Research Briefs on Adult Literacy. No. 1: Measuring health literacy: A challenge to curriculum design and evaluation

This is the first in a new series of research briefs that will focus on questions that currently preoccupy practitioners and policymakers in adult literacy. This brief on health literacy measurement will also be of special interest to health care providers, educators and curriculum designers, and policy people across the spectrum of health care.

The goal of the series is to review current knowledge and offer a critical perspective on topics that can inform better literacy practice and policy across diverse contexts.

The Centre for Literacy of Quebec supports international dialogue on key issues related to literacy among researchers, practitioners and policymakers.

Not long ago, a conference on health literacy curriculum development might have drawn an audience you could count on the fingers of one hand. In October 2008, The Centre for Literacy of Quebec and Bow Valley College (Calgary), with support from the Canadian Council on Learning’s Health and Learning Knowledge Centre, co-sponsored an institute on this topic that gathered nearly fifty attendees for three days. That level of engaged participation reflects the growing interest in health literacy and in developing curricula for health care providers and for the general public. However, developing curriculum without accompanying evaluation plans is like starting a race without a finish line, and current measures of health literacy are not up to the task of evaluating curriculum. This research brief critically reviews the literature on health literacy measures and proposes a future direction.

While many health literacy curricula identify health literacy as more than the ability to read health information, current measures of health literacy test only a narrow range of reading and, occasionally, numeracy skills (Agre et al. 2006; Kwan et al. 2006; Rogers et al. 2001; Schillinger & Davis, 2005; Simonds, 1974; Zarcadoolas et al. 2005, 2006).

Existing health literacy measures include various versions of the Rapid Estimate of Adult Literacy in Medicine (REALM), the Test of Functional Health Literacy in Adults (TOFHLA), a single-item screener, three screening questions, Health Activities Literacy Scale (HALS), Newest Vital Sign (NVS), Stieglitz Informal Reading Assessment of Cancer Text (SIRACT), Medical Achievement Reading Test (MART),

Literacy Assessment for Diabetes (LAD), and the Short Assessment of Health Literacy for Spanishspeaking Adults (SAHLSA). New ones are appearing. For instance in the United States alone, the Agency for Healthcare Research and Quality (AHRQ) is preparing a “health literacy item set” for the Consumer Assessment of Healthcare Providers and Systems surveys (AHRQ, 2007), the 2003 National Assessment of Adult Literacy (NAAL) included a health literacy assessment, and the Joint Commission is starting to develop health literacy standards as part of its hospital accreditation process.

Despite the number of assessment tools, there seems to be an emerging consensus that the field currently lacks a comprehensive measure of health literacy (Baker, 2006).