in the saying, “What gets measured gets done.” This is very important. To develop interventions that improve health literacy means that health literacy has to be measured. There is a developing science for health literacy, but it is not yet robust. One might think of health literacy as one thinks of medicine. Medicine may be a science, but it is practiced as an art. That is what needs to happen with health literacy. There must be a science of health literacy, but it must be artfully practiced.

One must align skills and abilities with the demands and complexity of the system. When that is accomplished, one has health literacy (see Figure 6-1).

What is known about measures of skills and abilities? Measures of individual skills and abilities such as the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Test of Functional Health Literacy in Adults (TOFHLA) are used to describe prevalence and association. These measures have been around for more than 15 years. But measures at the community level, such as the geocoding measures presented earlier by Lurie, are new and exciting. Such community-based modeling allows one to take a population health approach to the measurement of skills and abilities and the development of interventions. With such measures, one can identify areas of greatest need and align resources with those needs at the population level.

Other measures are used to determine the demands and complexity of the system. More than 300 studies have documented that health material demand exceeds the ability of those who need to use the material. The new Consumer Assessment of Healthcare Providers and Systems

FIGURE 6-1 Health literacy framework.

FIGURE 6-1 Health literacy framework.

SOURCE: Parker, 2009.

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