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



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