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Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

Index

A

AARP, 119, 292–293

ABEL. See Adult basic education and literacy system

Aboriginal people, cultural language of, 114–115

Academy for Educational Development, 153

Academy of General Dentistry, 193

Access to health care and preventive services, 179–180

See also Language access

Accreditation Council for Continuing Medical Education (ACCME), 159

Accreditation of health systems

Joint Commission on Accreditation of Healthcare Organizations, 14, 16, 55, 199, 228

National Committee for Quality Assurance, 14, 16, 55, 199–201, 228, 278

Accreditation of medical education

Accreditation Council for Continuing Medical Education, 159

Ad Hoc Committee on Health Literacy, 36

Adult Basic Education and Literacy (ABEL) system, 10, 154

Adult education system, 154–157

context of, 154–155

incorporating health content into, 156–157

strategies and opportunities in, 155–157

Adult Literacy & Lifeskills Survey (ALL), 62

Adult population groups

percentage with literacy skills at NALS levels 1, 2, or 3-4, 64

percentage with literacy skills at NALS levels 1 or 2, 294

Advertising and marketing

FDA involvement in, 194

a popular source of health information, 123–124

Advocacy organizations, 292

for African-Americans, 294–295

for the elderly, 292–293

for Hispanics, 293–294

prison systems, 296

professional associations, 296–297

social service agencies, 296

African-Americans

advocacy organizations for, 294–295

literacy proficiency among, 63

National Association for the Advancement of Colored People, 294–295

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

National Medical Association, 295

National Urban League, 295

Agency for Healthcare Research and Quality (AHRQ), 14–15, 103, 127, 136, 183, 197, 205, 291

Agency for International Development(AID), 25

Agency roles, 191–201

AHRQ. See Agency for Healthcare Research and Quality

AID. See Agency for International Development

Alaska Natives, literacy proficiency among, 63

ALL. See Adult Literacy & Lifeskills Survey

Alzheimer’s Association of Los Angeles, 135

AMA. See American Medical Association

American Academy of Neurology, 297

American Association of Family Physicians Foundation, 26

American Cancer Society, 119

American Medical Association (AMA), 160, 193

Ad Hoc Committee on Health Literacy, 36, 109

American Public Health Association, 160

Americans with Disabilities Act, 184 n

America’s health literacy

advocacy organizations, 286

employers, 286

governmental and social service agencies, 286–287

insurers, 286

organizations and systems acting to improve, 286–287

Approaches to improving health literacy, 127–137

approaches to increasing language access, 136–137

collaborative programs, 134–136

community opportunities, 127, 132–133

nongovernmental organizations, 134

Asian Health Services, 133

“Ask Me 3” program, 160

Assessment Framework Matrix, 152

Assessment of health literacy, in educational settings, 151–152

Assessments of literacy and health literacy

excerpts from the National Adult Literacy Survey, 308–322

excerpts from the Test of Functional Health Literacy in Adults, 304–307

Rapid Estimate of Adult Literacy in Medicine, 302–303

sample material from selected, 301–322

Association of American Colleges and Universities, 147

Associations of limited health literacy, 6–9, 59–107

associations with health knowledge, behavior, and outcomes, 82–100

financial, 7–8, 100–103

in health knowledge, behavior, and outcomes, 7, 82–100

Attaining Cultural Competency and Enriching Health Service Solutions, 133

Awareness, cultural, 112

B

Background information, 250–254

Basic print literacy, 38–39

Bayer Corporation, 146

Behavior, associations of limited health literacy with, 7, 82–100

Behavioral Health Risk Factor Surveillance System (BHRFSS), 14, 53, 55

BHRFSS. See Behavioral Health Risk Factor Surveillance System

Billie, Alvin, 132

Bolivia, literacy proficiency in, 83

Bridging Disciplines in the Brain: Behavioral and Clinical Sciences, 224

Building Effective AIDS Response initiative, 218

Bureau of Primary Health Care, 197, 219

C

CAHL. See Coalition for Allied Health Leadership

CAHPS. See Consumer Assessment of Health Plans Survey

Calculating literacy, 45

California HealthCare Foundation, 26

California Literacy, Inc., 160

California Medical Association (CMA), 160

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

California Statewide Health Initiative, 160

Canada, literacy in, 61

Capacity, individual, 32

Care delivery, 269

Carmona, Richard H., 136

Carstairs Index, of social deprivation, 88–89

Case studies. See Vignettes

CDC. See Centers for Disease Control and Prevention

Center for Epidemiologic Studies Depression Scale-Short Form, 96–97

Center for Health Services Research and Policy, 200

Center for Linguistic and Cultural Competence in Health Care, 114

Center for Youth Services, 134

Centers for Disease Control and Prevention (CDC), 14–15, 103, 119, 136, 153, 161, 192, 195, 267

Health Communication Division, 218

“Programs-That-Work,” 148

School Health Policies and Programs Study 2000, 143

Task Force on Guidelines for Community Preventative Services, 127

Centers for Medicare & Medicaid Services (CMS), 100n, 135, 193–194

Centro Latino de Salud, Educación y Cultura, 133

Charlson Comorbidity Index, 90–91

Children’s Partnership, 124

Chronic Care Model, 173, 268–271, 274–275, 279

shaping for patients with limited health literacy, 274–277

Chronic disease care and self-management, 171–173

chronic disease management program, 222

model for improvement of, 279

Chronic disease outcomes

community and environmental factors, 274

effect of limited health literacy on, 270–274

home-based monitoring and clinical support, 272–274

office-based clinician–patient communication, 271–272

Civil Rights Act, 184n

Clinician–patient communication, office-based, 271–272

Cloze procedure, 48

CMA. See California Medical Association

CMS. See Centers for Medicare and Medicaid Services

Coalition for Allied Health Leadership (CAHL), 159

Collaborative programs, to improve health literacy, 134–136

College and university health education, 147–148

Combined approaches, to health literacy in the health system, 220–221

Comments, from respondents to surveyors, 227

Commissioned papers and background information, 250–299

approaches to improving health literacy, 250–253

federal funding for health literacy over a 10-year period, 254

field lessons, 250–253

Committee on Comprehensive School Health Programs in Grades K-12, 146

Committee on Health Literacy, 3, 26–27, 243

First Workshop hosted by, 246

Second Workshop hosted by, 248

Third Workshop hosted by, 249

Commonwealth fund, 26

Communication techniques

office-based clinician-patient, 271–272

personal, 219–220

technology-based, 215–218

Community-based interventions, published studies of, 128–133

Community factors

effect on chronic disease outcomes, 274

opportunities to improve health literacy, 127, 132–133

Complexity of health information, 122–123

Components of literacy, 38

Conceptual framework for health literacy, 32–35

culture and society, 33–34

education system, 34–35

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

health system, 35

potential points for intervention in the health literacy framework, 34

Consumer Assessment of Health Plans Survey (CAHPS), 98–99, 200

Consumer-directed health care, 182–183

Context of health systems, 168–201

emerging issues in the health system context, 171–183

health law and health literacy, 183–191

Contexts of health literacy and opportunities for intervention, 9–12

culture and society, 9–10, 108

educational systems, 10–11, 142

health systems, 11–12, 167

Continuing education approaches, to educating health professionals, 159–160

Costs. See Health expenditures

Council of Chief State School Officers, State Collaborative on Assessment and Student Standards, 152

Council of State Governments, 198, 251

CRISP database, 195, 254

Crossing the Quality Chasm: A New Health System for the 21st Century, 12, 26, 177, 228

Cultural competence, 112–113

cultural awareness, 112

cultural encounter, 112

cultural knowledge, 112

cultural skill, 112

Cultural languages, traditional, 114–115

Culture

dissociation of culture, meaning, and health literacy, measures for, 118–119

language and meaning, in the context of health literacy, 115–118

mass culture, 119–126

meaning and language, in the context of health literacy, 115–118

traditional culture, 110–119

Culture and society, 9–10, 108–141

health literacy in, 33–34

mass culture, 119–126

opportunities for intervention in, 9–10, 108

opportunities to improve health literacy, 126–137

traditional culture, 110–119

Curricular approaches, to educating health professionals, 158–159

Curriculum Linking Science Education and Health Literacy program, 146, 153

Cycling literacy, 44

D

Data sources and methods, 243–254

commissioned papers and background information, 250–254

literature review, 243–244

public workshops, 244–249

study committee, 243

Definition of health literacy, 31–37

conceptual framework for health literacy, 32–35

scope of health literacy, 36–37

Definition of literacy, 37–40

basic print literacy, 38–39

components of literacy, 38

functionality of all literacy, 39–40

literacy for different types of text, 39

Demographic associations, with limited literacy, 62–65

Department of Cancer Control and Population Science, Portfolio Management Application software, 254

Disease registries, 269

Document literacy, and sample items from the National Adult Literacy Survey, 312–319

E

“Ecology” of health service organizations, 169

Economic factors, and health, 20–21

Education for health professionals, 157–160

continuing education approaches, 159–160

curricular approaches, 158–159

Educational materials

grade-level measures of, 47

tailored to health literacy in the health system, 221–224

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

Educational Resources Information Center (ERIC), 68, 127, 244

Educational systems, 10–11, 142–166

adult education system, 154–157

education for health professionals, 157–160

health literacy in, 34–35

K-12 and university education systems, 143–154

opportunities for intervention in, 10–11, 142

recommendations, 161

strategies for health literacy instruction, 149–151

Elderly people, advocacy organizations for, 292–293

Emerging issues in the health system context, 171–183

access to health care and preventive services, 179–180

chronic disease care and self-management, 171–173

consumer-directed health care, 182–183

health expenditures, 181–182

limitations on provider time, 180–181

patient–provider communication, 173–175

patient safety and health-care quality, 176–179

Employers, 290–292

Encounters, cultural, 112

England, literacy in, 61

Environmental factors, effect on chronic disease outcomes, 274

Epidemiology of limited health literacy, 65–81

association of limited health literacy, 81–103

and health literacy skills among various populations, 70–81

studies of limited health literacy, 67–69, 80

ERIC. See Educational Resources Information Center

Evidence-based approaches, to improving health literacy, 126–127

Excerpts

from the National Adult Literacy Survey, 308–322

from the Test of Functional Health Literacy in Adults, 304–307

Executive Order No. 13166, “Improving Access to Services for Persons with Limited English Proficiency, August 2000,” 114n

Expenditures. See Health expenditures

Experiential identity, 111

Extent and associations of limited health literacy, 6–9, 59–107

the associations of limited health literacy, 81

the epidemiology of limited health literacy, 65–81

literacy in America, 60–65

mock-up prescription medication instructions in Bahasa Malaysia, the written language of Malaysia, 60

recommendation, 103

F

Family and friends, a popular source of health information, 125

FDA. See Food and Drug Administration

Federal government, 191–198

Agency for Healthcare Research and Quality, 197

Centers for Disease Control and Prevention, 195

Centers for Medicare and Medicaid Services, 193–194

Department of Veterans Affairs, 197–198

Food and Drug Administration, 194–195

funding for health literacy over a 10-year period, 254

Health Resources and Services Administration, 196–197

National Institutes of Health, 195–196

Office of the Secretary, Office of Disease Prevention and Health Promotion, 192–193

Field lessons, 250–253

Financial associations, of limited health literacy, 7–8, 100–103

First Workshop, hosted by the Committee on Health Literacy, 246

Flesch-Kincaid Reading Grade Level, 47

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

Flesch Scale Analysis, 201

Florida/Caribbean AIDS Education and Training Center, 218

Food and Drug Administration (FDA), 192, 194–195

advertising, 194

labeling, 194

outreach, 194

Formulating literacy, 45

Foundation for Accountability, 183

Foundation for Informed Medical Decision Making, 217

Friends, a popular source of health information, 125

Fry Readability Scale, 47, 201

Functional literacy

functionality of all literacy, 39–40

measures of, 49–50

G

Gallup Organization polls, 121, 146

sources of health information reported in, 121

Gathering Place, 132

Generating literacy, 45

Georgia Academy of Family Physicians, 297

Geriatric Depression Scale, 84–85, 88–89

GEs. See Grade Equivalents

Governmental and agency roles, 191–201

roles of regulatory agencies, 199–201

roles of state governments, 198–199

roles of the federal government, 191–198

Grade Equivalents (GEs), 46

for the REALM, 303

Grade-level measures of literacy, 45–47, 50

grade-level ability for individual readers, 46–47

grade-level measures of materials, 47

Gunning Fog index, 50

H

Hablamos Juntos, 114–115

Harvard School of Public Health, 158

HCFA. See Health Care Financing Administration

Health, social and economic factors in, 20–21

Health Assessment Questionnaire, 88–89

Health care

and informed consent in research, 187–190

predicted spending on, 262

quality of, 176–179

Health Care Financing Administration (HCFA), 100, 291

See also Centers for Medicare & Medicaid Services

Health-care settings, interventions in, 206–213

Health Communication Division (CDC), 218

Health content, incorporating into adult education programs, 156–157

Health contexts, literacy skill demands of, 41, 43

Health Education Assessment Project, 152

Health education programs

K-12, 143–146

opportunities for, 148–149

Health expenditures, 181–182

“Health Framework for California’s Public Schools, Kindergarten through Grade Twelve,” 153

Health Information National Trends Survey (HINTS), 121

Health information sources, 123–126

advertising and marketing, 123–124

family and friends, 125

the Internet, 125–126

news media, 123

Health information use, 120–126

complexity of materials, 122–123

selected findings from Sex Matters, 122

sources of health information reported in a Gallup Poll, 121

Health Insurance Portability and Accountability Act of 1996, 192

Health Interview Survey (HIS), 53

“Health is Strength” Project, 133

Health knowledge, associations of limited health literacy with, 7, 82–100

Health law and health literacy, 183–191

doctrine of informed consent, 186–191

governmental and agency roles, 191–201

standard of reasonable care, 184–186

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

Health literacy, 4–6, 31–58

definition of, 31–37

framework for, 33

measures used in health literacy research, 43–51

needs and opportunities, 51–55

new field of inquiry and practice, 20

opportunities to improve, 126–137

as a public concern, 25–26

sample material from selected assessments of, 301–322

Health Literacy, Let Your Patients Understand, 160

Health literacy approaches in the health system, 204–225

combined approaches, 220–221

and in-sample prediction of total costs, 263

partnerships, 224–225

personal communication and education, 219–220

provision of simplified/more attractive written materials, 214–215

tailored materials, 221–224

technology-based communication techniques, 215–218

Health Literacy Coalition, 160

Health Literacy Educational Kit, 160

Health literacy framework, potential points for intervention in, 5, 34

Health literacy instruction, strategies for, 149–151

Health literacy measures, 50–51

Health literacy-related activities, frequency of doing, 203

Health literacy skills

among various populations, epidemiology of, 70–81

health-related associations of, 84–99

Health-literate America, vision for, 12–14, 240–242

Health on the Net Foundation Code of Conduct, 273

Health Professions Network, 159

Health-related associations, of health literacy skills, 84–99

Health Resources and Services Administration (HRSA), 14–15, 103, 136, 161, 196–197, 218–219, 226

Bureau of Primary Health Care, 219

Health service organizations, ecology of, 169

Health systems, 11–12, 167–239

context of, 168–201

emerging issues in, 171–183

health literacy in, 35

Joint Commission on Accreditation of Healthcare Organzations, 14, 16, 55, 199, 228

National Committee for Quality Assurance, 14, 16, 55, 199–201, 228, 278

navigating, 172

opportunities in, 11–12, 167, 201–227

Healthcare processes, rules for redesigning, 178

Healthy People 2010 program, 4, 25, 31, 36–37, 125, 149, 192–193

“Healthy Reading Kits,” 153

Helling v. Carey, 186

HHS. See U.S. Department of Health and Human Services

Hidding v. Williams, 190

HINTS. See Health Information National Trends Survey

HIS. See Health Interview Survey

Hispanics

advocacy organizations for, 293–294

cultural language of, 116–118

literacy proficiency among, 63

Mexican American Legal Defense and Educational Fund, 293

National Council of La Raza, 293

National Hispanic Medical Association, 293–294

HIV/AIDS Bureau, 197, 218

Home-based monitoring and clinical support, effect on chronic disease outcomes, 272–274

Ho’oponopono process, 175

Hospital Anxiety and Depression Scale, 88–89

Howard, David H., 8, 101, 256–266

HRSA. See Health Resources and Services Administration

I

IALS. See International Adult Literacy Surveys

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

IDL. See Instrument for Diagnosis of Reading/Instrumento Para Diagnostical Lecturas

“Improving Access to Services for Persons with Limited English Proficiency, August 2000,” 114n

“Improving Chronic Disease Care for Populations with Limited Health Literacy,” 171n, 267–284

Chronic Care Model, 268–270

effect of limited health literacy on chronic disease outcomes, 270–274

a framework based on health literacy and related research, 271

measuring progress, 277–278

shaping the chronic care model for patients with limited health literacy, 274–277

Improving Diabetes Efforts across Language and Literacy project, 218

Improving health literacy

collaborative programs, 134–136

combined approaches, 220–221

community-based interventions, 128–133

community opportunities, 127, 132–133

lessons from the field, 250–253

nongovernmental organizations, 134

promising approaches to, 127–137

Incollingo v. Ewing, 185

Increasing language access, approaches to, 136–137

Indian Health Service, 15, 136

Individual capacity, 32

Inflexxion® Incorporated, 153

Informed consent, 186–191

consent form, for participation in smoking cessation study, 216

difference between actual readability and target readability ofdocuments, 188–189

in health care and research, 187–190

legal precedents, 190–191

texts provided by institutional review boards at U.S. medical schools, 188

Institute for Healthcare Advancement, 134

Institute for Policy Innovation, 124

Institute of Medicine (IOM), 3, 9, 12–13, 20–21, 25, 101, 111, 115, 117, 168–169, 197, 224, 240, 244

Committee on Comprehensive School Health Programs in Grades K-12, 146

Institutional Review Boards, 16

Instrument for Diagnosis of Reading/Instrumento Para Diagnostical Lecturas (IDL), 47, 65, 78–79, 100

Insurers, 285–290

Medicaid, 288–290

Medicare, 285, 287–288

Tricare, 285, 290

Integrating literacy, 44

Interagency Education Research Initiative, 15, 150–151, 161

International Adult Literacy Surveys (IALS), 6, 45, 49, 52, 61

International Reading Association, 50

Internet, 119

a popular source of health information, 125–126

Intervention in the health literacy framework

opportunities for, 9–12

potential points for, 5, 34

samples of published studies of, 206–213

IOM. See Institute of Medicine

Iowa Medical Society, 297

Ireland, literacy in, 61

J

JCAHO. See Joint Commission on Accreditation of Healthcare Organizations

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 14, 16, 55, 199, 228

Joint Committee on National Health Standards, 11, 36, 144

Journal of the American Medical Association, 119

K

K-12 education, 143–147

health education programs, 143–146

literacy education, 147

science education, 146

Kellogg Foundation, 26

Knowledge, cultural, 112

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

L

Labeling, FDA involvement in, 194

Language

and meaning, in the context of health, 115–118

patient perspectives and, 117–118

traditional, 113–114

Language access, approaches to increasing, 136–137

“Language Access: Helping Non-English Speakers Navigate Health and Human Services,” excerpt from introduction to, 136

Legal issues

doctrine of informed consent, 186–191

governmental and agency roles, 191–201

standard of reasonable care, 184–186

Legal precedents, 190–191

LEP. See Limited English proficiency

Limitations of existing measures of health literacy, 49–51

functional literacy measures, 49–50

grade-level scores, 50

health literacy measures, 50–51

Limitations on provider time, 180–181

Limited English proficiency (LEP), 113–114

Limited health literacy, 6–9, 59–107

associations of, 7, 81–103

financial associations of, 7–8

studies of, 67–69, 80

Limited health literacy’s effect on chronic disease outcomes, 270–274

community and environmental factors, 274

home-based monitoring and clinical support, 272–274

office-based clinician-patient communication, 271–272

Limited literacy, demographic associations with, 62–65

Literacy

components of, 38

for different types of text, 39

examples of skills needed for health, 42

in health contexts, 41–43

literacy skill demands of health contexts, 41, 43

living in a society with high demands for, 21–25

sample material from selected assessments of, 301–322

Literacy education, K-12, 147

Literacy in America, 60–65

demographic associations with limited literacy, 62–65

extent and associations of, 60–65

Literacy surveys, 43–45

calculating, 45

cycling, 44

formulating, 45

generating, 45

integrating, 44

locating, 44

Literature review, 243–244

Locating literacy, 44

M

Maintenance-of-Effort (MOE) funds, 135

Managed Care Consumer Assistance Program (MCCAP), 134

Managed care contracts, state Medicaid, 200–201

Marketing health information, 123–124

Mass culture, 119–126

advertising and marketing, 123–124

family and friends, 125

Internet, 125–126

news media, 123

ways people obtain and use health information, 120–126

Materials

grade-level measures of, 47

tailored to health literacy in the health system, 221–224

Maternal and Child Health Bureau, 197

MBS. See Medicare Beneficiaries Survey

MCCAP. See Managed Care Consumer Assistance Program

MDI. See Metered dose inhaler technique

Meaning and language, in the context of health, 115–118

Measures used in health literacy research, 43–51

grade-level measures of literacy, 45–47

limitations of existing measures, 49–51

literacy surveys, 43–45

measures of health literacy, 47–49

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

Media Smart Youth”, 153

Medicaid, 15, 48, 65, 135, 274, 288–290

Arizona enrollees, 100

state managed care contracts, 200–201

Medicaid Health Plan Employer Data and Information Set, 277

Medical Expenditure Panel Survey(MEPS), 14, 53, 55

Medicare, 15–16, 83, 102, 228, 274, 285, 287–288

federal spending for, 285, 288

numbers of enrollees in, 287

predicted expenditures on, 289

Medicare Beneficiaries Survey (MBS), 14, 53, 55

Medline, 68, 127, 244

MEPS. See Medical Expenditure Panel Survey

Metered dose inhaler (MDI) technique, 98–99

Metlife Foundation, 26

Mexican American Legal Defense and Educational Fund, 293

Migrant Health Centers, 219

Mini-Mental State Examination (MMSE), 84–85

MMSE. See Mini-Mental State Examination

MOE. See Maintenance-of-Effort funds

Molina Healthcare, 134

Morocco, literacy proficiency in, 83

N

NAACP. See National Association for the Advancement of Colored People

NAAL. See National Assessment of Adult Literacy

NALS. See National Adult Literacy Survey

National Adult Literacy Survey (NALS), 6, 25, 44, 49–50, 52–53, 60–67, 80, 100, 102, 120, 154, 274, 288, 297

article “Swimmer completes Manhattan marathon” used in, 309

bank deposit slip used in, 320

bus schedule used in, 318

discrimination article used in, 311

document literacy and sample items, 312–319

energy chart used in, 317

excerpts from, 308–322

home equity loan advertisement used in, 322

job application used in, 314

Korean jet article used in, 313

Level 1, 8, 10, 45, 61–65, 100, 102, 120, 123

Level 2, 8, 10, 45, 61–64, 102, 120

Level 3, 10, 45, 120

Level 4, 45, 61

Level 5, 61, 123

peanut butter label used in, 321

prose literacy and sample items, 308–312

quantitative literacy and sample items, 319–322

sales graph used in, 316

wage and tax statement used in, 315

National Assessment of Adult Literacy (NAAL), 14, 49, 53, 55, 62

National Association for the Advancement of Colored People (NAACP), 294–295

National Cancer Institute (NCI), 26, 121, 153, 215, 254

National Center for Education Statistics, 193, 292

National Center for Health Promotion and Disease Prevention (NCP), 197

National Center for Research Resources, 153

National Center for the Study of Adult Learning and Literacy (NCSALL), 155–156

National Committee for Quality Assurance (NCQA), 14, 16, 55, 199–201, 228, 278

National Conference of State Legislatures’ Children’s Policy Initiative, 136

National Council of La Raza, 293

National Council on the Aging, 160

National Health Education Standards: Achieving Health Literacy (NHES), 11, 15, 143–145, 152, 161

National Health Objectives, 148

National Hispanic Medical Association, 293–294

National Immunization Program, 195

National Institute for Literacy (NIFL), 155, 251

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

National Institute for Occupational Safety and Health, 195

National Institute of Child Health and Human Development (NICHD), 15, 147, 161, 196

National Institute of Environmental Health Sciences, 196

National Institutes of Health (NIH), 14, 16, 52, 55, 103, 119, 195–196, 229

Department of Cancer Control and Population Science, 254

grant funding over the 1997–2002 period, 196

National Library of Medicine, 4, 31, 119

National Literacy Act of 1991, 43

National Medical Association, 112n, 295

National Network of Health Career Programs in Two Year Colleges, 159

National Research Council (NRC), 147

National Science Foundation, 15, 150–151, 161

National Science Teachers Association, 146, 150

National Standards to Protect the Privacy of Personal Health Information, 192

National Survey on Health Literacy Initiatives, 198

National Urban League, 295

National Youth Anti-Drug Media Campaign, 124

Native Americans

cultural language of, 114–115

literacy proficiency among, 63

Native Hawaiians, understanding of healing, 175

NCI. See National Cancer Institute

NCP. See National Center for Health Promotion and Disease Prevention

NCQA. See National Committee for Quality Assurance

NCSALL. See National Center for the Study of Adult Learning and Literacy

News media, a popular source of health information, 123

NHES. See National Health Education Standards: Achieving Health Literacy

NICHD. See National Institute of Child Health and Human Development

NIFL. See National Institute for Literacy

NIH. See National Institutes of Health

No Child Left Behind legislation, 147

Nongovernmental organizations, opportunities to improve health literacy, 134

Northwest AIDS Education and Training Center, 218

NRC. See National Research Council

Numeracy, sample items from the Test of Functional Health Literacy in Adults, 304–305

O

Office-based clinician–patient communication, effect on chronic disease outcomes, 271–272

Office of Civil Rights, 135

National Standards to Protect the Privacy of Personal Health Information, 192

Office of Disease Prevention and Health Promotion (OPHP), 192–193

Office of Minority Health, 14, 136

Center for Linguistic and Cultural Competence in Health Care, 114

Office of National Drug Control Policy, National Youth Anti-Drug Media Campaign, 124

Office of the Secretary, Office of Disease Prevention and Health Promotion, 192–193

Office of Vocational and Adult Education, 15, 154–155

OPHP. See Office of Disease Prevention and Health Promotion

Opportunities to improve health literacy in health systems, 201–227

approaches to health literacy in the health system, 204–225

evidence-based approaches, 126–127

other promising approaches, 127–137

overview of current efforts, 202–204

recommendations, 228–229

summary of approaches, 226–227

Organization for Economic Co-operation and Development, 61

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

Organizations, acting to improve America’s health literacy, 286–287

Outcomes, associations of limited health literacy with, 7, 82–100

Outreach, FDA involvement in, 194

“Outside the Clinician–Patient Relationship—A Call to Action for Health Literacy,” 63n, 285–299

advocacy organizations, 292

employers, 290–292

insurers, 285–290

OVID web gateway, 68

P

Pacific Islanders, literacy proficiency among, 63

Pakistan, literacy proficiency in, 83, 100

Partnership for Clear Health Communication, 160

Partnerships, for health literacy in the health system, 224–225

Patient-centered approach, 179

Patient Navigator Program, 220

Patient perspectives, and language, 117–118

Patient–provider communication, 173–175

Patient safety and health-care quality, 176–179

Peabody Individual Achievement Test-Revised, 48

People’s finding and using health information, 120–126

Percentiles, 46

Pfizer Corporation, 26, 160, 214

Pictograms for patient education, examples of, 215

“Plain Talk,” 134

Popular sources of health information, 123–126

advertising and marketing, 123–124

family and friends, 125

the Internet, 125–126

news media, 123

Portfolio Management Application software, 254

Prescription medication instructions, in Bahasa Malaysia, mock-up of, 60

Priority Areas for National Action in Quality Improvement, 13, 26, 168–169, 240

Prison systems, as advocacy organizations, 296

Private sector, national totals for enrollees and cost of hospitalization and physician service health plans for United States, 2000, 291

Professional associations, as advocacy organizations, 296–297

Program for Appropriate Technology in Health, 134

“Programs-That-Work,” 148

Progress, measuring, 277–278

Project Toolbox, description of, 223

ProLiteracy America, 296

Promoting Health: Intervention Strategies from Social and Behavioral Research, 111

Prose literacy, and sample items from the National Adult Literacy Survey, 308–312

Prudential Medicare HMO, 256

PsychInfo, 127, 244

PT Tool, 223–224

Public concern, health literacy as, 25–26

Public workshops, 244–249

Published studies of community-based interventions, examples of, 128–133

Q

Quality Chasm Report. See Crossing the Quality Chasm: A New Health System for the 21st Century

Quantitative literacy, and sample items from the National Adult Literacy Survey, 319–322

R

Race, and literacy proficiency, 63

Rapid Estimate of Adult Literacy in Medicine (REALM)©, 47–51, 66–68, 70–73, 76–79, 81–89, 92–95, 98–100, 195, 219, 302–303

scores and grade equivalents for, 303

Readability, of informed consent documents, 189

Reading comprehension, sample items from the Test of Functional Health Literacy in Adults, 305–307

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

REALM. See Rapid Estimate of Adult Literacy in Medicine

Reasonable care, standard of, 184–186

Recommendations, 14–16

for development of conceptual frameworks, 137

for educational systems, 161

for extent and associations of limited health literacy, 103

for health literacy, 55

for opportunities in health systems, 228–229

Redesigning healthcare processes, rules for, 178

Regulatory agencies, 199–201

Joint Commission on Accreditation of Healthcare Organizations, 199

National Committee for Quality Assurance, 199–201

“Relationship Between Health Literacy and Medical Costs,” 101n, 256–266

data description, 256–259

discussion, 263–264

results, 261–263

statistical analysis, 260–261

Robert Wood Johnson Foundation, 26, 116

Roles

of the federal government, 191–198

of regulatory agencies, 199–201

of state governments, 198–199

Roosevelt, Eleanor, 1

S

S-TOFHLA. See Short Test of Functional Health Literacy in Adults

Scandinavian countries, literacy in, 61

SCASS. See State Collaborative on Assessment and Student Standards

Schillinger, Dean, 267–284

SCHIP. See State Children’s Health Insurance Program

School Health Education Profiles Study, 145

School Health Policies and Programs Study 2000, 143

Science education, K-12, 146

Scores, for the REALM, 303

Second Workshop, hosted by the Committee on Health Literacy, 248

Self-management educational activities, 269

Sex Matters, 121–122

selected findings about the way people obtain and use health information, 122

SF-12. See Short Form-12 Health Survey

Shaw, George Bernard, 267

“Shima Yazhi” lay health program, 132

Short Form-12 Health Survey (SF-12), 84–85, 90–91, 259–261

Short Test of Functional Health Literacy in Adults (S-TOFHLA), 49, 66, 68–69, 72–73, 76–79, 81, 83–85, 88–89, 96–99, 101, 219, 256–258, 272

Simplified Measure of Gobbledygook (SMOG), 47, 201

Simplified/more attractive written materials, to improve health literacy in the health system, 214–215

Skill

cultural, 112

needed for health, 42

Slosson Oral Reading Test-Revised, 48

SMOG. See Simplified Measure of Gobbledygook

Social factors, and health, 20–21

Social service agencies, as advocacy organizations, 296

Society

culture and, 9–10, 108–141

health literacy framework, 5, 34

opportunities for intervention in, 9–10, 108

Sociological Abstracts, 68, 127, 244

Sources of health information, 123–126

advertising and marketing, 123–124

family and friends, 125

the Internet, 125–126

news media, 123

Speaking of Health, 20, 112, 217, 221

Standard of reasonable care, 184–186

Standard scores, 46

Stanines, 46

State Children’s Health Insurance Program (SCHIP), 135

State Collaborative on Assessment and Student Standards (SCASS), 152

Assessment Framework Matrix, 152

Health Education Assessment Project, 152

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
×

State Medicaid managed care contracts, 200–201

State Officials Guide to Health Literacy, The, 152, 198

Strategies and opportunities, in the adult education system, 155–157

Strategies and opportunities in K-12 and university systems, 148–154

assessment of health literacy in educational settings, 151–152

examples of current approaches, 152–154

opportunities for health education programs, 148–149

strategies for health literacy instruction, 149–151

Substance Abuse and Mental Health Services Administration, 15, 136

Survey of Income and Program Participation, 100

Surveys

representatives of the study sample, 257

respondents to survey, comments from, 227

T

TANF. See Temporary Assistance for Needy Families

Target readability, of informed consent documents, 189

Task Force on Guidelines for Community Preventative Services, 127, 267

Technology-based communication techniques

examples of ongoing approaches using, 218

and health literacy in the health system, 215–218

Temporary Assistance for Needy Families (TANF), 135

Test of Functional Health Literacy in Adults (TOFHLA), 8, 47–51, 68–71, 74–87, 90–95, 98–99, 101

abbreviated version, 74–75

excerpts from, 304–307

numeracy, sample items, 304–305

prompts for, 304–305

reading comprehension, sample items, 305–307

See also Short Test of Functional Health Literacy in Adults

TEXT study, 150–151

Third Workshop, hosted by the Committee on Health Literacy, 249

To Err Is Human: Building a Safer Health System, 25, 173, 176

TOFHLA. See Test of Functional Health Literacy in Adults

Traditional culture, 110–119

cultural languages, 114–115

language, 113–114

language and meaning in the context of health, 115–118

measures able to dissociate culture, meaning, and health literacy, 118–119

Tricare, 285, 290

U

Unequal Treatment, 136

University health education, 147–148

University of Colorado Medical School, 158

University of Virginia (UVA) School of Medicine, 158–159

U.S. Census, 108

U.S. Department of Defense, 14–15, 103

U.S. Department of Education, 15, 154–155, 161

National Center for Education Statistics, 193

Office of Vocational and Adult Education, 15, 154–155

U.S. Department of Health and Human Services (HHS), 2, 14, 16, 20, 25, 55, 103, 119, 149, 181, 193, 228

National Standards for Culturally and Linguistically Appropriate Services in Health Care, 109

Office for Civil Rights, 135

Office of the Actuary, 181n

Task Force on Community Preventive Services, 267

U.S. Department of Labor, survey by, 44

U.S. Department of Veterans Affairs (VA), 197–198

National Center for Health Promotion and Disease Prevention, 197

U.S. Pharmacopeial Convention, Inc. (USP), 215

Suggested Citation:"Index." Institute of Medicine. 2004. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. doi: 10.17226/10883.
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U.S. Surgeon General, 13, 142, 240–241

Use of health information, 120–126

complexity of materials, 122–123

popular sources of health information, 123–126

selected findings from Sex Matters, 122

sources of health information reported in a Gallup Poll, 121

USP. See U.S. Pharmacopeial Convention, Inc.

UVA. See University of Virginia

V

VA. See U.S. Department of Veterans Affairs

Veterans Administration, 14–15, 49, 103

Vignettes, 1, 3, 9, 19, 22, 31, 40, 67, 101, 108, 115–116, 167–168, 175, 177, 190, 227, 240

Virginia Medical Society, 297

Visual medicine schedule (VMS), 223

VMS. See Visual medicine schedule

W

Wagner, Ed, 269

Web-based survey, response to, 251

Weiss, Barry D., 285–299

What to Do for Health, 134

WHO. See World Health Organization

“Who’s in the Driver’s Seat? Increasing Consumer Involvement in Health Care,” 183

Wide Range Achievement Test-Revised (WRAT-R), 47–48, 72–73, 123

Women’s Health Initiative, 43

Workforce Investment Act, 154

Workshops, hosted by the Committee on Health Literacy, 246–249

World Bank, 83

World Health Organization (WHO), 25, 145

WRAT-R. See Wide Range Achievement Test-Revised

Written materials, simplified/more attractive, 214–215

Y

Young Adult Literacy Survey, 44

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To maintain their own health and the health of their families and communities, consumers rely heavily on the health information that is available to them. This information is at the core of the partnerships that patients and their families forge with today’s complex modern health systems. This information may be provided in a variety of forms – ranging from a discussion between a patient and a health care provider to a health promotion advertisement, a consent form, or one of many other forms of health communication common in our society. Yet millions of Americans cannot understand or act upon this information. To address this problem, the field of health literacy brings together research and practice from diverse fields including education, health services, and social and cultural sciences, and the many organizations whose actions can improve or impede health literacy.

Health Literacy: Prescription to End Confusion examines the body of knowledge that applies to the field of health literacy, and recommends actions to promote a health literate society. By examining the extent of limited health literacy and the ways to improve it, we can improve the health of individuals and populations.

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