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Measures of Health Literacy: Workshop Summary (2009)

Chapter: Front Matter

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

MEASURES OF HEALTH LITERACY

WORKSHOP SUMMARY

Lyla M. Hernandez, Rapporteur

Roundtable on Health Literacy

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

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

THE NATIONAL ACADEMIES PRESS

500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This study was supported by contracts between the National Academy of Sciences and the Academy for Educational Development (Unnumbered Award); Affinity Health Plan (Unnumbered Award); American Academy of Family Physicians (Unnumbered Award); Johnson & Johnson (Unnumbered Award); Kaiser Permanente (Unnumbered Award); Merck & Co., Inc. (Unnumbered Award); Missouri Foundation for Health (08-048-HL-8); and U.S. Department of Health and Human Services (N01-OD-4-2139, TO#148). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

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Suggested citation: IOM (Institute of Medicine). 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press.

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

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES


Advising the Nation. Improving Health.

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

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.


www.national-academies.org

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

MEMBERS OF THE PLANNING GROUP FOR THE WORKSHOP ON MEASURES OF HEALTH LITERACY

CINDY BRACH, Senior Health Policy Researcher,

Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality

CAROLYN COCOTAS, Senior Vice President,

Quality and Corporate Compliance, F.E.G.S. Health and Human Services System

DEBBIE FRITZ, Director,

Policy and Standards, Health Management Innovations Division, GlaxoSmithKline

RUTH PARKER, Professor of Medicine,

Emory University School of Medicine

TERRI TYE, Director of Public Affairs,

The Joint Commission

IOM planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

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

ROUNDTABLE ON HEALTH LITERACY

GEORGE ISHAM (Chair), Medical Director and Chief Health Officer,

HealthPartners

SHARON E. BARRETT, Health Literacy Staff Consultant,

Association of Clinicians for the Underserved

CINDY BRACH, Senior Health Policy Researcher,

Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality

CAROLYN COCOTAS, Senior Vice President,

Quality and Corporate Compliance, F.E.G.S. Health and Human Services System

MICHAEL L. DAVIS, Senior Vice President,

Human Resources, General Mills, Inc.

BENARD P. DREYER, Professor of Pediatrics,

New York University School of Medicine, and

Chair,

American Academy of Pediatrics Health Literacy Program Advisory Committee

DEBBIE FRITZ, Director,

Policy and Standards, Health Management Innovations Division, GlaxoSmithKline

MELODY GOLLER, Health Education Manager,

Scientific Activities Division, American Academy of Family Physicians Foundation

MARTHA GRAGG, Vice President of Program,

Missouri Foundation for Health

LINDA HARRIS, Team Leader,

Health Communication and eHealth Team, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services

BETSY L. HUMPHREYS, Deputy Director,

National Library of Medicine, National Institutes of Health

TERRIS KING, Deputy Director,

Office of Clinical Standards and Quality, Centers for Medicare & Medicaid Services

JEAN KRAUSE, Executive Vice President and CEO,

American College of Physicians Foundation

MARGARET LOVELAND,

Global Medical Affairs, Merck & Co., Inc.

DENNIS MILNE, Vice President of American Stroke Association and Patient Education,

American Heart Association

RUTH PARKER, Professor of Medicine,

Emory University School of Medicine

YOLANDA PARTIDA, Director,

National Program Office, Hablamos Juntos, University of California, San Francisco, Fresno Center for Medical Education & Research

IOM forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

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

SCOTT C. RATZAN, Vice President,

Global Health, Johnson & Johnson

KYU BAK LOUIS RHEE, Director,

Office of Innovation and Program Coordination, National Center on Minority Health and Health Disparities, National Institutes of Health

WILL ROSS, Associate Dean for Diversity, Associate Professor of Medicine,

Washington University School of Medicine

WILLIAM SMITH, Senior Scientist and Director,

Academy for Educational Development

AMY WILSON-STRONKS, Project Director,

Division of Standards and Survey Methods, and

Principal Investigator,

Hospitals, Language, and Culture Study, The Joint Commission

WINSTON F. WONG, Medical Director,

Community Benefit, Disparities Improvement and Quality Initiatives, Kaiser Permanente

SABRA WOOLLEY, Program Director,

Health Communication and Informatics Branch, National Cancer Institute

Study Staff

LYLA M. HERNANDEZ, Senior Program Officer

ERIN HAMMERS, Research Associate

ERIN RUSCH, Research Assistant

ROSE MARIE MARTINEZ, Director,

Board on Population Health and Public Health Practice

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

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:


Benard Dreyer, New York University School of Medicine

Crystal Duran, Cultural & Linguistics Unit, CIGNA

Jean Krause, American College of Physicians Foundation

Rima Rudd, Harvard School of Public Health


Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Harold J. Fallon, School of Medicine, University of Alabama at Birmingham. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
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Suggested Citation:"Front Matter." Institute of Medicine. 2009. Measures of Health Literacy: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12690.
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in memoriam


This workshop summary is dedicated to Dr. Sabra Woolley, an accomplished researcher and advocate in the field of health communication, health literacy, and health disparities, a valued sponsor and founding member of the Roundtable on Health Literacy, and an irreplaceable colleague and friend.

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

The sponsors of the Institute of Medicine Roundtable on Health Literacy made it possible to plan and conduct the workshop, Measures of Health Literacy. Sponsors from the U.S. Department of Health and Human Services are the Health Resources and Services Administration, the Office of Disease Prevention and Health Promotion, and the National Cancer Institute. Non-federal sponsorship was provided by the Academy for Educational Development, Affinity Health Plan, American Academy of Family Physicians, Johnson & Johnson, Kaiser Permanente, Merck & Co., Inc., and the Missouri Foundation for Health.

The Roundtable wishes to express its appreciation to the expert speakers whose presentations illuminated the ongoing work in developing measures of health literacy. These speakers were Marin Allen, Lisa Chew, Carolyn Clancy, John DuMoulin, Julie Gazmararian, Elizabeth Hahn, Amresh Hanchate, Nicole Lurie, Kathleen Mazor, Lauren McCormack, Ruth Parker, Andrew Pleasant, Sandra Smith, Beverly Weidmer Ocampo, Barry Weiss, and Amy Wilson-Stronks.

The Roundtable also wishes to thank the planning committee members for their work in developing an excellent workshop agenda. Members of the planning committee were Cindy Brach, Carolyn Cocotas, Debbie Fritz, Ruth Parker, and Terri Tye. Thanks also go to Cindy Brach, Carolyn Cocotas, and George Isham for moderating the workshop.

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

3-1

 

Characteristics of Pilot Test Participants,

 

39

4-1

 

Association (Odds Ratio) of Inadequate Literacy with Self-Reported Health and Chronic Conditions (Comparing NHIS 1997),

 

65

4-2

 

Association (Odds Ratio) of Inadequate Literacy with Self-Reported Health and Chronic Conditions (Comparing HRS),

 

65

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

2-1

 

Causal pathways between limited health literacy and health outcomes,

 

6

2-2

 

Conceptual model of the relationship among individual capacities, health-related print and oral literacy, and health outcomes,

 

8

2-3

 

Health care system and patients/public,

 

19

3-1

 

Conceptual framework for individual health literacy,

 

31

3-2

 

Signs of a stroke,

 

33

3-3

 

Caution symbols on medication bottles,

 

33

3-4

 

Item response theory,

 

35

3-5

 

Prose item,

 

37

3-6

 

Medications for Mr. Beta,

 

37

3-7

 

Sample body mass index chart,

 

38

3-8

 

Receiver Operating Characteristic curves for detecting limited health literacy,

 

46

3-9

 

Functional Healthcare Literacy Scale,

 

52

3-10

 

Functional Selfcare Literacy Scale,

 

52

3-11

 

Home visitation promotes parental functional health literacy,

 

53

4-1

 

Results: Comparison of S-TOFHLA and DAHL scores,

 

64

4-2

 

Mean health literacy by Public Use Microdata Area (PUMA) for Missouri,

 

68

4-3

 

Model and single variable estimates produce different area-level estimates,

 

69

5-1

 

Operating funds allocated to cultural and linguistic services,

 

85

6-1

 

Health literacy framework,

 

92

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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.

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