population measure? Pleasant responded that it is critically important to use a consensus process to develop an agreed-on theory and framework around which measures are developed. There should be a core module of health literacy and then, depending on the context that one is addressing (e.g., chronic disease, health literacy of physicians, health literacy of patients, etc.), add-on modules would be developed. If measures for these were based on an agreed-on framework, comparisons could be made across modules and contexts. It should be possible, Pleasant continued, to develop a telephone assessment of health literacy.

The issue of measurement for research versus measurement for improvement versus measurement for what might be called accountability was raised by one participant. It is hoped that the comprehensive measure under discussion will have components that can accommodate all needs. It seems important that one identify the various needs for measurement. Pleasant responded that a number of measures, such as the REALM and the TOFHLA, are used. But questions have been raised about their validity and whether they address the scope of health literacy. The way to resolve these issues is to develop a consensus approach to the theory and framework of health literacy and then to develop a new set of measures, based on that consensus, that will fill the needs of a variety of audiences.

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