Measures of Health Literacy Workshop Summary (2009) / Chapter Skim
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3 Approaches to Assessing Health Literacy
3 Approaches to Assessing Health Literacy
Pages 29-60
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From page 29... ...
Specific project tasks include developing a conceptual framework, developing health literacy items, cognitively testing these items, pilot testing the items in a survey, and conducting psychometric analyses of the pilot data. As discussed previously, existing measures of health literacy have limitations.
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. Thus, the literature review supports an increasing recognition of the importance of context and setting when assessing health literacy.
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RESOURCES Information Seeking (navigation) Community Family Culture HEALTH INDIVIDUAL/PATIENT RELATED UNDERSTANDING HEALTH RELATED MODERATORS OUTCOMES OF STIMULUS STIMULUS Media Health Care Provider Health Care CAPABILITIES System PRIOR KNOWLEDGE CONSTRUCTS DEMOGRAPHICS: age, race, ethnicity, income, gender HEALTH RELATED STIMULUS: educational brochure, conversation with doctor STIMULUS CONSIDERATIONS RESOURCES: occupation, employment, income, social s upport, culture, language, education, literacy Health literacy demand: complexity and difficulty of stimulus, one vs.
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From page 32... ...
; • Clinically important and not controversial; • Appropriate length of content; • Mixture of public- and private-sector materials; • Likely to stand the test of time; • Variety of formats/channels; • Wide range of difficulty; and • Has face validity. In developing criteria for the survey items themselves, the project team determined that prior knowledge should not be required to answer the questions.
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From page 33... ...
Other items in the survey require reading an article to obtain information and then answering questions based on information provided in the article. Other questions are based on short videos such as the public service announcement The Faces of Influenza, sponsored by the American Lung Association and posted on YouTube.com.
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From page 34... ...
HealthPartners One audience participant asked whether there is enough knowledge and new technology today (e.g., with the personal health record and the new health initiative measures) that one could develop a measure, be it of knowledge, skills, or function, that would take 5 minutes and that could be used to rapidly move the field forward.
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The project has four goals: 1. Develop English- and Spanish-language item banks for reading related health literacy skills; 2.
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He or she must then be able to apply that information in the management of her or his own health. The capacity to obtain information, which is part of other definitions of health literacy discussed earlier, is a navigation skill that is not included in this health literacy tool.
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APPRoACHeS To ASSeSSInG HeALTH LITeRACY FIguRE 3-5 Prose item.
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The participants were recruited mainly in primary care clinics, which are also where the ultimate calibration testing is being conducted. To obtain sufficient numbers for the pilot test, some testing was conducted at community-based organizations that provide general education develop ment (GED)
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Calibration testing is under way for the final set of 90 English items and 90 Spanish items. Those items are being tested with 600 English speakers and 600 Spanish speakers who are primary care patients.
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This tool will also provide better opportunities to determine the independent effects of limited English proficiency and limited health literacy. By using novel computer-based methods for health literacy assessment in clinical set tings, the tool could also increase the access of underserved populations to new technologies and contribute information about the experiences of diverse populations with new technologies.
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From page 41... ...
The few data that do exist indicate that the average literacy level may be lower among Spanish speakers than among English speakers. Has the project consid ered those who speak English as a second language and how appropriate the English-language instrument is for measuring those people's English literacy?
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Has Hahn's project considered developing test items that would determine whether partici pants could demonstrate the skill needed? Hahn replied that with item response theory item banks, once one has a well-calibrated bank and knows where the continuum is and whether the items are on that continuum, it is possible to add items at any time.
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Approximately 90 million American adults have limited health literacy and lack the needed literacy skills to navigate the health care environment (IOM, 2004)
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The gold standard to determine if a patient had limited health literacy was a Short Test of Functional Health Literacy in Adults (STOFHLA)
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The graph in Figure 3-8 represents the Receiver Operating Characteristic (ROC) curves of these three screening questions for detecting limited health literacy.
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The self-report screen ing questions were less effective in identifying patients with marginal health literacy. Combining the questions did not improve the screening performance of detecting limited health literacy or limited marginal health literacy.
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" appeared to be the strongest-performing question. Another recent study conducted in a primary care clinic among 225 patients with diabetes found a 15.1 percent prevalence of limited health literacy (Jeppesen et al., 2009)
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Finally, more studies are needed to determine whether the predictive value of these questions is better than demographic variables alone for limited health literacy. In conclusion, Chew said, future research is needed to answer additional questions about the use of these measures.
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Researchers and policy makers have dropped the function from functional health literacy and have switched the focus back to academic skills and reading tests. Nearly all studies have opera tionalized health literacy as reading skills in a medical setting and mea
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Reading and understanding information are important parts of functional health literacy, but they offer an incomplete picture and they are insufficient to promote appropriate use of health services, good self-care, and improved health. The problem with focusing on academic skills and information is that, like money, one needs it.
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to monitor parents' progress toward higher levels of functioning. To measure functional health literacy, two scales were derived from the Life Skills Progression instrument: a Functional Healthcare Literacy Scale (Figure 3-9)
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Figure 3-9 fixed images FIguRE 3-10 Functional Selfcare Literacy Scale. SOURCE: Wollesen and Peifer, 2006.
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It allows the integration of the social determinants of health, it guides interventions, it informs practice, and it is patient centered. The Life Skills Progression method presented here could be N = 1,808 Time in service = 36 mo P < 0.001 Change in Health Care Literacy and Personal Care Literacy Over Time with Home Visitation FIguRE 3-11 Home visitation promotes parental functional health literacy.
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The third aim is to develop and test recommendations for improving oral communication about cancer prevention and screening. Measurement The first step in developing the measures for assessing oral health literacy was to specify the test blueprint.
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A professional writer helped create the scripts, which clinicians then reviewed and revised. After that, the project team conducted its own review and revisions.
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Agency for Healthcare Research and Quality One participant said it appears that what both the assessment of functional health literacy described by Smith and the assessment of oral health
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Smith responded that the Life Skills Progression Instrument and the functional health literacy measure derived from it are used at all levels. The data are rich with information for the individual level, the particular practice level, and the organizational level.
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Assessment of oral health literacy would benefit from looking at this issue. One participant asked whether there is any assessment that observes what happens during an interaction between the patient and clinician, either with a peer observation of the process, a patient exit interview, a 4"The Care Model is a population-based model that relies on knowing which patients have the illness, assuring that they receive evidence-based care, and actively aiding them to participate in their own care.
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One participant asked, for the assessment of oral health literacy tak ing place in the CRN, are there any plans to study people's ability to understand information under distressing conditions? For the most part, it appears these assessments are being conducted under ideal conditions.
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This underscores the fact that attention must be paid to print material. In the study of oral health literacy, there are measures of cognitive function as well as memory.
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