Our Take
We advocate a universal precautions approach for health literacy.
At this time there is no single, comprehensive tool to measure health literacy. There are some measures of individual literacy skills and system audits.

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Individual measures

1. Behavioural clues
It is not possible to predict low health literacy from a person’s behaviour. However, certain behaviours may point to low health literacy: (Weiss, 2003; AMA, 2007):
  • filling out forms incompletely or inappropriately
  • unable to name medications or explain what they are for
  • not taking medication as prescribed
  • missing appointments
  • bringing someone to do the reading
  • avoiding having to read in front of others, by saying “I forgot my glasses”, “I’ll read this later” or “Let me take this home to read”
  • being quiet or passive
  • clowning around and using humour
  • becoming angry or demanding

2. Screening questions
Screening questions may be used to estimate a person’s health literacy. Ongoing research is attempting to discover which questions have the best predictive value. Some research suggests a single screening question may be effective, such as: “How confident are you filling out medical forms by yourself?” (Chew et al., 2008).

3. Tools
Common tools used to assess health literacy skills are :
  • Test Of Functional Health Literacy in Adults (TOFHLA)
  • Rapid Estimate of Adult Literacy in Medicine (REALM)
  • Newest Vital Sign (NVS)

These tools measure some literacy skills (primarily reading and numeracy, and not speaking, listening, and information seeking), without consideration of other personal factors and the health care context.

Limitations to individual measures
The evidence is not clear regarding the effectiveness of health literacy assessment or its potential to cause harm (feelings of shame or embarrassment, fear of labeling). Little is known about the influence of such assessments on health care providers’ communication or the patients’ health outcomes.

System measures
The complexity of written health messages can be measured in two ways:
  • Readability: Readability formulas measure the structure of the language (length of words and sentences). Examples include: Readability statistics in MSWORD, Fog, Smog
  • Suitability checklist assess criteria known to affect readability and comprehension. Examples include: SAM: Suitability Assessment of Materials (Doak & Doak , 1996. p. 41)and Checklist for patient education materials (Wizowski, Harper & Hutchings, 2008 p. 104).

The nature of the health care environment can be measured with a health literacy audit.
Health Literacy Universal Precautions Toolkit
Literacy Alberta "Opening Doors"

“In a clinical setting, the most important information to determine is not a health literacy score but whether a patient understands his or her medical conditions, the purpose of the treatment regimen including medications, and how to adhere to the treatment regimen.”
Paasche-Orlow, M. JAMA (2011) 306(10): 1125
Your Take
How would your patients/clients feel about having their health literacy skills tested?
Health Literacy Significance Influences Measurement Strategies About Us

Last updated: Aug 31, 2014
Health Literacy Connection