflections of the entire workshop as well as a vision for the future.

Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
×

This page intentionally left blank.

Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
×
Page 1
Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
×
Page 2
Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
×
Page 3
Suggested Citation:"1 Introduction." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
×
Page 4
Next: 2 An Overview of Measures of Health Literacy »
Measures of Health Literacy: Workshop Summary Get This Book
×
Buy Paperback | $45.00 Buy Ebook | $35.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Health literacy--the ability for individuals to obtain, process, and understand basic health information and services to facilitate appropriate health decisions--is increasingly recognized as an important facet of health care and health outcomes. Although research on health literacy has grown tremendously in the past decade, there is no widely agreed-upon framework for health literacy as a determinant of health outcomes. Most instruments focus on assessing an individual's health literacy, yet the scope of health literacy reaches far beyond an individual's skills and abilities. Health literacy occurs in the context of the health care system, and therefore measures of health literacy must also assess the demands and complexities of the health care systems with which patients interact. For example, measures are needed to determine how well the system has been organized so that it can be navigated by individuals with different levels of health literacy and how well health organizations are doing at making health information understandable and actionable.

To examine what is known about measures of health literacy, the Institute of Medicine convened a workshop. The workshop, summarized in this volume, reviews the current status of measures of health literacy, including those used in the health care setting; discusses possible surrogate measures that might be used to assess health literacy; and explores ways in which health literacy measures can be used to assess patient-centered approaches to care.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!