Index
A
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
financial associations of, 7–8
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
“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
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
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 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
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
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
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
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
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
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
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
