Health Literacy A Prescription to End Confusion (2004) / Chapter Skim
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2 What Is Health Literacy?
2 What Is Health Literacy?
Pages 31-58
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From page 31... ...
Health literacy skills are needed for dialogue and discussion, reading health information, interpreting charts, making decisions about participating in research studies, using medical tools for personal or familial health care -- such as a peak flow meter or thermometer -- calculating timing or dosage of medicine, or voting on health or environmental issues. This report makes use of the operational definition of health literacy developed for the National Library of Medicine and used by Healthy People 2010: 31
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From page 32... ...
In this report, the committee has captured the range of environments and situations related to health in the term "health context". The health context includes the media, the marketplace, and government agencies, as well as those individuals and materials a person interacts with regarding health -- all must be able to provide basic health information in an appropriate manner (Rudd, 2003)
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From page 33... ...
In this way, they influence how people interact with the health system and help determine the adequacy of health literacy skills in different settings. People know humanity, deal with the world they live in, and understand their place in the universe through cultural processes.
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From page 34... ...
Included are native language, socioeconomic status, gender, race, and ethnicity, along with influences of mass media as represented by news publishing, advertising, marketing, and the plethora of health information sources available through electronic sources. Culture is crucial for understanding, thinking, and responding to human experiences and world events.
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From page 35... ...
Finding 2-1 Literature from a variety of disciplines is consistent in finding that there is strong support for the committee's conclusion that health literacy as defined in this report is based on the interaction of individuals' skills with health contexts, the health-care system, the education system, and broad social and cultural factors at home, at work, and in the community. The committee concurs that responsibility for health literacy improvement must be shared by these various sectors.
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From page 36... ...
Another concept of health literacy is found in the definition used by the Joint Committee on National Health Education Standards: "the capacity of individuals to obtain, interpret and understand basic health information and services and the competence to use such information and services in ways which enhance health" (Joint Committee on National Health Education Standards, 1995)
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From page 37... ...
For our discussion in this report, we further differentiate among the following terms: basic print literacy, literacy for different types of text, and functional literacy. Basic print literacy ability means the ability to read, write, and understand written language that is familiar and for which one has the requisite amount of background knowledge.
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From page 38... ...
Finding 2-3 Health literacy, as defined in this report, includes a variety of skills beyond reading and writing, including numeracy, listening, and speaking, and relies on cultural and conceptual knowledge. Basic Print Literacy As mentioned earlier, basic print literacy ability means the ability to read, write, and understand written language that is familiar and for which
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From page 39... ...
" People who are termed "illiterate" have few, if any, of the skills needed for basic print literacy. The terms "low literate" or "limited" reading skills refer to difficulty with reading and comprehending materials written beyond very simple levels.
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From page 40... ...
This information is often present in a table format that requires special reading skills that many people do not have. An individual's ability to apply his or her literacy skills changes with the challenges of the task (Kirsch, 2001b; Kirsch et al., 1993)
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From page 41... ...
All are applying literacy skills to printed health information. This report uses the term "health contexts" to reflect the many situations and activities relating to health.
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From page 42... ...
42 HEALTH LITERACY TABLE 2-1 Examples of Skills Needed for Health Health-Related Goal Sample Tasks and Skills Needed Promote and protect · read and follow guidelines for physical activity health and prevent · read, comprehend, and make decisions based on food and disease product labels · make sense of air quality reports and modify behavior as needed · find health information on the internet or in periodicals and books Understand, interpret, · analyze risk factors in advertisements for prescription and analyze health medicines information · determine health implications of a newspaper article on air quality · determine which health web sites contain accurate information and which do not · understand the implications of health-related initiatives in order to vote Apply health · determine and adopt guidelines for increased physical information over a activity at an older age variety of life events · read and apply health information regarding childcare or and situations eldercare · read and interpret safety precautions at work; choose a health-care plan Navigate the health- · fill out health insurance enrollment or reimbursement care system forms · understand printed patient rights and responsibilities · find one's way in a complicated environment such as a busy hospital or clinical center Actively participate in · ask for clarification encounters with health- · ask questions care professionals and · make appropriate decisions based on information workers received · work as a partner with care providers to discuss and develop an appropriate regimen to manage a chronic disease Understand and give · comprehend required informed consent documents before consent procedures or for involvement in research studies Understand and · advocate for safety equipment based on worker right-toadvocate for rights know information · request access to information based on patient rights documents · determine use of medical records based on the privacy act · advocate on behalf of others such as the elderly or mentally ill to obtain needed care and services
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From page 43... ...
Literacy assessment has evolved over the years and takes several different forms, resulting in the necessity to interpret and use the results accordingly. Literacy Surveys Assessments of adult literacy conducted since the late 1980s have focused on functional literacy and numeracy as outlined by the National Literacy Act of 1991.1 This act defines literacy as "the ability to read, write, and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one's goals, and develop one's knowledge and potential." This definition was applied to the development of the national assessments of adult literacy in the United States and other industrialized nations.
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, and the International Adult Literacy Survey (IALS) (the initial study was performed in 19941998)
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From page 45... ...
Tasks were further identified by specific characteristics: type of match, type of information requested, plausibility of distracters, type of calculation, and operation specificity. Detailed discussions of how these factors contributed to scoring may be found in the International Adult Literacy Survey: Understanding What Was Measured (Kirsch, 2001b)
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From page 46... ...
For example, if the average score attained by fifth graders in the norm sample on a norm-referenced reading achievement test, taken in the second month of fifth grade, is 75 (out of, say 100) , then the score of 75 will be assigned a grade-level score of 5.2 (fifth year, second month)
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From page 47... ...
Two frequently used assessments that have been described in detail are the Rapid Estimate of Adult Literacy in Medicine (REALM; Davis et al., 1993) and the Test of Functional Health Literacy in Adults (TOFHLA; Parker et al., 1995)
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From page 48... ...
Reading passages were selected from instructions for preparation for an upper gastrointestinal series, the patient "Rights and Responsibilities" section of a Medicaid application, and a standard informed consent form. The numeracy items on the TOFHLA test a patient's ability to understand monitoring blood glucose, keep a clinic appointment, obtain financial assistance, and understand directions for taking medicines using an actual pill bottle.
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From page 49... ...
) do not fully measure all these aspects of literacy because measurements of oral literacy skills (including speech and speech comprehension)
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To this degree, they provide a valid picture of basic print literacy ability within health contexts. While the TOFHLA also includes a measure of numeracy, a full range of text types are not included.
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In addition, no current measures of health literacy include oral communication skills or writing skills and none measure the health literacy demands on individuals within different health contexts. NEEDS AND OPPORTUNITIES Links between socioeconomic status and health outcomes are well established (Adler et al., 1999; Berkman and Kawachi, 2000; Pamuk et al., 1998; Williams, 1990)
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From page 52... ...
This can be accomplished through a national consensus conference, bringing together stakeholders from a wide array of health contexts and researchers in health, education, and psychometrics to address the issue of developing operational measures of health literacy at population levels. Such a conference could build on the work of this committee by adopting the definition recommended here and concentrating on the measurement issues identified by the committee.
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From page 53... ...
NAAL has broadened the representation of health tasks and items in the current survey and the results will include a separate "health literacy score" derived from questions which assess how well adults apply literacy skills to understand health-related materials (National Center for Education Statistics, 2003)
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From page 54... ...
Finding 2-1 Literature from a variety of disciplines is consistent in finding that there is strong support for the committee's conclusion that health literacy, as de fined in this report, is based on the interaction of individuals' skills with health contexts, the health-care system, the education system, and broad social and cul tural factors at home, at work, and in the community. The committee concurs that responsibility for health literacy improvement must be shared by various sectors.
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From page 55... ...
In addition, no current measures of health literacy include oral communication skills or writing skills and none measure the health-literacy demands on individuals within different health contexts. Recommendation 2-1 The Department of Health and Human Services and oth er government and private funders should support research leading to the devel opment of causal models explaining the relationships among health literacy, the education system, the health system, and relevant social and cultural systems.
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From page 56... ...
1992. Assessing Literacy: The Framework for the National Adult Literacy Survey.
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From page 57... ...
2001b. The International Adult Literacy Survey (IALS)
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From page 58... ...
58 HEALTH LITERACY Slosson RJL.
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