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2 An Overview of Measures of Health Literacy
Pages 5-28

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From page 5...
... These findings show that nearly 1 Among the findings of that report was that adults with limited health literacy "have less knowledge of disease management and of health-promoting behaviors, report poorer health status, and are less likely to use preventive services." Another finding was that health literacy measures are indicators of reading skills and that no current measures include oral communication or writing skills and "none measure the health literacy demands on indi viduals within different health contexts" (IOM, 2004)
From page 6...
... As a determinant, health literacy affects a person's ability to access and use health care, to interact with providers, and to care for himself or herself. Health literacy measurement has generally followed this model, focusing on measuring an individual's capabili Occupation Access and Utilization of Health Care Employment Income Patient Factors System Factors Navigation Skills Complexity Social Support Self-Efficacy Acute Care Orientation Perceived Barriers Tiered Delivery Model Culture Language Provider-Patient Interaction Race/ Patient Factors Provider Factors Ethnicity Health Knowledge Communication Skills Health Beliefs Teaching Ability Outcomes Education Participation in Time Literacy Decision Making Patient-Centered Care Age Self-Car e Vision Patient Factors Extrinsic Factors Hearing Motivation Support Technologies Problem Solving Mass Media Verbal Ability Self-Efficacy Health Education Knowledge/Skills Resources Memory Reasoning FIguRE 2-1 Causal pathways between limited health literacy and health outcomes.
From page 7...
... The NAAL further identified substantial disparities associated with race and ethnicity, age, and insurance status. While the NAAL provided an overall assessment of the level of literacy of American adults, various research measures have been used to establish the relationships among limited health literacy, health care, and health outcomes as well as the impact of interventions on individuals with limited health literacy.
From page 8...
... The Baker model highlights an important question for health literacy measurement: What is the role of the health system in addressing issues of low health literacy? The health system has a responsibility to communi cate and identify the correct strategies for caring for patients.
From page 9...
... Second, health literacy measures need to guide quality improvement efforts. Such measures must be specific enough to provide information about the source of problems related to health literacy.
From page 10...
... surveys3 that can be used to assess the health literacy friendliness of hospitals and physician practices. AHRQ has also developed some pharmacy literacy tools designed to help pharmacists better serve their low-health-literacy patients.4 Another tool is a guide for developing and purchasing information technology that is accessible to populations with limited health literacy.5 Finally, AHRQ has been working with the Ad Council to develop messages that inform individuals about what they can do to play a more active role in their own health and health care.6 Conclusion Health literacy is not an individual problem, Clancy stated.
From page 11...
... laid out the questions that have been raised in the field recently over the issue of how the needs and skills of the provider as well as the individual impact health literacy. That report stated, "Health literacy emerges when the expecta tions, preferences, and skills of individuals seeking health information and services meet the expectations, preferences, and skill of those providing information and services.
From page 12...
... Interconnected health literacy and health disparities research funded through NIH and AHRQ grants is intended to involve health literacy as a key outcome, health literacy as a key explanatory variable for other outcomes, and prevention/intervention strategies that focus on health literacy. Woolley and Charlemagne found that more than half of the NIH and AHRQ grants primarily study the adult population.
From page 13...
... According to HP 2010, individuals are health literate when they possess the skills to understand information and services and use them to make appropriate decisions about health. Without the NAAL data, there is no ability to track health literacy skills over time at a national level.
From page 14...
... Some people have said that if there are no data, there is no problem. Without national data on the extent and characteristics of health literacy in America, Allen said, it will be impossible to develop effective interven tions that lead to improving the health literacy of the 90 percent of the population who, the NAAL data show, do not have the skills necessary to understand information and services and use them to make appropriate health decisions.
From page 15...
... Overall, then, researcher #1 had a positive experience with the NAAL data, with only minor comments about the rural data being collected in urban counties and the misclassification of some data from California as being from the Midwest. The same cannot be said for the other researchers who responded.
From page 16...
... Researcher #6 I proide frequent health literacy/plain language trainings for health profes sionals, and I am always asked what "grade leels" are represented by the four nAAL reporting categories. I know that the concept of grade leels is not precise, to say the least, but people want a quick and easy way to grasp the magnitude of the literacy/health literacy problem.
From page 17...
... HEALTH LITERACy MEASuREMENT: A bRIEF REVIEW AND PROPOSAL Andrew Pleasant, Ph.D. Rutgers Uniersity Health literacy is an important and powerful tool for improving health.
From page 18...
... Another major difficulty with current measures is that, using data from any of the currently available tools, the data do not describe how health literacy causes improved health. There are data about what happens
From page 19...
... Comprehensive means showing extensive understanding. A comprehensive measure builds a foundation of knowledge that is needed to enable accurate screening and to advance health literacy as a tool to improve health and reduce inequities in health.
From page 20...
... Eight Proposed Methodological Principles Eight principles of social research are needed in the development of a new and comprehensive measure of health literacy. The comprehensive measure must 1.
From page 21...
... As long as they are built on the same theoretical basis, they are comparable. eighth, prioritize social research and public health applications versus clinical use.
From page 22...
... A great deal of progress has been made, but if a comprehensive measure is to be developed, it is time for a consensus about the theory and conceptual framework of health literacy. A comprehensive measure of health literacy should use the scientific method, that is, the measure should explicitly test the definition of the social construct of health literacy.
From page 23...
... Language in the Act provides for new resources for health information technology and federal investment in collection of data on patient race, ethnicity, and primary language. Should health lit eracy measures be built into what is being developed in electronic records or as part of information collected on quality measures, or should health literacy be treated more as a vital statistic?
From page 24...
... Weiss agreed that such linkage would be valuable because then one could examine health literacy data in relationship to known health outcome data. One participant concluded the discussion with a series of questions.
From page 25...
... For example, having a way to measure what patients hear in their interactions with providers rather than what the providers do is very complex. Another participant asked Clancy, given the importance of health literacy to quality, how effective has The Joint Commission been in embracing health literacy and health literacy measurement?
From page 26...
... But implementing health literacy measurement for an individual in order to tailor care presents a different measurement challenge. Weiss agreed that it is definitely more difficult at the individual level.
From page 27...
... These things do exist, and they might be incorporated into a health literacy measure to make it more comprehensive. One participant asked how one could tie health literacy tools to selfmanagement training for prevention efforts.
From page 28...
... The issue of measurement for research versus measurement for improvement versus measurement for what might be called accountability was raised by one participant. It is hoped that the comprehensive measure under discussion will have components that can accommodate all needs.


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