9 out of 10 adults may lack the skills needed to manage their health and prevent disease. Hispanic adults were 4.5 times more likely than white adults to have below-basic health literacy, and African American, American Indian, and Alaskan Native adults were nearly 3 times more likely than white adults to have below-basic health literacy (AHRQ, 2007).
Health literacy is defined as “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). This definition focuses on individual capability, although it does imply needed skills.
In the conceptual model shown in Figure 2-1, developed by Paasche-Orlow and Wolf (2007), health literacy, which is affected by sociodemographic characteristics as well as cognitive and physical abilities, is a determinant of health outcomes. As a determinant, health literacy affects a person’s ability to access and use health care, to interact with providers, and to care for himself or herself. Health literacy measurement has generally followed this model, focusing on measuring an individual’s capabili-